Ultrasound technique may help make prostate biopsies less invasive

Scientists from Thomas Jefferson University and Hospitals found a way to make prostate biopsies easier and less invasive with the help of contrast-enhanced ultrasound.

This technique uses microscopic, shell-encased gas bubbles to visualize changes in blood flow, thus providing targeted guidance for needle placement during a biopsy. By comparison, standard ultrasound can help clinicians view the size of the prostate and the general area for needle insertion, but cannot tell the difference between benign and malignant tissues.

In order to evaluate the performance of this tool, the team of researchers conducted a phase III trial that included 311 men, who underwent a biopsy with either contrast-enhanced ultrasound or conventional techniques.

The newer modality detected 55 percent of clinically significant prostate cancers. That figure was 17 percent for the standard technique.

“Today, a physician may sample 12 to 18 tissue cores from the prostate in order to help diagnose a patient. But with contrast-enhanced, that number drops to six or even less,” said researcher Ethan Halpern, M.D. “So it’s less invasive, and a more effective guidance tool. We’ve found that with contrast-enhanced ultrasound, we are much more likely to detect cancers on the image, and in this case, the higher grades.”

The study is published in the Journal of Urology.

Nearly 242,000 men in the U.S. will be newly diagnosed with prostate cancer in 2012, as projected by the National Cancer Institute.

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Patients respond better when given doctors’ notes

Medical and dental practitioners may want to consider whether they are interested in somehow giving patients access to their notes following appointments, as a new study has found that it can have positive results.

The study, which took place at three medical centers across the country and encompassed more than 100 doctors, allowed patients access to notes from the physician online following an appointment. Of the more than 13,000 patients included in the research, more than 5,000 looked at the notes at least once and completed a follow-up survey.

Of those patients, those who reviewed the online notes were more likely to be actively involved in their health and were better taking prescribed medications, and many doctors noted improved relationships.

At the end of the study, a full 99 percent of patients said that they wanted the test program to continue in some form. That enthusiasm was present despite the fact that about a third of participants did have some concerns about privacy.

“We were thrilled by what we learned,” Dr. Tom Delbanco, who worked on the study at Beth Israel Deaconess Medical Center in Boston, told Reuters Health. “We had no clue that so many patients would read their notes, and that they would be both as enthusiastic and report so many clinically important changes in their behavior.”

Physicians who took part in the study said that they did not feel incorporating notes online was a significant inconvenience, and all said that they would continue to do so.

If this kind of openness between parties continues to grow, physicians may want to examine medical lending options to improve their level of technological capabilities. While the technique can have positive results, it’s important to weigh concerns about privacy and ensure online notes are secure.

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Upcoding remains a potential issue with EHRs

While much of the medical or dental lending issues surrounding electronic health records have focused on the costs of implementing the systems, officials are now raising the question of how to deal with alleged “upcoding” of Medicare claims.

A letter from Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius, published by the New York Times, warned major medical organizations about the issue, saying that they are aware of the “troubling indications” about the issue.

The controversy concerns the ability doctors and physicians have with EHRs to copy and paste notes from previous patient visits, which can provide the documentation for various tests or higher Medicare codes. Some physicians state that the ability simply allows them to more easily bill for things they might have otherwise done without proper compensation. However, the potential for others to “clone” records from other patients to justify unneeded billing is a connected issue.

Hospital officials quickly responded, also supporting the position that improper upcoding was unacceptable.

“We agree that the alleged practices described in your letter, such as so-called ‘cloning’ of medical records and ‘upcoding’ of the intensity of care, should not be tolerated,” stated Rich Umbdenstock, the chief executive of the American Hospital Association, in a response to the letter.

While medical practice financing to support the implementation of electronic health records may continue to be a question many practices will need to face, having a policy in place to deal with what might be the appearance of upcoding – even if claims are justified – may be another factor to consider. Physicians should be prepared to justify any records which may suggest these steps.

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