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Tuesday, January 24, 2012
Monday, January 23, 2012
Study examines quality of colonoscopy reporting and performance
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Public release date: 23-Jan-2012[ | E-mail |
Share ] Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Underscores the importance of implementing colonoscopy quality indicators and guidelines
OAK BROOK, Ill. January 23, 2012 Researchers in the Netherlands assessed the quality of colonoscopy reporting in daily clinical practice and evaluated the quality of colonoscopy performance. They found that colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards, however, considerable variability between endoscopy departments was found. Researchers concluded that the results of the study underline the importance of the implementation of quality indicators and guidelines, and that by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved. The study appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).
Quality assurance in endoscopy has become an important topic in recent decades. The implementation of colorectal cancer screening has driven a significant portion of these quality initiatives in colonoscopy. Suggested quality indicators for colonoscopy include, among others, cecal intubation rate, adenoma detection rate (ADR), and withdrawal time. Without complete and accurate reporting of colonoscopy parameters, continuous quality assurance is meaningless because deficits in service and quality improvements over time cannot be identified. By determining underlying reasons for quality deficits, specific training and education projects can be implemented to achieve the maximum benefit from colonoscopic procedures.
"Studies of quality indicators focus to a great extent on single quality indicators and often show the results of quality assurance in nondaily clinical practice, such as screening programs and study settings, where endoscopists were aware of the quality audit or were obliged to complete automated colonoscopy reporting systems. Less is known about the compliance with colonoscopy reporting and performance in daily clinical practice," said study lead author Vincent de Jonge, MSc, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. "Our study examined both reporting and performance in daily practice. We found that reporting varied significantly in clinical practice and that while performance met the suggested standards, there was considerable variability between endoscopy departments."
Methods
This study took place in the daily clinical practice of 12 endoscopy departments in the Netherlands (six teaching hospitals and six general hospitals). At the time of the study, there was no comprehensive quality assurance program either nationwide or at any of the endoscopy departments individually, although over the past 15 years, the Dutch Society of Gastroenterologists has put in place and maintained a quality audit system for endoscopy units. This system requires that endoscopy units and their staff undergo a thorough quality audit every five years according to a fixed format by trained external auditors from the Dutch Society. The audit focuses on, for example, organizational aspects of the units, case mix, number of endoscopy procedures performed, waiting lists, and complication registration, but not on specific performance indicators of individual endoscopists such as those investigated in this study (i.e., cecal intubation rate and ADR). The staff of each participating endoscopy department was informed about the study protocol and parameters of interest, and ethical approval was obtained from each institutional review board. During the study period, colonoscopies and colonoscopy reporting were performed according to local protocols.
A total of 4,800 colonoscopy reports were included covering scheduled colonoscopies on 4,738 patients. Reports were reviewed by hand. Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using cecal intubation rate and ADR.
Results
The 4,800 colonoscopies were performed by 116 endoscopists: 70 percent by gastroenterologists, 16 percent by gastroenterology fellows, 10 percent by internists, 3 percent by nurse-endoscopists, and 1 percent by surgeons. The mean age of the patients was 59 years old and 47 percent were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90 percent. Only 62 percent of the reports mentioned the quality of bowel preparation (range between departments was 7 to 100 percent). Photographic documentation of the cecal landmarks was present in 71 percent (range was 22 to 97 percent). The adjusted cecal intubation rate was 92 percent (range was 84 to 97 percent) and the ADR was 24 percent (range was 13 to 32 percent).
The researchers concluded that overall, the quality of colonoscopy reporting was high, although significant variability existed. This variance suggests that, with a relatively small amount of effort, the quality of reporting can be improved significantly. This may be achieved with the widespread introduction of computerized image storage and endoscopy reporting, and also has the potential to be cost-saving compared with handwritten or dictated reports. The overall quality of colonoscopy performance reached international standards, although remarkable variability between endoscopy departments was found. By continuous quality monitoring and disclosure of results, the overall quality of performance can be further improved. This study emphasizes that national guidelines for both colonoscopy performance and reporting parameters are needed to set common targets for the quality of colonoscopy, thereby improving uniformity in daily clinical practice of both colonoscopy reporting and colonoscopy performance.
