News for Your Practice

The use of emergency contraception has more than doubled in recent years, primarily due to large increases in use by women in their early twenties, according to a February data brief issued by the US Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

Kimberly Daniels, PhD, from the NCHS in Hyattsville, Maryland, and colleagues interviewed more than 12,000 sexually-experienced women in the United States, aged 15 to 44, from 2006 to 2010, to ask about their use of emergency contraception and their use of other forms of birth control.

The researchers found that, overall, about one in nine women (11% or 5.8 million) used emergency contraception between 2006 and 2010, up from 4.2% in 2002. Of these, 59% had used emergency contraception once, and 24% had used it twice. About one in four women (23%) aged 20 to 24 used emergency contraception at some point.

“Among women who had ever used emergency contraception, nearly equal percentages of women, around 50%, reported having used it because of fear of method failure and because of unprotected sex,” the authors write. “Non-Hispanic black and Hispanic women and those with less education were more likely to have used emergency contraception because of unprotected sex, compared with women of other characteristics. Older women, non-Hispanic white women, and women with more education more often used emergency contraception because of fear of method failure, compared with women of other characteristics.”

To access NCHS Data Brief No. 112, “Use of Emergency Contraception Among Women Aged 15–44: United States, 2006–2010,” click here.

The use of emergency contraception has more than doubled in recent years, primarily due to large increases in use by women in their early twenties, according to a February data brief issued by the US Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

Kimberly Daniels, PhD, from the NCHS in Hyattsville, Maryland, and colleagues interviewed more than 12,000 sexually-experienced women in the United States, aged 15 to 44, from 2006 to 2010, to ask about their use of emergency contraception and their use of other forms of birth control.

The researchers found that, overall, about one in nine women (11% or 5.8 million) used emergency contraception between 2006 and 2010, up from 4.2% in 2002. Of these, 59% had used emergency contraception once, and 24% had used it twice. About one in four women (23%) aged 20 to 24 used emergency contraception at some point.

“Among women who had ever used emergency contraception, nearly equal percentages of women, around 50%, reported having used it because of fear of method failure and because of unprotected sex,” the authors write. “Non-Hispanic black and Hispanic women and those with less education were more likely to have used emergency contraception because of unprotected sex, compared with women of other characteristics. Older women, non-Hispanic white women, and women with more education more often used emergency contraception because of fear of method failure, compared with women of other characteristics.”

To access NCHS Data Brief No. 112, “Use of Emergency Contraception Among Women Aged 15–44: United States, 2006–2010,” click here.

The use of emergency contraception has more than doubled in recent years, primarily due to large increases in use by women in their early twenties, according to a February data brief issued by the US Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

Kimberly Daniels, PhD, from the NCHS in Hyattsville, Maryland, and colleagues interviewed more than 12,000 sexually-experienced women in the United States, aged 15 to 44, from 2006 to 2010, to ask about their use of emergency contraception and their use of other forms of birth control.

The researchers found that, overall, about one in nine women (11% or 5.8 million) used emergency contraception between 2006 and 2010, up from 4.2% in 2002. Of these, 59% had used emergency contraception once, and 24% had used it twice. About one in four women (23%) aged 20 to 24 used emergency contraception at some point.

“Among women who had ever used emergency contraception, nearly equal percentages of women, around 50%, reported having used it because of fear of method failure and because of unprotected sex,” the authors write. “Non-Hispanic black and Hispanic women and those with less education were more likely to have used emergency contraception because of unprotected sex, compared with women of other characteristics. Older women, non-Hispanic white women, and women with more education more often used emergency contraception because of fear of method failure, compared with women of other characteristics.”

To access NCHS Data Brief No. 112, “Use of Emergency Contraception Among Women Aged 15–44: United States, 2006–2010,” click here.

For older women, biennial screening mammography is associated with similar rates of advanced disease and lower rates of false-positive recall, irrespective of comorbidity, according to a study published online in the Journal of the National Cancer Institute.

To examine the risk of adverse tumor characteristics and false-positive rates according to screening interval, age, and comorbidity, Dejana Braithwaite, PhD, from the University of California in San Francisco, and colleagues conducted a prospective study involving 2,993 women with breast cancer and 137,949 women without breast cancer, aged 66 to 89 years at study entry, who underwent screening mammography.

The researchers found that adverse tumor characteristics were not significantly different based on comorbidity, age, or screening interval. Compared with biennial screeners, annual screeners had a higher 10-year cumulative probability of a false-positive mammography result (48% of annual screeners aged 66 to 74 years versus 29% of biennial screeners), regardless of comorbidity.

“More high-quality observational research examining additional measures of comorbidity and breast cancer mortality may facilitate improved understanding of the benefits and harms of different screening mammography frequencies among older women and, ultimately, inform clinical and policy decisions about the appropriate use of screening in this growing population,” the authors write.

To read the abstract of “Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?” click here.

For older women, biennial screening mammography is associated with similar rates of advanced disease and lower rates of false-positive recall, irrespective of comorbidity, according to a study published online in the Journal of the National Cancer Institute.

To examine the risk of adverse tumor characteristics and false-positive rates according to screening interval, age, and comorbidity, Dejana Braithwaite, PhD, from the University of California in San Francisco, and colleagues conducted a prospective study involving 2,993 women with breast cancer and 137,949 women without breast cancer, aged 66 to 89 years at study entry, who underwent screening mammography.

The researchers found that adverse tumor characteristics were not significantly different based on comorbidity, age, or screening interval. Compared with biennial screeners, annual screeners had a higher 10-year cumulative probability of a false-positive mammography result (48% of annual screeners aged 66 to 74 years versus 29% of biennial screeners), regardless of comorbidity.

“More high-quality observational research examining additional measures of comorbidity and breast cancer mortality may facilitate improved understanding of the benefits and harms of different screening mammography frequencies among older women and, ultimately, inform clinical and policy decisions about the appropriate use of screening in this growing population,” the authors write.

To read the abstract of “Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?” click here.

For older women, biennial screening mammography is associated with similar rates of advanced disease and lower rates of false-positive recall, irrespective of comorbidity, according to a study published online in the Journal of the National Cancer Institute.

To examine the risk of adverse tumor characteristics and false-positive rates according to screening interval, age, and comorbidity, Dejana Braithwaite, PhD, from the University of California in San Francisco, and colleagues conducted a prospective study involving 2,993 women with breast cancer and 137,949 women without breast cancer, aged 66 to 89 years at study entry, who underwent screening mammography.

The researchers found that adverse tumor characteristics were not significantly different based on comorbidity, age, or screening interval. Compared with biennial screeners, annual screeners had a higher 10-year cumulative probability of a false-positive mammography result (48% of annual screeners aged 66 to 74 years versus 29% of biennial screeners), regardless of comorbidity.

“More high-quality observational research examining additional measures of comorbidity and breast cancer mortality may facilitate improved understanding of the benefits and harms of different screening mammography frequencies among older women and, ultimately, inform clinical and policy decisions about the appropriate use of screening in this growing population,” the authors write.

To read the abstract of “Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?” click here.

