In a surprise twist, authors here retracted findings of a study that found N95 respirators were better than surgical masks at preventing flu.

After a re-analysis prompted by questions from reviewers, the findings were no longer significant, said Holly Seale of the University of New South Wales in Sydney, Australia.

The original study, presented earlier this year, formed the basis of several important policy decisions, including Centers for Disease Control and Prevention guidance on the use of masks in a health care setting.

The retraction — near the end of a presentation at the annual meeting of the Infectious Diseases Society of America — prompted a “rush to the microphones” by those involved in flu prevention, one expert said.

The findings appeared to differ — not only from previous reports, but also from the abstract submitted to this meeting, said Dr. Andrew Pavia of the University of Utah.

Seale acknowledged those differences and agreed that the original results no longer stand. She was not immediately available for additional comment.

The lead author of the study, Raina MacIntyre, also of the University of New South Wales, did not attend the meeting here.

The retraction took experts here by surprise, although many had been critical of some statistical aspects of the study, according to Dr. Neil Fishman of the University of Pennsylvania.

“I think there was little bit of shock that there was such a large change (in the results),” he told MedPage Today after the session.

The study was first presented in San Francisco earlier this year and led to important policy decisions in the United States.

Among other things, it influenced an Institute of Medicine recommendation that health care workers caring for flu patients should use the more expensive N95 respirators.

The doctor doesn’t look like much of a crusader, bent over the frail frame of 90-year-old Alberta Scott.

He has a lavender stethoscope strung round his neck and some serious bedside manner at work on this stubborn nonagenarian who wants to be anywhere but where she is: in a nursing home bed, hoping to heal and get back home.

“Squeeze my hand,” Dr. Peter Boling prods. “Squeeze my hand. Come on. Hard!”

This is Boling’s day job, providing medical care to some of Richmond’s oldest and sickest patients. A geriatrician and head of general medicine at Virginia Commonwealth University Medical Center, he visits nursing home patients with a smile and an encouraging word, and he leads a team of specialists who take to the road, medical bags in hand, to see patients where and when they need it most — in their own homes, before a crisis lands them in the ER or a nursing facility.

Boling and his team make house calls.

And now he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma.

There are house-calls programs here and there. San Diego. Boston. The Veterans Health Administration cares for thousands in their own homes, saving money by reducing unnecessary hospitalizations and emergency room visits.

But Boling wants to bring house calls to the masses — up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost savings, but to provide a financial incentive to persuade more doctors to return to this kind of work. It’s also about improving access and providing patients the independence they so desire.

Mostly, it’s about people like Alberta Scott and the questions that first came to Boling’s mind when he heard she’d been admitted to an institution for treatment of a blood infection.

In a few weeks, if all goes well, can she go home? If so, who will take care of her?

———

At 55, Boling has a vague memory of his own pediatrician standing in the kitchen of his childhood home. It’s not an image many of us can conjure in an era of overcrowded ERs and specialty clinics and the type of “managed care” that often means a long wait in a sterile reception room followed by a hasty examination.

The visiting doc went out not long after the horse and buggy, as technology advanced and institutionalized health care became the norm. In 1930, house calls accounted for 40 percent of doctor-patient encounters. By 1980, that had dropped to less than 1 percent. Today, about 4,000 of the nation’s 800,000-plus doctors make house calls a substantial part of their practices, although nurses and physician assistants have picked up some of the slack, the American Academy of Home Care Physicians reports.

Boling was just a young doc himself, finishing up his residency, when a mentor persuaded him to spend half his time doing clinic work, and the other half developing a house-calls program. Like most medical students today, Boling had never thought about making house calls a part of his practice. He nevertheless hung a giant map of Richmond on his office wall and began identifying patients who lived within a 15-mile radius of the downtown VCU medical center.

Each home was marked on the map with colored pins, and visits were scheduled by geography — north, south, east, west — to maximize Boling’s time. It took only a few stops, and some memorable patients, for Boling to recognize that home care made sense.

For pregnant women, an influenza vaccination leads to bigger babies and infants who are less likely to get the flu, according to three studies presented here.

Experts said the findings — presented at the annual meeting of the Infectious Diseases Society of America — might help persuade pregnant women reluctant to get a flu shot.

It might also bring the issue to the attention of obstetricians, who typically do not raise the notion of a flu shot with their patients, said Dr. William Schaffner, infectious disease specialist and chair of Preventive Medicine at Vanderbilt University Medical Center in Nashville, Tenn.

“This is powerful information for obstetricians and pregnant women to have,” said Schaffner, who moderated a news conference at which the studies were discussed.

