American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

NEWS FROM THE LITERATURE

Alerting System Improves Adherence

Systems are available to ensure that test results are communicated to patients. However, lack of adherence to recommended follow-up evaluation increases risk for adverse health outcomes and medical or legal issues. According to data published in Gastroenterology, a simple protocol of letters and a telephone call to patients who are due for colonoscopy examinations significantly improved adherence to endoscopic follow-up recommendations. This work provides justification for the creation of reminder systems to improve patient adherence to medical recommendations.

Gastroenterology; 2011: 140(4): 1166-1173

Abdominal Adiposity Does Not Improve Disease Risk Prediction

Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. Data results in The Lancet suggest that body mass index, waist circumference and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes and lipids.

Lancet 2011: 377(9771): 1085-1095

Gastric Electrical Stimulation Improves Outcomes

In a study published in Clinical Gastroenterology and Hepatology, doctors reported that gastric electrical stimulation therapy significantly improved subjective and objective parameters in patients with severe gastroparesis. Efficacy was sustained for up to 10 years and was accompanied by good safety and tolerance profiles. Patients with diabetic or postsurgical gastroparesis benefited more than those with idiopathic disease.
 
Clinical  Gastroenterology and Hepatology; 2011: 9(4): 314-319

Boceprevir Increases Virological Response

Peginterferon–ribavirin therapy is the current standard of care for chronic infection with hepatitis C virus. The rate of sustained virologic response has been below 50 percent in cases of hepatitis C virus genotype 1 infection. Boceprevir, a potent oral hepatitis C virus protease inhibitor, has been evaluated as an additional treatment in Phase I and Phase II studies. The New England Journal of Medicine reports that the addition of boceprevir to standard therapy with peginterferon–ribavirin, as compared with standard therapy alone, significantly increased the rates of sustained virologic response in previously untreated adults with chronic hepatitis C genotype 1 infection. The rates were similar with 24 weeks and 44 weeks of boceprevir.

The New England Journal of Medicine; 2011: 364: 1195-1206

PRACTICE

CGH Image of the Month

Duodenal Perforation by an Inferior Vena Cava Filter
Jessica Widmer, Stavros Stavropoulos, David Friedel

A 61-year-old woman presented with right subcostal pain for eight months. She denied nausea, vomiting or a change in bowel habits. Physical examination was significant for obesity and right subcostal tenderness. Laboratory results were unremarkable. Endoscopic examination revealed a metallic foreign body projecting through the wall and into the lumen of the second portion of the duodenum (figure). Gentle manipulation proved that it was fixed. Fluoroscopy established that the structure was an inferior vena cava (IVC) filter strut, consistent with the woman's known history of an IVC filter for a right lower-extremity deep vein thrombosis more than a year ago.

Read more in Clinical Gastroenterology and Hepatology. 

UpToDate^® Free Topic of the Month

Produced in cooperation with the AGA Institute, UpToDate^® is a subscription-based clinical information resource available on the Web, CD-ROM and pocket PC handheld devices. Each month, a free topic is made available on the AGA website. This month's free topic is:

• Hepatitis E virus infection.

Nearly 232 physicians write more than 673 topic reviews for UpToDate in gastroenterology and hepatology alone. UpToDate provides gastroenterologists with access to more than 60,000 pages of original, peer-reviewed text, 160,000 MEDLINE abstracts, drug information and drug interactions databases, and hundreds of patient information handouts across 12 specialties. Moreover, UpToDate is used by tens of thousands of clinicians in more than 110 countries and by hundreds of premier medical institutions worldwide.

Order your subscription to UpToDate.

Medicare Attestation Begins on April 18

Attestation for the Medicare electronic health record (EHR) incentive program begins on April 18, 2011. In order to receive an EHR incentive payment, a physician must attest through CMS' Web-based Medicare and Medicaid EHR incentive programs registration and attestation system.

Physicians can preview selected screenshots of the attestation system to understand what the attestation process will involve. These screenshots are only examples — the final appearance and language may incorporate additional changes.

In order to successfully attest, physicians need to understand the required meaningful use criteria.