Maternal use of folic acid supplements around the time of conception is associated with a reduced risk of having children with autistic disorder, according to a study published in the Journal of the American Medical Association.

To determine whether prenatal folic acid use reduces the risk of neurodevelopmental disorders in addition to neural tube defects, Pål Surén, MD, MPH, from the Norwegian Institute of Public Health in Oslo, and colleagues examined the association between folic acid supplement use 4 weeks before to 8 weeks after the start of pregnancy and risk of autism spectrum disorders in 85,176 children born between 2002 and 2008.

As of March 31, 2012, the researchers found that 270 children (0.32%) had been diagnosed with an autism spectrum disorder (114 with autistic disorder, 56 with Asperger syndrome, and 100 with pervasive developmental disorder–not otherwise specified [PDD-NOS]). The risk of being diagnosed with an autistic disorder was significantly lower for children whose mothers had taken folic acid (0.10% versus 0.21%; adjusted odds ratio, 0.61). In contrast, there was no association between folic acid use and Asperger syndrome or PDD-NOS.

“Our main finding was that maternal use of folic acid supplements around the time of conception was associated with a lower risk of autistic disorder,” Surén and colleagues conclude. “This finding does not establish a causal relation between folic acid use and autistic disorder but provides a rationale for replicating the analyses in other study samples and further investigating genetic factors and other biological mechanisms that may explain the inverse association.”

To access the abstract of “Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children,” click here.

Maternal use of folic acid supplements around the time of conception is associated with a reduced risk of having children with autistic disorder, according to a study published in the Journal of the American Medical Association.

To determine whether prenatal folic acid use reduces the risk of neurodevelopmental disorders in addition to neural tube defects, Pål Surén, MD, MPH, from the Norwegian Institute of Public Health in Oslo, and colleagues examined the association between folic acid supplement use 4 weeks before to 8 weeks after the start of pregnancy and risk of autism spectrum disorders in 85,176 children born between 2002 and 2008.

As of March 31, 2012, the researchers found that 270 children (0.32%) had been diagnosed with an autism spectrum disorder (114 with autistic disorder, 56 with Asperger syndrome, and 100 with pervasive developmental disorder–not otherwise specified [PDD-NOS]). The risk of being diagnosed with an autistic disorder was significantly lower for children whose mothers had taken folic acid (0.10% versus 0.21%; adjusted odds ratio, 0.61). In contrast, there was no association between folic acid use and Asperger syndrome or PDD-NOS.

“Our main finding was that maternal use of folic acid supplements around the time of conception was associated with a lower risk of autistic disorder,” Surén and colleagues conclude. “This finding does not establish a causal relation between folic acid use and autistic disorder but provides a rationale for replicating the analyses in other study samples and further investigating genetic factors and other biological mechanisms that may explain the inverse association.”

To access the abstract of “Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children,” click here.

Maternal use of folic acid supplements around the time of conception is associated with a reduced risk of having children with autistic disorder, according to a study published in the Journal of the American Medical Association.

To determine whether prenatal folic acid use reduces the risk of neurodevelopmental disorders in addition to neural tube defects, Pål Surén, MD, MPH, from the Norwegian Institute of Public Health in Oslo, and colleagues examined the association between folic acid supplement use 4 weeks before to 8 weeks after the start of pregnancy and risk of autism spectrum disorders in 85,176 children born between 2002 and 2008.

As of March 31, 2012, the researchers found that 270 children (0.32%) had been diagnosed with an autism spectrum disorder (114 with autistic disorder, 56 with Asperger syndrome, and 100 with pervasive developmental disorder–not otherwise specified [PDD-NOS]). The risk of being diagnosed with an autistic disorder was significantly lower for children whose mothers had taken folic acid (0.10% versus 0.21%; adjusted odds ratio, 0.61). In contrast, there was no association between folic acid use and Asperger syndrome or PDD-NOS.

“Our main finding was that maternal use of folic acid supplements around the time of conception was associated with a lower risk of autistic disorder,” Surén and colleagues conclude. “This finding does not establish a causal relation between folic acid use and autistic disorder but provides a rationale for replicating the analyses in other study samples and further investigating genetic factors and other biological mechanisms that may explain the inverse association.”

To access the abstract of “Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children,” click here.

One of the largest physician surveys ever conducted in the United States identified some disturbing trends in practice.¹ The comprehensive survey of 13,575 physicians, commissioned by the nonprofit Physicians Foundation, found that physicians are working fewer hours, seeing fewer patients, and limiting access to their practices as a response to significant changes to the medical practice environment.

If these patterns continue, as many as 44,250 full-time–equivalent physicians may leave the workforce over the next 4 years. The survey also found that, over the next 1 to 3 years, more than 50% of physicians will cut back on the number of patients they see, switch to part-time work or concierge medicine, retire, or take other steps likely to reduce patient access. And if 100,000 physicians transition from practice-owner to employed status over the next 4 years (eg, moving to a hospital setting), this shift will lead to 91 million fewer patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the US health-care system through health-care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, MD, vice president of the Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52%) have limited the access of Medicare patients to their practices or are planning to do so, and one out of four physicians (26%) have already closed their practices to Medicaid patients, the survey reveals. Physicians cited rising operating costs, time constraints, and diminishing reimbursement as the primary reasons they are unable to accept additional Medicare and Medicaid patients.

Physician morale is flagging

An overwhelming 80% of physicians cited “patient relationships” as the most satisfying part of their job. Yet, 77% of respondents are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the health-care system.

Among the variables cited as driving discontent:

• medicolegal risk and the pressure to practice defensively
  
• Medicare, Medicaid, and government regulations
  
• reimbursement issues
  
• uncertainty about the changes imposed by health reform.
  

These issues and others cited throughout the survey tend to distract from or interfere with the time physicians spend with patients, respondents said.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, PhD, president of the Physicians Foundation and chief executive officer (CEO) of the Texas Medical Association. “More than 84% of physicians feel that the medical profession is in decline, and nearly 58% are reluctant to recommend medicine as a career to their children. That means that we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”

Other notable findings

• Sixty-nine percent of physicians cited defensive medicine as the No. 1 cost driver, and 65% cited the “aging population.” Older patients visit physicians three times as often as younger patients, on average. Other expense drivers cited were the cost of pharmaceuticals, advances in technology and treatment, and “social conditions.”
  
• Close to 92% of physicians are unsure where the health-care system will be or how they will fit into it 3 to 5 years from now.
  
• More than 62% of physicians said Accountable Care Organizations are either unlikely to increase the quality of health care and decrease costs, or that any quality/cost gains will not be worth the effort.
  
• Although almost 70% of physicians have implemented electronic medical records, 47.4% have significant concerns that these records pose a risk to patient privacy.
  

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of the Physicians Foundation.

We want to hear from you! Tell us what you think.

One of the largest physician surveys ever conducted in the United States identified some disturbing trends in practice.¹ The comprehensive survey of 13,575 physicians, commissioned by the nonprofit Physicians Foundation, found that physicians are working fewer hours, seeing fewer patients, and limiting access to their practices as a response to significant changes to the medical practice environment.

