Survey Of Clinicians: Majority Believe Electronic Exchange Of Health Information Will Have Positive Impact On Health Care

Main Category: IT / Internet / E-mail
Also Included In: Medical Practice Management;  Primary Care / General Practice
Article Date: 05 Oct 2012 - 2:00 PDT

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Survey Of Clinicians: Majority Believe Electronic Exchange Of Health Information Will Have Positive Impact On Health Care

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Survey results released today reveal that an overwhelming majority of clinicians believe that the electronic exchange of health information will have a positive impact on improving the quality of patient care, coordinating care, meeting the demands of new care models, and participating in third-party reporting and incentive programs.

The American College of Physicians (ACP), the Bipartisan Policy Center, and Doctors Helping Doctors Transform Health Care developed the survey and analyzed 527 responses in the report Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care.

"The exchange of patient health information across care settings is a critical component to the success of the new models to improve care, such as the patient-centered medical home," said Michael S. Barr, MD, FACP, MBA, who leads ACP's Medical Practice, Professionalism & Quality division. "ACP agrees with the 78 percent of survey respondents who believe that exchanging health information will have a positive effect on clinicians' ability to meet the demands of these new care models."

Yet challenges remain for the widespread electronic exchange of health information. More than 70 percent of clinicians surveyed identified lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges as major barriers, preventing clinicians from exchanging information with others.

"The Office of the National Coordinator for Health Information Technology has done a lot to encourage the development of the technology needed to support the exchange of information across care settings, but we still have a long way to go," said Dr. Barr. "These gaps are most apparent when we look at the infrastructure, or lack thereof, needed to support the exchange of information and the governance surrounding such exchange."

Additional key findings from the survey include:

• Access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities for transitions of care.
• More than half of respondents prefer that information they view as "essential" get "pushed" to them, with the ability to access the rest of the information through a query.
• Timeliness of information is important. A clear majority of clinicians consider "within 24 hours" a reasonable timeframe for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem.
• When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated.

"By categorizing clinicians' views on the types of information they want to receive, how they want to receive it, how quickly they want to receive it, and what they want to do with it, we can support efforts to facilitate the exchange of health information," Dr. Barr said.

The survey was fielded by AmericanEHR Partners, founded by ACP and Cientis Technologies to provide comprehensive information to support clinicians in the selection and use of EHRs; the American Association of Medical Directors of Information Systems; the American College of Surgeons; and the American Academy of Pediatrics.

The clinicians who responded to the survey are predominately primary care providers who work in practice settings that include 10 physicians or less and who are electronic health record (EHR) users.

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Survey Of Clinicians: Majority Believe Electronic Exchange Of Health Information Will Have Positive Impact On Health Care

Main Category: IT / Internet / E-mail
Also Included In: Medical Practice Management;  Primary Care / General Practice
Article Date: 05 Oct 2012 - 2:00 PDT

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Survey Of Clinicians: Majority Believe Electronic Exchange Of Health Information Will Have Positive Impact On Health Care

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Survey results released today reveal that an overwhelming majority of clinicians believe that the electronic exchange of health information will have a positive impact on improving the quality of patient care, coordinating care, meeting the demands of new care models, and participating in third-party reporting and incentive programs.

The American College of Physicians (ACP), the Bipartisan Policy Center, and Doctors Helping Doctors Transform Health Care developed the survey and analyzed 527 responses in the report Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care.

"The exchange of patient health information across care settings is a critical component to the success of the new models to improve care, such as the patient-centered medical home," said Michael S. Barr, MD, FACP, MBA, who leads ACP's Medical Practice, Professionalism & Quality division. "ACP agrees with the 78 percent of survey respondents who believe that exchanging health information will have a positive effect on clinicians' ability to meet the demands of these new care models."

Yet challenges remain for the widespread electronic exchange of health information. More than 70 percent of clinicians surveyed identified lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges as major barriers, preventing clinicians from exchanging information with others.

"The Office of the National Coordinator for Health Information Technology has done a lot to encourage the development of the technology needed to support the exchange of information across care settings, but we still have a long way to go," said Dr. Barr. "These gaps are most apparent when we look at the infrastructure, or lack thereof, needed to support the exchange of information and the governance surrounding such exchange."

