Sherry Boschert

SAN FRANCISCO — Nonphysician staff in 10 primary care clinics initially were leery of giving patients the ability to e-mail their clinics, but they became more enthusiastic 6 months after using an electronic communication system, a study of 76 staff members found.

Physicians might be more willing to offer electronic communications to patients if e-mails could be triaged by their staff, Anne F. Kittler and her associates said in a poster presentation at the triennial congress of the International Medical Informatics Association. The study suggests that staff can overcome their initial reservations to embrace the benefits of electronic communications, said Ms. Kittler of Partners HealthCare System, Wellesley, Mass.

Paper-based surveys of 76 staff before adoption of Patient Gateway, a secure Web portal for electronic communication with patients, found that 44 feared that patient e-mails would increase their workload. Only 13 (17%) were enthusiastic about adopting the system, 28 (37%) were hesitant, and the rest were indifferent or unsure about it. A majority already used e-mail in their daily work routine, usually to communicate with physicians or other staff in the practice.

After full implementation of Patient Gateway in three of clinics, half of 21 staff members who had used the system for at least 6 months were enthusiastic about the system, repeat surveys found. The proportion of staff members hesitant to use the system dropped to 20% (four people). A majority of the survey participants said that Patient Gateway either reduced or did not change their overall workload.

The surveyed staff members found the system particularly helpful for dealing with patient requests for medication refills, Ms. Kittler and her colleagues reported.

All the clinics used electronic health records before adding Patient Gateway.

SAN FRANCISCO — Nonphysician staff in 10 primary care clinics initially were leery of giving patients the ability to e-mail their clinics, but they became more enthusiastic 6 months after using an electronic communication system, a study of 76 staff members found.

Physicians might be more willing to offer electronic communications to patients if e-mails could be triaged by their staff, Anne F. Kittler and her associates said in a poster presentation at the triennial congress of the International Medical Informatics Association. The study suggests that staff can overcome their initial reservations to embrace the benefits of electronic communications, said Ms. Kittler of Partners HealthCare System, Wellesley, Mass.

Paper-based surveys of 76 staff before adoption of Patient Gateway, a secure Web portal for electronic communication with patients, found that 44 feared that patient e-mails would increase their workload. Only 13 (17%) were enthusiastic about adopting the system, 28 (37%) were hesitant, and the rest were indifferent or unsure about it. A majority already used e-mail in their daily work routine, usually to communicate with physicians or other staff in the practice.

After full implementation of Patient Gateway in three of clinics, half of 21 staff members who had used the system for at least 6 months were enthusiastic about the system, repeat surveys found. The proportion of staff members hesitant to use the system dropped to 20% (four people). A majority of the survey participants said that Patient Gateway either reduced or did not change their overall workload.

The surveyed staff members found the system particularly helpful for dealing with patient requests for medication refills, Ms. Kittler and her colleagues reported.

All the clinics used electronic health records before adding Patient Gateway.

SAN FRANCISCO — Nonphysician staff in 10 primary care clinics initially were leery of giving patients the ability to e-mail their clinics, but they became more enthusiastic 6 months after using an electronic communication system, a study of 76 staff members found.

Physicians might be more willing to offer electronic communications to patients if e-mails could be triaged by their staff, Anne F. Kittler and her associates said in a poster presentation at the triennial congress of the International Medical Informatics Association. The study suggests that staff can overcome their initial reservations to embrace the benefits of electronic communications, said Ms. Kittler of Partners HealthCare System, Wellesley, Mass.

Paper-based surveys of 76 staff before adoption of Patient Gateway, a secure Web portal for electronic communication with patients, found that 44 feared that patient e-mails would increase their workload. Only 13 (17%) were enthusiastic about adopting the system, 28 (37%) were hesitant, and the rest were indifferent or unsure about it. A majority already used e-mail in their daily work routine, usually to communicate with physicians or other staff in the practice.

After full implementation of Patient Gateway in three of clinics, half of 21 staff members who had used the system for at least 6 months were enthusiastic about the system, repeat surveys found. The proportion of staff members hesitant to use the system dropped to 20% (four people). A majority of the survey participants said that Patient Gateway either reduced or did not change their overall workload.

The surveyed staff members found the system particularly helpful for dealing with patient requests for medication refills, Ms. Kittler and her colleagues reported.

All the clinics used electronic health records before adding Patient Gateway.

SAN FRANCISCO — Most adults seen in emergency departments have health insurance and a usual source of care, countering the common notion that uninsured patients are using emergency departments because they have nowhere else to go, Ellen J. Weber, M.D., said at the annual meeting of the American College of Emergency Physicians.

She and her associates extrapolated from data on a population-based sample of 49,603 adults to estimate that more than 45 million U.S. adults made nearly 80 million visits to EDs over a 1-year period. Of those who went to emergency departments, 83% said they had a usual source of care other than the ED (accounting for 82% of ED visits), and 85% had some form of health insurance (accounting for 85% of ED visits), said Dr. Weber.

Improving the delivery of outpatient care may be the key to decreasing ED use, the investigators concluded.

The study is one of a few that compare ED users with nonusers in these respects. The results showed that uninsured adults were no more likely to visit the ED during the study period than were people with private insurance. Compared with privately insured patients, those with Medicaid or Medicare were 51% and 19% more likely, respectively, to use the ED.

Adults with no usual source of care were 25% less likely to visit the ED than were adults whose usual care came from a private physician. Patients who used the ED for their usual care or who had no source of usual care were responsible for only 17% of ED visits.

People who used the ED most had poor health or changes in their usual care or insurance, the study found.