In an accompanying editorial, David A. Johnson, MD, FACG, FASGE, Department of Internal Medicine Gastroenterology Division, Eastern VA Medical School, Norfolk, Virginia, states, "The results of this study highlight several important points. First, there is clearly room for significant improvement, both for reporting and performance of colonoscopy. Second, despite the use of the quality metrics, there was not consistent use nor was there any improvement even when the endoscopists knew that they were being evaluated. This suggests that the process perhaps needs to be better standardized via an electronic report with required fields. What the study does not address is whether this information was to be used in feedback to the individual endoscopists as part of a quality improvement program, which clearly should be the intent of comparative metrics."
###
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.
About Endoscopy
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Public release date: 23-Jan-2012[ | E-mail |
Share ] Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Underscores the importance of implementing colonoscopy quality indicators and guidelines
OAK BROOK, Ill. January 23, 2012 Researchers in the Netherlands assessed the quality of colonoscopy reporting in daily clinical practice and evaluated the quality of colonoscopy performance. They found that colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards, however, considerable variability between endoscopy departments was found. Researchers concluded that the results of the study underline the importance of the implementation of quality indicators and guidelines, and that by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved. The study appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).
Quality assurance in endoscopy has become an important topic in recent decades. The implementation of colorectal cancer screening has driven a significant portion of these quality initiatives in colonoscopy. Suggested quality indicators for colonoscopy include, among others, cecal intubation rate, adenoma detection rate (ADR), and withdrawal time. Without complete and accurate reporting of colonoscopy parameters, continuous quality assurance is meaningless because deficits in service and quality improvements over time cannot be identified. By determining underlying reasons for quality deficits, specific training and education projects can be implemented to achieve the maximum benefit from colonoscopic procedures.
"Studies of quality indicators focus to a great extent on single quality indicators and often show the results of quality assurance in nondaily clinical practice, such as screening programs and study settings, where endoscopists were aware of the quality audit or were obliged to complete automated colonoscopy reporting systems. Less is known about the compliance with colonoscopy reporting and performance in daily clinical practice," said study lead author Vincent de Jonge, MSc, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. "Our study examined both reporting and performance in daily practice. We found that reporting varied significantly in clinical practice and that while performance met the suggested standards, there was considerable variability between endoscopy departments."
Methods
This study took place in the daily clinical practice of 12 endoscopy departments in the Netherlands (six teaching hospitals and six general hospitals). At the time of the study, there was no comprehensive quality assurance program either nationwide or at any of the endoscopy departments individually, although over the past 15 years, the Dutch Society of Gastroenterologists has put in place and maintained a quality audit system for endoscopy units. This system requires that endoscopy units and their staff undergo a thorough quality audit every five years according to a fixed format by trained external auditors from the Dutch Society. The audit focuses on, for example, organizational aspects of the units, case mix, number of endoscopy procedures performed, waiting lists, and complication registration, but not on specific performance indicators of individual endoscopists such as those investigated in this study (i.e., cecal intubation rate and ADR). The staff of each participating endoscopy department was informed about the study protocol and parameters of interest, and ethical approval was obtained from each institutional review board. During the study period, colonoscopies and colonoscopy reporting were performed according to local protocols.
A total of 4,800 colonoscopy reports were included covering scheduled colonoscopies on 4,738 patients. Reports were reviewed by hand. Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using cecal intubation rate and ADR.
Results
The 4,800 colonoscopies were performed by 116 endoscopists: 70 percent by gastroenterologists, 16 percent by gastroenterology fellows, 10 percent by internists, 3 percent by nurse-endoscopists, and 1 percent by surgeons. The mean age of the patients was 59 years old and 47 percent were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90 percent. Only 62 percent of the reports mentioned the quality of bowel preparation (range between departments was 7 to 100 percent). Photographic documentation of the cecal landmarks was present in 71 percent (range was 22 to 97 percent). The adjusted cecal intubation rate was 92 percent (range was 84 to 97 percent) and the ADR was 24 percent (range was 13 to 32 percent).