Additional key findings from the survey include:

• Access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities for transitions of care.
• More than half of respondents prefer that information they view as "essential" get "pushed" to them, with the ability to access the rest of the information through a query.
• Timeliness of information is important. A clear majority of clinicians consider "within 24 hours" a reasonable timeframe for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem.
• When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated.

"By categorizing clinicians' views on the types of information they want to receive, how they want to receive it, how quickly they want to receive it, and what they want to do with it, we can support efforts to facilitate the exchange of health information," Dr. Barr said.

The survey was fielded by AmericanEHR Partners, founded by ACP and Cientis Technologies to provide comprehensive information to support clinicians in the selection and use of EHRs; the American Association of Medical Directors of Information Systems; the American College of Surgeons; and the American Academy of Pediatrics.

The clinicians who responded to the survey are predominately primary care providers who work in practice settings that include 10 physicians or less and who are electronic health record (EHR) users.

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Article adapted by Medical News Today from original press release. Source: American College of Physicians
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New Study Provides Compelling Evidence That Commercially Available Electronic Health Records Are Associated With Better Physician Performance

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Also Included In: Primary Care / General Practice;  Medical Practice Management
Article Date: 11 Oct 2012 - 1:00 PDT

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New Study Provides Compelling Evidence That Commercially Available Electronic Health Records Are Associated With Better Physician Performance

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A new study by Weill Cornell Medical College researchers, published in the Journal of General Internal Medicine, provides compelling evidence that electronic health records (EHRs) enhance the quality of patient care in a community-based setting with multiple payers, which is representative of how medicine is generally practiced across the United States.

The use of EHRs is on the rise, in part because the federal government has invested up to $29 billion in incentives promoting the meaningful use of these systems, with the aim of tracking and improving patient outcomes. Previous studies have provided conflicting evidence about the impact of EHRs, and until now it had been not clear whether they improved the quality of patient care, particularly in typical communities that use commercially available systems.

"The previous studies on the effects of electronic health records in the outpatient setting have been mixed," says the study's lead investigator, Dr. Lisa M. Kern, associate professor of public health and medicine at Weill Cornell Medical College. "This is one of the first studies to find a positive association between the use of EHRs and quality of care in a typical community-based setting, using an off-the-shelf electronic health record that has not been extensively tailored and refined. This increases the generalizability of these findings."

"This study starts to grow the evidence that the use of these systems can systematically improve the quality of care, although their maximum value likely lies in their ability to support new health care delivery models," says the study's senior investigator Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell Medical College. "The findings of this study lend support to the very significant investments in health information technology that are being made by the federal government, states, and health care providers."

This study was conducted with the Health Information Technology Evaluation Collaborative (HITEC)--a multi-institutional effort directed by Drs. Kaushal and Kern and funded by New York State, in order to evaluate and assess the impact of New York's health information technology strategy. In 2008, the researchers collected data about the quality of patient care across nine measures from nearly 500 physicians and 75,000 patients in ambulatory practices in the Hudson Valley region of New York, where there has been a concerted effort to implement EHRs. They gathered data from five different health plans, including two national commercial plans, two regional commercial plans and one regional Medicaid health maintenance organization.

"This study reflects data from five different health plans, which is another strength of the study and which is critical for understanding the experiences of patients in the community," says Dr. Kern. "If you only have one health plan, then you will not be seeing the whole picture."

The team found that the 56 percent of physicians who used commercially available EHRs provided significantly better quality of care than physicians using paper records for four measures, including hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening and colorectal cancer screening. EHRs typically provide reminders about these clinical tests. Moreover, the combined score across all nine measures indicated that EHRs led to better patient care than paper records.

"EHRs may improve the quality of care by making information more accessible to physicians, providing medical decision-making support in real time and allowing patients and providers to communicate regularly and securely," says Dr. Kaushal. "However, the real value of these systems is their ability to organize data and to allow transformative models of health care delivery, such as the patient-centered medical home, to be layered on top."

To follow up on this study, the researchers plan to determine how the effects of EHRs on patient care vary over time and across different locations in New York, to examine the effects EHRs on the cost of patient care and to work on improving ways to measure the quality of patient care.

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Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our it / internet / e-mail section for the latest news on this subject.

