In a new study in this month's Gastroenterology, researchers in Canada evaluated postoperative morbidity and mortality following a colectomy for ulcerative colitis using a nationally representative database. Their findings concluded that postoperative mortality was lowest in hospitals that performed the highest volume of operations, and increasing the proportion of total colectomies performed in high-volume hospitals may improve clinical outcomes for patients with ulcerative colitis.

Doctors analyzed the 1995 to 2005 Nationwide Inpatient Sample to identify 7,108 discharges for ulcerative colitis patients who underwent a total abdominal colectomy. The effects of hospital volume on postoperative morbidity and mortality were evaluated in logistic regression models adjusting for demographic and clinical factors. The researchers found that postoperative mortality and morbidity rates were 2 percent and 31 percent, respectively.

The researchers also determined the factors that influenced outcomes. The teams that performed most operations in low-volume hospitals had an increased risk of death. They found in-hospital mortality was increased in patients who were admitted emergently, aged 60 to 80 years, and those with Medicaid. Emergency-admitted ulcerative colitis patients, whose surgery was performed six days after their admission, also had significantly increased likelihood of in-hospital death.

Postoperative morbidity and mortality following a colectomy for ulcerative colitis has been primarily reported from tertiary care referral centers that perform a high volume of operations. However, the postoperative outcomes among nonselected hospitals are not known.

A study in this week's Journal of the American Medical Association reports that the addition of gemcitabine to adjuvant fluorouracil-based chemoradiation is associated with a survival benefit for patients with resected pancreatic cancer, although this improvement is not statistically significant.

Among patients with locally advanced metastatic pancreatic adenocarcinoma, gemcitabine has been shown to improve outcomes compared with fluorouracil. Doctors in Canada determined if the addition of gemcitabine to adjuvant fluorouracil chemo radiation (chemotherapy plus radiation) improves survival for patients with resected pancreatic adenocarcinoma.

The researchers randomized a total of 451 patients, of which 388 had pancreatic head tumors. The team performed a randomized controlled phase 3 trial of patients with complete gross total resection of pancreatic adenocarcinoma. The patients had no prior radiation or chemotherapy and were enrolled between 1998 and 2002 with follow-up through 2006, at 164 U.S. and Canadian institutions. The team used chemotherapy with either fluorouracil in 230 patients or gemcitabine in 221 patients for three weeks prior to chemoradiation therapy and for 12 weeks after chemoradiation therapy. The researchers reported that chemoradiation with a continuous infusion of fluorouracil was the same for all patients. The team's primary end point was survival for all patients and survival for patients with pancreatic head tumors. Secondary end points included toxicity.

Researchers noted that the median survival in the gemcitabine group was 21 months with a three-year survival of 31 percent versus a median survival of 17 months and a three-year survival of 22 percent in the fluorouracil group. The treatment effect was strengthened on multivariate analysis. Grade 4 hematologic toxicity was 1 percent in the fluorouracil group and 14 percent in the gemcitabine group without a difference in febrile neutropenia or infection. The team found no differences in the ability to complete chemotherapy or radiation therapy.

The latest issue of Hepatology reports that optical digital analysis of computed tomography images of the liver is effective in determining the stage and distribution of liver fibrosis in chronic hepatitis C. In patients with homogeneous fibrosis distribution, the correlation between fibro-computed tomography and histology was better than in patients with heterogeneous distribution. The research team concludes that fibro-computed tomography is a simple to use, readily available and useful method for the diagnosis of fibrosis in patients with chronic hepatitis C.

In this study, doctors in Spain evaluated an image processing method for assessing liver fibrosis in conventional computed tomography scans in patients with chronic hepatitis C. The team assessed two cohorts of 141 patients with chronic hepatitis C using digitized conventional helical computed tomography. Weighted computed tomography mean fibrosis was calculated as a nonlinear weighted mean F-score for each sample.

Fibrosis was defined according to Scheuer on the F0 to F4 scale by two pathologists blinded to the data. Fibrosis according to fibro-computed tomography correlated with histology-determined fibrosis and with increasing F-stage.

The team found that the receiver operating characteristics curve to diagnose significant fibrosis was 0.83. The receiver operating characteristics curve to diagnose advanced fibrosis was 0.86. The correlation between fibro-computed tomography and fibrosis was higher in patients with homogeneous distribution of fibrosis than in patients with heterogeneous distribution.

A study in the most recent issue of the Journal of Clinical Oncology indicates that as oncologists become less involved in colorectal cancer survivor care, cancer-related screening decreases significantly. The U.S. team overseeing the research concludes that the results support the need for survivorship care plans that explicitly outline the roles of primary care providers and oncologists in sharing care for cancer survivors and how these roles may change over time.