The researchers concluded that overall, the quality of colonoscopy reporting was high, although significant variability existed. This variance suggests that, with a relatively small amount of effort, the quality of reporting can be improved significantly. This may be achieved with the widespread introduction of computerized image storage and endoscopy reporting, and also has the potential to be cost-saving compared with handwritten or dictated reports. The overall quality of colonoscopy performance reached international standards, although remarkable variability between endoscopy departments was found. By continuous quality monitoring and disclosure of results, the overall quality of performance can be further improved. This study emphasizes that national guidelines for both colonoscopy performance and reporting parameters are needed to set common targets for the quality of colonoscopy, thereby improving uniformity in daily clinical practice of both colonoscopy reporting and colonoscopy performance.
In an accompanying editorial, David A. Johnson, MD, FACG, FASGE, Department of Internal Medicine Gastroenterology Division, Eastern VA Medical School, Norfolk, Virginia, states, "The results of this study highlight several important points. First, there is clearly room for significant improvement, both for reporting and performance of colonoscopy. Second, despite the use of the quality metrics, there was not consistent use nor was there any improvement even when the endoscopists knew that they were being evaluated. This suggests that the process perhaps needs to be better standardized via an electronic report with required fields. What the study does not address is whether this information was to be used in feedback to the individual endoscopists as part of a quality improvement program, which clearly should be the intent of comparative metrics."
###
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.
About Endoscopy
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Source: http://www.eurekalert.org/pub_releases/2012-01/asfg-seq012312.php
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Gingrich wins most delegates in South Carolina (AP)
WASHINGTON ? Newt Gingrich has won the most delegates in South Carolina's Republican presidential primary, narrowing Mitt Romney's lead in the race for delegates to the party's national convention this summer.
Gingrich, the former House speaker, has won at least 15 delegates, with 10 to be awarded. These are the first delegates Gingrich has won in a primary or caucus, though the race for delegates is still in the early stages. In all, Gingrich has 17 delegates, including endorsements from Republican National Committee members who will automatically attend the convention. Romney has 33 delegates.
It will take 1,144 delegates to win the GOP nomination.
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Sunday, January 22, 2012
Joe Paterno, revered coach tainted by scandal, dies (Reuters)
STATE COLLEGE, Pennsylvania (Reuters) ? Penn State football coach Joe Paterno, the winningest coach in major college football history who was fired in November over a child sexual abuse scandal involving an assistant that rocked America, died on Sunday of lung cancer. He was 85.
Paterno won adoration from fans of the highly successful and profitable Penn State football program and they unleashed invective at the university board of trustees who fired him unceremoniously after 46 years as head coach, tarnishing his outsized legacy.
Equally outraged were his critics and advocates for victims of sexual abuse who faulted Paterno for his relative inaction upon hearing an accusation that former defensive coordinator Jerry Sandusky had sexually abused a young boy in the Penn State football showers in 2002.
Paterno told university officials but not police, opening him to criticism that he protected an accused child molester for nine years.
Sandusky, 67, who has maintained his innocence, faces 52 criminal counts accusing him of sexually abusing 10 boys over 15 years, using his position as head of a The Second Mile, a charity dedicated to helping troubled children, to find his victims. The court placed him under house arrest.
Waves of mourners descended on a makeshift shrine to Paterno outside the university's Beaver Stadium. They draped an American flag on a statue of Paterno and wrapped its neck with a Penn State scarf.
Sobbing at the statue's feet was Dana Gordon, a 1982 graduate who blamed the school's Board of Trustees for hastening Paterno's death by firing him in a "callous way."
"The way the board treated him took a lot of the fight out of him," Gordon said.
The case raised questions about the measures the university took to protect Sandusky and a football program that Forbes magazine estimated made a profit of $53 million in 2010, especially since accusations against him first surfaced in 1998. At that time a university police detective admonished Sandusky to stop showering naked with boys but stopped short of bringing criminal charges.
One of the biggest scandals in college sports history, it provoked a national discussion about pedophilia in the same way charges involving Roman Catholic priests did years earlier.
The matter also drew impassioned arguments about the balance between protecting the young and the rights of criminal defendants, who are presumed innocent until proven guilty.
