Eugene Chang, MD
AGA is advocating for specialist needs related to Health IT and increased NIH funding as the Senate debates its version of the American Recovery and Reinvestment Act. The act is an $888 billion economic stimulus package that includes tax cuts, assistance to states, Medicaid assistance and unemployment extensions to address the country's economic crisis. The House last week passed its version without a single Republican vote and its fate is uncertain in the Senate.
Like the House package, the Senate bill spends $23.9 billion to provide grants to physicians and health-care providers to purchase health information technology (HIT). It would establish standards for interoperability and minimum functionality and require the certification of systems as meeting those standards. Physicians would be eligible for grants to purchase HIT and bonus payments for using a certified HIT system. However, physicians would not receive full Medicare and Medicaid updates if they do not use certified HIT.
Although the AGA supports HIT adoption and believes it will help improve efficiency and quality, we are concerned that many physicians, especially those in small practices, may not be able to take advantage of the available grants. Additionally, the AGA is concerned that many physicians will be penalized for not having certified HIT before the government establishes HIT standards. The AGA and the Alliance of Specialty Medicine sent a letter to congressional leaders outlining these concerns.
The Senate package also includes $3.5 billion for NIH, and includes $1.1 billion for comparative effectiveness research to evaluate different health-care and treatment options. The bill would allocate $1.35 billion for research to be distributed to the institutes and centers proportional to their current funding level, with NIDDK receiving $81.4 million, $1.35 billion for research at the discretion of the office of the director and $500 million for NIH buildings and facilities. Sen. Tom Harkin, D-IA, offered an amendment, which passed, to increase NIH funding by $6.5 billion, bringing the total of NIH funding to $10 billion, with $7.85 going to research and NIDDK receiving $473.7 million.
The AGA, along with the Ad Hoc Group for Medical Research, have been advocating for the inclusion of at least $1.5 billion for NIH in any economic recovery package and are appreciative of Sen. Harkin's efforts to help NIH regain some of its purchasing power and help stimulate the economy. This funding will not only expand research funding by NIH, but will also fund research infrastructure, instrumentation and capital equipment.
Gallbladder Lymphoma in Primary Sclerosing Cholangitis
Darrin L. Willingham, David M. Menke, Raj Satyanarayana
A 74-year-old man with long-term primary sclerosing cholangitis and ulcerative colitis had a soft-tissue mass in the gallbladder that was detected during a semiannual magnetic resonance imaging surveillance examination in March 2006. That study (Figure A; coronal enhanced fat-suppressed, T1-weighted image) revealed uniform enhancement in the thickened gallbladder wall (long arrow) and mild dilatation of the intrahepatic ducts (small arrows) with more central effacement indicated underlying primary sclerosing cholangitis.
In the community, reporting poor sleep is associated with upper and lower GI symptoms, but this is independent of body mass index (BMI), reports a study published in Neurogastroenterology & Motility.
In tertiary referral patients, there is association between altered sleep patterns, functional bowel disorders and altered gut motor function. BMI is also associated with GI symptoms including diarrhea, and with sleep disturbances.
Researchers hypothesized that sleep disturbances are associated with GI symptoms, and this is not explained by BMI. A 48-item validated questionnaire was mailed to 6,939 community participants; the survey included GI symptoms, sleep disturbance, daily lifestyle and quality of life (QOL). Independent contributions of sleep disturbance to individual symptoms were assessed using logistic regression adjusting for age, gender, lifestyle and mental health status.
The researchers examined the association of an overall sleep score with an overall symptom score. The team also evaluated the ability of both scores to predict Short Form-12 physical and mental functioning scores assessed in multiple linear regression models.
Among 3,228 respondents, 27 percent reported trouble staying asleep. There was a significant correlation of overall sleep scores with overall GI symptom scores. Waking up once nightly at least four times a month was significantly associated with pain, nausea, dysphagia, diarrhea, loose stools, urgency and a feeling of anal blockage. Trouble falling asleep was significantly associated with rectal urgency. Associations were independent of gender, age, lifestyle factors and BMI. Overall, sleep scores and GI symptom scores were both significant independent predictors of impaired QOL.
Neurogastroenterology & Motility; 2009: 21(2): 128-35
Listen in as experts address important esophageal disorders in juniors and adolescents, in mid-life and in seniors, as well as areas for improving current treatments for these disorders and the next generation of PPIs.