If these patterns continue, as many as 44,250 full-time–equivalent physicians may leave the workforce over the next 4 years. The survey also found that, over the next 1 to 3 years, more than 50% of physicians will cut back on the number of patients they see, switch to part-time work or concierge medicine, retire, or take other steps likely to reduce patient access. And if 100,000 physicians transition from practice-owner to employed status over the next 4 years (eg, moving to a hospital setting), this shift will lead to 91 million fewer patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the US health-care system through health-care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, MD, vice president of the Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52%) have limited the access of Medicare patients to their practices or are planning to do so, and one out of four physicians (26%) have already closed their practices to Medicaid patients, the survey reveals. Physicians cited rising operating costs, time constraints, and diminishing reimbursement as the primary reasons they are unable to accept additional Medicare and Medicaid patients.

Physician morale is flagging

An overwhelming 80% of physicians cited “patient relationships” as the most satisfying part of their job. Yet, 77% of respondents are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the health-care system.

Among the variables cited as driving discontent:

• medicolegal risk and the pressure to practice defensively
  
• Medicare, Medicaid, and government regulations
  
• reimbursement issues
  
• uncertainty about the changes imposed by health reform.
  

These issues and others cited throughout the survey tend to distract from or interfere with the time physicians spend with patients, respondents said.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, PhD, president of the Physicians Foundation and chief executive officer (CEO) of the Texas Medical Association. “More than 84% of physicians feel that the medical profession is in decline, and nearly 58% are reluctant to recommend medicine as a career to their children. That means that we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”

Other notable findings

• Sixty-nine percent of physicians cited defensive medicine as the No. 1 cost driver, and 65% cited the “aging population.” Older patients visit physicians three times as often as younger patients, on average. Other expense drivers cited were the cost of pharmaceuticals, advances in technology and treatment, and “social conditions.”
  
• Close to 92% of physicians are unsure where the health-care system will be or how they will fit into it 3 to 5 years from now.
  
• More than 62% of physicians said Accountable Care Organizations are either unlikely to increase the quality of health care and decrease costs, or that any quality/cost gains will not be worth the effort.
  
• Although almost 70% of physicians have implemented electronic medical records, 47.4% have significant concerns that these records pose a risk to patient privacy.
  

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of the Physicians Foundation.

We want to hear from you! Tell us what you think.

One of the largest physician surveys ever conducted in the United States identified some disturbing trends in practice.¹ The comprehensive survey of 13,575 physicians, commissioned by the nonprofit Physicians Foundation, found that physicians are working fewer hours, seeing fewer patients, and limiting access to their practices as a response to significant changes to the medical practice environment.

If these patterns continue, as many as 44,250 full-time–equivalent physicians may leave the workforce over the next 4 years. The survey also found that, over the next 1 to 3 years, more than 50% of physicians will cut back on the number of patients they see, switch to part-time work or concierge medicine, retire, or take other steps likely to reduce patient access. And if 100,000 physicians transition from practice-owner to employed status over the next 4 years (eg, moving to a hospital setting), this shift will lead to 91 million fewer patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the US health-care system through health-care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, MD, vice president of the Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52%) have limited the access of Medicare patients to their practices or are planning to do so, and one out of four physicians (26%) have already closed their practices to Medicaid patients, the survey reveals. Physicians cited rising operating costs, time constraints, and diminishing reimbursement as the primary reasons they are unable to accept additional Medicare and Medicaid patients.

Physician morale is flagging

An overwhelming 80% of physicians cited “patient relationships” as the most satisfying part of their job. Yet, 77% of respondents are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the health-care system.

Among the variables cited as driving discontent:

• medicolegal risk and the pressure to practice defensively
  
• Medicare, Medicaid, and government regulations
  
• reimbursement issues
  
• uncertainty about the changes imposed by health reform.
  

These issues and others cited throughout the survey tend to distract from or interfere with the time physicians spend with patients, respondents said.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, PhD, president of the Physicians Foundation and chief executive officer (CEO) of the Texas Medical Association. “More than 84% of physicians feel that the medical profession is in decline, and nearly 58% are reluctant to recommend medicine as a career to their children. That means that we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”

Other notable findings

• Sixty-nine percent of physicians cited defensive medicine as the No. 1 cost driver, and 65% cited the “aging population.” Older patients visit physicians three times as often as younger patients, on average. Other expense drivers cited were the cost of pharmaceuticals, advances in technology and treatment, and “social conditions.”
  
• Close to 92% of physicians are unsure where the health-care system will be or how they will fit into it 3 to 5 years from now.
  
• More than 62% of physicians said Accountable Care Organizations are either unlikely to increase the quality of health care and decrease costs, or that any quality/cost gains will not be worth the effort.
  
• Although almost 70% of physicians have implemented electronic medical records, 47.4% have significant concerns that these records pose a risk to patient privacy.
  

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of the Physicians Foundation.

We want to hear from you! Tell us what you think.

Physician earnings as a whole have remained stagnant over the past 15 years, while the earnings of other health professionals have continued to rise, according to research published late in 2012.¹ For example, physician earnings increased 19.9% from 1987–1990 to 1996–2000 (95% confidence interval [CI], 15.2% to 24.5%). However, from 1996–2000 to 2006–2010, physician earnings decreased 1.6% (95% CI, –5.4% to 2.2%), and earnings for other health professionals continued to grow from 1996–2000 to 2006–2010, increasing 34.4% for pharmacists, for example (95% CI, 28.4% to 40.3%) ( TABLE ).

Earnings of health-care professionals from 1987–2010

Health-care professional	Median earnings
	1987–1990	1991–1995	1996–2000	2001–2005	2006–2010
Physicians (n = 6,258)	$143,963	$147,135	$166,773	$167,478	$157,751
Dentists (n = 1,640)	$105,511	$120,075	$132,029	$123,126	$129,795
Pharmacists (n = 1,745)	$70,341	$72,685	$76,616	$89,4321	$101,279
Registered nurses (n = 17,774)	$44,149	$48,181	$47,739	$52,944	$54,886
Physician assistants (n = 761)	$42,229	$37,201	$45,484	$49,127	$64,818
Health-care and insurance executives (n = 2,378)	$86,755	$88,282	$89,002	$94,543	$100,000
Adapted from Seabury et al1

Details of the study

Seabury and colleagues drew from the Current Population Survey—a nationally representative, monthly survey of approximately 60,000 households conducted by the Bureau of Labor Statistics and the Census Bureau—to gather data on occupation, number of hours worked, self-reported earnings, and other information. The survey had a high response rate (93.3%). Investigators focused on median earnings because “survey earnings were capped by the US Census to protect identities.” ¹ Among the occupations reported were:

• physician or surgeon
  
• dentist
  
• pharmacist
  
• registered nurse
  
• physician assistant
  
• health-care executive
  
• insurance executive.
  

Physician data were not broken down by specialty.

Analysis was limited to subjects older than 35 years because “the majority of physicians under this age are in training.”¹

The sample included 30,556 individuals who reported being a health professional. Of these, 6,258 were physicians (20.5%).

Why the stagnant earnings?