"I hope his passing and the controversy surrounding Sandusky will deter other people, especially powerful people, from covering up child sex crimes," said David Clohessy, director of Survivors Network of those Abused by Priests, a support group.
"Even decades of professional achievement should not obscure dreadfully reckless and callous inaction that results in child sex crimes," Clohessy said.
Sandusky issued a statement sending condolences to the Paterno family that did not mention the investigation.
"Nobody did more for the academic reputation of Penn State than Joe Paterno. He maintained a high standard in a very difficult profession," Sandusky said.
Paterno won a reputation for making sure his players graduated and one of the program's mottos was "Success With Honor."
Paterno's downfall was spectacular. For decades he was a symbol of vitality who patrolled the Penn State sidelines with unchallenged authority, easily recognizable by his thick eyeglasses and jet-black hair that only showed a hint of gray in his later years. His two national championships, in 1982 and 1986, won him enduring loyalty from fans who affectionately called him "JoePa."
In the end, he was confined to a wheelchair upon breaking his hip in a fall one month after being fired, and he wore a wig after losing his hair to chemotherapy, according to the Washington Post, which interviewed Paterno about a week before his death.
Paterno was surrounded by family when he died 9:25 a.m. on Sunday of metastatic small cell carcinoma of the lung, Mount Nittany Medical Center said in a statement.
IMPACT ON CRIMINAL CASE
Paterno's death may not significantly affect the case against Sandusky, but was more likely to weaken the criminal case against two university officials charged with perjury, at least one legal expert said.
Paterno learned of at least one accusation against Sandusky in 2002, when graduate assistant Mike McQueary told Paterno he witnessed Sandusky molesting a boy of about 10 years old in the showers of the Lasch Football Building.
Paterno told university officials but not police, a decision that ultimately led to his downfall.
Paterno, in an interview with the Washington Post published on January 14, said he was uncertain how to handle the matter and trusted the university administration.
Paterno testified before the grand jury that he informed former athletic director Tim Curley about what McQueary told him. About 10 days later, McQueary testified, he was called to a meeting with Curley and university finance official Gary Schultz to discuss what happened.
Curley and Schultz both face perjury charges based on their inaction. Schultz also testified before the grand jury he was aware of the 1998 investigation of Sandusky.
University President Graham Spanier was fired along with Paterno, and Curley and Schultz stepped down.
"If he (Paterno) had known the devastation that this means, he would have reacted differently," said Peter Pelullo, founder of Let Go, Let Peace Come In, a support group helping some of Sandusky's accusers with counseling.
"If there had been an auto accident on the Penn State campus and a kid had been run over, everybody would have called 911. That boy was being crushed at the moment he was in the shower with Sandusky. It's not just Joe Paterno but the rest of the country that didn't understand this," Pelullo said.
Because Paterno was not believed to have witnessed any purported abuse, his testimony would not have been crucial to Sandusky trial, said Paul Callan, a former prosecutor and criminal defense attorney.
But his death could set back the criminal case against Curley and Schultz.
"The Confrontation Clause (of the constitution) guarantees that criminal defendants will have the right to confront and cross-examine the witnesses against them at the time of trial," Callan said. "No defense attorneys were present at the grand jury proceedings to do such a cross-examination."
Max Kennerly, a Philadelphia trial lawyer who has followed the case, said Paterno's death was unlikely to alter any civil litigation being contemplated by Sandusky's accusers. If any were considering suing Paterno, they could just name his estate.
"Death doesn't change your status as a party," Kennerly said.
(Additional reporting by Ian Simpson, Barbara Goldberg and Noeleen Walder; Writing by Daniel Trotta and Barbara Goldberg; Editing by Cynthia Osterman)
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Factbox: Etta James (Reuters)
LOS ANGELES (Reuters) ? Three-time Grammy winner Singer Etta James, a pioneer of 1950s rhythm-and-blues and rock music known for her show-stopping hit "At Last," died on Friday at the age of 73.
Following are some keys facts about James.
* James died on Friday, January 20., due to complications from leukemia, according to her longtime manager and friend Lupe De Leon. Her live-in doctor said in December she was terminally ill. She had been in failing health for a number of years and also suffered from diabetes, kidney problems and dementia.