People with poor physical health were more than twice as likely to have visited an ED as were people in good health, and they accounted for nearly half of all ED visits. People with poor mental health were 51% more likely to go to an ED than were people with good mental health. People who had had a change in their usual source of care were 30% more likely to seek help in an ED than were people with stable care. A change in insurance increased the odds of an ED visit by 15%.

Poverty increased the likelihood of an ED visit, but patients with incomes below the poverty level accounted for only one in five visits.

“People affected by ED overcrowding and closures of emergency departments are the seriously ill,” said Dr. Weber, medical director of the emergency department at the University of California, San Francisco.

Data for the study came from the Community Tracking Study Household Survey. The Center for Studying Health System Change, a nonpartisan policy research group in Washington, conducted the survey. The survey data, from July 2000 through June 2001, included interviews in English or Spanish with up to eight adults per household in 60 communities and in a national sample, plus administration of the SF-12 Health Survey.

Several factors thought to decrease ED usage were not associated with fewer visits, including enrollment in an HMO, early availability of appointments, and patients' satisfaction with their primary physicians.

Previous studies reported conflicting data about whether people visiting EDs were more likely to be uninsured or to have no usual source of care, perhaps because they studied individual departments, focused on special populations, and didn't compare ED visitors to nonvisitors, Dr. Weber said.

KEVIN FOLEY, RESEARCH/DESIGN

SAN FRANCISCO — Most adults seen in emergency departments have health insurance and a usual source of care, countering the common notion that uninsured patients are using emergency departments because they have nowhere else to go, Ellen J. Weber, M.D., said at the annual meeting of the American College of Emergency Physicians.

She and her associates extrapolated from data on a population-based sample of 49,603 adults to estimate that more than 45 million U.S. adults made nearly 80 million visits to EDs over a 1-year period. Of those who went to emergency departments, 83% said they had a usual source of care other than the ED (accounting for 82% of ED visits), and 85% had some form of health insurance (accounting for 85% of ED visits), said Dr. Weber.

Improving the delivery of outpatient care may be the key to decreasing ED use, the investigators concluded.

The study is one of a few that compare ED users with nonusers in these respects. The results showed that uninsured adults were no more likely to visit the ED during the study period than were people with private insurance. Compared with privately insured patients, those with Medicaid or Medicare were 51% and 19% more likely, respectively, to use the ED.

Adults with no usual source of care were 25% less likely to visit the ED than were adults whose usual care came from a private physician. Patients who used the ED for their usual care or who had no source of usual care were responsible for only 17% of ED visits.

People who used the ED most had poor health or changes in their usual care or insurance, the study found.

People with poor physical health were more than twice as likely to have visited an ED as were people in good health, and they accounted for nearly half of all ED visits. People with poor mental health were 51% more likely to go to an ED than were people with good mental health. People who had had a change in their usual source of care were 30% more likely to seek help in an ED than were people with stable care. A change in insurance increased the odds of an ED visit by 15%.

Poverty increased the likelihood of an ED visit, but patients with incomes below the poverty level accounted for only one in five visits.

“People affected by ED overcrowding and closures of emergency departments are the seriously ill,” said Dr. Weber, medical director of the emergency department at the University of California, San Francisco.

Data for the study came from the Community Tracking Study Household Survey. The Center for Studying Health System Change, a nonpartisan policy research group in Washington, conducted the survey. The survey data, from July 2000 through June 2001, included interviews in English or Spanish with up to eight adults per household in 60 communities and in a national sample, plus administration of the SF-12 Health Survey.

Several factors thought to decrease ED usage were not associated with fewer visits, including enrollment in an HMO, early availability of appointments, and patients' satisfaction with their primary physicians.

Previous studies reported conflicting data about whether people visiting EDs were more likely to be uninsured or to have no usual source of care, perhaps because they studied individual departments, focused on special populations, and didn't compare ED visitors to nonvisitors, Dr. Weber said.

KEVIN FOLEY, RESEARCH/DESIGN

SAN FRANCISCO — Most adults seen in emergency departments have health insurance and a usual source of care, countering the common notion that uninsured patients are using emergency departments because they have nowhere else to go, Ellen J. Weber, M.D., said at the annual meeting of the American College of Emergency Physicians.

She and her associates extrapolated from data on a population-based sample of 49,603 adults to estimate that more than 45 million U.S. adults made nearly 80 million visits to EDs over a 1-year period. Of those who went to emergency departments, 83% said they had a usual source of care other than the ED (accounting for 82% of ED visits), and 85% had some form of health insurance (accounting for 85% of ED visits), said Dr. Weber.

Improving the delivery of outpatient care may be the key to decreasing ED use, the investigators concluded.

The study is one of a few that compare ED users with nonusers in these respects. The results showed that uninsured adults were no more likely to visit the ED during the study period than were people with private insurance. Compared with privately insured patients, those with Medicaid or Medicare were 51% and 19% more likely, respectively, to use the ED.

Adults with no usual source of care were 25% less likely to visit the ED than were adults whose usual care came from a private physician. Patients who used the ED for their usual care or who had no source of usual care were responsible for only 17% of ED visits.

People who used the ED most had poor health or changes in their usual care or insurance, the study found.

People with poor physical health were more than twice as likely to have visited an ED as were people in good health, and they accounted for nearly half of all ED visits. People with poor mental health were 51% more likely to go to an ED than were people with good mental health. People who had had a change in their usual source of care were 30% more likely to seek help in an ED than were people with stable care. A change in insurance increased the odds of an ED visit by 15%.

Poverty increased the likelihood of an ED visit, but patients with incomes below the poverty level accounted for only one in five visits.

“People affected by ED overcrowding and closures of emergency departments are the seriously ill,” said Dr. Weber, medical director of the emergency department at the University of California, San Francisco.

