January 19, 2012 Home|Journals & Publications|  AGA eDigest
AGA eDigest

News from the Literature | Practice | Research | Education & Meetings | Journals & Publications | GI Fellows

LEADING THE NEWS

Drug Shortages for Moderate Sedation Burden GI Practices

As gastroenterologists across the U.S. face difficulty obtaining drugs to sedate patients for endoscopy, AGA is monitoring the situation and looking for remedies. Shortages currently include midazolam and fentanyl, which are expected to continue to be difficult to obtain in the near future. Manufacturers note back orders for injectable forms of these drugs lasting anywhere from late January to May. The FDA provides a list of current drug shortages, and the American Society of Health System Pharmacists also provides detailed information.

Lawmakers have taken action to address the drug shortages. Last October, the Obama administration directed FDA to develop a program to address issues, including broader reporting of manufacturing discontinuances and expedited regulatory review of new drug suppliers, manufacturing sites and manufacturing changes. In addition, Sen. Amy Klobuchar, D-MN, has introduced the Preserving Access to Life-Saving Medications Act (S. 296), which would take similar and additional steps to abate drug shortages. The AGA is reviewing the proposed legislation and considering endorsing it. We will continue to keep AGA members informed of any issues that may affect access to drugs crucial  for gastroenterology practices.

NEWS FROM THE LITERATURE

Celiac Patients Have Low Risk of GI Cancer

Celiac disease has been associated with GI cancers in small studies. Risks have not been estimated from large populations or based on histopathology analyses. Although celiac disease, inflammation and latent disease all increase risk for GI cancers in the first year after diagnosis, there is no increase in risk thereafter, concluded authors in a study in Clinical Gastroenterology and Hepatology.

Clinical Gastroenterology and Hepatology 2012: 10(1): 30-36

Acute Kidney Injury Is Early Predictor of Mortality in Hepatitis

Alcoholic hepatitis is a severe condition with high mortality. To improve therapeutic strategies, it is important to identify factors that affect survival times. The age, bilirubin, international normalized ratio and creatinine scoring system was developed previously to determine the prognosis of patients with alcoholic hepatitis. According to data published in Clinical Gastroenterology and Hepatology, acute kidney injury network criteria are useful and more accurate than traditional criteria in predicting mortality. Therefore, strategies to prevent acute kidney injury should be considered in the management of patients with alcoholic hepatitis.

Clinical Gastroenterology and Hepatology 2012: 10(1): 65-71

Crohn's Patients Relapse after Infliximab Is Stopped

It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. In a study appearing in Gastroenterology, doctors found that approximately 50 percent of patients with Crohn's disease who were treated for at least one year with infliximab and an anti-metabolite agent experienced a relapse within one year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.

Gastroenterology 2012: 142(1): 63-70

Doctors Examine Hypercoagulability in NC-PVT Patients

Although they have normal liver histology and function, patients with chronic noncirrhotic nontumoral portal vein thrombosis (NC-PVT) frequently have abnormal results from coagulation tests. A study in Clinical Gastroenterology and Hepatology suggests that patients with NC-PVT have hypercoagulability that is independent of the underlying etiology, based on in vitro analyses of thrombin-generation capacity and increased levels of biomarkers in blood samples. Further studies are required to determine if activation of hemostasis increases the risk for thrombotic events.

Clinical Gastroenterology and Hepatology 2012: 10(1): 72-78

PRACTICE

Gastroenterology Image of the Month

A Fishy Nodule

Question: A 65-year-old patient presented with a painful epigastric mass. It had been diagnosed as a hematoma after a blunt abdominal trauma three months prior. Since then, the mass remained and continued to cause the patient pain. Past medical history included chronic alcohol consumption and benign prostatic hyperplasia. Upon physical examination, he was determined to have a hard, irregular mass in the epigastric area associated with an ulcerated, 1.5 cm large nodule of the umbilicus (figure). Laboratory tests revealed a mild anemia with a low prothrombin time and a total bilirubinemia of 26 mg/L. His serum alpha-fetoprotein concentration was 16.8 ng/mL. Thoracoabdominopelvic CT was performed. It revealed a 12 × 7-cm solid mass in the epigastric region associated with a hypertrophy of the left hepatic lobe. What is your diagnosis?

Answer.

Submit Your Pending Medicare Claims

For eligible professionals who participated in the Medicare electronic health record (EHR) incentive program in 2011, the reporting year ended on Dec. 31, 2011. Eligible professionals must have completed their 90-day reporting period by that date.

Eligible professionals that have completed that 90-day reporting period in 2011 have until Feb. 29, 2012, to actually register and attest to meeting meaningful use to receive an incentive payment for calendar year (CY) 2011 through the Medicare and Medicaid EHR incentive program registration and attestation system.