Seabury and colleagues hypothesize that the growth of managed care, cuts to Medicaid payments, poor growth to Medicare payments, and “bargaining” by insurance companies have contributed to the sluggish physician earnings since 1996–2000.

We want to hear from you!  Tell us what you think.

Physician earnings as a whole have remained stagnant over the past 15 years, while the earnings of other health professionals have continued to rise, according to research published late in 2012.¹ For example, physician earnings increased 19.9% from 1987–1990 to 1996–2000 (95% confidence interval [CI], 15.2% to 24.5%). However, from 1996–2000 to 2006–2010, physician earnings decreased 1.6% (95% CI, –5.4% to 2.2%), and earnings for other health professionals continued to grow from 1996–2000 to 2006–2010, increasing 34.4% for pharmacists, for example (95% CI, 28.4% to 40.3%) ( TABLE ).

Earnings of health-care professionals from 1987–2010

Health-care professional	Median earnings
	1987–1990	1991–1995	1996–2000	2001–2005	2006–2010
Physicians (n = 6,258)	$143,963	$147,135	$166,773	$167,478	$157,751
Dentists (n = 1,640)	$105,511	$120,075	$132,029	$123,126	$129,795
Pharmacists (n = 1,745)	$70,341	$72,685	$76,616	$89,4321	$101,279
Registered nurses (n = 17,774)	$44,149	$48,181	$47,739	$52,944	$54,886
Physician assistants (n = 761)	$42,229	$37,201	$45,484	$49,127	$64,818
Health-care and insurance executives (n = 2,378)	$86,755	$88,282	$89,002	$94,543	$100,000
Adapted from Seabury et al1

Details of the study

Seabury and colleagues drew from the Current Population Survey—a nationally representative, monthly survey of approximately 60,000 households conducted by the Bureau of Labor Statistics and the Census Bureau—to gather data on occupation, number of hours worked, self-reported earnings, and other information. The survey had a high response rate (93.3%). Investigators focused on median earnings because “survey earnings were capped by the US Census to protect identities.” ¹ Among the occupations reported were:

• physician or surgeon
  
• dentist
  
• pharmacist
  
• registered nurse
  
• physician assistant
  
• health-care executive
  
• insurance executive.
  

Physician data were not broken down by specialty.

Analysis was limited to subjects older than 35 years because “the majority of physicians under this age are in training.”¹

The sample included 30,556 individuals who reported being a health professional. Of these, 6,258 were physicians (20.5%).

Why the stagnant earnings?

Seabury and colleagues hypothesize that the growth of managed care, cuts to Medicaid payments, poor growth to Medicare payments, and “bargaining” by insurance companies have contributed to the sluggish physician earnings since 1996–2000.

We want to hear from you!  Tell us what you think.

Physician earnings as a whole have remained stagnant over the past 15 years, while the earnings of other health professionals have continued to rise, according to research published late in 2012.¹ For example, physician earnings increased 19.9% from 1987–1990 to 1996–2000 (95% confidence interval [CI], 15.2% to 24.5%). However, from 1996–2000 to 2006–2010, physician earnings decreased 1.6% (95% CI, –5.4% to 2.2%), and earnings for other health professionals continued to grow from 1996–2000 to 2006–2010, increasing 34.4% for pharmacists, for example (95% CI, 28.4% to 40.3%) ( TABLE ).

Earnings of health-care professionals from 1987–2010

Health-care professional	Median earnings
	1987–1990	1991–1995	1996–2000	2001–2005	2006–2010
Physicians (n = 6,258)	$143,963	$147,135	$166,773	$167,478	$157,751
Dentists (n = 1,640)	$105,511	$120,075	$132,029	$123,126	$129,795
Pharmacists (n = 1,745)	$70,341	$72,685	$76,616	$89,4321	$101,279
Registered nurses (n = 17,774)	$44,149	$48,181	$47,739	$52,944	$54,886
Physician assistants (n = 761)	$42,229	$37,201	$45,484	$49,127	$64,818
Health-care and insurance executives (n = 2,378)	$86,755	$88,282	$89,002	$94,543	$100,000
Adapted from Seabury et al1

Details of the study

Seabury and colleagues drew from the Current Population Survey—a nationally representative, monthly survey of approximately 60,000 households conducted by the Bureau of Labor Statistics and the Census Bureau—to gather data on occupation, number of hours worked, self-reported earnings, and other information. The survey had a high response rate (93.3%). Investigators focused on median earnings because “survey earnings were capped by the US Census to protect identities.” ¹ Among the occupations reported were:

• physician or surgeon
  
• dentist
  
• pharmacist
  
• registered nurse
  
• physician assistant
  
• health-care executive
  
• insurance executive.
  

Physician data were not broken down by specialty.

Analysis was limited to subjects older than 35 years because “the majority of physicians under this age are in training.”¹

The sample included 30,556 individuals who reported being a health professional. Of these, 6,258 were physicians (20.5%).

Why the stagnant earnings?

Seabury and colleagues hypothesize that the growth of managed care, cuts to Medicaid payments, poor growth to Medicare payments, and “bargaining” by insurance companies have contributed to the sluggish physician earnings since 1996–2000.

We want to hear from you!  Tell us what you think.

Women who have hormone-sensitive breast cancer and who have taken tamoxifen for 5 years as adjuvant therapy stand to benefit from an additional 5 years of the drug, according to preliminary findings from the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial.¹

Tamoxifen is widely used to treat estrogen-receptor–positive (ER-positive) breast cancer and is generally prescribed for 5 years of daily use once the cancer has been excised. The drug substantially reduces the breast cancer mortality rate not only while treatment continues, but throughout the first 15 years after diagnosis.

It was known that 5 years of tamoxifen are more effective than 2 years. Until now, however, it was unclear whether continuation beyond 5 years further reduces the 15-year breast cancer mortality rate.

Details of the trial

In the trial of 12,894 women, investigators randomly assigned those who had received tamoxifen for 5 years to another 5 years of therapy or to no additional therapy, regardless of ER status. For the analysis, however, they included only the 6,847 women known to have ER-positive disease. Of these women, 3,428 were randomly assigned to continue tamoxifen for another 5 years (10 years total), and 3,418 were allocated to stop the therapy immediately (5 years total).

Women who continued tamoxifen had a lower rate of recurrence and breast cancer mortality, but that benefit took several years to emerge. From the beginning of the ATLAS trial to year 15, the risk of recurrence was 21.4% among women who had continued tamoxifen to 10 years, and it was 25.1% among women who had only 5 years of therapy. Breast cancer mortality also declined significantly during years 5 to 15; it was 12.2% among women who continued tamoxifen to 10 years, and it was 15% among women who had only 5 years of therapy.

“Our results, taken together with results from previous trials of 5 years of tamoxifen versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis,” said Christina Davies, MBChB, lead investigator. “Good evidence now exists that 10 years of tamoxifen in ER- positive breast cancer produces substantial reductions in rates of recurrence and in breast cancer mortality, not only during the first decade, while treatment continues, but also during the second decade, long after it has ended.”