This work was supported by the Commonwealth Fund, the Taconic Independent Practice Association, and the New York State Department of Health (contract #C023699).

Co-authors of the study include Yolanda Barrón, Rina V. Dhopeshwarkar, and Alison Edwards of Weill Cornell Medical College, as well as the HITEC investigators.

Weill Cornell Medical College

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Olympic Athletes Live Longer Than General Population

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Main Category: Cardiovascular / Cardiology
Also Included In: Obesity / Weight Loss / Fitness;  Sports Medicine / Fitness
Article Date: 14 Dec 2012 - 10:00 PST

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Olympic Athletes Live Longer Than General Population

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Olympic medalists live longer than the general population, according to a new study published in BMJ.

The researchers compared the longevity of medalists from different countries, disciplines of sport and amount of physical contact involved in the sport. Their nationality made almost no difference to their longevity, making the researchers believe they have a "survival advantage" because of meeting physical activity guidelines.

In the first study, a total of 15,174 Olympic athletes were tracked between 1896 and 2010. On average, they lived 2.8 years longer than the general population of the same age, gender and nationality.

There was no difference of survival advantage found between gold, silver and bronze medallists. However, athletes who took part in power sports had a slightly smaller advantage than those in endurance and mixed sports.

The authors explained that genetics, lifestyle and wealth factors could be some of the reasons why the athletes live longer.

The second study analyzed the longevity of 9,889 Olympians from 43 different disciplines (of different exercise intensity) between 1896 and 1936.

Surprisingly, the athletes who took part in sports of high cardiovascular intensity had almost identical longevity rates as those who did low cardiovascular sports like golf.

The only substantial difference they found was among disciplines which involved a lot of body collisions, such as boxing, ice hockey and rugby. The athletes that participated in these sports had an 11% increased risk of mortality compared to the others. The researchers suggest that this could be a result of repeated injuries that occur when playing such sports.

At least 150 minutes of moderate exercise each week can result in an increased life expectancy, according to an editorial by two public health experts. They noted the need for more effort by the government to improve the number of hours people spend exercising. PLOS Medicine published research on how exercise can increase life expectancy.

They concluded:

"Our inability to improve physical activity is a public health failure, and it is not yet taken seriously enough by many in government and in the medical establishment. Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity. We could and should all award ourselves that personal gold medal."

Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Visitor Opinions (latest shown first)

Just 2.8 yrs. for Olympic Athletes

posted by Dr Seshadri Reddy on 19 Dec 2012 at 5:26 pm

Just to live 2.8 yrs longer than many, one need not be an olympian. Winston Churchill lived 92 yrs and when asked his secret, he replied: never played sport always enjoyed my cigar and whisky. The moral is one needs a longevity gene and a lot of good habits(Churchill was lucky, though he had a heart attack in US).

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Not enough information Olympic athlete longevity

posted by bellasgra on 15 Dec 2012 at 10:57 am

Think of it this way: say there is a special event, Old Peoples Olympics, where the contestants have to be 90 years old. Then the headline would read O. P. Olypians live longer. Of course, in this case it's automatic. Reduce the requirement to 60 years old. Now it's not quite automatic but the OPO still have a skewed advantage. The question shouldn't be how long do they live against the general public's average lifespan but the conditional out of those who reach the age of 60, what is the average life span.
Now, replace the 60 by say, 25 (or whatever the average age of a true olypian athlete is) and unless you used the conditional for 25 year old's, as above, your results are meaningless.
Also, having gained a medalist one could argue that the athlete from there on, in general, has an easier life than the rest of us which helps them achieve a higher that average age.

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One of dumbest studies ever

posted by Steve on 14 Dec 2012 at 1:23 pm

So - exceptionally, healthy, world class athletes live longer? Wow! Who could have imagined that??

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thanks, captain obvious - Olympic athletes live longer

posted by Luke on 14 Dec 2012 at 12:56 pm

"The authors explained that genetics, lifestyle and wealth factors could be some of the reasons why the athletes live longer."

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and so..... the extra time was spent in the gym

posted by Rich on 14 Dec 2012 at 12:42 pm

When they really breakdown the data they will find that the 2.8 extra years were spent running or in the gym. Might be worth it. Who knows?

