Every once in a while we get a new health recommendation that calls into question much of what we have been told through the years. The latest, from the American College of Physicians, says there’s little value to the annual pelvic examination in women who are not pregnant and have no worrisome symptoms, such as irregular bleeding or pain.

The College of Physicians says there’s no evidence to support the clinical value of this annual exam — that the exam rarely detects disease and does not reduce mortality. Instead, these exams create discomfort for many women, and are associated with “false positives” and extra cost.

But the American College of Obstetricians and Gynecologists disagrees. It has restated its support for these routine examinations. And in recent days many have publicly told anecdotes of finding masses and other problems in patients during these examinations, even when the women had no symptoms.

At the Quality Institute we are lucky to have Dr. Ronald J. Librizzi on our provider council. He is a perinatologist and chief of maternal fetal medicine at Virtua. He is always sensible and objective so I have asked him to weigh in on this latest controversy and provide women with his thoughts on these conflicting recommendations.

Here’s what he had to say:

I think the critical word here is “routine.” If a woman tests negative for HPV, does not need a pap smear for another two or three years, has no symptoms, such as pain or irregular bleeding, she’s probably OK to skip the annual pelvic exam as a matter of routine.

And of course we also are talking about women with no previous history of cancer or irregular pap smears, or a family history of gynecological cancers, or any other risk factors.

Also it’s important for women to know that skipping the pelvic exam does not mean skipping the annual physical or skipping regular mammograms. At the end of the day, I tell women to listen to their bodies. They know their bodies better than anyone else does.

If something does not feel right they should demand their doctors take them seriously. We know ovarian cancer is usually not found until more advanced stages, and the only symptoms can be bloating, pelvic pressure or indigestion.

So the question is: Should women go for an annual pelvic exam as a matter of routine? We know in medicine that when you chase the bug you find the bug. There is a downside to over-screening; we find things that would never harm people but then feel compelled to treat them. We also know the anxiety of false positives can harm woman, and of course unnecessary screening contributes to the cost of health care.

I suggest women talk to their physicians and ask about their risk factors. Ask your doctor to explain exactly how, and if, a routine exam will help you. Don’t just obtain an annual pelvic exam because you always did in the past. And most important, listen to your body. You know your body better than your doctor knows your body.

MADISON – The weekly Madison Farmers’ Market is about “Jersey Fresh” food.

It’s also about charity, through its “Buy Fresh, Give Fresh” donations of food every week to the Faith Kitchen soup kitchen in Dover.

On Thursday, July 31, the themes of great food and generosity to the poor will be highlighted at the market with a visit by the chief executive chef of a nonprofit dining club dedicated to charity.

Special attractions are a weekly occurrence at the Madison Farmers’ Market, which is open from 1 to 6 p.m. each Thursday – including this coming Thursday, July 24, which will feature its own added events – now through Oct. 16 on Green Village Road at Main Street, outside the Museum of Early Trades and Crafts at 9 Main St.

On July 31, the Madison Farmers’ Market will partner with the elegant Park Avenue Club of Florham Park when Executive Chef Arnold Kruck will demonstrate recipes using market produce, as well as working with the farmers to show shoppers new ways to use the products available at the market.

Spirit Of Giving’

The nonprofit Park Avenue Club not only provides its members with memorable dining experiences, but also has a mission to benefit various charities and cultural organizations through its relationship with the Park Avenue Foundation. The dining club is committed to offering the highest level of service and cuisine to its members while at the same time celebrating “The Spirit of Giving” in the community.

Executive Chef Kruck explained, “The Park Avenue Club is coming to the Madison Farmers Market because our culinary philosophy is very much ‘farm-to-table,’ and through our relationship with the Park Avenue Foundation it is centered around the ‘Spirit of Giving,’ where it is our goal to ‘give back;’ what better way to ‘give back’ than to break bread with our neighbors who support the same culinary philosophy as the club?

“This is not only an opportunity for the chef to educate the market-goers on unique and creative ways for them to utilize the best of the fresh produce,” Kruck noted, “but also to create creative dishes for their children as well, so that a vegetable becomes a friend and not a foe.”

The Park Avenue Club continues to fulfill the mission it was founded on: to succeed in its nonprofit work with a variety of charities and organizations. Kruck said the chefs from the Park Avenue Club look forward to inspiring and working with the community on different ways to cook with featured farmers’ market products.

In addition to Executive Chef Kruck of the Park Avenue Club, the market on Thursday, July 31, will feature Georgia Van Ryzin of Van Ryzin Design of Madison, selling her designs, including new yoga skirts for summer.

At This Thursday’s Market

But market patrons won’t have to wait to July 31 for special attractions.

At the Farmers’ Market this coming Thursday, July 24, the nonprofit Friends of the Madison Public Library will return to the market to sell tickets to their fund-raising “Touch-A-Truck” event for children and families, coming up from 10 a.m. to 3 p.m. Saturday, Aug. 2, along Keep Street from the library to the Madison Area YMCA. Tickets for toddlers to 12-year-olds are $8 in advance and $10 on the day of the event; admission for teens and adults is $5. This time the Friends group will bring a fun car to the market to give people a preview of the “Touch-A-Truck” experience.

This coming Thursday’s market, July 24, also will host Jaime Conroy and other representatives from Autism Speaks, publicizing the upcoming “Autism Speaks Walk,” scheduled for Saturday, Oct. 25, in Morris Plains.