The study explored the mix of physician specialties that long-term survivors visit and how the mix relates to preventive care. The researchers conducted a retrospective, longitudinal study of stage I to III Medicare fee-for-service colorectal cancer patients diagnosed in 1997. The team used the Surveillance, Epidemiology, and End Results-Medicare database and examined physician visits and preventive care each year for five years, starting 366 days postdiagnosis. In addition, the team investigated how preventive service receipt related to the physician mix seen, including primary care provider only, oncologist only, both or neither.

A total of 1,541 patients met the eligibility criteria. During five years, primary care provider visits increased from a mean of four to five, and oncology visits decreased from one to 0.5. Survivor care by primary care providers only increased from 44 percent to 62 percent. However, the researchers noted that shared care by primary care providers and oncologists dropped from 37 percent to 21 percent.

Survivors who saw both primary care providers and oncologists were most likely to receive influenza vaccination, mammograms and cervical cancer screening. The team noted that survivors who saw primary care providers only were most likely to receive cholesterol screening and bone densitometry. Higher socioeconomic status was associated with increased influenza vaccination, mammograms and cervical cancer screening. Over time, there was a decrease in mammography and cervical cancer screening and an increase in influenza vaccination.

The House and Senate this week are scheduled to vote on respective fiscal year 2009 budget resolutions — approved by committees last week — before leaving for Easter recess. The AGA has advocated that a Medicare physician payment fix be included in the budget. Both budget plans reject the president's call for nearly $200 billion in cuts to Medicare and Medicaid and include language to address the Medicare physician payment cut in July 2008. Each also makes funds available for the adoption of electronic prescribing, health information technology and comparative effectiveness research. Either plan would increase spending above the president's request by between $18-22 billion; the president has threatened to veto any measure that is above his recommendations.

Both plans would also increase the NIH budget to $30 billion, $950 million above the president's request. Additionally, Sens. Tom Harkin, D-IA, and Arlen Specter, R-PA, plan to offer an amendment to increase the NIH budget by an additional $2.1 billion. The AGA strongly supports the efforts of Sens. Harkin and Specter and will advocate for passage of this important amendment.

The AGA will continue to monitor the budget process and continue to advocate for increased funding for medical research and a fix to the Medicare physician payment cuts.

Last week, the House approved the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424). This legislation would require health plans and employers to cover all mental illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders and cover them in the same manner as all other medical and surgical benefits. The legislation also includes provisions in the previously passed H.R. 493 that would prohibit insurers and employers from discriminating against patients based on genetic information.

The legislation is partially financed by prohibiting physicians from referring Medicare patients to hospitals in which they have an ownership interest, but provides a grandfather clause for existing physician-owned hospitals. The legislation is opposed by the Bush administration and business groups, which prefer a Senate-passed mental health parity bill (S. 558) that is not as broad in scope as the House bill. The House and Senate must now work in conference to reconcile the differences between their two respective bills.

Annually, the Gastroenterology Research Group (GRG), in collaboration with the AGA, presents the GRG/AGA Young Investigator Awards, the Fellow Travel Award and the Abstract of the Year Award to promising young investigators and trainees. Members of GRG and AGA are encouraged to submit nominations or applications for these honors.

The GRG/AGA Young Investigator Clinical Science Award and the GRG/AGA Young Investigator Basic Research Award recognize the specific achievements of young clinical investigators and young basic research scientists whose focus is in the area of digestive and/or liver diseases. Nominees must be independent investigators who have held an independent faculty position at the level of Assistant Professor or higher for less than seven years and must be AGA and GRG members.

This award includes a prize of $3,000, to be awarded at the GRG Spring Symposium at DDW^®. The nomination deadline is March 21, 2008.

The GRG/AGA Fellow Travel Award provides $500 travel grants to individuals chosen to present outstanding abstracts, of which they are first authors, at DDW. Qualified applicants are MD or PhD postdoctoral fellows. Applicants must be sponsored by a member of the AGA and the GRG. The application deadline is March 21, 2008.

The recipient of the GRG/AGA Abstract of the Year Award is selected by the GRG from among the applications submitted for the GRG/AGA Fellow Travel Awards. A prize of $1,000 will be awarded to encourage trainees to become more involved in digestive disease research.

For complete details about the Young Investigator, Fellow Travel and Abstract of the Year Awards, please visit the GRG’s Web site at www.gastroresearch.org.

The AGA Institute offers members access to an extensive listing of funding opportunities, updated monthly, via the Community of Science™ (COS) database, the largest, most comprehensive database of funding available. The COS database includes:

• More than 22,000 records representing more than $33 billion in funding.
• Opportunities by sponsors throughout the world for recipients throughout the world.
• Sponsors include private foundations, public agencies, national and local governments, corporations, and more.
• Funding for many purposes, such as research, collaborations, travel, curriculum development, conferences, fellowships, postdoctoral positions, equipment acquisitions, and capital or operating expenses.

Recent updates have been made to the database of awards related to digestive diseases/disorders, housed on the AGA Web site.