* Her hit songs included "The Wallflower," which originally was titled "Roll With Me Henry," "At Last," "All I Could Do Was Cry," "Something's Got a Hold on Me," "Tell Mama," "I'd Rather Go Blind" and "Stop the Wedding."
* James was born Jamesetta Hawkins in Los Angeles January 25, 1938, to a 14-year-old girl in Los Angeles. Over the years, her mother mentioned several different men as her father, including Rudolph Wanderone, the legendary pool hustler best known as Minnesota Fats. James came to think of Wanderone as her father and sought him out at a Nashville, Tennessee, hotel in 1987. She was unable to confirm he was her father but told an interviewer, "When he passed, he sent me a beautiful golden watch that hung on his clothes that had his name on it. And he sent me a letter and told me that he wanted me to write a song about him and stuff."
* James was an influence on performers such as Tina Turner, Bonnie Raitt, Diana Ross and Janis Joplin. She also toured as an opening act with the Rolling Stones and performed with the Grateful Dead.
* James fought a long battle with heroin addiction. In her autobiography, "Rage to Survive," she wrote that at one point she and an accomplice stole the musical instruments of her own band and pawned them in order to buy drugs. After stints in rehabilitation programs, she broke the habit at age 50.
* James' weight reached an estimated 400 pounds at one point and she often had to perform sitting down. She lost some 200 pounds after gastric bypass surgery about 10 years ago.
* James was survived by her husband, Artis Mills, two sons Donto and Sametto and four grandchildren.
(Reporting By Bill Trott; Editing by Jill Serjeant and Bob Tourtellotte)
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Saturday, January 21, 2012
Stocks edge higher as unemployment claims fall
In this Jan. 18, 2012 photo, specialist Matthew Diez, left, works on the floor of the New York Stock Exchange. Financial markets were subdued Thursday, Jan. 19, 2012, as investors awaited developments in Greece's debt-reduction talks with private creditors, a day after the International Monetary Fund revealed it was looking to get its hands on another half a trillion dollars to help it shore up a fragile global economy. (AP Photo/Richard Drew)
In this Jan. 18, 2012 photo, specialist Matthew Diez, left, works on the floor of the New York Stock Exchange. Financial markets were subdued Thursday, Jan. 19, 2012, as investors awaited developments in Greece's debt-reduction talks with private creditors, a day after the International Monetary Fund revealed it was looking to get its hands on another half a trillion dollars to help it shore up a fragile global economy. (AP Photo/Richard Drew)
NEW YORK (AP) ? Stocks rose in midday trading Thursday after a decline in applications for unemployment benefits and strong earnings reports from Bank of America and Morgan Stanley.
The Dow Jones industrial average rose 35 points to 12,613 shortly after noon.
The number of people seeking unemployment benefits plunged last week to the lowest level since April 2008, the latest sign that the job market is strengthening. France and Spain also held successful bond auctions, easing worries about that region's two-year-old debt crisis.
Utilities companies were among the few industries to fall, an indication that investors are becoming more comfortable owning riskier stocks. Utilities, which were the best-performing industry last year, tend to pay higher dividends and fluctuate less than companies like Caterpillar Inc. and FedEx Corp., whose fortunes are more closely tied to the economic cycle. Financial technology companies each rose 1 percent, the most of the 10 industries tracked by the S&P 500 index.
In another sign that investors are shedding low-risk assets, the dollar and Treasury prices fell. The yield on the benchmark 10-year Treasury note rose to 1.97 percent from 1.90 percent late Wednesday.
Bank of America and Morgan Stanley each rose 5 percent after reporting results that were better than analysts had expected. BofA returned to profit in the fourth quarter while Morgan Stanley's loss was much less than forecast, thanks largely to better stock trading results.
Investors also drove up shares of Renewable Energy Group Inc., the nation's largest producer of biodiesel, in its market debut. The stock rose 1 percent after pricing below what the Iowa company had initially expected. It was the first initial public offering of the year.