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Athletes from Africa and the West differ.

posted by donald luke on 14 Dec 2012 at 11:40 am

I would seriously doubt this is true if you compare athletes from Africa and athletes from the West. If you compare within countries this is probably true.

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Really? Olympic athletes live longer?

posted by Brian on 14 Dec 2012 at 11:35 am

Well, no sh*** Sherlock!!!

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good grief charlie brown - Olympians live longer

posted by ralph fife on 14 Dec 2012 at 11:17 am

and this was news because?? must have been a truly glacial news day...

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'Olympic Athletes Live Longer Than General Population'

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High-Throughput Sequencing Shows Potentially Hundreds Of Gene Mutations Related To Autism

Main Category: Autism
Also Included In: Genetics
Article Date: 31 Dec 2012 - 0:00 PST

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High-Throughput Sequencing Shows Potentially Hundreds Of Gene Mutations Related To Autism

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Genomic technology has revolutionized gene discovery and disease understanding in autism, according to an article published in the December 20 issue of the journal Neuron.

The paper highlights the impact of a genomic technology called high-throughput sequencing (HTS) in discovering numerous new genes that are associated with autism spectrum disorder (ASD).

"These new discoveries using HTS confirm that the genetic origins of autism are far more complex than previously believed," said Joseph D. Buxbaum, PhD, Director of the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai, and lead author of the article in Neuron.

Dr. Buxbaum is co-founder and co-director of the Autism Sequencing Consortium (ASC), a large multisite collaboration which is a model for future research. The co-authors of the article are Mark J. Daly, Broad Institute and Harvard Medical School; Bernie Devlin, University of Pittsburgh; Thomas Lehner, National Institute of Mental Health; Kathryn Roeder, Carnegie-Mellon University; Matthew W. State (co-director), Yale University, and the ASC.

HTS is a revolutionary new technology that allows scientists to obtain the sequence of all 22,000 human genes and the entire human genome in one experiment. This provides an unparalleled look at an individual's genetic makeup and allows for gene discovery and for genetic testing.

"HTS shows us that there are not just a few mutations, but potentially hundreds of mutations that are linked to autism," said Dr. Buxbaum. "By identifying the many genetic roots of this disorder, we can better understand its biology, which in turn will allow us to develop more tailored treatments for individuals. It is a transformative time for genetic research in autism."

Ground-breaking, highly reproducible discoveries identified through HTS described in the article include:

• the "staggering degree" of genetic heterogeneity in autism, which means that many individuals with autism do not share similar gene mutations;
• the identification of an increasing number of specific genes and chromosomal intervals conferring risk;
• the important emerging role in autism of both rare and "de novo germline mutations," or mutations developed in the sperm or ovaries of parents and passed on to children; and
• gene loci associated with autism that overlap with gene loci associated with other illnesses, such as intellectual disability and epilepsy.

Dr. Buxbaum estimates that researchers have already identified 50 specific genes and 20-40 chromosomal loci conferring risk. The researchers predict, based on the first studies in 1,000 families, that there are many hundreds of undiscovered ASD associated genes. This surge in the number of genes related to autism revealed by HTS marks a coming of age for high-throughput sequencing, the authors believe. The path forward for new discoveries, they write, is via one of two HTS processes: whole exome sequencing (WES) or whole genome sequencing (WGS) in large cohorts. The exome is the small fraction of the genome that codes for proteins.

The article spotlights the successful work of the ASC, founded in 2010, as a model to bring to fruition an explosive gene discovery process. The ASC member sites, using WES technology also available at Mount Sinai, recently discovered six de novo mutations in autism patients: CHD8, DYRK1A, GRIN2B, KATNAL2, POGZ and SCN2A. These six genes may be targets for future treatments. Some of these discoveries were accomplished rapidly because the Consortium's 25 research groups, located around the world, combined their data and shared it before publication. As a result, they conducted four large studies using 1,000 families.

There are approximately 8,000 to 10,000 families currently available to the Consortium to study autism, but the article suggests many more are needed to speed up gene discoveries. Also needed for the future is increased collaboration among research teams and the integration of autism studies with studies of other psychiatric disorders. In addition, high-capacity supercomputers are needed to analyze the data. The ASC was designed to address these issues, and Mount Sinai has created Minerva, one of the largest academic supercomputers in the world, to help with these goals.