Data for the study came from the Community Tracking Study Household Survey. The Center for Studying Health System Change, a nonpartisan policy research group in Washington, conducted the survey. The survey data, from July 2000 through June 2001, included interviews in English or Spanish with up to eight adults per household in 60 communities and in a national sample, plus administration of the SF-12 Health Survey.

Several factors thought to decrease ED usage were not associated with fewer visits, including enrollment in an HMO, early availability of appointments, and patients' satisfaction with their primary physicians.

Previous studies reported conflicting data about whether people visiting EDs were more likely to be uninsured or to have no usual source of care, perhaps because they studied individual departments, focused on special populations, and didn't compare ED visitors to nonvisitors, Dr. Weber said.

KEVIN FOLEY, RESEARCH/DESIGN

SAN FRANCISCO — Patients with decompensated heart failure were three times more likely than patients without heart failure to have S3 or S4 heart sounds detected by sensors in a study of 135 patients seen in emergency departments, Sean P. Collins, M.D., reported.

The add-on sensor device, which attaches to an ECG machine to analyze heart sounds, may allow quicker diagnosis and treatment of patients with heart failure, Dr. Collins said at the annual meeting of the American College of Emergency Physicians.

The abnormal diastolic heart sounds S3 and S4 indicate elevated ventricular filling pressures and suggest that the heart's ability to squeeze out blood is impaired.

Previous studies have shown that the Audicor sensor system detects more of the hard-to-hear S3 and S4 sounds than can be heard by cardiologists, said Dr. Collins of the University of Cincinnati. Inovise Medical Inc., which makes the Audicor system, funded the current study.

The prospective study of patients with signs and symptoms of decompensated heart failure compared the heart sounds detected by the Audicor system in patients with a primary or secondary diagnosis of heart failure or a non-heart failure diagnosis. The diagnosis was based on the attending physician's discharge summary, not on the Audicor data.

Of 46 patients with a primary diagnosis of heart failure, 19 (41%) had an S3 sound, and 8 (17%) had an S4 sound. Those rates were triple the prevalences seen in 68 patients with non-heart failure diagnoses, 9 (13%) of whom had an S3, and 4 (6%) of whom had an S4. Among 21 patients with a secondary diagnosis of heart failure, 6 (29%) had an S3 and 4 (19%) had an S4, Dr. Collins said. (See table.)

In general, about 80% of people with heart failure come through emergency departments, but 10%-20% are misdiagnosed. To have results from an ECG plus Audicor at the patient's bedside “would allow me to immediately treat them and not wait for other tests to come back” if the printout reports an S3 or S4, he added.

The Food and Drug Administration-approved Audicor system costs approximately $6,000, plus $40 per patient for the leads, Dr. Collins said.

Andy Jagoda, M.D., who moderated the press briefing on the research findings, praised the study and said the Audicor system has “a lot of potential.” With approximately 800,000 patients per year seen in emergency departments for heart failure, anything to improve diagnostic accuracy would be welcomed, said Dr. Jagoda, professor of emergency medicine at Mount Sinai School of Medicine, New York.

Kevin Foley. Research

SAN FRANCISCO — Patients with decompensated heart failure were three times more likely than patients without heart failure to have S3 or S4 heart sounds detected by sensors in a study of 135 patients seen in emergency departments, Sean P. Collins, M.D., reported.

The add-on sensor device, which attaches to an ECG machine to analyze heart sounds, may allow quicker diagnosis and treatment of patients with heart failure, Dr. Collins said at the annual meeting of the American College of Emergency Physicians.

The abnormal diastolic heart sounds S3 and S4 indicate elevated ventricular filling pressures and suggest that the heart's ability to squeeze out blood is impaired.

Previous studies have shown that the Audicor sensor system detects more of the hard-to-hear S3 and S4 sounds than can be heard by cardiologists, said Dr. Collins of the University of Cincinnati. Inovise Medical Inc., which makes the Audicor system, funded the current study.

The prospective study of patients with signs and symptoms of decompensated heart failure compared the heart sounds detected by the Audicor system in patients with a primary or secondary diagnosis of heart failure or a non-heart failure diagnosis. The diagnosis was based on the attending physician's discharge summary, not on the Audicor data.

Of 46 patients with a primary diagnosis of heart failure, 19 (41%) had an S3 sound, and 8 (17%) had an S4 sound. Those rates were triple the prevalences seen in 68 patients with non-heart failure diagnoses, 9 (13%) of whom had an S3, and 4 (6%) of whom had an S4. Among 21 patients with a secondary diagnosis of heart failure, 6 (29%) had an S3 and 4 (19%) had an S4, Dr. Collins said. (See table.)

In general, about 80% of people with heart failure come through emergency departments, but 10%-20% are misdiagnosed. To have results from an ECG plus Audicor at the patient's bedside “would allow me to immediately treat them and not wait for other tests to come back” if the printout reports an S3 or S4, he added.

The Food and Drug Administration-approved Audicor system costs approximately $6,000, plus $40 per patient for the leads, Dr. Collins said.

Andy Jagoda, M.D., who moderated the press briefing on the research findings, praised the study and said the Audicor system has “a lot of potential.” With approximately 800,000 patients per year seen in emergency departments for heart failure, anything to improve diagnostic accuracy would be welcomed, said Dr. Jagoda, professor of emergency medicine at Mount Sinai School of Medicine, New York.

Kevin Foley. Research

SAN FRANCISCO — Patients with decompensated heart failure were three times more likely than patients without heart failure to have S3 or S4 heart sounds detected by sensors in a study of 135 patients seen in emergency departments, Sean P. Collins, M.D., reported.

The add-on sensor device, which attaches to an ECG machine to analyze heart sounds, may allow quicker diagnosis and treatment of patients with heart failure, Dr. Collins said at the annual meeting of the American College of Emergency Physicians.

