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American College of Physicians, April 23-25, 2009

Last Updated: April 28, 2009.

American College of Physicians Internal Medicine 2009

The American College of Physicians' (ACP) Internal Medicine 2009 conference took place April 23 to 25 in Philadelphia and attracted about 10,000 attendees, including more than 6,000 internists. The meeting presented 260 lectures, workshops and demonstrations to update members on recent clinical developments, ACP policy initiatives and patient education efforts.

The meeting's Scientific Sessions included updates on hypertension, vaccines, breast cancer, drug interactions, and delirium in hospitalized older adults. During one session, Scott E. Kasner, M.D., director of the Comprehensive Stroke Center at the University of Pennsylvania in Philadelphia, gave a lecture entitled "Debunking the gospel of heparin for strokes."

Kasner urged attendees to rethink the "heparinism gospel" that supports treating every stroke patient to prevent recurrent embolism, stroke propagation of thrombus, and systemic thromboembolism. He faulted neurologists for rejecting the conclusions of three major randomized trials that found that acute anticoagulation had no benefit. "It was heparinism heresy," Kasner said in a statement.

In most patients with a cardioembolic source of stroke, Kasner recommended waiting to administer heparin -- 48 hours in those with minor strokes and five to seven days in those with major strokes. In most patients with other sources of stroke, he said that antiplatelet therapy is preferable to heparin. "Aspirin, ticlopidine, clopidogrel, and dipyridamole plus aspirin are as effective, safer, easier to use, and less expensive," he said in a statement.

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During another session, Robert J. Mayer, M.D., of the Dana-Farber Cancer Institute at Harvard University in Boston, suggested that adult-dose aspirin may significantly reduce the risk of colon cancer. He cited a subgroup analysis of 83,000 women enrolled in the Nurses' Health Study showing that an intake of more than 14 aspirin tablets per week was associated with a one-third lower risk of colon cancer mortality.

"This is cohort observation, but the numbers here are so large, and there are so many other data that support this with a dose relationship, that I think most of us have accepted this observation," Mayer said in a statement.

Mayer said that folic acid and calcium also may help prevent colon cancer and that vitamin D deserves more investigation, but added that fiber and antioxidants such as vitamins C and E have been conclusively shown to have no preventive effects.

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During the meeting, two new policy papers were presented during a panel discussion entitled "ACP's Comprehensive Strategies for Payment Reform and Solutions to the Challenges Facing Primary Care Medicine."

"These reforms are all designed to help support primary care, which is on the verge of collapse," said ACP president-elect, Joseph W. Stubbs, M.D., a private practitioner based in Albany, Ga.

The "Payments" paper contains 30 policy recommendations aimed at achieving greater value in health care spending. The "Solutions" paper contains a comprehensive strategy to reform medical education, reduce regulatory and administrative burdens, and redesign the finance and delivery of primary care to encourage a greater number of physicians to enter the field.

"Our feeling is that universal health coverage is very important," Stubbs said. "But if you don't reform the health care delivery system so that it rewards the contributions of primary care, then even people with coverage are not going to have access to good care."

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In other developments, the ACP released a free guidebook and DVD featuring sportscaster James Brown to increase patient awareness of hypertension. Sponsored by Daiichi Sankyo Inc., "Know Your Numbers: A Guide to Managing High Blood Pressure" addresses the importance of regular blood pressure screenings and strategies for normalizing high levels. "Almost everyone with hypertension can bring their numbers down with lifestyle changes, medicines, or both," Patrick C. Alguire, M.D., the ACP's director of education and career development, said in a statement.

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"Another exciting development was the announcement that Christine Laine, M.D., will succeed Harold C. Sox, M.D., as the editor of our flagship journal: the Annals of Internal Medicine," Stubbs said. "She has been a very innovative deputy editor, and will help move the Annals forward to being a more current Web-based journal."

"I want to publish practice-defining studies and cutting edge commentary on current issues, while continuing to improve the amount and quality of practical, summative articles that have immediate clinical relevance," Laine said in a statement. "I also plan to devote a great deal of energy to developing innovative electronic delivery of Annals content to our readers, so that the journal is an accessible and trusted source of health information for both physicians and the public around the globe."

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ACP: New Web Site Launched to Increase COPD Awareness

MONDAY, April 27 (HealthDay News) -- A new Web-based resource -- the ACP COPD Portal -- was launched during the annual American College of Physicians' Internal Medicine 2009 meeting, held from April 23 to 25 in Philadelphia, to provide evidence-based information about emphysema and chronic bronchitis.

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ACP: Board Votes to Enhance Perception of Primary Care

FRIDAY, April 24 (HealthDay News) -- Prior to this week's annual American College of Physicians' Internal Medicine 2009 meeting held from April 23 to 25 in Philadelphia, the Board of Regents approved a range of measures to support College members and improve health care nationwide.

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ACP: New Strategies Needed for Controlling Hypertension

FRIDAY, April 24 (HealthDay News) -- Primary care physicians should rethink some treatment strategies for hypertension, according to a presentation at the annual American College of Physicians' Internal Medicine 2009 meeting held from April 23 to 25 in Philadelphia.

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