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Visit our autism section for the latest news on this subject.

The research conducted at Mount Sinai was supported by grants from the National Institutes of Health and the Seaver Foundation.

About Autism Spectrum Disorder

ASD is a developmental disability that causes significant language delays, and social and communication challenges, and affects one in 88 children, according to the U.S. Centers for Disease Control and Prevention. There is no cure for autism and some researchers are probing possible environmental causes of the disorder. But, gene mutations are today considered the key cause of autism, so discovering new genes related to autism is crucial in finding novel treatments.

The Mount Sinai Hospital / Mount Sinai School of Medicine

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Scientists Home In On Cause Of Osteoarthritis Pain

Main Category: Arthritis / Rheumatology
Article Date: 31 Dec 2012 - 1:00 PST

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Researchers at Rush University Medical Center, in collaboration with researchers at Northwestern University, have identified a molecular mechanism central to the development of osteoarthritis (OA) pain, a finding that could have major implications for future treatment of this often-debilitating condition.

"Clinically, scientists have focused on trying to understand how cartilage and joints degenerate in osteoarthritis. But no one knows why it hurts," said Dr. Anne-Marie Malfait, associate professor of biochemistry and of internal medicine at Rush, who led the study. An article describing the research was published in the December 11 print version of the Proceedings of the National Academy of Sciences.

Joint pain associated with OA has unique clinical features that provide insight into the mechanisms that cause it. First, joint pain has a strong mechanical component: It is typically triggered by specific activities (for example, climbing stairs elicits knee pain) and is relieved by rest. As structural joint disease advances, pain may also occur in rest. Heightened sensitivity to pain, including mechanical allodynia (pain caused by a stimulus that does not normally evoke pain, such as lightly brushing the skin with a cotton swab), and reduced pain-pressure thresholds are features of OA.

Malfait and her colleagues took a novel approach to unraveling molecular pathways of OA pain in a surgical mouse model exhibiting the slow, chronically progressive development of the disease. The study was conducted longitudinally, that is, the researchers were able to monitor development of both pain behaviors and molecular events in the sensory neurons of the knee and correlate the data from repeated observations over an extended period.

"This method essentially provides us with a longitudinal 'read-out' of the development of OA pain and pain-related behaviors, in a mouse model" Malfait said.

The researchers assessed development of pain-related behaviors and concomitant changes in dorsal root ganglia (DRG), nerves that carry signals from sensory organs toward the brain. They found that a chemokine known as monocyte chemoattractant protein (MCP)-1 (CCL2) and its receptor, chemokine receptor 2 (CCR2), are central to the development of pain associated with knee OA.

Monocyte chemoattractant protein-1 regulates migration and infiltration of monocytes into tissues where they replenish infection-fighting macrophages. Previous research has shown that MCP-1/CCR2 are central in pain development following nerve injury.

In the study, following surgery the laboratory mice developed mechanical allodynia that lasted 16 weeks. Levels of MCP-1, CCR2 mRNA and protein were temporarily elevated, and neuronal signaling activity increased in the DRG at eight weeks after surgery. This result correlated with the presentation of movement-provoked pain behaviors (for instance, mice with OA travelled less distance, when monitored overnight, and climbed less often on the lid of their cage -- suggesting that they avoid movement that triggers pain) which were maintained up to 16 weeks.

Mice that lack Ccr2 (knockout mice) also developed mechanical allodynia, but this began to resolve from eight weeks onward. Despite having severe allodynia and structural knee joint damage equal to that in normal mice, Ccr2-knockout mice did not develop movement-provoked pain behaviors at eight weeks.

To confirm the key role of CCR2 signaling in development of the observed movement-provoked pain behavior after surgery, the researchers administered a CCR2 receptor-blocker to normal mice at nine weeks after surgery and found that this reversed the decrease in distance traveled, that is, movement-provoked pain behavior.

Interestingly, levels of MCP-1 and CCR2 returned to baseline or lower by 16 weeks in mice exhibiting movement-provoked pain behaviors. This finding may suggest that the MCP-1/CCR2 pathway is involved only in the initiation of changes in the DRG, but once macrophages are present, the process is no longer dependent on increased MCP-1/CCR2.