The abnormal diastolic heart sounds S3 and S4 indicate elevated ventricular filling pressures and suggest that the heart's ability to squeeze out blood is impaired.

Previous studies have shown that the Audicor sensor system detects more of the hard-to-hear S3 and S4 sounds than can be heard by cardiologists, said Dr. Collins of the University of Cincinnati. Inovise Medical Inc., which makes the Audicor system, funded the current study.

The prospective study of patients with signs and symptoms of decompensated heart failure compared the heart sounds detected by the Audicor system in patients with a primary or secondary diagnosis of heart failure or a non-heart failure diagnosis. The diagnosis was based on the attending physician's discharge summary, not on the Audicor data.

Of 46 patients with a primary diagnosis of heart failure, 19 (41%) had an S3 sound, and 8 (17%) had an S4 sound. Those rates were triple the prevalences seen in 68 patients with non-heart failure diagnoses, 9 (13%) of whom had an S3, and 4 (6%) of whom had an S4. Among 21 patients with a secondary diagnosis of heart failure, 6 (29%) had an S3 and 4 (19%) had an S4, Dr. Collins said. (See table.)

In general, about 80% of people with heart failure come through emergency departments, but 10%-20% are misdiagnosed. To have results from an ECG plus Audicor at the patient's bedside “would allow me to immediately treat them and not wait for other tests to come back” if the printout reports an S3 or S4, he added.

The Food and Drug Administration-approved Audicor system costs approximately $6,000, plus $40 per patient for the leads, Dr. Collins said.

Andy Jagoda, M.D., who moderated the press briefing on the research findings, praised the study and said the Audicor system has “a lot of potential.” With approximately 800,000 patients per year seen in emergency departments for heart failure, anything to improve diagnostic accuracy would be welcomed, said Dr. Jagoda, professor of emergency medicine at Mount Sinai School of Medicine, New York.

Kevin Foley. Research

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%) compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” said Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: “Our colleagues in cardiology tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,'” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodologic problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview.

“Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%) compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” said Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: “Our colleagues in cardiology tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,'” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodologic problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview.

“Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%) compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” said Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: “Our colleagues in cardiology tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,'” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodologic problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview.

“Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin-negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%), compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin-negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” according to Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: Cardiologists “tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,' ” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodological problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview. “Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin-negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%), compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin-negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” according to Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: Cardiologists “tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,' ” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodological problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview. “Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — Patients seen in the emergency department for acute decompensated heart failure fared much worse if they had elevated serum troponin, W. Frank Peacock IV, M.D., said in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The results should have a profound impact on controversy about the clinical implications of elevating troponin in patients with heart failure, several speakers said in a session discussing cutting-edge research in emergency medicine at the meeting.

The analysis of data on 67,924 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) showed that 6% had elevated troponin levels, and the rest were considered troponin-negative. Patients with elevated serum troponin were more likely than troponin-negative patients to develop systolic heart failure (61% vs. 51%) or undergo coronary artery bypass grafting (4% vs. 1%), intra-aortic balloon counterpulsation (3% vs. less than 1%), mechanical ventilation (11% vs. 4%), or cardioversion (3% vs. 2%), said Dr. Peacock of the Cleveland Clinic and his associates.

Patients with acute decompensated heart failure and elevated serum troponin also had longer hospitalizations (median 5.1 vs. 4.1 days) and longer ICU stays (a median of 2.9 vs. 2.3 days) and were more likely to die in the hospital (8% vs. 3%), compared with troponin-negative patients.

The study defined elevated serum troponin as a level of at least 1 ng/mL for troponin I or at least 0.1 ng/mL for troponin T. Patients with levels below those cutoffs were considered troponin-negative.

“This [study] is important, because cardiologists everywhere—particularly our heart failure cardiologists—tend to pooh-pooh troponin leaks,” according to Judd E. Hollander, M.D., professor of emergency medicine at the University of Pennsylvania, Philadelphia.

Elevated troponin in heart failure does not necessarily indicate underlying coronary disease, he said. “It's not something that cardiologists can fix in the cath lab—and that's what cardiologists look for. What this doesn't tell us is whether there's something we can fix in the hospital to decrease that mortality” associated with elevated troponin, he added.

Charles V. Pollack Jr., M.D., agreed: Cardiologists “tend to talk about benign troponin leaks. We've got to be careful about that.” Particularly in older patients, elevated troponin has been a marker for sick patients in studies of sepsis, shock, chest pain, or congestive heart failure. “It's a worrisome marker and should be treated as such,” said Dr. Pollack, chair of emergency medicine at the University of Pennsylvania.

Troponin is a structural protein, and elevated levels are produced by cell death, noted Brian J. O'Neil, M.D., of Wayne State University, Detroit. “These are not 'leaks,' ” he said.

In a separate interview, cardiologist Christopher P. Cannon, M.D., agreed that some of his colleagues have been misled by the common use of elevated troponin levels as a marker for acute coronary syndrome. When catheterizations found no arterial blockage in some patients with elevated troponin, the marker gained a reputation for false positives.

“We've learned that there are other things that cause elevations in troponin. We're all learning how to use this in these other patient groups. People are realizing it's a good marker of high-risk patients independent of whether the arteries have blockages or not,” said Dr. Cannon of Brigham and Women's Hospital, Boston.

Previous studies have shown that troponin is a biomarker for myocardial injury. In earlier studies of patients hospitalized for heart failure, troponin elevations have been associated with lower ejection fractions, worse functional status, repeat hospitalizations for heart failure, and death. Studies on the clinical implications of troponin in heart failure are few, however, and have been plagued by methodological problems.