The findings are all the more persuasive, he said, because different investigators, using varied methods, “all came out with the same answer.”

The issue is important, according to Dr. Marietta Vazquez, a pediatric infectious disease specialist at the Yale University School of Medicine, because the proportion of pregnant women who are vaccinated against the flu is “dismal” — fewer than one in four, she and others said.

Vazquez and colleagues conducted a study of infants admitted to their hospital, starting in 2000. Infants with confirmed flu were the cases, and for comparison they each were matched with two babies who were admitted for other reasons.

Proof in the Numbers

The goal of the study is to compare the mothers — using both questionnaires and medical records — to see if they were vaccinated during their pregnancies, Vazquez said.

For the 119 women with complete medical records and an infant with the flu, only 5 percent had been vaccinated, the researchers found. By contrast, of the 172 mothers of control infants, 16 percent had been vaccinated.

The numbers suggested that flu vaccine given to mothers during pregnancy is effective in preventing hospitalization of their infants, Vazquez said.

Specifically, for all nonvaccinated infants, the effectiveness was 80.4 percent.

Vazquez said the results might help persuade more women to get vaccinated. “If they’re not getting vaccinated for themselves,” she said, “maybe they’ll do it for their babies.”

Since outbreaks of the so-called swine flu first made headlines in April, Americans have nervously anticipated the virus’ second coming in the fall, when traditional flu season begins. But while the first shipments of the vaccine for H1N1 are available, many people find themselves unable to get protection, even if they are in high-risk groups.

“My diabetes doctor does not have it, my private doctor does not have it,” Maryland resident Kathy O’Grady, 38, said. “They tell me I need it and I can’t get it.”

Like other patients with chronic diseases, pregnant women are in danger of being left out initially because they can only receive the shot, not the nasal spray form delivered in many of the early shipments.

“That is frustrating because you know that was a missed opportunity and they made the effort and they came out and we wish we had the vaccine for them,” said Dr. Ulder Tillman, a Montgomery County, Md., health officer.

O’Grady was among those turned away this week without a vaccine.

Susan Schwartz, a mother of two boys, Gary, 6 and Ryan, 3, had been waiting in line for four hours.

“I am still terrified that we are going to get to the front of the line and they are going to say, “So sorry, we just gave the last dose to the people in front of you,’” she said.

The problems are not limited to people like Schwartz in Rockville, Md., with doctors in states nationwide speaking of shortfalls in vaccine, many predicting that they will be forced to ration the supplies they have.

“It is a huge hassle because of all the extra communication required and work created by not having publicity and demand matched by supply,” said Dr. Thomas Schwenk, chairman of family medicine at the University of Michigan in Ann Arbor. “We are having to make difficult decisions about who gets seasonal flu vaccine because of shortages and will have to do the same thing with H1N1.”

When Cathlene Echan walked into her pediatrician’s office two weeks after giving birth, she was nervous about discussing her recent decision not to vaccinate her second baby.

But Echan, of Orange County, Calif., did not expect to be asked to leave.

“The doctor said it was too much of a liability to have us as patients,” said Echan, a 28-year-old stay at home mom. Echan’s oldest child, Josiah, now 5, had just been diagnosed with autism around the same time her second son Torren, now 2, was born.

Echan said she did research and read articles online about autism, she talked with other parents and then came to the pediatrician’s office with doubts about vaccines.

“I hadn’t come to a conclusion at that point when I saw the doctor, but I was so nervous because they’re brothers, and I thought there could be a predisposition for it,” said Echan. “As a mom, I can’t knowingly do something to my second child when I believe it played a role in causing my older child’s neurological disorder.

“She was very nice at first, but when I asked her to give him [Torren] a checkup, she said, ‘you need to leave,’” said Echan.

Echan’s situation is a growing problem for parents and pediatricians alike. Despite adamant statements from the American Academy of Pediatrics and the U.S. Centers of Disease Control that vaccines have no link to autism, an anti-vaccination movement is growing online, from parent to parent, and through activist celebrities, such as actress Jenny McCarthy.

Now, more and more doctors are feeling compelled to say “no” back to these parents. The issue was raised Wednesday at the annual American Academy of Pediatrics meeting in Washington, D.C.

Dr. Gary Marshall, a presenter at the meeting, said there are some cases when it’s ethical and legal to refuse to continue to see, or treat, a child.

“In the middle of treatment, you can’t just say, I’m done,” Marshall, of the University of Louisville School of Medicine, said during a session that addressed parental concerns about vaccinations and how pediatricians can respond.