Medicare EHR incentive payments are based on 75 percent of the Part B allowed charges for covered professional services furnished by the eligible professionals during the entire payment year. CMS allows 60 days after Dec. 31, 2011, for all pending claims to be processed. Therefore, the deadline to submit any pending Medicare Part B claims from CY 2011 is Feb. 29, 2012.

Earn a 2011 Medicare Bonus Using the AGA Registry

Providers wanting to use the AGA Digestive Health Outcomes Registry® to submit to CMS for the 2011 Physician Quality Reporting System (PQRS) now have until Feb. 17, 2012, to enroll, and until Feb. 29 to enter their patient data. Both full- and half-year reporting options are available for 2011.

The CMS-qualified AGA Registry provides clinicians with an easy and inexpensive way to report on the hepatitis C measures group as part of PQRS. Using the registry's simple online forms, a physician can potentially earn a 1 percent bonus on all Medicare Part B allowable charges for calendar year 2011 by following these three easy steps:

  1. Enroll in the AGA Registry by Feb. 17, 2012.
  2. Choose a PQRS reporting method. Note: for 2011, ALL patients must be Medicare Part B fee-for-service.
  3. Submit data by Feb. 29, 2012.

Earning the 2011 physician quality reporting bonus through the AGA Registry is much easier than using claims-based physician reporting, which requires billing codes and submitting data for 80 percent of eligible patients. Physicians who use the registry need only to successfully report on 30 unique patients aged 18 and over with chronic hepatitis C. Additionally, physicians who do not see at least 30 chronic hepatitis C patients per year can report on at least 80 percent of their patients, provided that they have seen at least 16 patients with chronic hepatitis C within 2011, or at least eight patients during either half of the year.

Additional benefits of using the registry for submission of data include:

  • Real-time, easy-to-understand status reports to let physicians see the data they have entered.
  • Separation of the reporting of PQRS data from the claims-reporting process, allowing retrospective data entry and preventing the physician reporting process from delaying claims.
  • Built-in quality checks that reduce errors, improving the likelihood of qualifying for the 1 percent bonus payment.

Learn more at www.gastro.org/agaregistry.

Want to Learn More?

View an on-demand webinar to learn more about earning a 2011 Medicare bonus.

RESEARCH

Research Awards Available for Young Investigators

The AGA Research Foundation and Gastroenterology Research Group (GRG) encourage students and junior investigators to pursue independent research careers in gastrointestinal-related fields, and offer funding to support career development. A number of research awards are available.

For students:

  • AGA-Horizon Pharma Student Abstract Prizes will be given to high school, undergraduate, graduate and medical students who have submitted abstracts chosen by the AGA to be presented during Digestive Disease Week® (DDW). Medical residents up to and including postgraduate year three are also eligible. Deadline: Feb. 24.
  • AGA Student Research Fellowship Awards are offered to support undergraduate students performing digestive disease or nutrition research for a minimum of 10 weeks. A total of 10 awards are designated for underrepresented minority students. Deadline: March 23.
  • AGA-Broad Foundation Student Research Fellowship Awards are offered to support high school students performing digestive disease or nutrition research for a minimum of 10 weeks. Deadline: March 23.

For fellows and young GIs:

Apply online at www.gastro.org/foundation.

Your AGA Research Foundation Gifts Support ...

 ... David Nguyen, of Stanford University, who received a 2011 AGA-Stuart Brotman Student Research Fellowship Award.

"My long-term career goal is to become a medical researcher (physician-scientist) and I have been fascinated with the wide spectrum of diseases and challenges involving the digestive tract. The opportunity to work in the lab of Aida Habtezion, MD, will undoubtedly provide me with an excellent opportunity to learn the critical thinking as well as the methodology for today's research. Perhaps what excites me the most is the potential impact of our laboratory's work on acute pancreatitis in humans, a disease for which active therapy is yet to be found. I am excited to study the role of hemeoxygenase-1 in acute pancreatitis and investigate mechanisms that can be potentially used as therapeutic targets. To see this from the front lines is nothing short of inspiring, as the ultimate goal of medical research is to transfer successful results from the bench to the bedside."

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

EDUCATION & MEETINGS

Discount on Functional GI Disorders Resources

AGA members will receive a 20 percent discount on the purchase of educational products from the Rome Foundation.

The Rome Foundation computer-based learning program is a collection of state-of-the-art slides that brings to life information from the Rome III book and updates this information from the recent scientific literature.

Designed by the world’s leading experts on functional GI disorders, the program is the product of a two-year effort by international clinicians and investigators. Using animations and videos, the slides illustrate concepts that can be difficult to explain verbally. Every image includes a clearly written description with key references.

The slides are available for purchase as a complete set of 825 images, as modules or as individual slides.