Although speakers at the emergency medicine meeting lauded the current study for the number and breadth of patients in the database, Jerome R. Hoffman, M.D., pointed out one major limitation: possible incorporation bias. Higher rates of procedures and longer hospitalizations may be due to physicians' reactions.

“When somebody tells you a patient has a high troponin level, you might keep them in the hospital or ICU a little longer. It may be a self-fulfilling prophecy” and not necessarily an appropriate step, said Dr. Hoffman of the University of California, Los Angeles.

Cardiologist Sorin J. Brener, M.D., called the study “important and well executed” but agreed with Dr. Hoffman's criticism. A multivariate logistic regression analysis controlling for the differences between patients in the two troponin groups would be necessary to isolate the independent effect of elevated troponin on outcomes, he said in a separate interview. “Elevated troponin levels are indeed a marker of adverse prognosis and cannot be ignored. Unfortunately, more often than not there is no specific intervention tailored to this finding in patients with decompensated heart failure that one would not apply in patients without elevated troponin,” said Dr. Brener, director of the angiography core laboratory at the Cleveland Clinic.

SAN FRANCISCO — An online tool developed by pediatricians is helping day care workers promote immunizations and health screenings, Jerold M. Aronson, M.D., said at the annual meeting of the American Academy of Pediatrics.

Children in day care programs that used the WellCareTracker tool were more likely to be up to date on their immunizations, compared with a 10% sample of children in licensed day care programs in Pennsylvania, a review of 2002-2003 data found.

WellCareTracker is used by more than 250 child care programs that have entered records for more than 20,000 children. The investigators found that in centers using WellCareTracker for more than 6 months, more than 80% of children were up to date with all recommended vaccines, compared with less than 75% of 13,645 children in the statewide sample, said Dr. Aronson of Narberth, Penn.

The AAP's Pennsylvania chapter, which has a history of providing programs that link pediatricians with community-based services, developed WellCareTracker and offered it as a component of its Early Childhood Education Linkage System-Healthy Child Care PA, which networks with child day care programs to provide technical assistance for improving child health. Pediatricians deliver information on individual children for input into WellCareTracker to the day care programs through the parent, which avoids any privacy issues, Dr. Aronson said.

WellCareTracker's tools can be used by anyone accessing the Web site at www.wellcaretracker.org

WellCareTracker allows a nonclinical person to determine whether the child is up to date now, whether the child started vaccinations at the right time or started late, and when a vaccination is due, he said.

All states require that children in group day care programs receive immunizations and health screenings within 60 days of enrollment, he said, but this can be a confusing process for day care workers. Complex immunization and screening schedules, parental resistance, and requirements for documentation and reporting all pose challenges.

Commercial programs are available to help with these, but they are costly and complex, he said. These programs only count vaccine doses, rather than assessing each child's individual up-to-date status per national recommendations, Dr. Aronson added.

SAN FRANCISCO — An online tool developed by pediatricians is helping day care workers promote immunizations and health screenings, Jerold M. Aronson, M.D., said at the annual meeting of the American Academy of Pediatrics.

Children in day care programs that used the WellCareTracker tool were more likely to be up to date on their immunizations, compared with a 10% sample of children in licensed day care programs in Pennsylvania, a review of 2002-2003 data found.

WellCareTracker is used by more than 250 child care programs that have entered records for more than 20,000 children. The investigators found that in centers using WellCareTracker for more than 6 months, more than 80% of children were up to date with all recommended vaccines, compared with less than 75% of 13,645 children in the statewide sample, said Dr. Aronson of Narberth, Penn.

The AAP's Pennsylvania chapter, which has a history of providing programs that link pediatricians with community-based services, developed WellCareTracker and offered it as a component of its Early Childhood Education Linkage System-Healthy Child Care PA, which networks with child day care programs to provide technical assistance for improving child health. Pediatricians deliver information on individual children for input into WellCareTracker to the day care programs through the parent, which avoids any privacy issues, Dr. Aronson said.

WellCareTracker's tools can be used by anyone accessing the Web site at www.wellcaretracker.org

WellCareTracker allows a nonclinical person to determine whether the child is up to date now, whether the child started vaccinations at the right time or started late, and when a vaccination is due, he said.

All states require that children in group day care programs receive immunizations and health screenings within 60 days of enrollment, he said, but this can be a confusing process for day care workers. Complex immunization and screening schedules, parental resistance, and requirements for documentation and reporting all pose challenges.

Commercial programs are available to help with these, but they are costly and complex, he said. These programs only count vaccine doses, rather than assessing each child's individual up-to-date status per national recommendations, Dr. Aronson added.

SAN FRANCISCO — An online tool developed by pediatricians is helping day care workers promote immunizations and health screenings, Jerold M. Aronson, M.D., said at the annual meeting of the American Academy of Pediatrics.

Children in day care programs that used the WellCareTracker tool were more likely to be up to date on their immunizations, compared with a 10% sample of children in licensed day care programs in Pennsylvania, a review of 2002-2003 data found.

WellCareTracker is used by more than 250 child care programs that have entered records for more than 20,000 children. The investigators found that in centers using WellCareTracker for more than 6 months, more than 80% of children were up to date with all recommended vaccines, compared with less than 75% of 13,645 children in the statewide sample, said Dr. Aronson of Narberth, Penn.

The AAP's Pennsylvania chapter, which has a history of providing programs that link pediatricians with community-based services, developed WellCareTracker and offered it as a component of its Early Childhood Education Linkage System-Healthy Child Care PA, which networks with child day care programs to provide technical assistance for improving child health. Pediatricians deliver information on individual children for input into WellCareTracker to the day care programs through the parent, which avoids any privacy issues, Dr. Aronson said.