"Increased expression of both MCP-1 and its receptor CCR2 may mediate increased pain signaling through direct excitation of DRG neurons, as well as through attracting macrophages to the DRG," the researchers said.

"This is an important contribution to the field of osteoarthritis research. Rather than looking at the cartilage breakdown pathway in osteoarthritis, Dr. Malfait and her colleagues are looking at the pain pathway, and this can take OA research in to a novel direction that can lead to new pain remedies in the future," said Dr. Joshua Jacobs, professor and chairman of orthopedic surgery at Rush University Medical Center.

Treatment of OA in the United States costs almost $200 billion annually. According to the Centers for Disease Control and Prevention, it is expected that by 2030 nearly 70 million adults in the U.S. will have been diagnosed with some form of arthritis.

According to the Arthritis Foundation, an estimated 27 million Americans live with OA, but, despite the frequency of the disease, its cause is still not completely known and there is no cure. In fact, many different factors may play a role in whether or not you get OA, including age, obesity, injury or overuse and genetics.

Osteoarthritis (OA) is one of the oldest and most common forms of arthritis and is a chronic condition characterized by the breakdown of the joint's cartilage. Cartilage is the part of the joint that cushions the ends of the bones and allows easy movement of joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.

Malfait's co-researchers on this study were Rush scientists Rachel E. Miller. PhD, Phuoong B. Tran, PhD, Rosalina Das, and Nayereh Ghoreishi-Haack, and Dr. Richard J. Miller, PhD, and Dongjun Ren from Northwestern University.

Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number R01AR060364.

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Stanford Researchers Report Progress In Quest To Create Objective Method Of Detecting Pain

Main Category: Pain / Anesthetics
Also Included In: Medical Devices / Diagnostics;  Back Pain
Article Date: 24 Dec 2012 - 0:00 PST

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Stanford Researchers Report Progress In Quest To Create Objective Method Of Detecting Pain

Main Category: Pain / Anesthetics
Also Included In: Medical Devices / Diagnostics;  Back Pain
Article Date: 24 Dec 2012 - 0:00 PST

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Consumers Desire Greater Control Over Their Electronic Health Information

Main Category: IT / Internet / E-mail
Also Included In: Medical Practice Management
Article Date: 12 Sep 2012 - 2:00 PDT

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Patients in New York, a state where patients must actively consent to having their data accessed through health information exchange, are generally supportive of the electronic sharing of health information and are willing to have their health information automatically stored in an HIE; however, they want to have control over the privacy and security of that information.

The telephone survey of 170 residents found more than two-thirds of people surveyed were willing to have their health information automatically stored in an HIE. Most respondents, however, wanted safeguards against unauthorized viewing of their information (86 percent). They also wanted to be able to see who has viewed their information (86 percent), to be able to stop electronic storage of their data (84 percent), to be able to stop all viewing (83 percent) and to be able to select which parts of their health information are shared (78 percent).

Among the approximately one-third of patients who were uncomfortable with automatic inclusion of their health information in an electronic database for HIE, 78 percent wished to approve all information explicitly, and most preferred restricting information by clinician (83 percent), visit (81 percent), or information type (88 percent).

The authors conclude that given the highly sensitive nature of health information and the consequences that can occur in the event of its disclosure, patient preferences around the storing and sharing of electronic health information should be considered when developing and implementing systems, standards and policies. They advocate for consent policies that allow consumers to control what, by whom and for how long their health information can be accessed.

"Health Care Consumers' Preferences Around Health Information Exchange"
By Rina V. Dhopeshwarkar, MPH, et al
Weill Cornell Medical College, New York, NY

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Disruption Of Newly Identified Mechanism Could Set Off Food Allergies, Autoimmune Disorders

Main Category: Immune System / Vaccines
Also Included In: Crohn's / IBD;  Allergy;  Food Intolerance
Article Date: 18 Dec 2012 - 1:00 PST

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A type of immune cell found in the small intestine plays a previously unsuspected role in monitoring antigens circulating in the bloodstream. The findings from a team of Massachusetts General Hospital (MGH) researchers clarify how dendritic cells in the intestinal lining collect antigens from both intestinal contents and the circulation, leading to the generation of T cells that suppress inflammation. Disruption of that regulatory system may lead to the development of autoimmune disorders, inflammatory bowel disease or food allergies.