According to a study published in the Journal of the American Medical Association, short-term supplementation of non-malnourished children with ready-to-use therapeutic foods reduced the decline in the weight-for-height z score and the incidence of wasting and severe wasting over eight months.
Ready-to-use therapeutic foods are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. Doctors evaluated the effect of a three-month distribution of ready-to-use therapeutic foods on the nutritional status, mortality and morbidity of children aged six to 60 months in Niger.
The team conducted a cluster randomized trial of 12 villages in Maradi, Niger; they randomized six villages to intervention and six to no intervention. All children in the study villages aged six to 60 months were eligible for recruitment. Children with weight-for-height 80 percent or more of the National Center for Health Statistics reference median in the six intervention villages received a monthly distribution of one packet per day of ready-to-use therapeutic foods in 2006. Children in the six nonintervention villages received no preventive supplementation.
Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from 2006 to 2007. The team's main outcome measures included changes in weight-for-height z score according to the World Health Organization Child Growth Standards and incidence of wasting over eight months of follow up.
The number of children with height and weight measurements in August, October, December and February was 3,166, 3,110, 2,936 and 3,026, respectively. The difference between the intervention and nonintervention groups was -0.10 z at baseline and 0.12 z after eight months of follow up. The adjusted effect of the intervention from baseline to the end of follow up was 0.22 z. The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child year and 0.03 events per child year in the intervention villages. In the non-intervention villages, the absolute rate of wasting and severe wasting was 0.26 events per child year and 0.07 events per child year. The intervention thus resulted in a 36 percent reduction in the incidence of wasting and a 58 percent reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.01 deaths per child year in the intervention villages and 0.02 deaths per child year in the nonintervention villages.
Journal of the American Medical Association; 2009: 301(3): 277-85
Study results in the British Journal of Cancer support the use of adjuvant 5-fluorouracil and folinic acid in pancreatic cancer.
A research team from the U.K. conducted a meta-analysis using the ESPAC-1, ESPAC-1 plus and early ESPAC-3 results. They identified 458 randomized patients and 364 deaths, and estimated the effectiveness of adjuvant 5-fluorouracil and folinic acid versus resection alone for pancreatic cancer.
The pooled hazard ratio was 0.7. The median survival was 23 months with adjuvant 5-fluorouracil and folinic acid versus 17 months with resection alone.
British Journal of Cancer; 2009: 100: 246-50
Results published in the Journal of the American College of Surgeons state that laparoscopic appendectomy results in higher costs and increased morbidity for patients with uncomplicated appendicitis. Nevertheless, laparoscopy is increasingly used. Patients undergoing laparoscopy benefit from a slightly shorter hospital stay. In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for laparoscopy in selected subgroups of patients.
Laparoscopic appendectomy is widely used for treatment of appendicitis; it is still unclear if it is superior to the open approach. Researchers evaluated the Nationwide Inpatient Sample 2000 to 2005 and hospitalizations with the primary ICD-9 procedure code of laparoscopic and open appendectomy. Outcomes of length of stay, costs and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess). Regression methods were used to adjust for covariates and to detect trends. Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index.
Between 2000 and 2005, 132,663 patients underwent open appendectomy and 102,810 had laparoscopy. Frequency of laparoscopy increased from 32 percent to 58 percent. The conversion rates decreased from 10 percent to 7 percent. Covariate adjusted length of stay for laparoscopy was approximately 15 percent shorter than for open appendectomy in both uncomplicated and complicated cases. Adjusted costs for laparoscopy were 22 percent higher in uncomplicated appendicitis and 9 percent higher in patients with complicated appendicitis. Costs and length of stay decreased over time in open appendectomy and laparoscopy. The risk for a complication was higher in the laparoscopic group with uncomplicated appendicitis.
Journal of the American College of Surgeons; 2009: 208(2): 179-85
With decreases in funding for scientific research, how does that impact physician-scientists today? What does the future landscape look like for medical research? Mark Donowitz, MD, AGAF, LeBoff professor of medicine and director of the Center for Epithelial Disorders at the Johns Hopkins University School of Medicine, as well as immediate past-president of the AGA, discusses with host Mark DeLegge, MD, AGAF, some of the barriers and challenges physician-scientists face, and how we can ensure a sound future for research.
ReachMD XM 160 is the channel for medical professionals and brings you educational news and information on satellite radio, online and on-demand. GI Insights, broadcast through ReachMD XM 160, features the field's top gastroenterologists discussing today's issues. Each week, a new topic will air twice per day for the first week it is released. AGA members receive free access to the broadcasts online on the ReachMD Web site by using discount code AGA. Broadcasts are also available as podcast downloads on the AGA Web site. Learn more today!