And, representatives of Fulton Bank of Madison will visit the July 24 market, giving away their distinctive bright blue umbrellas, piggy banks, water bottles, and reusable shopping bags.

‘Jersey Fresh’

The Madison Farmers’ Market is presented by the borough’s Downtown Development Commission (DDC) and sponsored by Drew University, 36 Madison Ave. and Gary’s Wine and Marketplace, 131 Main St., both of Madison.

Along with the main attractions – “Jersey Fresh” produce at the Alstede Farms, Melick’s Town Farm and Vacchiano Farm tents – the weekly market features a variety of vendors, including Kettle Korn, Pickle Licious, Paolo’s Kitchen, Gourmet Nuts and Dried Fruits, Secret Garden Soap of Madison, Breadsmith, and Squeezed Fresh Lemonade.

Sponsor Gary’s Wine and Marketplace has a weekly presence at the market as well, inviting shoppers to sample an array of artisan cheeses, spreads, dips, and breads.

Meanwhile, human patrons aren’t the only visitors enjoying refreshments and treats at the Farmers’ Market. Since a good number of shoppers bring their dogs along with them to the weekly market, Ned Finn of the nearby Madison Pet Shop at 26 Main St. is placing a bowl of fresh water outside his store each Thursday for thirsty dogs. As always, Finn also has free treats for dogs inside his shop as well.

‘Buy Fresh, Give Fresh’

For the second year, Farmers’ Market patrons also have the opportunity to help feed the needy through the “Buy Fresh, Give Fresh” program, which is running weekly throughout the 2014 season.

Last year, Drew University and the Madison Farmers’ Market collaborated on the “Buy Fresh, Give Fresh” program, which enabled shoppers to buy a little extra fresh produce at the market and donate it to Faith Kitchen, the soup kitchen run by Trinity Lutheran Church in Dover.

While “Buy Fresh, Give Fresh” debuted on a monthly basis in 2013, the program is running weekly this year on each market day. Drew University Sustainability Director Tina Notas explained, “In 2013 we ran the program once a month, and it was embraced by Madison shoppers who often looked for the collection site on the weeks we weren’t doing it. So this season we will collect produce every week.

“We were very pleased that the people of Madison supported this so enthusiastically,” Notas added.

Volunteers Welcome

The “Buy Fresh, Give Fresh” program welcomes volunteers to help transport the donated Farmers’ Market produce to Dover. Volunteers will pick up the donated produce from the Farmers’ Market between 6 and 6:45 p.m. each Thursday, and then deliver it to Trinity Lutheran Church on the morning of the following day, Friday, any time after 8 a.m.

For organizations, congregations, Scout troops, businesses, families and individuals interested in volunteering, the program has schedule openings available through Thursday and Friday, Oct. 16 and 17. Prospective volunteers are asked to email Farmers’ Market Coordinator Barbara Hughes at

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A new study has found that medical care provided through innovative “patient-centered” programs is yielding both better-coordinated care and lower costs, according to Horizon Blue Cross Blue Shield of New Jersey. Horizon on Tuesday released results of a 2013 study of more than 200,000 members enrolled in various patient-centered programs.

“Our most recent study results clearly demonstrate the value of the patient-centered model, which will continue to improve and transform health care in New Jersey,” said Jim Albano, Horizon vice president of network management and Horizon Healthcare Innovations. “The results also demonstrate the commitment of our participating doctors, nurses and care teams, and we look forward to expanding these efforts to benefit more of our members.”

Horizon said it now has more than 500,000 of its members enrolled in patient-centered care. The 2013 study of claims data for more than 200,000 of them shows patient-centered practices are performing better than traditional practices in a number of clinical metrics, including:

14 percent higher rate in improved diabetes control.
12 percent higher rate in cholesterol management.
8 percent higher rate in breast cancer screenings.
6 percent higher rate in colorectal cancer screenings.
The study also shows that these patient-centered practices achieved lower costs, as evidenced by:

4 percent lower rate of emergency room visits.
2 percent lower rate of hospital admissions.
4 percent lower cost of care for diabetic patients.
4 percent lower total cost of care.
Joel Cantor, director of the Rutgers Center for State Health Policy, said the numbers are impressive.

“Clearly, Horizon sees patient-centered care models as the future; they are investing heavily in them,” Cantor said. “There is growing evidence from studies around the country that these models achieve better care at lower cost, particularly for patients with complex chronic illnesses. They also appear to improve access to care for patients overall.”

Horizon said “patient-centered” care refers to innovative approaches where health insurance companies provide incentives to doctors to meet certain clinical quality, patient satisfaction and efficiency benchmarks. Unlike the traditional fee-for-service model, patient-centered practices are financially rewarded to improve the patient experience and improve care based upon national clinical guidelines.

The company said the study found that members in patient-centered practices avoided more than 1,200 emergency room visits and 260 inpatient hospitals admissions, which represent a savings of approximately $4.5 million.

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, said: “The numbers are impressive. Giving providers data on their patients, paying providers to spend more time with their patients and provide more comprehensive and holistic care, and sharing savings with customers by reducing the cost of insurance premiums makes good sense. The next step will be to provide more information to consumers about the cost to them and the quality of the health care services out there. As networks narrow, consumers need to have the right information to make the best decisions for them, their family and their wallet.”

Horizon, the state’s largest health plan provider with more than 3.7 million members statewide, said it has 3,700 physicians in more than 900 locations in its patient-centered network.

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