 

Side effects were more common among postmenopausal women

Although tamoxifen has some side effects, they had a relatively small net effect on survival. The most significant effect was an increased risk—among postmenopausal women—of endometrial cancer. However, the excess risk of dying of endometrial cancer by year 15 was only 0.2% (0.4% among women who continued tamoxifen to 10 years vs 0.2% in the control group).

Investigators found no evidence that tamoxifen increases the risk of stroke, despite the fact that the US Food and Drug Administration lists stroke as a possible side effect of the drug.

We want to hear from you!  Tell us what you think.

Women who have hormone-sensitive breast cancer and who have taken tamoxifen for 5 years as adjuvant therapy stand to benefit from an additional 5 years of the drug, according to preliminary findings from the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial.¹

Tamoxifen is widely used to treat estrogen-receptor–positive (ER-positive) breast cancer and is generally prescribed for 5 years of daily use once the cancer has been excised. The drug substantially reduces the breast cancer mortality rate not only while treatment continues, but throughout the first 15 years after diagnosis.

It was known that 5 years of tamoxifen are more effective than 2 years. Until now, however, it was unclear whether continuation beyond 5 years further reduces the 15-year breast cancer mortality rate.

Details of the trial

In the trial of 12,894 women, investigators randomly assigned those who had received tamoxifen for 5 years to another 5 years of therapy or to no additional therapy, regardless of ER status. For the analysis, however, they included only the 6,847 women known to have ER-positive disease. Of these women, 3,428 were randomly assigned to continue tamoxifen for another 5 years (10 years total), and 3,418 were allocated to stop the therapy immediately (5 years total).

Women who continued tamoxifen had a lower rate of recurrence and breast cancer mortality, but that benefit took several years to emerge. From the beginning of the ATLAS trial to year 15, the risk of recurrence was 21.4% among women who had continued tamoxifen to 10 years, and it was 25.1% among women who had only 5 years of therapy. Breast cancer mortality also declined significantly during years 5 to 15; it was 12.2% among women who continued tamoxifen to 10 years, and it was 15% among women who had only 5 years of therapy.

“Our results, taken together with results from previous trials of 5 years of tamoxifen versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis,” said Christina Davies, MBChB, lead investigator. “Good evidence now exists that 10 years of tamoxifen in ER- positive breast cancer produces substantial reductions in rates of recurrence and in breast cancer mortality, not only during the first decade, while treatment continues, but also during the second decade, long after it has ended.”

 

Side effects were more common among postmenopausal women

Although tamoxifen has some side effects, they had a relatively small net effect on survival. The most significant effect was an increased risk—among postmenopausal women—of endometrial cancer. However, the excess risk of dying of endometrial cancer by year 15 was only 0.2% (0.4% among women who continued tamoxifen to 10 years vs 0.2% in the control group).

Investigators found no evidence that tamoxifen increases the risk of stroke, despite the fact that the US Food and Drug Administration lists stroke as a possible side effect of the drug.

We want to hear from you!  Tell us what you think.

Women who have hormone-sensitive breast cancer and who have taken tamoxifen for 5 years as adjuvant therapy stand to benefit from an additional 5 years of the drug, according to preliminary findings from the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial.¹

Tamoxifen is widely used to treat estrogen-receptor–positive (ER-positive) breast cancer and is generally prescribed for 5 years of daily use once the cancer has been excised. The drug substantially reduces the breast cancer mortality rate not only while treatment continues, but throughout the first 15 years after diagnosis.

It was known that 5 years of tamoxifen are more effective than 2 years. Until now, however, it was unclear whether continuation beyond 5 years further reduces the 15-year breast cancer mortality rate.

Details of the trial

In the trial of 12,894 women, investigators randomly assigned those who had received tamoxifen for 5 years to another 5 years of therapy or to no additional therapy, regardless of ER status. For the analysis, however, they included only the 6,847 women known to have ER-positive disease. Of these women, 3,428 were randomly assigned to continue tamoxifen for another 5 years (10 years total), and 3,418 were allocated to stop the therapy immediately (5 years total).

Women who continued tamoxifen had a lower rate of recurrence and breast cancer mortality, but that benefit took several years to emerge. From the beginning of the ATLAS trial to year 15, the risk of recurrence was 21.4% among women who had continued tamoxifen to 10 years, and it was 25.1% among women who had only 5 years of therapy. Breast cancer mortality also declined significantly during years 5 to 15; it was 12.2% among women who continued tamoxifen to 10 years, and it was 15% among women who had only 5 years of therapy.

“Our results, taken together with results from previous trials of 5 years of tamoxifen versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis,” said Christina Davies, MBChB, lead investigator. “Good evidence now exists that 10 years of tamoxifen in ER- positive breast cancer produces substantial reductions in rates of recurrence and in breast cancer mortality, not only during the first decade, while treatment continues, but also during the second decade, long after it has ended.”

 

Side effects were more common among postmenopausal women

Although tamoxifen has some side effects, they had a relatively small net effect on survival. The most significant effect was an increased risk—among postmenopausal women—of endometrial cancer. However, the excess risk of dying of endometrial cancer by year 15 was only 0.2% (0.4% among women who continued tamoxifen to 10 years vs 0.2% in the control group).

Investigators found no evidence that tamoxifen increases the risk of stroke, despite the fact that the US Food and Drug Administration lists stroke as a possible side effect of the drug.

We want to hear from you!  Tell us what you think.

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

Physicians who treat infertile women should be aware of the potential risks associated with antidepressant use during pregnancy, and should consider alternative treatments such as some forms of counseling, according to a study published online in Human Reproduction.

Noting that selective serotonin reuptake inhibitor (SSRI) use is associated with possible reduced infertility treatment efficacy as well as higher rates of adverse pregnancy outcomes, Alice D. Domar, PhD, from Boston IVF, and colleagues reviewed the current literature to examine the safety and efficacy of SSRI use in infertile women. All studies that assessed females taking antidepressant medications for depressive symptoms who were experiencing infertility were included.

The researchers found that there were increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn, and possible longer term neurobehavioral effects seen with antidepressant use during pregnancy. No evidence was found for improved pregnancy outcomes with antidepressant use. Noting that some evidence suggests decreases in depressive symptoms with psychotherapy, including cognitive-behavioral therapy and exercise, some forms of counseling were also shown to be effective for treating these symptoms in infertile women.

“Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size,” the authors write. “Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients.”

For the abstract of the article in Human Reproduction, click here.

Physicians who treat infertile women should be aware of the potential risks associated with antidepressant use during pregnancy, and should consider alternative treatments such as some forms of counseling, according to a study published online in Human Reproduction.

Noting that selective serotonin reuptake inhibitor (SSRI) use is associated with possible reduced infertility treatment efficacy as well as higher rates of adverse pregnancy outcomes, Alice D. Domar, PhD, from Boston IVF, and colleagues reviewed the current literature to examine the safety and efficacy of SSRI use in infertile women. All studies that assessed females taking antidepressant medications for depressive symptoms who were experiencing infertility were included.