CT Colonography: Hands-On Training for the Gastroenterologist
Space is limited. Register early.
Applications are now being accepted for the Young Investigator Grant for Probiotics Research. Two $50,000 grants will be awarded to young investigators committed to basic research on gastrointestinal microbiota, probiotics and their role in health and disease.
The purpose of the grant is to contribute to the advancement of probiotics and gastrointestinal microbiota research in the U.S. and to attract promising, young researchers to this field of study.
For more information or to submit an application, visit www.probioticsresearch.com. The application deadline is Feb. 10, 2009.
This program is supported by the Global Probiotics Council, a committee formed by DannonTM and Yakult.
View an online patient guide or listen to a podcast on probiotics and their health benefits.
Implemented in January 2004, the Ribavirin Pregnancy Registry is a voluntary and largely prospective registry collecting observational data on pregnancies and the outcomes following exposure to ribavirin during pregnancy. The development of this registry was mandated by the Federal Drug Administration and includes both direct exposure through the pregnant female and indirect exposure through her male sexual partner.
Reports of exposure will be accepted from health-care providers, pregnant patients or the male partners of pregnant patients and the data collected are minimal and targeted. Data are collected at each trimester and at the outcome of the pregnancy through the obstetric health-care provider and, for a live birth, for 12 months after the birth through the pediatric health-care provider. Patient identity is confidential.
This registry is the primary source for collecting and evaluating direct and indirect exposures to ribavirin in pregnancy and the success of the registry relies on the participation of patients and health-care providers. For more information and details on how to participate, please visit the Registry Web site.
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:
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;].
A new educational resource has been posted to the Electronic Prescribing (E-Prescribing) Incentive Program section page on CMS' PQRI Web page. "2009 Electronic Prescribing Incentive Program Made Simple" is a fact sheet, which provides detailed information on how to participate in the 2009 e-prescribing incentive program by reporting the e-prescribing measure.
To access this new, and all, available e-prescribing educational resources, click on the electronic prescribing incentive program tab. Once on the e-prescribing page, scroll down to the "Downloads" section and click on the "2009 Electronic Prescribing Incentive Program Made Simple" link.
Take a free readiness assessment to find out at www.GetRxConnected.com/AGA, sponsored by the AGA Institute.
CMS will hold a special open-door forum to discuss the 2009 Physician Quality Reporting Initiative (PQRI). This call will be geared to those eligible professionals planning to participate for the first time and will cover the basics of how to satisfactorily report the 2009 PQRI quality measures through claims-based reporting. Afterwards, there will be an opportunity for the public to ask questions.
Participation instructions:An audio recording of this special forum will be posted online and accessible for download beginning Feb. 20, 2009.
Read more information about the PQRI, including educational products.
Ulcerative colitis (UC) is a treatable condition that affects more than 500,000 Americans. Most UC cases are mild to moderate and can be managed medically. However, patients with UC require constant management of their treatment program to ensure the best quality of life.
The AGA Institute's popular program, Virtual UC Clinic, includes a series of three online case simulators. Based on realistic clinical situations, the cases test your clinical decision-making skills related to the treatment and management of UC while measuring your performance against that of the case author and your peers.
Cases include:
This program offers up to 1.5 AMA PRA Category 1 Credits™.
Supported through an independent educational grant from Shire Pharmaceuticals, Inc.
The syllabus from the AGA Institute's 2009 Clinical Congress of Gastroenterology and Hepatology is available for sale. For those who missed this year's congress, you can still find out about the latest developments in the detection, management and treatment of GI disorders by ordering this valuable resource.
Designed by clinicians for clinicians, the congress provided a comprehensive, in-depth review of clinical gastroenterology and hepatology. Some of GI's most challenging issues were addressed, including:
The syllabus includes comprehensive details of all general sessions and breakout sessions and contains abstracts, key points, references, slides, graphs, charts and tables. Learning objectives and complete reference lists are also provided.
The price is $35 for members and $40 for nonmembers. Shipping is additional.
Order online at www.gastro.org/cc09syllabus or contact AGA Member Services at (301) 941-2651 to request an order form.
Register for DDW
Pre-registration for the 2009 GI Training Directors' Workshop closes Tuesday, Feb. 18.
Held every two years, this course is designed to facilitate discussion about the key issues involved in running a successful program and to explore solutions to common challenges. The 2009 workshop will take place from Feb. 27 to 28 at the Walt Disney Dolphin in Lake Buena Vista, Florida.