A listing of COS Funding Opportunities™ for gastroenterologists can be found online on the AGA Web site. The listing is available only to members and requires logging-in to the site using your AGA member ID [&MASID;].

The AGA Institute is committed to the development of clinical practice guidelines related to the diagnosis, treatment and management of digestive diseases. Under the guidance of the Clinical Practice & Quality Management Committee, a new process for development of clinical practice recommendations is being implemented. The goal is to make the guidelines more useful to members and practices.

The process includes an annual "call for topics" from AGA Institute members to identify potential topics for guideline development. The committee prioritizes and ranks topics based on strength of evidence, importance in clinical practice, importance in payment and to payers, importance in pay for performance (potential for development of quality or performance measures), variation in care, and prevalence and cost of disease.

Please send your suggestions for guidelines to Sheila Agyeman at sagyeman@gastro.org. Current guidelines and AGA Institute's process for developing practice recommendations are available online at www.gastro.org/medicalstatements.

On March 4, the AMA convened a meeting of, the Endoscopy and Polyp Surveillance Performance Measures Work Group. This multi-stakeholder panel of experts is a joint effort of the AGA Institute, ASGE and the AMA Physician Consortium for Performance Improvement™ (PCPI). Evidence based guidelines for gastroenterology and gaps/variation in care are the major considerations that will guide the group's efforts.

John I. Allen, MD, MBA, AGAF, chair, AGA Institute Clinical Practice & Quality Management Committee, is the co-chair of the workgroup along with Douglas O. Faigel, MD FASGE, ASGE Taskforce on Quality in Endoscopy. Representatives from the American College of Gastroenterology, the College of American Pathologists, the American College of Surgeons and health plans are also participating in this work group.

The work group intends to release its draft performance measures for public comment within two months. Based upon the public comment, any necessary revisions will be made before the measures go to the PCPI for a vote in May. Measures that are accepted by the PCPI will then go to the AQA Alliance meeting in October for possible consideration by CMS as potential PQRI measures.

The public comment period and other measures-related information will be announced via AGA eDigest.

Please contact Debbie Robin at drobin@gastro.org with any questions you may have about the PCPI process or the work group's efforts.

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 Web Site. This month’s free topic is:

• Sclerosing Mesenteritis

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.

The AGA Institute has added two new programs to its popular Web site, TheGut.org.

FastTrack, a series of CME/CE-certified programs, offers progroms that cover a wide variety of "must know" topics in gastroenterology. This is the second edition of this program, which offers PowerPoint presentations on hot topics and case studies, as well as summaries and critiques of the most important recent publications.

The second program, Treating Crohn's Disease: Now and into the Future, is a Webcast that addresses best-practice management plans in Crohn’s disease to optimize patients’ long-term clinical outcomes with anti-TNF-a therapy.

Additional programs on TheGut.org include:

• Expert Dialogues in Acid-Related Disorders: Keeping on TRACK with the Must-Know Points
• CME Monograph from DDW^® Symposium: Innovative Strategies for Biologic Therapy in Crohn's Disease
• Fresh Perspectives in Chronic Constipation and Other Functional Bowel Disorders

All available programs on TheGut.org have been developed by ACCME-accredited organizations other than the AGA Institute, though the AGA Institute reviews all programs posted on the site. Programs can be viewed for up to one year.

Additional programs are added on an ongoing basis. Visit TheGut.org for the latest information.

Attend the 2008 IPA World Congress in Beverly Hills, CA on April 11 and 12, 2008. The meeting, endorsed by the AGA Institute, will bring together health, academia and industry professionals for two days of presentations on probiotic-related topics. AGA members receive a discount (use code AG615MK49X).

For more information about the scientific program as well as hotel and registration information, visit www.ipaworldcongress.com.

AGA and AGA Institute committees recommend and oversee new and existing policies and programs. Committee service offers members several benefits: you can network with other physicians and scientists, pursue a special interest, or make an impact in an area that is important to you. The following committees will have open positions for members (the number of openings follows the committee name):

• Clinical Practice & Quality Management (4)
• Education & Training (6, including a trainee and a non-physician provider)
• Ethics (2)
• Future Trends (4)
• International (4)
• Nominating (4)
• Practice Management & Economics (4, including a non-physician practice manager)
• Public Affairs & Advocacy (4)
• Publications (2)
• Research Policy (4)

If you want to be considered for a committee appointment, send a letter expressing your interest along with a bio-sketch or an abbreviated CV of not more than six pages to AGA Vice President Gail A. Hecht, MD, AGAF. Submissions should be made electronically to dfield@gastro.org no later than March 31, 2008.

The vice president will consider applications and nominate appointees for each committee. These nominations will then be brought before the Governing Board for ratification at its November 2008 meeting. The appointees ratified in November will begin serving three-year terms in June 2009.