The researchers found that there were increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn, and possible longer term neurobehavioral effects seen with antidepressant use during pregnancy. No evidence was found for improved pregnancy outcomes with antidepressant use. Noting that some evidence suggests decreases in depressive symptoms with psychotherapy, including cognitive-behavioral therapy and exercise, some forms of counseling were also shown to be effective for treating these symptoms in infertile women.

“Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size,” the authors write. “Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients.”

For the abstract of the article in Human Reproduction, click here.

Physicians who treat infertile women should be aware of the potential risks associated with antidepressant use during pregnancy, and should consider alternative treatments such as some forms of counseling, according to a study published online in Human Reproduction.

Noting that selective serotonin reuptake inhibitor (SSRI) use is associated with possible reduced infertility treatment efficacy as well as higher rates of adverse pregnancy outcomes, Alice D. Domar, PhD, from Boston IVF, and colleagues reviewed the current literature to examine the safety and efficacy of SSRI use in infertile women. All studies that assessed females taking antidepressant medications for depressive symptoms who were experiencing infertility were included.

The researchers found that there were increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn, and possible longer term neurobehavioral effects seen with antidepressant use during pregnancy. No evidence was found for improved pregnancy outcomes with antidepressant use. Noting that some evidence suggests decreases in depressive symptoms with psychotherapy, including cognitive-behavioral therapy and exercise, some forms of counseling were also shown to be effective for treating these symptoms in infertile women.

“Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size,” the authors write. “Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients.”

For the abstract of the article in Human Reproduction, click here.

In a Phase 3 trial of an investigational contraceptive patch—known for the time being as AG200-15, under development by Agile Therapeutics—women were more compliant with the patch than with an oral contraceptive (OC).¹ Over the first six cycles of the study, the percentage of cycles with perfect compliance was significantly higher among patch users than among women taking the pill (90.5% vs 78.8%; P <.001). In addition, compliance with the patch rose steadily over the first six cycles of the study, while compliance with the pill declined. Compliance was defined as no missed days of contraception in the cycle.

The AG200-15 patch is applied weekly and contains low-dose ethinyl estradiol in combination with levonorgestrel (LNG). The OC used in the study was Levlite (Berlex), a formulation containing 20 μg ethinyl estradiol and 0.1 mg LNG.

Data from the Phase 3 trial were presented at the annual meeting of the Association of Reproductive Health Professionals in late September. Findings were presented in a poster presentation by Andrew M. Kaunitz, MD, David F. Archer, MD, and Marie Foegh, MD, DrSc. Dr. Kaunitz is Associate Chair and Professor of Obstetrics and Gynecology at the University of Florida-Jacksonville and serves on the OBG Management Board of Editors. Dr. Archer is Director of the CONRAD Clinical Research Center and Professor of Obstetrics and Gynecology at Eastern Virginia Medical School. Dr. Foegh is Chief Medical Officer of Agile Therapeutics.

In the open-label, randomized, parallel-group, multicenter study, 1,328 women were treated for 1 year (13 cycles) with a patch (n = 998) or for six cycles with an OC, followed by seven cycles of the patch (n = 330). Women recorded their patch-application and pill-taking behavior in a diary.

The mean age of women in this study was 26.4 years; 60% were new users of hormonal contraception; 33% were obese; and 46% were non-Caucasian. Although there was no difference in the rate of compliance between obese and nonobese women using the patch or pill, compliance did vary by race and ethnicity, age, and education.

“Noncompliance among contraceptive users is an ongoing challenge,” Dr. Kaunitz said, “as the effectiveness of a contraceptive can decrease if it is not used correctly. The once-weekly regimen of AG200-15 is intended to be simple to use correctly, and we are encouraged to see that in this clinical trial, compliance was better with AG200-15 than with an oral contraceptive.”

Patch performed favorably in other measures, too

In a poster presentation at the 2012 annual clinical meeting of the American College of Obstetricians and Gynecologists,² Dr. Kaunitz and colleagues presented Phase 3 data on the efficacy, cycle control, and safety of AG200-15, compared with a low-dose OC.

Overall, 1,503 women were randomly assigned to the patch (n = 1,128) or to the OC (n = 375). The women in both groups had comparable age, racial and ethnic demographics, body mass index, and smoking status. A majority of women (60%) were new users of hormonal contraception; 14% had switched from another contraceptive.

The patch had contraceptive efficacy similar to that of the pill, among both obese and nonobese participants; there were no clinically meaningful differences in efficacy between groups. Cycle control was also similar between groups.

The patch was well tolerated, with a low rate of adverse effects. For example, four women (1.2%) in the OC group and 14 women in the patch group (1.3%) experienced a serious adverse event (SAE). One SAE (0.3%) in the OC group (liver problem) and three SAEs (0.3%) in the patch group (drug overdose with diphenhydramine, vomiting, and left subclavian venous thrombosis in a nonobese woman with risk factors) were thought to be possibly or probably related to the study drug.²

Agile recently filed a new drug application for AG200-15 with the US Food and Drug Administration and anticipates a response during the first quarter of 2013.

We want to hear from you! Tell us what you think.

In a Phase 3 trial of an investigational contraceptive patch—known for the time being as AG200-15, under development by Agile Therapeutics—women were more compliant with the patch than with an oral contraceptive (OC).¹ Over the first six cycles of the study, the percentage of cycles with perfect compliance was significantly higher among patch users than among women taking the pill (90.5% vs 78.8%; P <.001). In addition, compliance with the patch rose steadily over the first six cycles of the study, while compliance with the pill declined. Compliance was defined as no missed days of contraception in the cycle.

The AG200-15 patch is applied weekly and contains low-dose ethinyl estradiol in combination with levonorgestrel (LNG). The OC used in the study was Levlite (Berlex), a formulation containing 20 μg ethinyl estradiol and 0.1 mg LNG.

Data from the Phase 3 trial were presented at the annual meeting of the Association of Reproductive Health Professionals in late September. Findings were presented in a poster presentation by Andrew M. Kaunitz, MD, David F. Archer, MD, and Marie Foegh, MD, DrSc. Dr. Kaunitz is Associate Chair and Professor of Obstetrics and Gynecology at the University of Florida-Jacksonville and serves on the OBG Management Board of Editors. Dr. Archer is Director of the CONRAD Clinical Research Center and Professor of Obstetrics and Gynecology at Eastern Virginia Medical School. Dr. Foegh is Chief Medical Officer of Agile Therapeutics.

In the open-label, randomized, parallel-group, multicenter study, 1,328 women were treated for 1 year (13 cycles) with a patch (n = 998) or for six cycles with an OC, followed by seven cycles of the patch (n = 330). Women recorded their patch-application and pill-taking behavior in a diary.

The mean age of women in this study was 26.4 years; 60% were new users of hormonal contraception; 33% were obese; and 46% were non-Caucasian. Although there was no difference in the rate of compliance between obese and nonobese women using the patch or pill, compliance did vary by race and ethnicity, age, and education.

“Noncompliance among contraceptive users is an ongoing challenge,” Dr. Kaunitz said, “as the effectiveness of a contraceptive can decrease if it is not used correctly. The once-weekly regimen of AG200-15 is intended to be simple to use correctly, and we are encouraged to see that in this clinical trial, compliance was better with AG200-15 than with an oral contraceptive.”

