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Summer 2013

California Law Requires Dense Breast Notification

A new California law (SB538) requires radiologists to notify women by letter when their screening mammography shows they have dense breast tissue. About 50 percent of U.S. women have dense breast tissue, as defined by the American College of Radiology. In response to the law (effective April 1) and to assist providers and patients to understand breast density, the California Breast Density Information Group, including UCSF radiologists, created an evidence-based informational website at www.breastdensity.info.

Dense breast tissue can make it harder to evaluate a mammogram and is associated with an increased risk of breast cancer. About 40 percent of women have heterogeneously dense breast tissue, which has a breast cancer risk that's about 1.2 times greater than average breast density. About 10 percent of women have extremely dense breasts, which has a cancer risk that's two times greater than average breast density. The UCSF Breast Imaging Clinic offers advanced imaging techniques, such as full-field digital mammography and screening breast MRI for high-risk women. To refer a patient, call (415) 353-2573 or visit www.UCSFhealth.org/clinics/breast_imaging.

UCSF Opens Pediatric Emergency Department

UCSF Benioff Children's Hospital has a new Pediatric Emergency Department that's open 24 hours. The ED, which opened in April at 505 Parnassus Ave. in San Francisco, is staffed by doctors and nurses trained in pediatric emergency medicine and who work with UCSF's pediatric specialists, as necessary. Child life specialists are available to explain treatment to children and help them cope with their fears. For more information, see www.UCSFbenioffchildrens.org/emergency.

New Device for Fecal Incontinence in Women Being Tested

The LIFE (LivSure for Fecal Incontinence) study, conducted by the UCSF Center for Pelvic Physiology, is evaluating the experimental LivSure vaginal insert for the control of fecal incontinence (FI). The insert is non-surgical and doesn't contain drugs or hormones. It resides in a position similar to a diaphragm or tampon. Like a diaphragm, it can be removed by the patient at any time. While in the vagina, the device supports the rectum in a way that may control bowel leakage.

Several other new treatments also are available for the nearly 18 million adults in the U.S. — about one in 12 — who have FI. Therapies include sacral nerve stimulation that uses electrical pulses to keep the anal sphincter closed. Electrodes are inserted under the skin in the lower back and connected to a pulse generator. When a person wants to pass feces, he or she uses a magnet to interrupt the pulses of electricity. To refer a patient to the UCSF Center for Pelvic Physiology, call (415) 885-7673 or visit www.UCSFhealth.org/pelvicphysiology. To refer a patient to the LivSure study, call (415) 353-7252.

UCSF Expands Pediatric Sleep Lab

Research has shown that children and adolescents with obstructive sleep apnea (OSA) have increased neuropsychological morbidity, including mood disturbance and poor academic performance. It also causes deficits in attention, memory and executive functions as well as behavior problems, predominantly hyperactivity, impulsivity, aggression, oppositional behavior and conduct problems. Common medical disorders associated with childhood OSA include asthma, allergic rhinitis, attention deficit hyperactivity disorder (ADHD) and obesity. OSA is thought to affect 1 to 3 percent of children, although the number may be higher as the condition often goes undiagnosed.

The Pediatric Sleep Laboratory at UCSF Benioff Children’s Hospital, one of the only sleep centers of its kind in the Bay Area, has been upgraded to include a bed in a homelike setting, rather than a hospital bed, for overnight polysomnograms. After recently expanding its staff, the wait time for a sleep study, offered seven days a week, has been reduced to a month with test results back in one to two weeks. Children, ranging from babies to adolescents, are evaluated for obstructive or central sleep apnea, periodic limb movement disorder and parasomnias. To refer a patient, fax a referral to (415) 476-9278 or visit www.UCSFbenioffchildrens.org/sleeplaboratory for more information.

Diagnostic Challenges in Outpatient Settings

About half of primary care physicians (PCPs) report missed or delayed diagnosis, involving at least 5 percent of patients, according to a study published in BMJ Quality and Safety (July 20, 2012). The study, conducted by UCSF internist Dr. Urmimala Sarkar in collaboration with colleagues at Kaiser Permanente, surveyed 1,054 PCPs in integrated health systems across 10 geographically dispersed states in 2005. Factors contributing to diagnostic delays included insufficient knowledge of the condition (20 percent), diagnostic test not available in a timely manner (19 percent), delay in test results notification (14 percent), and referral delays (20 percent). PCPs noted that without a gold standard of tracking test results, process breakdowns are common.

Strategies to improve diagnosis include reducing workloads to allow for critical thinking, longer visit times with patients to allow more thorough histories and physical exams, improving communication and collaboration between providers, improving computer systems so patient medical histories are more accessible, reducing wait times for tests and improving test result tracking. See the article at http://tinyurl.com/bmjdiagnosis.

Online Recruitment for Clinical Trials

The UCSF Research Participant Registry helps connect research participants to clinical studies. Participants don't have to be ill to join the registry. Healthy participants are needed too. The registry is currently recruiting for:

  • Brain Initiative, a study designed to transform the way research is conducted in brain function and aging by creating a large database of individuals interested in brain health.
  • Tobacco Status Project, designed to measure the efficacy of a Facebook-based tobacco cessation group, tailored to each participant's readiness to quit smoking. The Tobacco Status Project is for 18- to 25-year-old smokers. Smokers who want to quit and those who don't want to quit are eligible for this year-long study. Participants will be paid between $130 and $180.

Continuing Medical Education

UCSF's Continuing Medical Education Program offers courses throughout the year. The following are upcoming conferences:

  • Essentials of Primary Care: A Core Curriculum for Ambulatory Practice, Aug. 4 - 9, Resort at Squaw Creek, North Lake Tahoe
  • Primary Care Medicine: Principles and Practice, Oct. 31- Nov. 2, Hotel Nikko, San Francisco
  • Controversies in Women's Health, Dec. 12 - 13, Hotel Nikko, San Francisco

For more information, call the CME office at (415) 476-4251 or visit www.cme.ucsf.edu.

Need Help Making a Referral?

UCSF Medical Center

The Physician Liaison Service assists physicians, medical groups and health plans refer patients or arrange consultations.
Phone: (800) 444-2559
Fax: (415) 353-4395
Email: referral.center@ucsfmedctr.org
Website: www.UCSFhealth.org/healthprofessionals

UCSF Benioff Children's Hospital

Our toll-free Access Center is the gateway for all services at UCSF Benioff Children's Hospital.
Phone: (877) 822-4453 (UC-CHILD)
Websites: www.UCSFbenioffchildrens.org/accesscenter and www.UCSFbenioffchildrens.org/healthprofessionals

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