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American College of Physicians, April 22-24, 2010

Last Updated: April 27, 2010.

American College of Physicians' Annual Scientific Meeting

The American College of Physicians' Annual Scientific Meeting -- Internal Medicine 2010 -- took place April 22 to 24 in Toronto, and attracted 8,035 attendees from around the world, including 6,169 physician and allied health attendees. The meeting is the largest continuing education event for internists, and this year featured more than 260 workshops, lectures, panel discussions, and demonstrations.

Highlights included a series of sessions cited by ACP Internist that updated members on ACP public policy initiatives, summarized significant new research affecting clinical practice, and addressed the management of some common medical conditions.

"We discussed with the membership the policy process we use to develop our position on health care reform legislation," said new ACP president, J. Fred Ralston Jr., M.D., of Fayetteville Medical Associates in Tennessee. "We also talked about the practical aspects of the new law and how they might be modified, and how we're going to have to work on having the implementation clarified over the next few years."

During a session devoted to health care reform, Ralston and Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, talked about some of the first aspects of the new law to affect internists and their patients: the phase-out of the Medicare "doughnut hole," and expansions in Medicare coverage to include comprehensive health assessments and preventive services that have received an A or B rating from the U.S. Preventive Services Task Force.

Doherty said the next round of significant changes in 2014 will include an expansion of Medicaid coverage for people making up to 133 percent of poverty-level income, and an increase in Medicaid payments to match Medicare rates. Noting that the increased payments are only mandated for a two-year period, during which time they will be covered by the federal government, Doherty said that the ACP will lobby to make the change permanent, and is confident of success. "Once you establish that as a floor, it's going to be hard to take it away," he said in a statement.

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During an update session, Jack Ende, M.D., and Robert K. Cato, M.D., discussed eight recent studies they said have the potential to quickly change clinical practice. The selected articles addressed topics such as the new anticoagulant drug dabigatran and how it will change the management of atrial fibrillation, and the U.S. Preventive Services Task Force recommendation to routinely perform mammograms on women with no risk factors starting at age 50, perform biannual screening until age 74, and no longer teach breast self-examination.

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During a precourse entitled "Cardiology for the Internist," David L. Fischman, M.D., of Thomas Jefferson University in Philadelphia, discussed the risks associated with mixing clopidogrel with proton-pump inhibitors. In patients who need both drugs, Fischman suggested that it may be safer to use the proton-pump inhibitor pantoprazole, which has less effect on CYP2C19, the liver enzyme that metabolizes clopidogrel.

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An "Update in Critical Care" addressed recent research showing that intensive glucose control in critically ill patients is associated with an increased risk of hypoglycemia and fatal events; the benefits of sedation vacations; and strategies to reduce the risk of infection in patients with venous catheters.

Henry Masur, M.D., chief of the critical care medicine department at the National Institutes of Health, discussed a recent study showing that death rates are higher in patients with septic shock who initially receive inappropriate antibiotic therapy than in those who receive appropriate therapy (52 versus 10 percent). He said the study supports the wider use of broader-spectrum drugs in intensive care units based on the physician's understanding of the patient and likely causes of the potential infection. "With a life-threatening infection, you can't afford to guess wrong," Masur said in a statement.

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During another session, Neil M. Resnick, M.D., of the University of Pittsburgh, spoke about the diagnosis and treatment of female urinary incontinence, which affects an estimated 20 to 25 percent of premenopausal women and about twice that many postmenopausal women. He recommended a multi-step workup that includes the assignment of a voiding diary and an investigation of possible transient causes such as infection or stool impaction. He noted that treatment of these causes will cure incontinence in about one-third of patients, and improve it the other patients.

Cases of persistent urinary incontinence should be treated according to type, Resnick said. For urge incontinence caused by detrusor overactivity, "the cornerstone of treatment is behavioral," he said in a statement. "The only place for drugs is at the very, very, very end, after you've done the rest." He also said that drugs should not be used to treat stress incontinence, citing a recent study showing that overweight women who lose just 5 to 10 percent of their weight can achieve a 50 percent decrease in urinary leakage.

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ACP: Electronic Health Records' Potential Addressed

FRIDAY, April 23 (HealthDay News) -- Electronic health records (EHRs) are vital to achieving effective reporting of quality measures, according to research presented at the annual scientific meeting of the American College of Physicians (ACP), held from April 22 to 24 in Toronto.

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ACP: New Care Initiative to Contain Costs Announced

FRIDAY, April 23 (HealthDay News) -- A new initiative announced this week at the annual scientific meeting of the American College of Physicians (ACP), held from April 22 to 24 in Toronto, will provide physicians and patients with evidence-based recommendations about the benefits, harms, and costs of diagnostic tests and treatments across a wide range of medical conditions. The object is to help physicians and patients determine whether the tests and treatments provide good value.

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ACP: Updates Summarize Key Studies From 2009

FRIDAY, April 23 (HealthDay News) -- A series of articles summarizing some of the most important 2009 studies in the fields of cardiology, gastroenterology and hepatology, hematology and oncology, pulmonary/critical care medicine, and nephrology were published online April 21 in the Annals of Internal Medicine to coincide with the annual scientific meeting of the American College of Physicians, held from April 22 to 24 in Toronto.

Update in Cardiology
Update in Gastroenterology and Hepatology
Update in Hematology and Oncology
Update in Pulmonary and Critical Care Medicine
Update in Nephrology
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