Trading was halted in shares of photography icon Eastman Kodak after the company filed for Chapter 11 bankruptcy protection. The ailing company failed to find a buyer for its trove of 1,100 digital imaging patents.
In other trading, the Standard & Poor's 500 rose 7 points, or 0.5 percent, to 1,315. The Nasdaq composite rose 23 points, or 0.9 percent, to 2,793.
Among other stocks making large moves:
? eBay Inc. rose more than 4 percent after the online auction company beat analysts' earnings forecasts and provided a healthy outlook for the year.
? Southwest Airlines Co. rose nearly 4 percent after it said its fourth-quarter net income and revenue jumped. Southwest said it expects strong revenue in the first quarter too, based on passenger-booking trends.
? Johnson Controls Inc., an auto parts and building equipment maker, fell 7 percent. The Milwaukee-based company reported earnings and revenue that fell short of Wall Street's forecasts. It also cut its estimate for its fiscal year earnings, blaming weaker auto production in Europe, a lower euro and poor demand for batteries.
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Protest exposes Silicon Valley-Hollywood rivalry
This screen shot shows the blacked-out Wikipedia website, announcing a 24-hour protest against proposed legislation in the U.S. Congress, intended to protect intellectual property that critics say could facilitate censorship, referred to as the "Stop Online Piracy Act," or "SOPA," and the "Protect IP Act," or "PIPA." (AP Photo/Wikipedia)
This screen shot shows the blacked-out Wikipedia website, announcing a 24-hour protest against proposed legislation in the U.S. Congress, intended to protect intellectual property that critics say could facilitate censorship, referred to as the "Stop Online Piracy Act," or "SOPA," and the "Protect IP Act," or "PIPA." (AP Photo/Wikipedia)
This screen shot shows the home page Google.com. A campaign whose backers include tech heavyweights like Google Inc. and Yahoo Inc. has successfully portrayed the bills _ the Stop Online Piracy Act and Protect Intellectual Property Act _ as an attack on a free and open Internet rather than a way to protect the jobs of Americans in the movie and music industries, in a protest Wenesday, Jan. 18, 2012. (AP Photo/Google.com)
Demonstrators protest in front of the building housing the New York offices of U.S. Sens. Charles Schumer and Kristen Gilliband, Wednesday, Jan. 18, 2012. January 18 is a date that will live in ignorance, as Wikipedia started a 24-hour blackout of its English-language articles, joining other sites in a protest of pending U.S. legislation aimed at shutting down sites that share pirated movies and other content. (AP Photo/Richard Drew)
Reddit co-founder Alexis Ohanian addresses a protest in front of the building housing the New York offices of U.S. Sens. Charles Schumer and Kristen Gilliband, Wednesday, Jan. 18, 2012. January 18 is a date that will live in ignorance, as Wikipedia started a 24-hour blackout of its English-language articles, joining other sites in a protest of pending U.S. legislation aimed at shutting down sites that share pirated movies and other content. Reddit.com shut down its social news service for 12 hours. (AP Photo/Richard Drew)
Demonstrators protest in front of the building housing the New York offices of U.S. Sens. Charles Schumer and Kristen Gilliband, Wednesday, Jan. 18, 2012. January 18 is a date that will live in ignorance, as Wikipedia started a 24-hour blackout of its English-language articles, joining other sites in a protest of pending U.S. legislation aimed at shutting down sites that share pirated movies and other content. (AP Photo/Richard Drew)
LOS ANGELES (AP) ? In a move that heightens the growing tension between Silicon Valley and Hollywood, Wikipedia and other websites went dark Wednesday in protest of two congressional proposals intended to thwart the online piracy of copyrighted movies and TV programs.
The web-based encyclopedia is part of a loose coalition of dot-coms and large technology companies that fear Congress is prepared to side with Hollywood and enact extreme measures ? possibly including the blocking of entire websites? to stop the online sharing and unauthorized use of Hollywood productions.
The fight will test which California-based industry has the most sway in Washington.
For now, Silicon Valley appears to have the upper hand. Supporters of the legislation ? called the Stop Online Piracy Act in the House and the Protect Intellectual Property Act in the Senate ? say the bills are aimed at protecting jobs in the movie and music industries. But a campaign including tech heavyweights such as Google Inc. and Yahoo Inc. has successfully portrayed the bills as an attack on a free and open Internet.