Patch performed favorably in other measures, too

In a poster presentation at the 2012 annual clinical meeting of the American College of Obstetricians and Gynecologists,² Dr. Kaunitz and colleagues presented Phase 3 data on the efficacy, cycle control, and safety of AG200-15, compared with a low-dose OC.

Overall, 1,503 women were randomly assigned to the patch (n = 1,128) or to the OC (n = 375). The women in both groups had comparable age, racial and ethnic demographics, body mass index, and smoking status. A majority of women (60%) were new users of hormonal contraception; 14% had switched from another contraceptive.

The patch had contraceptive efficacy similar to that of the pill, among both obese and nonobese participants; there were no clinically meaningful differences in efficacy between groups. Cycle control was also similar between groups.

The patch was well tolerated, with a low rate of adverse effects. For example, four women (1.2%) in the OC group and 14 women in the patch group (1.3%) experienced a serious adverse event (SAE). One SAE (0.3%) in the OC group (liver problem) and three SAEs (0.3%) in the patch group (drug overdose with diphenhydramine, vomiting, and left subclavian venous thrombosis in a nonobese woman with risk factors) were thought to be possibly or probably related to the study drug.²

Agile recently filed a new drug application for AG200-15 with the US Food and Drug Administration and anticipates a response during the first quarter of 2013.

We want to hear from you! Tell us what you think.

In a Phase 3 trial of an investigational contraceptive patch—known for the time being as AG200-15, under development by Agile Therapeutics—women were more compliant with the patch than with an oral contraceptive (OC).¹ Over the first six cycles of the study, the percentage of cycles with perfect compliance was significantly higher among patch users than among women taking the pill (90.5% vs 78.8%; P <.001). In addition, compliance with the patch rose steadily over the first six cycles of the study, while compliance with the pill declined. Compliance was defined as no missed days of contraception in the cycle.

The AG200-15 patch is applied weekly and contains low-dose ethinyl estradiol in combination with levonorgestrel (LNG). The OC used in the study was Levlite (Berlex), a formulation containing 20 μg ethinyl estradiol and 0.1 mg LNG.

Data from the Phase 3 trial were presented at the annual meeting of the Association of Reproductive Health Professionals in late September. Findings were presented in a poster presentation by Andrew M. Kaunitz, MD, David F. Archer, MD, and Marie Foegh, MD, DrSc. Dr. Kaunitz is Associate Chair and Professor of Obstetrics and Gynecology at the University of Florida-Jacksonville and serves on the OBG Management Board of Editors. Dr. Archer is Director of the CONRAD Clinical Research Center and Professor of Obstetrics and Gynecology at Eastern Virginia Medical School. Dr. Foegh is Chief Medical Officer of Agile Therapeutics.

In the open-label, randomized, parallel-group, multicenter study, 1,328 women were treated for 1 year (13 cycles) with a patch (n = 998) or for six cycles with an OC, followed by seven cycles of the patch (n = 330). Women recorded their patch-application and pill-taking behavior in a diary.

The mean age of women in this study was 26.4 years; 60% were new users of hormonal contraception; 33% were obese; and 46% were non-Caucasian. Although there was no difference in the rate of compliance between obese and nonobese women using the patch or pill, compliance did vary by race and ethnicity, age, and education.

“Noncompliance among contraceptive users is an ongoing challenge,” Dr. Kaunitz said, “as the effectiveness of a contraceptive can decrease if it is not used correctly. The once-weekly regimen of AG200-15 is intended to be simple to use correctly, and we are encouraged to see that in this clinical trial, compliance was better with AG200-15 than with an oral contraceptive.”

Patch performed favorably in other measures, too

In a poster presentation at the 2012 annual clinical meeting of the American College of Obstetricians and Gynecologists,² Dr. Kaunitz and colleagues presented Phase 3 data on the efficacy, cycle control, and safety of AG200-15, compared with a low-dose OC.

Overall, 1,503 women were randomly assigned to the patch (n = 1,128) or to the OC (n = 375). The women in both groups had comparable age, racial and ethnic demographics, body mass index, and smoking status. A majority of women (60%) were new users of hormonal contraception; 14% had switched from another contraceptive.

The patch had contraceptive efficacy similar to that of the pill, among both obese and nonobese participants; there were no clinically meaningful differences in efficacy between groups. Cycle control was also similar between groups.

The patch was well tolerated, with a low rate of adverse effects. For example, four women (1.2%) in the OC group and 14 women in the patch group (1.3%) experienced a serious adverse event (SAE). One SAE (0.3%) in the OC group (liver problem) and three SAEs (0.3%) in the patch group (drug overdose with diphenhydramine, vomiting, and left subclavian venous thrombosis in a nonobese woman with risk factors) were thought to be possibly or probably related to the study drug.²

Agile recently filed a new drug application for AG200-15 with the US Food and Drug Administration and anticipates a response during the first quarter of 2013.

We want to hear from you! Tell us what you think.

Analyses from the Cancer Genome Atlas (TCGA) have confirmed the existence of four primary subtypes of breast cancer, each with its own biology and survival outlooks, according to a study published in the journal Nature.¹

The standard molecular subtypes are:

• luminal A tumors
• luminal B tumors
• basal-like cancer, also known as triple-negative breast cancer because most of these tumors test negative for three receptors: estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2)
• HER2-enriched tumors.

In their analyses, funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of the National Institutes of Health (NIH), researchers described new insights into the four subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

Most breast Ca cases involve luminal tumors

The milk ducts of the human breast, lined with luminal cells, are the most common origin of breast cancers. Malignancies that arise from these cells are fed by estrogen, spurring growth. Treatment for luminal cancers is fairly uniform, with good outcomes for many patients, though some respond poorly. Therefore, luminal cancers are divided into type A (responsive to treatment) and type B (not as responsive).

Researchers theorize that women with luminal A tumors may respond well to hormonal (estrogen-blocking) therapy, whereas those with luminal B tumors may require chemotherapy in addition to hormonal therapy.

In general, luminal subtypes of breast cancer tumors had the lowest overall mutation rate but the largest number of genes observed to be significantly mutated. This finding suggests that each of the genes identified as significantly mutated in the luminal subtypes is more likely to be important in fueling cancer progression.

Triple-negative breast cancers linked to serous ovarian cancer

One of the most dramatic discoveries of this analysis was the marked genomic similarities between the basal-like subtype and serous ovarian cancer. The mutation spectrum—or types and frequencies of genomic mutations—were largely the same in both cancer types. Further analyses identified several additional common genomic features, such as gene-mutation frequency, suggesting that diverse genomic aberrations can converge into a limited number of cancer subtypes.

Computational analyses suggest that basal-like breast cancer and serous ovarian cancer might both be susceptible to agents that inhibit blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.

“The molecular similarity of one of the principal subtypes of breast cancer to that found in ovarian cancer gives us additional leverage to compare treatments and outcomes across these two cancers,” said Harold Varmus, MD, NCI director.