WellCareTracker's tools can be used by anyone accessing the Web site at www.wellcaretracker.org

WellCareTracker allows a nonclinical person to determine whether the child is up to date now, whether the child started vaccinations at the right time or started late, and when a vaccination is due, he said.

All states require that children in group day care programs receive immunizations and health screenings within 60 days of enrollment, he said, but this can be a confusing process for day care workers. Complex immunization and screening schedules, parental resistance, and requirements for documentation and reporting all pose challenges.

Commercial programs are available to help with these, but they are costly and complex, he said. These programs only count vaccine doses, rather than assessing each child's individual up-to-date status per national recommendations, Dr. Aronson added.

SAN FRANCISCO — Not many patients are e-mailing their physicians, and of those who do, the majority click “send” less than once a month, an online survey of 1,881 people suggests.

Fewer than 17% of respondents reported recently e-mailing their physicians, Dr. Thomas K. Houston said at the triennial congress of the International Medical Informatics Association.

The survey recruited respondents mainly from the Aetna InteliHealth Web site (www.intelihealth.com

In-depth phone interviews with 56 of the 311 respondents who had e-mailed their physicians revealed that 30 did so less than once a month, 12 e-mailed about once per month, and 14 e-mailed their physicians more frequently, said Dr. Houston of the University of Alabama, Birmingham.

“Certainly, one of the concerns that physicians have had is being overwhelmed by e-mail” if they offer that option to patients, he said. These results suggest that this is not a problem, but that conclusion could change if more patients begin e-mailing, he added.

E-mail messages were mostly requests for prescription renewals or lab results, but some patients tried to use e-mail to communicate urgent problems such as chest pains. “That is a big concern,” and suggests the need for patient education about e-mail use, he said.

Half the e-mail messages went to general internists, about 25% went to subspecialty internists, and the rest went to family physicians, ob.gyns., surgeons, pediatricians, and other specialists.

These “early adopters” of e-mail communication with physicians liked the efficiency of e-mail and the ability to communicate without a face-to-face appointment, Dr. Houston said. On the other hand, they sometimes worried that they would not get a reply, and they were concerned about bugging their physicians with too many e-mails.

SAN FRANCISCO — Not many patients are e-mailing their physicians, and of those who do, the majority click “send” less than once a month, an online survey of 1,881 people suggests.

Fewer than 17% of respondents reported recently e-mailing their physicians, Dr. Thomas K. Houston said at the triennial congress of the International Medical Informatics Association.

The survey recruited respondents mainly from the Aetna InteliHealth Web site (www.intelihealth.com

In-depth phone interviews with 56 of the 311 respondents who had e-mailed their physicians revealed that 30 did so less than once a month, 12 e-mailed about once per month, and 14 e-mailed their physicians more frequently, said Dr. Houston of the University of Alabama, Birmingham.

“Certainly, one of the concerns that physicians have had is being overwhelmed by e-mail” if they offer that option to patients, he said. These results suggest that this is not a problem, but that conclusion could change if more patients begin e-mailing, he added.

E-mail messages were mostly requests for prescription renewals or lab results, but some patients tried to use e-mail to communicate urgent problems such as chest pains. “That is a big concern,” and suggests the need for patient education about e-mail use, he said.

Half the e-mail messages went to general internists, about 25% went to subspecialty internists, and the rest went to family physicians, ob.gyns., surgeons, pediatricians, and other specialists.

These “early adopters” of e-mail communication with physicians liked the efficiency of e-mail and the ability to communicate without a face-to-face appointment, Dr. Houston said. On the other hand, they sometimes worried that they would not get a reply, and they were concerned about bugging their physicians with too many e-mails.

SAN FRANCISCO — Not many patients are e-mailing their physicians, and of those who do, the majority click “send” less than once a month, an online survey of 1,881 people suggests.

Fewer than 17% of respondents reported recently e-mailing their physicians, Dr. Thomas K. Houston said at the triennial congress of the International Medical Informatics Association.

The survey recruited respondents mainly from the Aetna InteliHealth Web site (www.intelihealth.com

In-depth phone interviews with 56 of the 311 respondents who had e-mailed their physicians revealed that 30 did so less than once a month, 12 e-mailed about once per month, and 14 e-mailed their physicians more frequently, said Dr. Houston of the University of Alabama, Birmingham.

“Certainly, one of the concerns that physicians have had is being overwhelmed by e-mail” if they offer that option to patients, he said. These results suggest that this is not a problem, but that conclusion could change if more patients begin e-mailing, he added.

E-mail messages were mostly requests for prescription renewals or lab results, but some patients tried to use e-mail to communicate urgent problems such as chest pains. “That is a big concern,” and suggests the need for patient education about e-mail use, he said.

Half the e-mail messages went to general internists, about 25% went to subspecialty internists, and the rest went to family physicians, ob.gyns., surgeons, pediatricians, and other specialists.

These “early adopters” of e-mail communication with physicians liked the efficiency of e-mail and the ability to communicate without a face-to-face appointment, Dr. Houston said. On the other hand, they sometimes worried that they would not get a reply, and they were concerned about bugging their physicians with too many e-mails.

SAN FRANCISCO — African American men with a history of gonorrhea were more likely to develop prostate cancer than were those without gonorrhea in a case-control study of 836 African American men, reported Aruna V. Sarma, Ph.D.

The population-based study also found associations between greater sexual activity or higher numbers of sexual partners and an increased risk for prostate cancer, she said at the annual meeting of the American Urological Association.

Data came from a detailed in-home epidemiologic interview completed by 719 cancer-free African American men in 1996 and 117 African American men in the same county diagnosed with prostate cancer between 1996 and 2001. The questionnaire was part of the Flint (Mich.) Men's Health Study, said Dr. Sarma of the University of Michigan, Ann Arbor.