The program will focus on topics such as:
In addition to educational sessions, the course offers attendees the opportunity to network with their peers and with the faculty, who are experts in the field of training.
For the first time this year, program coordinators and other administrative staff are encouraged to attend. A special break-out session, Pearls for Program Coordinators, has been designed especially for this group.
Online registration and program details are available at www.gastro.org/tdw2009. Onsite registrations will be accepted on a first-come, first-serve basis.
This program is sponsored by AASLD, ACG, the AGA Institute and ASGE.
Exam Registration Deadline: March 31, 2009
Exam Dates: April 14-27, 2009
Training directors and fellows benefit from the GTE by receiving detailed score reports allowing them to effectively gauge training progress over time.
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):
To be considered for a committee appointment, send a letter expressing your interest (along with a CV) to AGA Institute Vice President Ian L. Taylor, MD, PhD, AGAF. E-mail submissions to dfield@gastro.org by March 31, 2009.
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 2009 meeting. The appointees ratified in November will begin serving three-year terms in June 2010.
The FDA has approved KAPIDEX™ (dexlansoprazole) delayed release capsules for the once-daily, oral treatment of heartburn associated with symptomatic non-erosive GERD, the healing of erosive esophagitis (EE) and the maintenance of healed EE.
KAPIDEX (30 mg and 60 mg) is the first proton pump inhibitor with a dual delayed release™ formulation, designed to provide two separate releases of medication.
This approval was based on global studies conducted in 20 countries in approximately 6,000 patients with erosive and non-erosive GERD. Two identically designed, double-blind, eight-week, randomized, controlled trials compared treatment with KAPIDEX to treatment with lansoprazole in patients with EE. KAPIDEX (60 mg) produced high overall healing rates at week eight when compared to lansoprazole 30 mg and was generally well-tolerated.
Instead of waiting for late-breaking FDA-required alerts to arrive through the mail, receive them instantly in your inbox. Visit the AGA Institute/Health Care Notification Network Web site to complete the short registration process.
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 Anil K. Rustgi, MD, 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:
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.
Listen in each month as online editor John F. Kuemmerle, MD, AGAF, presents author interviews and expert commentary.
Listen to this month's Gastroenterology podcast.
Listen to this month's Clinical Gastroenterology and Hepatology podcast.
For only $82.50, you can place an ad of 100 words or less in two consecutive issues and for $165 in four consecutive issues. Ads can also be placed in AGA Perspectives, AGA's bi-monthly magazine. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. For more information, contact Jessica Zeiler at jzeiler@gastro.org or (301) 941-2640.
Maryland
Baltimore — The division of gastroenterology and hepatology at the Johns Hopkins Bayview Medical Center is recruiting for full-time faculty positions available July 1, 2009. Candidates should be board-certified or eligible and proficient in endoscopic procedures. ERCP/EUS desirable, but not required. Responsibilities include patient care and teaching with opportunity for clinical investigation. Salary and rank commensurate with experience. Please e-mail cover letter and CV to Mack C. Mitchell, Jr., MD, director, Johns Hopkins Bayview Division of Gastroenterology, at mmitch15@jhmi.edu. AA/EOE.
New York
Syracuse — Crouse Hospital, a 500+ bed acute care facility located in Syracuse, NY, is currently seeking a board certified/eligible gastroenterology hospitalist. This position will be responsible for performing standard gastroenterology consultative services, including peg tube placement, colonoscopy, panendoscopy and flexible sigmoidoscopy. ERCP experience preferred, but not required. GI hospitalist shall be available to service all appropriate emergency room patients, as well as inpatients in need of GI medical services. Position is full time and hours worked/on-call schedules will be shared with other gastroenterologists. All interested candidates should visit www.crouse.org/careers to apply online or contact (315) 470-7521 for more information.
Virginia
Washington, D.C. Suburbs/Northern Virginia — Within minutes of all the excitement that our nation's capital has to offer. GI group with two physicians and two PAs seeks BE/BC gastroenterologist to join them in busy 100 percent GI practice. Office endoscopy center next door. Affiliated with premier university-affiliated teaching hospital with house staff and medical students. Academic appointment and teaching opportunities available. Early partnership opportunity. E-mail CV to ofcmgr.gidoc@gmail.com.
Whether you are looking for a candidate or a job, GICareerSearch.com is your source for GI job placement and recruitment.
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