April/May News Briefs

WASHINGTON — Aetna's announcement that it will restore coverage for monitored anesthesia services during colonoscopies was lauded by the 37,000-member American Association of Nurse Anesthetists (AANA), which had requested that the health insurance giant reverse its recent policy change denying such coverage.

"Colon cancer kills, early detection saves lives, and the most reliable method for early detection is colonoscopy," says AANA president Wanda O. Wilson, CRNA, PhD. "Patients and physicians agree that the safest and most comfortable colonoscopy is delivered with monitored anesthesia care (MAC) provided by a certified registered nurse anesthetist (CRNA) or other anesthesia professional. By restoring coverage for MAC as AANA had requested, Aetna is making colonoscopies safer and more accessible for patients."

In December 2007, Aetna proposed denying coverage of MAC by anesthesia professionals in routine GI endoscopy cases, effective April 1, 2008. On behalf of nurse anesthetists, Wilson urged Aetna to withdraw the policy. In a February meeting, AANA and Aetna representatives carefully examined the evidence Aetna was relying on to make policy. Included were data showing that patients undergoing colonoscopy with propofol rated their procedures as being more comfortable (81 percent vs. 47 percent). The data also showed that patients were more likely to report that they felt no discomfort (84 percent vs. 66 percent) and had a shorter recovery time (12 min. vs. 93 min.).

"We respect that Aetna has expressed concerns about propofol MAC for colonoscopies costing too much," says Wilson. "Though insurers have reportedly stated that anesthesiologists charge up to $1,000 for this service, such a figure is two to three times what CRNAs report from other private payers, and about eight times Medicare’s fee. We realize Aetna hopes that new technology can further reduce costs. With the Institute of Medicine reporting that today’s anesthesia is 50 times safer than in the early 1980s, America’s CRNAs have long been on the forefront of technological change that improves patient safety."

As obesity and carb-intake rates have increased, so has specific cancer

CLEVELAND, Ohio — Cases of esophageal cancer (adenocarcinoma) in the United States have risen in recent decades from 300,000 cases in 1973 to 2.1 million in 2001 at age-adjusted rates. A new study published in The American Journal of Gastroenterology shows that these rates in the United States closely mirrored trends of increased carbohydrate intake and obesity from 1973-2001.

The study illustrates what may be a public heath concern as the composition of U.S. diets changes and total carbohydrate and refined carbohydrate intakes increase. Obesity is a risk factor for many types of cancer, and a diet that includes a high percentage of calories from refined carbohydrates is a common contributor to obesity. Carbohydrates were also unique in that no other studied nutrients were found to correlate with esophageal cancer rates.

The causes of esophageal cancer remain largely unknown. Despite recent advances in treatment, esophageal cancer has a poor prognosis. The five-year rate of survival for esophageal cancer remains below 20 percent and is the eighth-leading cause of cancer related death in American men.

"If we can reverse the trends in refined carbohydrate intake and obesity in the U.S., we may be able to reduce the incidence of esophageal cancer," says Li Li, PhD, MPH, senior author of the study.

UCLA and University of North Carolina researchers have found that women with irritable bowel syndrome (IBS) who have experienced sexual and/or physical abuse may have a heightened brain response to pain that makes them more sensitive to abdominal discomfort.

Researchers used brain imaging to show that patients with IBS who also had a background of abuse were not as able to turn off a pain modulation mechanism in the brain as effectively as were IBS patients who had not suffered abuse.

According to previous studies, more than 50 percent of patients with IBS have been physically or sexually abused at some time in their lives. The new finding may help explain why those in this subset of IBS patients experience greater pain and poorer health outcomes than others with the disorder. Such insight provides a greater understanding of how the disorder develops and may offer new pathways for treatment. Brain imaging studies were performed at the UCLA Brain Mapping Center.

The study was funded by the National Institutes of Health (NIDDK and NCCAM). The research appears in the Feb. 1, 2008, online edition of the peer-reviewed journal Gastroenterology.