"In the circuitry we uncovered, mucosal dendritic cells interact with specialized capillaries that allow antigens to move from the blood into intestinal tissues," explains Hans-Christian Reinecker, MD, of the Center for the Study of Inflammatory Bowel Disease in the MGH Gastrointestinal Unit, corresponding author of the report released online in the journal Immunity. "Within these dendritic cells, antigens from the blood mix with food and microbial antigens absorbed by the intestine. We were suprised to find that, even before the antigens are carried to the lymph nodes, some are directly processed by intestinal dendritic cells to induce production of a type of T cell that controls intestinal inflammation."

It had been believed that dendritic cells found in the mucosal lining of the small intestine primarily monitored intestinal contents, both to suppress inflammatory reactions against food and to protect against invading pathogens. Nutrients are absorbed into the bloodstream through small pores in intestinal capillaries, but whether those pores allowed dendritic cells in adjacent intestinal tissue to recognize antigens in the blood was not known. Noting that the position within the intestinal lining of a subset of dendritic cells brings them into contact with both the bloodstream and with compounds absorbed from the intestine, Reinecker's team investigated whether those cells collected antigens from both sources.

Experiments in mice confirmed that these dendritic cells, which carry a receptor called CX3CR1, collect and process both circulating and intestinal antigens, inducing production of a type of CD8 T cell that can help induce tolerance to antigens in food. Previously, the source of those intestinal T cells - which differ from the cytotoxic CD8 T cells that kill virally-infected and other damaged cells - and their function were unknown. Further experiments by the MGH team showed that these intestinal CD8 T cells secreted proteins that suppressed the activation of CD4 T cells, preventing intestinal inflammation.

Based on these results, the researchers propose that CX3CR1 dendritic cells in the intestinal lining are a central immune system component for surveillance of both foreign antigens consumed in food and circulating "self" antigens. Since CX3CR1 dendritic cells set off a process leading to suppression of inflammation, disturbance of their function could generate the inappropriate immune response to "self" cells or tissues that characterizes chronic inflammatory and autoimmune disorders.

"When dendritic cells process information about microbes within the intestine, they induce production of both T cells that specifically target those pathogens and regulatory T cells that control the immune response," he adds. "Disruption of the balance between those two types of T cells could lead to inflammatory bowel disorders such as Crohn's disease and ulcerative colitis. Failure to control T cell activation in the intestine also could lead to food allergies and celiac disease; so this regulatory circuit that we have uncovered establishes the small intestinal immune system as a site that could have a major impact on the immune response throughout the body."

Reinecker is an associate professor of Medicine at Harvard Medical School. His team is now looking at genetic variants that may regulate the function of this newly discovered system and investigating whether the microbial population of the intestines - both beneficial bacteria and pathogenic organisms - can alter the outcome of the process.

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Co-lead authors of the Immunity paper are Sun Young Chang and Joo-Hye Song, MGH Gastrointestinal Unit. Additional co-authors are Bayasi Guleng, Carmen Alonso Cotoner, Seiji Arihiro, Yun Zhao, and Hao-Sen Chiang, MGH Gastrointestinal Unit; Atul Bhan, MGH Pathology; Michael O'Keeffe and Gongxian Liao, Beth Israel Deaconess Medical Center; Christopher L. Karp and Cox Terhorst, University of Cincinnati College of Medicine; Mi-Na Kweon, International Vaccine Institute, Korea; and Arlene Sharpe, Harvard Medical School. The study was supported by National Institutes of Health grants DK-068181, DK-033506, AI093588, DK-043351, AI-057992, and DK-52510.
Massachusetts General Hospital

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First Classification Criteria For Polymyalagia Rheumatica Released By American College Of Rheumatology

Main Category: Pain / Anesthetics
Also Included In: Arthritis / Rheumatology;  Body Aches
Article Date: 06 Mar 2012 - 0:00 PDT

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Aiming To Reduce Death, Disability, And Cost Of Prosthetic Joint Infections: New IDSA Guidelines

Main Category: Bones / Orthopedics
Also Included In: Arthritis / Rheumatology;  Infectious Diseases / Bacteria / Viruses
Article Date: 11 Dec 2012 - 0:00 PST

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Of the one million people each year who get hips and knees replaced, as many as 20,000 will get an infection in the new joint, a number that is expected to skyrocket in the next 20 years. Multispecialty physician teams need to work together to reduce disability, death and costs associated with the ever-growing number of these prosthetic joint infections, note the first guidelines on the topic being released by the Infectious Diseases Society of America (IDSA).