Physicians must report on 15 core measures, five of 10 menu measures and six clinical quality measures, consisting of three required core measures and three additional measures.

• Read additional  information on core and menu measures for eligible professionals (EPs).
• Go to the clinical quality measures page for information on the required clinical quality measures for EPs.

Physicians should also make sure that they begin their 90-day reporting period in time to attest and receive a Medicare payment in 2011. The last day for EPs to begin the 90-day reporting period for 2011 incentive payments is Oct. 1, 2011.

Under the Medicaid EHR incentive programs, the date when participants can begin attestation for adopting, implementing, upgrading or demonstrating meaningful use of certified EHR technology varies by state. For more information, see the Medicaid state EHR incentive program Web tool.

FDA Clarifies Medical Device Clearance Process

The FDA announced the availability of updated special controls guidance documents for class II devices, which contain edits that reflect the agency's effort to clarify questions and confusion regarding its position on the binding nature of special controls guidance documents. The revised language does not change the agency's position or view, but rather is intended to clarify its position and remedy any possible confusion or misunderstanding.

Participate in Physician Quality Reporting, E-Prescribing Call

CMS will host a national provider conference call on the 2011 Physician Quality Reporting System and electronic prescribing incentive program from 1:30–3 p.m., ET on Tuesday, April 19, 2011.
                
For additional call details and to register, go to http://www.eventsvc.com/palmettogba/041911.

Avoid Payment Adjustments

Beginning in 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between Jan. 1, 2011, and June 30, 2011, may be subject to a payment adjustment on their Medicare Part B physician fee schedule-covered professional services. From 2012 through 2014, the payment adjustment will increase each calendar year.

An eligible professional can avoid the 2012 electronic prescribing (eRx) payment adjustment if (s)he:

• Is not a physician, nurse practitioner or physician assistant as of June 30, 2011.
• Does not have prescribing privileges.
• Does not have at least 100 cases containing an encounter code in the measure denominator.
• Becomes a successful electronic prescriber.
• Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure.

For group practices that are participating in eRx group practice reporting option (GPRO) I or GPRO II during 2011, the group practice must become a successful electronic prescriber.

Learn more.

RESEARCH

Your AGA Research Foundation Gifts Support ...

... Ryan Lam, who received a 2010 AGA-Eli and Edythe Broad Foundation Student Research Fellowship Award.

“I am very grateful for the opportunity that the AGA Research Foundation has provided me with, especially because I know that it is a rarity for high school students to work in a research lab. However, I also feel obligated to excel and make a significant contribution immediately. I am excited — not only because I am conducting research in a field that I know very little about, but also because I know that I will be able to improve the lives of the people around me. As I am intent on studying the sciences in university and pursuing a career in medicine, this award offers a perfect opportunity for me to explore my interest in biology, gain more experience in scientific research, and clarify my future career path. Under the guidance of Kenneth Croitoru, MD, I will strive to contribute as much as I can to the field of gastroenterology.”

To make a donation, visit www.gastro.org/contribute.

AGA Research Foundation: New Name, Same Mission

Reflecting 27 years of success supporting the GI community through research grants, the AGA is pleased to announce a new name for our foundation: the AGA Research Foundation.

Formerly known as the Foundation for Digestive Health and Nutrition, the AGA Research Foundation is the cornerstone of AGA’s effort to expand digestive disease research funding. Since 1984, the AGA, through its foundations, has provided more than $40 million in research grants to 606 scientists. The majority of the support is for career development grants to young investigators.

The AGA Research Foundation serves as a bridge to the future of research in gastroenterology and hepatology by providing critical funding to advance the careers of young researchers between the end of training and the establishment of credentials that earn NIH grants. The AGA Research Foundation also provides an opportunity for AGA members to give back to their field through donations that will foster the growth of talented researchers who are discovering new treatments and cures to improve patient care.

To learn more about the AGA Research Foundation, its strategic plan or to make a contribution, visit www.gastro.org/aga-foundation. 

