ACP Internist

Monday, October 12, 2009

Beware, convention attendees.

The recession has hit hotels hard and they seem to have hit back by finding sleazy new ways to charge more. Two recent examples from my convention travel:

In Miami, a hotel charged me because I opened the minibar. They were willing to remove the charge when I asked, but their standard procedure is to assume you ate something and bill you $12 for it.

In Denver, my hotel warned me at check-in that they were running my card right then for the cost of my stay plus $75 "for incidentals." If I failed to buy enough incidentals, they would refund the difference at check-out.

Combine these schemes with the trend toward express check-outs that don't show you an itemized bill and you've got a recipe for hotel profit at the expense of oblivious consumers. So next time you're headed home from a convention, keep an eye out so as not to lose an arm and a leg.

Labels: conference coverage

News from Digestive Disease Week: Crohn's disease

CHICAGO--IBD radiation risk: Are your patients with ulcerative colitis (UC) or Crohn's disease getting too much radiation exposure?

Patients with Crohn's--who often have complications that require radiologic tests sometimes starting at a young age--were exposed to twice as much radiation as patients with UC, according to the results of a study of 500 patients with Crohn's and UC presented here today.

Between 66% and 75% of the radiation came from CT scans, which produce more radiation than X-rays or MRIs, but do a better job diagnosing complications associated with irritable bowel disease, according to the study's lead researcher Karen Kroeker, MD, fellow with the division of gastroenterology at the University of Alberta.

She said the problem could be addressed by finding new diagnostic tools such as intestinal ultrasound that could eventually replace CT scans.

Meanwhile, she suggested doctors keep closer tabs on what their patients are experiencing. "Physicians need to be aware of how many CT scans their patients have been exposed to so that they can determine the risk of additional CT scans," she said.

The environment and Crohn's: Pollution, changes in diet, or smoking habits could be responsible for the 48.5% increase in Crohn's disease in patients under age 19, according to another study released today.

Investigators tracked nearly 6 million patients in northern France between 1988 and 2005. While the incidence of Crohn's increased 20.7% overall, that rate had stabilized after 10 years. Not so for people under age 19; that rate had a linear and dramatic increase.

Future studies should look at why Crohn's disproportionately affects young people, said Guillaume Savoye, MD, EPIMAD registry and department of gastroenterology, University Hospital, Rouen, France.

--By Paula Katz, special to ACP Internist

Labels: conference coverage, crohn's disease, digestive disease week

News from Digestive Disease Week: Patients often in the dark about NAFLD

CHICAGO--Primary care physicians should take more initiative in talking to their patients about how they can avoid non-alcoholic fatty liver disease (NAFLD), according to the results of a new study released at Digestive Disease Week here today.

In what the lead researcher called a "disturbing and significant" finding, 98% of 5,000 outpatient adults studied said their physicians had never talked to them about NAFLD. The survey also found that 95% did not know that fat in the liver could lead to serious health problems and 80 percent had never heard of cirrhosis.

Prevention is critical since treatment options are limited for "this silent but deadly disease," said Sury Anand, MD, chief of gastroenterology at Brooklyn Hospital Center. He recommended that physicians encourage their patients to maintain healthy weight through diet and exercise to avoid NAFLD just as they limit carbohydrate intake to prevent diabetes.

NAFLD is the most common cause of abnormal liver enzymes, one of the most common causes of cirrhosis of the liver, and the 10th leading cause of death.
--By Paula Katz, special to ACP Internist

Labels: conference coverage, digestive disease week

Digestive Disease Week: Colorectal cancer detection

Digestive Disease Week is underway in Chicago this week, and our correspondent Paula Katz will be dispatching news from the meeting over the next few days. Studies on tools to detect colorectal cancer are among today's research highlights:

Fewer perforation risks: Rates of perforation, a serious complication of colonoscopy, are low and decreasing, according to the results of a new study. The study analyzed 17 abstracts that included 274,265 colonoscopies to find an accurate measure of perforation rates, which other research has found ranged from 0.01 percent to 1.1 percent. This study found that the perforation rate in therapeutic colonoscopies was 0.066 percent (one in 1,500) and .017 percent in diagnostic colonoscopies (one in 6,000) with a trend towards decreasing perforation rates for both procedures. Further studies should be done in community and university settings, stratify patients by different risk factors and indications, and follow up at day seven or 30 to capture all complications, said researcher S. M. Abbas Fehmi, MD, clinical faculty at the University of Pennsylvania School of Medicine.

Advantage deep sedation? Endoscopy found 25% more large polyps in patients who had deep sedation during colonoscopy than those who had the procedure performed under moderate conscious sedation, according to a new study. Researchers examined a database of endoscopy reports from 61 practice sites from patients who had average risk screening colonoscopy and controlled for age, gender, and race. Researcher Katherine M. Hoda, MD, senior fellow, department of gastroenterology, Oregon Health & Science University, said it's unclear if those polyps would have been found if the patients were under moderate sedation and that more studies are needed since this study was small and not randomized.

Three-year follow-up: Patients who had advanced pre-malignant polyps removed during colonoscopy had a substantial rate of advanced polyp detection at second colonoscopy, which guidelines recommend after a three-year interval, according to the results of another study. Removal of polyps with villous and high-grade features was particularly predictive of more future advanced polyps and increased susceptibility to cancer. The rate of discovering advanced polyps at the third colonoscopy was less than the second colonoscopy. However, researchers said it was still high enough to suggest that continued exams are an efficient use of resources.

Labels: conference coverage, digestive disease week

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

Contact ACP Internist

Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by a doctor.

RSS feed

American College of Physicians: Internal Medicine — Doctors for Adults ®

Related ACP Resources:

ACP EHR Partner Program