The results support previous conjectures that sexual behavior and a history of sexually transmitted diseases may be related to an increased risk for prostate cancer among African American men compared with whites. African American men also get more advanced prostate cancer and have worse stage-specific survival rates than do whites.

The current analysis included men aged 40-79 years and was adjusted for differences in age, income, and education between men with and without prostate cancer.

Men with a history of gonorrhea were 80% more likely to develop prostate cancer than were men without gonorrhea. Dr. Sarma speculated that urethral colonization by gonorrhea might trigger inflammatory mediators that could increase the risk for prostate cancer.

Men with other sexually transmitted diseases also showed increased risks for prostate cancer (a 50% increase in men with syphilis, a 20% increase in men with herpes) compared with men without those diseases, but these associations were not statistically significant.

The risk of being diagnosed with prostate cancer was tripled in men with a history of more than 20 sexual partners, compared with men reporting 5 or fewer sexual partners. A prostate cancer diagnosis also was three times more common in men who said they had sex two to three times per month or per week than in men who said they had no sexual activity in the past 12 months.

SAN FRANCISCO — African American men with a history of gonorrhea were more likely to develop prostate cancer than were those without gonorrhea in a case-control study of 836 African American men, reported Aruna V. Sarma, Ph.D.

The population-based study also found associations between greater sexual activity or higher numbers of sexual partners and an increased risk for prostate cancer, she said at the annual meeting of the American Urological Association.

Data came from a detailed in-home epidemiologic interview completed by 719 cancer-free African American men in 1996 and 117 African American men in the same county diagnosed with prostate cancer between 1996 and 2001. The questionnaire was part of the Flint (Mich.) Men's Health Study, said Dr. Sarma of the University of Michigan, Ann Arbor.

The results support previous conjectures that sexual behavior and a history of sexually transmitted diseases may be related to an increased risk for prostate cancer among African American men compared with whites. African American men also get more advanced prostate cancer and have worse stage-specific survival rates than do whites.

The current analysis included men aged 40-79 years and was adjusted for differences in age, income, and education between men with and without prostate cancer.

Men with a history of gonorrhea were 80% more likely to develop prostate cancer than were men without gonorrhea. Dr. Sarma speculated that urethral colonization by gonorrhea might trigger inflammatory mediators that could increase the risk for prostate cancer.

Men with other sexually transmitted diseases also showed increased risks for prostate cancer (a 50% increase in men with syphilis, a 20% increase in men with herpes) compared with men without those diseases, but these associations were not statistically significant.

The risk of being diagnosed with prostate cancer was tripled in men with a history of more than 20 sexual partners, compared with men reporting 5 or fewer sexual partners. A prostate cancer diagnosis also was three times more common in men who said they had sex two to three times per month or per week than in men who said they had no sexual activity in the past 12 months.

SAN FRANCISCO — African American men with a history of gonorrhea were more likely to develop prostate cancer than were those without gonorrhea in a case-control study of 836 African American men, reported Aruna V. Sarma, Ph.D.

The population-based study also found associations between greater sexual activity or higher numbers of sexual partners and an increased risk for prostate cancer, she said at the annual meeting of the American Urological Association.

Data came from a detailed in-home epidemiologic interview completed by 719 cancer-free African American men in 1996 and 117 African American men in the same county diagnosed with prostate cancer between 1996 and 2001. The questionnaire was part of the Flint (Mich.) Men's Health Study, said Dr. Sarma of the University of Michigan, Ann Arbor.

The results support previous conjectures that sexual behavior and a history of sexually transmitted diseases may be related to an increased risk for prostate cancer among African American men compared with whites. African American men also get more advanced prostate cancer and have worse stage-specific survival rates than do whites.

The current analysis included men aged 40-79 years and was adjusted for differences in age, income, and education between men with and without prostate cancer.

Men with a history of gonorrhea were 80% more likely to develop prostate cancer than were men without gonorrhea. Dr. Sarma speculated that urethral colonization by gonorrhea might trigger inflammatory mediators that could increase the risk for prostate cancer.

Men with other sexually transmitted diseases also showed increased risks for prostate cancer (a 50% increase in men with syphilis, a 20% increase in men with herpes) compared with men without those diseases, but these associations were not statistically significant.

The risk of being diagnosed with prostate cancer was tripled in men with a history of more than 20 sexual partners, compared with men reporting 5 or fewer sexual partners. A prostate cancer diagnosis also was three times more common in men who said they had sex two to three times per month or per week than in men who said they had no sexual activity in the past 12 months.

SAN DIEGO – A new Howard University program offering a master's degree in public health aims to train leaders who will help eliminate racial and ethnic disparities in health.

The degree program is the first to focus on health disparities using a multidisciplinary team approach, Mohammad N. Akhter, M.D., said at the annual meeting of the National Medical Association.

“Leadership is very important because leadership is all about setting the priorities. If you are a leader, you are in a position where you can change our policies, you can change the system,” said Dr. Akhter of the university in Washington.

Currently, few public health leaders are members of racial and ethnic minorities. “For us, this is the next battle of the civil rights movement,” he said.

The new degree option is the fastest-moving program in the university's history, he said.

After the deans of all 15 schools at the university met in November 2003 and backed the new M.P.H. program, a 29-member public health council was formed from faculty, community leaders, representatives of the city's health department, foundations, and others to flesh out the program and its policies.

The program has accepted 22 students from 18 different disciplines for the first class, out of more than 100 applicants. Students were warned that they would have to be fighters in this field; jobs are not waiting for them to eliminate racial and ethnic health disparities, Dr. Akhter said.