Source: University of California, Los Angeles (UCLA), Health Sciences

ROCHESTER, Minn. — A new Mayo Clinic study found that endoscopic ultrasound-guided therapy appears to be a safe and effective treatment for patients with severe gastrointestinal bleeding for whom conventional therapies have failed. The study was published in the February issue of American Journal of Gastroenterology.

"Despite advances in conventional therapies, recurrent bleeding is common in many patients," says Michael Levy, MD, an author of this study and a gastroenterologist at Mayo Clinic. "At times, there are no options for patients with severe and refractory bleeding and, unfortunately in this setting, the morbidity and mortality are high."

Levy and a team of Mayo Clinic physicians set out to identify more effective therapies to control bleeding and manage recurrent bleeding if standard therapies do not work. The team reviewed the results of five patients with severe gastrointestinal bleeding who received endoscopic ultrasound-guided therapy.

"Endoscopic ultrasound imaging often provides more detailed information about the appearance, size, and precise location of bleeding than other endoscopic or radiologic imaging modalities," says Levy. "Equally important, endoscopic ultrasound provides specific details about the anatomy of the blood vessels surrounding the bleeding so therapy can be precisely delivered to the most effective location."

This study sheds light on an additional therapy that appears to be both safe and effective in halting severe and refractory gastrointestinal bleeding. Each patient in the study had experienced at least two episodes of severe bleeding and at least two attempts at conventional therapy to control the bleeding had not worked. Using endoscopic ultrasound guidance, the team was able to identify and characterize the location of each patient’s bleeding. With the specific site of bleeding in view, various agents such as 99 percent alcohol or medical glue were injected directly into the source to stop the bleeding. Following this therapy, none of the five patients experienced recurrent bleeding and no complications were reported.

Levy and his team have continued to perform and evaluate this therapy to confirm its safety and effectiveness and to identify the type of patient most likely to benefit from endoscopic ultrasound-guided therapy. This therapy is considered only in carefully selected patients following consideration by a multidisciplinary team of endosonographers, clinicians, surgeons and interventional radiologists.

LAS VEGAS — The Southern Nevada Health District is notifying approximately 40,000 patients of a local medical clinic about potential exposure to hepatitis C following an investigation of several acute cases of the illness. Patients who had procedures requiring injected anesthesia at the Endoscopy Center of Southern Nevada, located at 700 Shadow Lane, Las Vegas, began receiving letters at the end of February. The health district’s notification includes patients who had procedures at the clinic between March 2004 and January 11, 2008, and recommends they contact their primary care physicians or healthcare providers to get tested for hepatitis C as well as hepatitis B and human immunodeficiency virus (HIV).

The health district identified a cluster of three acute cases of hepatitis C in January 2008 and has identified a total of six cases to date. The health district typically receives reports of approximately two cases of acute hepatitis C annually. Five of the cases had procedures requiring injected anesthesia on the same day. Following a joint investigation with the Nevada State Bureau of Licensure and Certification (BLC) and with consultation from the Centers for Disease Control and Prevention (CDC), the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients. The exposures did not result from the medical procedures performed.

The joint investigation identified the re-use of syringes (not needles) and the use of single-dose vials of anesthesia medication on multiple patients as the potential sources of contamination. The clinic took corrective action when notified by staff conducting the investigation.

This center and five others under the same ownership have had their licenses revoked.

"Based on the information we discovered during our investigation, it appears the injection practices that can lead to the transmission of hepatitis C and other bloodborne infections have been occurring at this clinic for several years. We are recommending all patients during this timeframe to get tested because we cannot determine which patients may have been exposed," says Lawrence Sands, chief health officer.

The Southern Nevada Health District has posted additional information on its Web site at www.SouthernNevadaHealthDistrict.org. In addition, the health district has set up a hotline at (702) 759-4636 (INFO) for people with questions about this notification or hepatitis C.

Source: Southern Nevada Health District

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