EDUCATION & MEETINGS

New AGA Trainee and Young GI Track at DDW^®

To address the needs of physicians new to the field, the AGA is introducing a trainee and young GI track at DDW^®. The track consists of exciting new sessions that provide the necessary tools and information for a successful clinical practice career. Led by course director, Michelle K. Kim, MD, the track features:

Mentor and Advisor Networking Reception (May 7) — presents an opportunity for attendees to network and interact with peers and colleagues. Sponsored by the AGA Mentor and Advisor Program and the AGA Women’s Committee.

Board Review Session (May 8) — will prepare attendees for the board certification exam using AGA’s popular Digestive Diseases Self-Education Program^® (DDSEP) 6. DDSEP editors and authors will cover select questions, answers and critiques from the book. Participants will receive a 40 percent discount coupon for DDSEP 6 to use at the AGA Store or at the AGA Booth during DDW.

Career- and Professional-Related Issues (May 8) — provides practical advice on how to address common career and professional issues. Topics include choosing a practice type and location, developing an effective CV, learning how to interview successfully, negotiating contracts, and maintaining a healthy work-life balance.

Immediate Advancement in Skills for Teaching (May 10) — offers expert insight on how to successfully pursue a teacher/clinician educator career path; uses questions and vignettes to engage attendees in discussions about how to deliver effective presentations, use team-building learning techniques and manage small-group dynamics.

Advance Your Leadership Skills: How to Rise to a Position of Leadership in Gastroenterology or Hepatology (May 10) — helps participants develop a leadership growth plan, learn how to recognize steps for success and avoid issues, improve interpersonal communication skills, practice challenging decision-making, and more.

Immediate Advancement in Skills for Clinical Practice (May 10) — presents essential skills, including practice management and managerial skills, for building a successful clinical practice career. Topics cover how to deal with support staff, understanding the financial stresses and benefits of clinical practice, and more.

The above sessions are free; however, participants must be registered for DDW to attend the sessions. Learn more about these sessions by visiting www.gilearn.org/traineetrack. To register for DDW, visit www.ddw.org.

AGA Spring Postgraduate Course
Obtain an overview of the latest science behind clinical advances and the best approaches for handling controversial management issues for GI and liver disorders. Trainees may register at a reduced fee.

Ideal Preparation Resource for ABIM MOC Exam

The Digestive Diseases Self-Education Program^® (DDSEP) 6, the AGA Institute’s popular self-education program, has long been used by physicians as a comprehensive resource for preparing for the American Board of Internal Medicine maintenance of certification exam. The program provides an in-depth review of gastroenterology, nutrition and hepatology, including more than 350 board-type questions, each with accompanying critiques and references for further study. DDSEP 6 provides a stepwise approach for identifying and improving upon gaps in knowledge while fine-tuning test taking skills.

A rigorous and intense peer-review process ensures that the latest advances in GI clinical care are addressed, including new information on digestive health in women, as well as nutrition, obesity and eating disorders. DDSEP 6 offers a convenient print/online format, allowing access anytime and anywhere. Up to 64 CME credits can be earned — claim CME for each chapter or in its entirety.

Learn more and order.

Earn MOC Points with GI SAM®
Still need points toward self-evaluation of medical knowledge? Qualify for recertification with GI SAM®, a series of online self-assessment modules.

Just Released: Crohn’s Management Education Program

Crohn’s disease affects approximately 500,000 people in the U.S. and can have a profound impact on the sufferers’ quality of life. The ability of a physician to predict response to therapy and individualize a plan of action is crucial as more and more physicians report that treatment of patients with Crohn’s disease continues to increase in their practice. Further, lack of long-term safety data on available therapies continue to be a major hurdle in providing optimal care.

To help, the AGA Institute, in collaboration with MedscapeCME, has developed the Crohn’s Disease Management Education Program. This program is designed to provide physicians and other health-care providers with data that has been translated into practical information that can help bridge educational gaps in the assessment, diagnosis and care of patients with Crohn’s disease.

This program will reinforce and strengthen competencies in the following:

• Patient care.
• Medical knowledge.
• Practice-based learning and improvement.
• Interpersonal and communication skills.
• Professionalism.
• Systems-based practice.