The Rome III book, available in English and Spanish, is designed for one-stop learning about functional GI disorders. It serves as a valuable resource to general and specialist physicians, mental health professionals, and basic and clinical investigators.

Both products can be purchased from the Rome Foundation’s online store. Enter the discount code AGAMEMBER to save 20 percent on your order.

Tech Conference Focuses on Advancing GI through Innovation

Register today for the third annual Fostering Innovation and Technology in Digestive and Metabolic Diseases, which will be held March 23 and 24, 2012, at the Four Seasons Hotel Silicon Valley in East Palo Alto, CA.

The conference addresses critical elements that impact the likelihood of success in developing and obtaining adoption and coverage of new medical technologies in today’s GI market. Sessions explore the latest developments in reimbursement, the regulatory and legal environment, intellectual property, and more. Hear directly from the FDA, private payors and medical device executives who will address specific requirements. Areas of unmet need and clinical and research opportunities will be discussed in areas such as: optical endomicroscopy, molecular diagnostics, GI motility and endoscopy.

The program is specifically designed to encourage attendee and faculty dialogue, to identify issues that need to be addressed by the AGA and others, and to identify promising technologies and unmet needs in the digestive and metabolic diseases. The AGA is committed to fostering the development of evidence-based technologies that can improve patient outcomes. You will also learn about what the AGA is doing to help create a more supportive environment for new technologies, like the AGA Technology Center and AGA initiatives that support innovation in digestive and metabolic diseases.

A new addition to the program includes a forum for companies with an innovative technology or FDA-regulated medical device looking for financing or licensing. There will also be chances to make a presentation to industry experts, investors, clinicians and entrepreneurs in an effort to secure distribution and/or partnership opportunities. Companies will be able to receive valuable feedback that enables the development and implementation of strategies toward commercializing their technology.

For the latest program information and to register online, visit www.gilearn.org/tech-conference.

The AGA Institute and Kleiner Perkins Caufield & Byers gratefully acknowledge the following sponsors:

  • Pentax Corporation (Diamond).
  • BÂRRX® Medical (Platinum).
  • Medtronic, Inc. (Platinum).
  • SmartPill® Corporation (Platinum).
  • Boston Scientific Corporation (Silver).
  • Crospon (Silver).
  • Apollo Endosurgery, Inc. (Bronze).
  • Avantis Medical Systems (Bronze).
  • Cook Medical® (Bronze).
  • EndoGastric Solutions (Bronze).
  • Given® Imaging (Bronze).
  • Mauna Kea Technologies (Bronze).
AGA Center for GI Innovation and Technology

The center works with companies to foster the development and adoption of medical technologies, diagnostics and therapeutics that can improve patient care under the guidance of evidence-based standards.
 

JOURNALS & PUBLICATIONS

Call for Papers on Clinical Trials: Gastroenterology

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Bishr Omary, MD, PhD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at Phases I, II and especially III, to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

  • With an impact factor of 12.9, Gastroenterology is the premier journal in the field.
  • Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with GI or liver disease.
  • Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
  • Accepted manuscripts will be published online and indexed on PubMed within 10 days of acceptance.

To submit your manuscript to Gastroenterology, go to www.editorialmanager.com/gastro.

For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.

GI FELLOWS

AGA Website Medical Editor Request for Applications

The AGA is soliciting applications from interested members for the position of website medical editor. The individual selected will oversee the management and growth of the AGA’s family of websites, consistent with governing board strategic directives and program initiatives.

The current editor, Geoffrey L. Braden, MD, AGAF, will complete his term in May 2012. The new editor takes up the role immediately following.

The website medical editor will:

  • Provide leadership and oversight of the AGA’s online presence.
  • Direct strategy for www.gastro.org, including mobile devices.
  • Work with the national office staff and committees to conceptualize and implement new online features and mobile tools/applications.
  • Critically evaluate existing features and proposals for new functionality.
  • Review requests to add or delete content to www.gastro.org.
  • Evaluate requests for links to and from external sites.
  • Review requests for major modifications to www.gastro.org.
  • Serve as chair of the AGA E-Communications Advisory Board.

The position is for a term of three years and will entail a time commitment and place leadership demands on the individual appointed.

The deadline for receipt of applications is noon on Monday, Feb. 6, 2012. All inquiries regarding this position will be treated in confidence. Learn more and view application requirements.

In Case You Missed It ...

Articles from our blog, journal and newsletter were popular items last week. See which ones were retweeted most often.  