Two types of HER2-positive tumors?

When researchers analyzed the genomic findings from tumors determined to be HER2-positive by standard cellular tests, they found that only half of the samples were actually HER2-enriched. The other half were characterized as luminal subtypes, suggesting that there are at least two types of clinically defined HER2-positive tumors.

Overall, the scale of the TCGA program allows researchers to perform the integrative analyses that detect these complex patterns of genomic changes and interactions. This close inspection of the cancer genome has led to a deeper understanding of the mutations essential for cancer progression, and several new mutations were identified in the study.

“The data generated by the TCGA program comprise a vast resource that investigators will be analyzing for years to come,” said Eric D. Green, MD, PhD, NHGRI director. “The resource of information about breast cancer genomes will undoubtedly fuel myriad discoveries by the cancer research community.”

So far, TCGA research has published analyses of ovarian serous adenocarcinoma, colorectal adenocarcinoma, lung squamous cell carcinoma, and glioblastoma multiforme.

We want to hear from you! Tell us what you think.

Analyses from the Cancer Genome Atlas (TCGA) have confirmed the existence of four primary subtypes of breast cancer, each with its own biology and survival outlooks, according to a study published in the journal Nature.¹

The standard molecular subtypes are:

• luminal A tumors
• luminal B tumors
• basal-like cancer, also known as triple-negative breast cancer because most of these tumors test negative for three receptors: estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2)
• HER2-enriched tumors.

In their analyses, funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of the National Institutes of Health (NIH), researchers described new insights into the four subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

Most breast Ca cases involve luminal tumors

The milk ducts of the human breast, lined with luminal cells, are the most common origin of breast cancers. Malignancies that arise from these cells are fed by estrogen, spurring growth. Treatment for luminal cancers is fairly uniform, with good outcomes for many patients, though some respond poorly. Therefore, luminal cancers are divided into type A (responsive to treatment) and type B (not as responsive).

Researchers theorize that women with luminal A tumors may respond well to hormonal (estrogen-blocking) therapy, whereas those with luminal B tumors may require chemotherapy in addition to hormonal therapy.

In general, luminal subtypes of breast cancer tumors had the lowest overall mutation rate but the largest number of genes observed to be significantly mutated. This finding suggests that each of the genes identified as significantly mutated in the luminal subtypes is more likely to be important in fueling cancer progression.

Triple-negative breast cancers linked to serous ovarian cancer

One of the most dramatic discoveries of this analysis was the marked genomic similarities between the basal-like subtype and serous ovarian cancer. The mutation spectrum—or types and frequencies of genomic mutations—were largely the same in both cancer types. Further analyses identified several additional common genomic features, such as gene-mutation frequency, suggesting that diverse genomic aberrations can converge into a limited number of cancer subtypes.

Computational analyses suggest that basal-like breast cancer and serous ovarian cancer might both be susceptible to agents that inhibit blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.

“The molecular similarity of one of the principal subtypes of breast cancer to that found in ovarian cancer gives us additional leverage to compare treatments and outcomes across these two cancers,” said Harold Varmus, MD, NCI director.

Two types of HER2-positive tumors?

When researchers analyzed the genomic findings from tumors determined to be HER2-positive by standard cellular tests, they found that only half of the samples were actually HER2-enriched. The other half were characterized as luminal subtypes, suggesting that there are at least two types of clinically defined HER2-positive tumors.

Overall, the scale of the TCGA program allows researchers to perform the integrative analyses that detect these complex patterns of genomic changes and interactions. This close inspection of the cancer genome has led to a deeper understanding of the mutations essential for cancer progression, and several new mutations were identified in the study.

“The data generated by the TCGA program comprise a vast resource that investigators will be analyzing for years to come,” said Eric D. Green, MD, PhD, NHGRI director. “The resource of information about breast cancer genomes will undoubtedly fuel myriad discoveries by the cancer research community.”

So far, TCGA research has published analyses of ovarian serous adenocarcinoma, colorectal adenocarcinoma, lung squamous cell carcinoma, and glioblastoma multiforme.

We want to hear from you! Tell us what you think.

Analyses from the Cancer Genome Atlas (TCGA) have confirmed the existence of four primary subtypes of breast cancer, each with its own biology and survival outlooks, according to a study published in the journal Nature.¹

The standard molecular subtypes are:

• luminal A tumors
• luminal B tumors
• basal-like cancer, also known as triple-negative breast cancer because most of these tumors test negative for three receptors: estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2)
• HER2-enriched tumors.

In their analyses, funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of the National Institutes of Health (NIH), researchers described new insights into the four subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

Most breast Ca cases involve luminal tumors

The milk ducts of the human breast, lined with luminal cells, are the most common origin of breast cancers. Malignancies that arise from these cells are fed by estrogen, spurring growth. Treatment for luminal cancers is fairly uniform, with good outcomes for many patients, though some respond poorly. Therefore, luminal cancers are divided into type A (responsive to treatment) and type B (not as responsive).

Researchers theorize that women with luminal A tumors may respond well to hormonal (estrogen-blocking) therapy, whereas those with luminal B tumors may require chemotherapy in addition to hormonal therapy.

In general, luminal subtypes of breast cancer tumors had the lowest overall mutation rate but the largest number of genes observed to be significantly mutated. This finding suggests that each of the genes identified as significantly mutated in the luminal subtypes is more likely to be important in fueling cancer progression.

Triple-negative breast cancers linked to serous ovarian cancer

One of the most dramatic discoveries of this analysis was the marked genomic similarities between the basal-like subtype and serous ovarian cancer. The mutation spectrum—or types and frequencies of genomic mutations—were largely the same in both cancer types. Further analyses identified several additional common genomic features, such as gene-mutation frequency, suggesting that diverse genomic aberrations can converge into a limited number of cancer subtypes.

Computational analyses suggest that basal-like breast cancer and serous ovarian cancer might both be susceptible to agents that inhibit blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.

“The molecular similarity of one of the principal subtypes of breast cancer to that found in ovarian cancer gives us additional leverage to compare treatments and outcomes across these two cancers,” said Harold Varmus, MD, NCI director.

Two types of HER2-positive tumors?

When researchers analyzed the genomic findings from tumors determined to be HER2-positive by standard cellular tests, they found that only half of the samples were actually HER2-enriched. The other half were characterized as luminal subtypes, suggesting that there are at least two types of clinically defined HER2-positive tumors.

Overall, the scale of the TCGA program allows researchers to perform the integrative analyses that detect these complex patterns of genomic changes and interactions. This close inspection of the cancer genome has led to a deeper understanding of the mutations essential for cancer progression, and several new mutations were identified in the study.

“The data generated by the TCGA program comprise a vast resource that investigators will be analyzing for years to come,” said Eric D. Green, MD, PhD, NHGRI director. “The resource of information about breast cancer genomes will undoubtedly fuel myriad discoveries by the cancer research community.”

So far, TCGA research has published analyses of ovarian serous adenocarcinoma, colorectal adenocarcinoma, lung squamous cell carcinoma, and glioblastoma multiforme.

We want to hear from you! Tell us what you think.