Newly released resources from the program include two CME certified activities:

• Contemporary Issues in Crohn’s Disease: Where Do the Data Lead Us? (1 AMA PRA Category 1 Credit™)
• Trends in Biologic Therapy for Crohn’s Disease: Where Are We and Where Are We Going? (0.50 AMA PRA Category 1 Credits™)

Additional resources will be released over the next several months, including clinical updates, video panel discussions, surveys and research findings.

This program is supported by an independent educational grant from Abbott Laboratories and the Elan Corporation.

Additional Hepatitis Resources
More AGA Institute and MedscapeCME collaborations: Clinical Course in Viral Hepatitis

JOURNALS & PUBLICATIONS

Journal Editors' Picks

The editors of Gastroenterology and Clinical Gastroenterology and Hepatology (CGH) would like to bring to your attention highlighted articles from the April issues of the journals.

Gastroenterology

• An Alerting System Improves Adherence to Follow-up Recommendations From Colonoscopy Examinations; By Daniel A. Leffler, et al.
• Increasing Prevalence of HCC and Cirrhosis in Patients With Chronic Hepatitis C Virus Infection; By Fasiha Kanwal, et al.
• Dll1- and Dll4-Mediated Notch Signaling Are Required for Homeostasis of Intestinal Stem Cells; By Luca Pellegrinet, et al.
• Use of Methylation Patterns to Determine Expansion of Stem Cell Clones in Human Colon Tissue; By Trevor A. Graham, et al.
• The Clonal Origins of Dysplasia From Intestinal Metaplasia in the Human Stomach; By Lydia Gutierrez-Gonzalez, et al.

CGH

• Natural History of Potential Celiac Disease in Children; By Antonella Tosco, et al.
• MiraLAX Is Not as Effective as GoLytely in Bowel Cleansing Before Screening Colonoscopies; By Michael Hjelkrem, et al.
• Impact of IL28B Genotype on the Early and Sustained Virologic Response in Treatment-Naïve Patients With Chronic Hepatitis C; By Albert Friedrich Stättermayer, et al.
• Diagnostic Yield Improves With Collection of 2 Samples in Fecal Immunochemical Test Screening Without Affecting Attendance; By Aafke H.C. van Roon, et al.
• Gastric Electrical Stimulation Improves Outcomes of Patients With Gastroparesis for up to 10 Years; By Richard W. McCallum, et al.

ANNOUNCEMENTS

AGA Now Accepting Applications for Fellowship

The AGA is now accepting applications for fellowship, the organization’s highest level of membership. The prestigious designation of fellowship is awarded to select members for their outstanding contributions to the field of gastroenterology. To date, 1,694 members have been honored as AGA fellows.

As an AGA fellow, you will have the use of the letters “AGAF” in your professional activities. The AGA will recognize your fellowship with a recognition pin and certificate upon acceptance. During DDW^® 2012, you will be recognized with a ribbon denoting your fellowship status, and your name will be printed in the Recognition and Research Awards booklet. You will also be listed as a fellow on the AGA website.

Fellowship in the AGA is by application only and applicants must meet certain criteria in order to apply. One such criterion is membership in the AGA for at least seven years.

The review and selection process for this program falls under the oversight of the AGA Fellowship Recognition Committee, with final approval by the AGA Governing Board. Fellows will be selected based on superior achievements in clinical practice or in research. Applicants will be notified of their acceptance by Jan. 31, 2012. Fellowship will commence upon notification of acceptance.
 
The application deadline for 2012 is July 18, 2011. Eligibility requirements and an application can be found online.

Council Elections Open
The AGA Institute Council is holding elections for seven new vice chairs and nominating committee members. Voting ends on April 15, 2011.

Classifieds

Place GI Position Listings and Activity Announcements

For as little as $82.50, you can place a classified ad of 100 words or less in AGA's weekly e-mail newsletter, AGA eDigest, or AGA's bi-monthly magazine, AGA Perspectives. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. Advertising in either includes a free online classified listing. Learn More