"There are very few things that improve quality of life as much as joint replacement, but 1 to 2 percent of the time the new joint can become infected, even when precautions are taken," said Douglas R. Osmon, MD, associate professor of medicine in the division of infectious diseases at Mayo Clinic, Rochester, Minn. "There are many different ways to treat these infections to achieve the same outcome. The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient."

Hips, knees and other joint replacements - such as shoulders and elbows - can become infected during the surgery or months or even years later.

The guidelines, which were published online in the journal Clinical Infectious Diseases, outline the evidence and opinions regarding methods that are appropriate to diagnose the infections early and treat them most effectively, according to patients' specific situations. Most infections require long courses of antibiotics and surgery, which can range from washing out the infected area to removal and replacement of the joint to permanent removal of the prosthesis to amputation.

Multidisciplinary teams should include an orthopedist and an infectious diseases specialist, as well as other specialists on a case-by-case basis. For instance, if the patient is older and has heart disease, an internist should be involved, and if the surgical wound is difficult to close, a plastic surgeon should be consulted, said Dr. Osmon. In rural areas with few specialists, doctors should consider consulting with infectious diseases specialists or orthopedists at referral centers.

The guidelines describe the best methods for diagnosis of prosthetic joint infections. These infections can be difficult to diagnose, and not all are obvious, notes Dr. Osmon. Also, problems with joint replacements - particularly loosening of the prosthesis and pain - may be caused by infection or by problems in the materials in the device itself.

Among the recommendations in the guidelines:

• Physicians should suspect a prosthetic joint infection in a patient who has any of the following: persistent wound drainage in the skin over the joint replacement; sudden onset of a painful prosthesis, or ongoing pain after the prosthesis has been implanted, especially if there had been no pain for several years or if there is a history of prior wound healing problems or infections.
• In patients with prosthetic joint infections:

  Those with a well-fixed prosthesis without an open wound to the skin who had surgery less than 30 days previously are likely candidates for debridement, which means re-opening the incision and cleaning out the wound.

  Those who have more extensive infection that has affected the bone and tissue may need to have the prosthesis replaced, either in the same surgery in which the prosthesis is removed, or in a later surgery.

  Patients who cannot walk and who have limited bone stock, poor soft tissue coverage and infections due to highly resistant organisms may need to have the implants permanently removed. In some cases the joint may need to be fused.

  Amputation of the limb may be necessary, but only as a last resort. Prior to amputation, the patient should be referred to a center with specialist experience in prosthetic joint infections, if his or her condition allows.

• Four to six weeks of intravenous or highly bioavailable oral antibiotic therapy is almost always necessary to treat prosthetic joint infections.

"The number of people suffering from prosthetic joint infections will continue to grow because, although we are getting better at preventing infection, that is countered by the increase in older and sicker people having joint replacement," said Dr. Osmon.

The nine-member prosthetic joint infections guidelines panel comprises experts from the United States and Europe representing the infectious diseases and orthopedic specialties. In addition to Dr. Osmon, the panel includes: Elie F. Berbari, Anthony R. Berendt, Daniel Lew, Werner Zimmerli, James M. Steckelberg, Nalini Rao, Arlen Hanssen and Walter R. Wilson.

AT A GLANCE

A million people have their hips and knees replaced every year, but as many as 20,000 of them (2 percent) will get an infection in the new joint during their lifetimes.

The first prosthetic joint infections guidelines released by the Infectious Diseases Society of America (IDSA) suggest different specialists should work together to best treat patients based on individual circumstances.

The guidelines provide a framework for the various options for diagnosis and treatment of prosthetic joint infections.

Treatment of prosthetic joint infection can range from washing out the infected wound to replacement of the prosthesis to amputation.

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