  • New Gastro issue highlight: Liver fibrosis protects mice from acute hepatocellular injury. ow.ly/8sK6T.
  • CDC reports HCV-related deaths are now more common than deaths associated with HIV; Pg 1. GI & Hep News: ow.ly/8oMnX.
  • New post from The AGA Journals Blog: Should Colonoscopies Include Anesthesiologists? ow.ly/8opfa.
  • The January 2012 issue of GI & Hep News is now available online. Be sure to check out the interactive version here: ow.ly/8oyA6.

Have any news that you would like us to share with our AGA members? Please send them to communications@gastro.org or share them on our social media channels:

 

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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.

Global Probiotics Council — Young Investigator Grant for Probiotics Research
The Global Probiotics Council, a committee established in 2004 by DANONE and YAKULT HONSHA CO., LTD., has announced the fifth annual Young Investigator Grant for Probiotics Research. The purpose of the two annual grants of $50,000 each is to contribute to the advancement of probiotics and gastrointestinal microbiota research in the U.S., and to impact academic and career development of young investigators, attracting them into the field of probiotics and microbiota.

Deadline: Feb. 15, 2012.

The official announcement and description of this opportunity may be found at:
http://www.probioticsresearch.com/.

North Dakota
Regional Leaders in Gastroenterology
Immediate openings for BC/BE gastroenterologists interested in practicing in an organization experiencing dynamic growth and development. This procedure-oriented practice with Sanford Health Fargo offers you a great work-life balance with a call schedule of 1:8. Procedures performed include ERCP, EUS, SpyGlass® and capsule studies. Consults only in 583-bed level II trauma center with EMR and PACS. Opportunity to teach medical students and IM residents. Sanford Health Fargo consists of 585+ physicians located in Fargo and 34 regional primary care clinics.

Fargo, ND, with a metro population of 190,000, is a diverse, stimulating and family-oriented city with all the amenities that make for a satisfying and fulfilling life. We offer exceptional K-12 and higher education systems, world-class health care, affordable housing, low cost of living, and myriad cultural and entertainment opportunities.

Jean Keller, physician recruiter
Sanford Health Physician Placement
Phone: 701-280-4853
E-mail: Jean.Keller@sanfordhealth.org

J1 candidates accepted.

New York
Extraordinary Opportunities with a Pace-Setting Institution in Rochester, NY: Rochester General Health System
Rochester General Hospital is seeking a BC/BE gastroenterologist to join our progressive and expanding GI team. Our gastroenterologists provide consultative services to both inpatients and outpatients, and combine high-tech services with highly skilled and compassionate care to prevent, diagnose and treat a wide range of gastrointestinal and liver disorders. Doctors throughout the region refer their most complex cases to our expert gastroenterologists, whose specialties include colon cancer screening, hepatobiliary and pancreatic disease, and IBD.

Our physicians, all board certified in internal medicine and gastroenterology, use minimally invasive techniques and procedures in a fully equipped endoscopy center. We work closely as a team with highly skilled nurse practitioners, radiologists, oncologists, surgeons and other health professionals. Blending private and academic practice, we participate in advanced clinical research, including the region’s only stem-cell study for the treatment of Crohn’s disease, to help move their field forward and provide even better care for our patients.

Highlights of Rochester General Health System

  • A top 100 integrated health network and the third largest employer in the region encompassing seven affiliates, including Rochester General Hospital and Newark-Wayne Community Hospital.
  • First in New York state for overall medical care, according to the latest report from CareChex®.
  • Only Thomson Reuters top 100 cardiac hospital in the region.
  • Nurse magnet designation.
  • National top 20 robotic surgery center.
  • World class medical and dental staff.
  • Large primary care referral base.
  • Recognized leader in quality improvement and commitment to deliver unparalleled patient care inclusive of an institute for patient safety and clinical excellence as a means to develop a comprehensive program of patient safety education initiatives, performance improvement processes, and prevention techniques.
  • Cutting edge EMR system.
  • State-of-the-art emergency department with average annual patient volume of 110,000.
  • Innovative affiliations/strategic partnerships with Rochester Institute of Technology, Cleveland Clinic, Roswell Park Cancer Institute and Carestream Health.
  • For more information on our health-care system, visit: www.rochestergeneral.org.

Highlights of Rochester, NY
Rochester provides residents with an exceptional quality of life. We have the arts, sports and culture of a big city, and the comfort and easy commutes of a small town. Rochester’s unsurpassed private and public educational institutions include 15 of the country’s finest colleges and universities, and public high schools ranked among the 100 best high schools in America. Rochester is ranked fourth on Forbes magazine’s list of most affordable cities and third best metropolitan region in the country for raising a family.

If you are looking to join a nationally recognized health system known for its unwavering commitment to patient care, an atmosphere of innovation and collaboration, and unparalleled physician support from a dedicated physician services team devoted to enhancing the physician experience, please contact: kathy.peishel@rochestergeneral.org or alison.ayres@rochestergeneral.org.

EOE