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19-08-2012 | Article

The week in review, August 12‑18

medwireNews: This week's news featured warnings to fairgoers about porcine petting, bad news about a drug-resistant sexually transmitted disease, malpractice payments take a dive, primary care practitioners (PCPs) fare better than other physicians in salary gains, weighty news on US obesity and antisnack food laws in schools, and US hospitals get slapped on the wrist for readmissions.

This little piggy has swine flu

Don't pet pigs, the Centers for Disease Control and Prevention (CDC) advises.

As of August 10, there were a total of 153 cases of human infection with influenza A (H3N2) variant virus (H3N2v), more commonly known as "swine flu," this year, report Shawn Richards (Indiana State Department of Health) and co-authors in Morbidity and Mortality Weekly Report.

The virus appears to be transmitted to people who touch infected pigs, with more than 90% of the reported infections in children younger than 18 (median age 7 years). Most cases are mild, self-limited, and resolve without further treatment and there have been no reported deaths, although two patients were hospitalized. Both have recovered and were discharged, the CDC reports.

The patients, primarily from Illinois, Indiana, and Ohio, had all reported direct or indirect contact with pigs, mostly at country fairs.

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For gonorrhea, resistance is not futile

Oral cephalosporins are no longer recommended for treatment of gonococcal infections, due to the emergence of antimicrobial-resistant gonorrhea, health authorities warn.

Urethral Neisseria gonorrhoeae isolates collected in the USA over the past 6 years show increasing resistance to cefixime, an oral cephalosporin antibiotic that is one of the last remaining defenses against gonorrheal infections, according to the CDC.

Instead of an oral cephalosporin, the CDC now recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose, or doxycycline 100 mg orally twice daily for 7 days for treatment of uncomplicated gonorrhea.

The CDC advises that when a patient has a persistent gonococcal infection after treatment with the recommended combination regimen, clinicians should culture clinical specimens and test the isolates for antimicrobial susceptibility.

If ceftriaxone is not available or contraindicated, patients may be treated with either cefixime 400 mg orally plus either azithromycin 1 g orally or doxycycline 100 mg twice daily orally for 7 days, or azithromycin 2 g orally in a single dose if ceftriaxone cannot be given because of severe allergy.

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Malpractice payments fall to lowest level since records began

Malpractice payments made by insurers on behalf of physicians were at their lowest ebb in 2011, a public advocacy group reports.

Adjusted for inflation, the value of malpractice payments was at the lowest level since the US government began collecting insurance payout data in 1991, says a report by Public Citizen, based in Washington, DC.

Although welcome news for physicians, hospitals, and insurers, the downward trend comes at the expense of patients, writes Taylor Lincoln, research director for Public Citizen's Congress Watch division.

The investigators found that malpractice payments were 0.12% of the USA's total healthcare bill in 2011, and that in 2010 the liability insurance premiums were lower than at any time since data collection began.

The author says that the data contradict claims of unjustified malpractice awards made by advocates for tort reform.

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PCP salaries hold their own

According to the American Medical Group Association (AMGA), primary care specialists as a whole experienced an increase in compensation in 2011 of approximately 4.0% compared with 2010. Other medical specialists saw an average 2.8% increase, and surgical specialists enjoyed a 3.4% average bump-up in pay.

Among PCPs, family medicine practitioners had the highest average pay raise at 5.1%.

Hematologists/oncologists fared the best of all specialists, netting an average 7.13% increase over the previous year, followed by hypertension experts and nephrologists (6.99%), and urgent care practitioners (5.17%).

But the survey also showed that "many provider organizations continue to operate at a significant loss (eg, ‑US $ 1235 per physician national median operating margin), and although 79% of specialties saw increases in compensation in 2011, most increases were marginal," according to a statement on the AMGA website.

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Living large

Twelve US states now have adult obesity rates topping 30%, according to a report.

Mississippi once again earns the dubious distinction of having the heaviest population, with 34.9% of its adult citizens being obese, compared with 20.7% for Colorado, which continues to boast the lowest obesity prevalence of all 50 states and the District of Columbia.

The figures come from an analysis of CDC data published by the Trust for America's Health and the Robert Wood Johnson Foundation.

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School snack controls work

In states with laws regulating nutrition in "competitive" foods ‑ food and drink sold outside of federal meal programs ‑ students gained fewer body-mass index (BMI) units than children in states with no such laws, report Daniel Taber (University of Illinois, Chicago) and colleagues in Pediatrics.

Students in states with tougher food laws were also less likely to become overweight or obese over time, the study showed

The team found that in states where competitive foods in schools were tightly controlled at baseline, students gained an average of 0.25 fewer BMI units than did students in states with no such laws. Additionally, students in states where the laws remained consistently strong throughout the study period gained fewer BMI points than students in states with no laws.

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High readmission rates cost hospitals

Hospitals in the USA are expected to lose a combined $ 280 million in Medicare reimbursements when a new rule governing readmissions goes into effect in October, a report says.

Among the more than 2211 hospitals that will forfeit some of their Medicare reimbursements, 278 will lose the maximum amount allowed under the healthcare law: 1% of their base reimbursement amount.

The hospitals paying the biggest penalty include Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, New York, and Beth Israel Deaconess Medical Center in Boston.

The penalties will be based on 30-day readmission rates from July 2008 through June 2011 for heart failure, acute myocardial infarction, and pneumonia. Future Medicare reimbursements will have the specified penalty amount, which is expected to rise, deducted from the total.

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By Neil Osterweil, medwireNews Reporter