Preference is given to applicants who already hold advanced degrees (M.D., D.D.S., Pharm.D., Ph.D., and the like) or who have an undergraduate degree and at least 2 years of fieldwork in public health. Courses are held at night so that students can continue their jobs if desired. The degree could be obtained in 2 years, Dr. Akhter said.

The program has no dedicated faculty but instead uses faculty from Howard, George Washington, and Georgetown universities as well as teachers from the city's health department and the community. Students must take five core courses (such as biostatistics, epidemiology, and social and behavioral sciences) and two other required courses–global health, and eliminating racial and ethnic disparities in health. They also choose three electives from among 65 graduate classes that include three new courses introduced alongside the M.P.H. program–community nutrition, mental health, and public health policy.

Students also attend a biweekly seminar focused on solutions to current public health problems and complete a community practicum in which they use a team approach to solve a problem in the school system, the health department, or a cancer center.

The Robert Wood Johnson Foundation funds a separate 2-year program–at six institutions–that accepts 18 scholars who have completed doctoral training. The program aims “to build the field of population health,” defined as taking a broad approach to understanding why some groups of people are healthy and others are not, but it does not focus specifically on racial and ethnic health disparities.

SAN DIEGO – A new Howard University program offering a master's degree in public health aims to train leaders who will help eliminate racial and ethnic disparities in health.

The degree program is the first to focus on health disparities using a multidisciplinary team approach, Mohammad N. Akhter, M.D., said at the annual meeting of the National Medical Association.

“Leadership is very important because leadership is all about setting the priorities. If you are a leader, you are in a position where you can change our policies, you can change the system,” said Dr. Akhter of the university in Washington.

Currently, few public health leaders are members of racial and ethnic minorities. “For us, this is the next battle of the civil rights movement,” he said.

The new degree option is the fastest-moving program in the university's history, he said.

After the deans of all 15 schools at the university met in November 2003 and backed the new M.P.H. program, a 29-member public health council was formed from faculty, community leaders, representatives of the city's health department, foundations, and others to flesh out the program and its policies.

The program has accepted 22 students from 18 different disciplines for the first class, out of more than 100 applicants. Students were warned that they would have to be fighters in this field; jobs are not waiting for them to eliminate racial and ethnic health disparities, Dr. Akhter said.

Preference is given to applicants who already hold advanced degrees (M.D., D.D.S., Pharm.D., Ph.D., and the like) or who have an undergraduate degree and at least 2 years of fieldwork in public health. Courses are held at night so that students can continue their jobs if desired. The degree could be obtained in 2 years, Dr. Akhter said.

The program has no dedicated faculty but instead uses faculty from Howard, George Washington, and Georgetown universities as well as teachers from the city's health department and the community. Students must take five core courses (such as biostatistics, epidemiology, and social and behavioral sciences) and two other required courses–global health, and eliminating racial and ethnic disparities in health. They also choose three electives from among 65 graduate classes that include three new courses introduced alongside the M.P.H. program–community nutrition, mental health, and public health policy.

Students also attend a biweekly seminar focused on solutions to current public health problems and complete a community practicum in which they use a team approach to solve a problem in the school system, the health department, or a cancer center.

The Robert Wood Johnson Foundation funds a separate 2-year program–at six institutions–that accepts 18 scholars who have completed doctoral training. The program aims “to build the field of population health,” defined as taking a broad approach to understanding why some groups of people are healthy and others are not, but it does not focus specifically on racial and ethnic health disparities.

SAN DIEGO – A new Howard University program offering a master's degree in public health aims to train leaders who will help eliminate racial and ethnic disparities in health.

The degree program is the first to focus on health disparities using a multidisciplinary team approach, Mohammad N. Akhter, M.D., said at the annual meeting of the National Medical Association.

“Leadership is very important because leadership is all about setting the priorities. If you are a leader, you are in a position where you can change our policies, you can change the system,” said Dr. Akhter of the university in Washington.

Currently, few public health leaders are members of racial and ethnic minorities. “For us, this is the next battle of the civil rights movement,” he said.

The new degree option is the fastest-moving program in the university's history, he said.

After the deans of all 15 schools at the university met in November 2003 and backed the new M.P.H. program, a 29-member public health council was formed from faculty, community leaders, representatives of the city's health department, foundations, and others to flesh out the program and its policies.

The program has accepted 22 students from 18 different disciplines for the first class, out of more than 100 applicants. Students were warned that they would have to be fighters in this field; jobs are not waiting for them to eliminate racial and ethnic health disparities, Dr. Akhter said.

Preference is given to applicants who already hold advanced degrees (M.D., D.D.S., Pharm.D., Ph.D., and the like) or who have an undergraduate degree and at least 2 years of fieldwork in public health. Courses are held at night so that students can continue their jobs if desired. The degree could be obtained in 2 years, Dr. Akhter said.

The program has no dedicated faculty but instead uses faculty from Howard, George Washington, and Georgetown universities as well as teachers from the city's health department and the community. Students must take five core courses (such as biostatistics, epidemiology, and social and behavioral sciences) and two other required courses–global health, and eliminating racial and ethnic disparities in health. They also choose three electives from among 65 graduate classes that include three new courses introduced alongside the M.P.H. program–community nutrition, mental health, and public health policy.

Students also attend a biweekly seminar focused on solutions to current public health problems and complete a community practicum in which they use a team approach to solve a problem in the school system, the health department, or a cancer center.

The Robert Wood Johnson Foundation funds a separate 2-year program–at six institutions–that accepts 18 scholars who have completed doctoral training. The program aims “to build the field of population health,” defined as taking a broad approach to understanding why some groups of people are healthy and others are not, but it does not focus specifically on racial and ethnic health disparities.