"It has nothing to do with stolen songs or movies," said Justin Ruben, executive director of MoveOn.org, which is participating in the blackout. Ruben says tougher legislation ? even directed overseas ? could make domestic cultural commentators more prone to legal attack.
Rather than showing encyclopedia articles, Wikipedia displayed a blacked-out page describing the protest and offering more information on the bills. Many articles were still viewable on cached pages.
Reddit.com shut down its social news service for 12 hours. Other sites made their views clear without cutting off services. Google blacked out the logo on its home page, directing people to a page where they could add their names to a petition.
The one-day outage was timed to coincide with key House and Senate committee hearings as they prepare to send the bills to the full floor for debate.
However, sponsor Rep. Lamar Smith, a Texas Republican, sought last week to remove a controversial provision from the House bill that could force Internet service providers to interfere with the way Web addresses work for foreign sites deemed dedicated to piracy. He postponed work on the measure until February.
Critics believe such tinkering with core Internet technology treads into dangerous territory that could lead to online censorship. It might also give hackers a new way to wreak havoc.
The White House raised concerns that the bills could stifle innovation. Over the weekend, the Obama administration reacted to two online petitions, saying it "will not support legislation that reduces freedom of expression, increases cybersecurity risk or undermines the dynamic, innovative global Internet."
At the same time, the administration called on all sides to "pass sound legislation this year that provides prosecutors and rights holders new legal tools to combat online piracy originating beyond U.S. borders."
That nuanced stance is President Barack Obama's attempt at "threading the needle" between two important constituencies as he seeks re-election in November, said Jeffrey Silva, a technology policy analyst at Medley Global Advisors in Washington.
On the one hand, his administration has defended a free, open Internet as it watched repressive regimes fall in the Middle East with help from social media such as Twitter. It has also been a proponent of the concept of "net neutrality," which prevents Internet service providers from slowing online traffic that comes from file-sharing sites known to trade in pirated content.
On the other hand, Obama and other Democrats have gone to Hollywood dozens of times to raise campaign funds over the years.
"The administration is trying to fight to protect the Internet space," Silva said. "But at the same time, it doesn't want to disenfranchise Hollywood and the business community."
Indeed, behind the protests and public posturing, both Hollywood and Silicon Valley spend generously to lobby causes in Washington. According to the Center for Responsive Politics, the movie, television and music industries spent a combined $91.7 million on lobbying efforts in 2011, compared with the computer and Internet industry's $93 million.
In the 2012 election cycle, the movie, television and music industry offered up $7.7 million in direct campaign contributions to congressional candidates. The computer and Internet industry contributed $6.6 million.
Despite the uproar on websites and blogs, PIPA remains firmly in play. Senate Judiciary Committee Chairman Patrick Leahy said Tuesday that he intends to push the bill toward a floor vote on Jan. 24. He said much of the criticism of the bill is "flatly wrong."
But amid the high-tech campaign against the bills, several lawmakers came out in opposition. At least three Senate Republicans who had previously cosponsored the Senate bill ? Orrin Hatch of Utah, Roy Blunt of Missouri and John Boozman of Arkansas ? issued statements Wednesday saying they were withdrawing their support.
It remains to be seen whether the two industries can come to the table and negotiate a compromise.
"There are good companies, and then there are companies simply out to preserve the Wild West, free-to-steal business model," said Recording Industry Association of America CEO Cary Sherman. He expects to know "within the next few weeks" whether the legislation can survive.
Lawmakers may have a personal incentive to keep online piracy on the nation's political radar, said Fred Wertheimer, president of Democracy 21, a non-partisan government-accountability watchdog. If the issue stays alive through the current election cycle, it may help bring in campaign contributions from high-tech donors and Hollywood later this year.
The issue "becomes an opportunity for raising more money from these groups," Wertheimer said. "If you're into an important issue and money is flowing in on both sides, then both sides can up the ante."
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Congressional reporter Jim Abrams contributed to this report from Washington.
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