Video

WASHINGTON – Experts in pediatric quality improvement convened at the annual meeting of the American Academy of Pediatrics to discuss important next steps that must occur for quality improvement to advance.

In part 1 of a video roundtable, they described how networks are being formed to spur data sharing and determination of benchmarks in a variety of pediatric conditions, such as urinary tract infections and asthma. Dr. Matt D. Garber, director of pediatric hospitalists and chief quality officer at Palmetto Health Children’s Hospital, Columbia, S.C., representing the American Academy of Pediatrics Quality Improvement Innovation Networks (QUIIN), discussed how one such study on bronchiolitis guidelines enlisted the help of emergency physicians and inpatient physicians.

Dr. Anupam B. Kharbanda, director of research for emergency services at Children’s Minnesota, Minneapolis, and chairman, AAP pediatric emergency medicine collaborative research committee of the section on emergency medicine, questioned whether what third party payers want as benchmarks and what physicians, patients, and parents want in terms of quality of care are the same.

Dr. Joel S. Tieder, a pediatric hospitalist and director of the maintenance of certification program at Seattle Children’s Hospital and vice-chair of the AAP Council on Quality Improvement and Patient Safety (COQIPS), said, “With asthma, now we have a world where patient preferences matter, and they are hard to measure across this complicated health system.”

Dr. Michael L. Rinke, a pediatric hospitalist who is medical director of quality at Children’s Hospital at Montefiore in New York and cochair of the implementation committee of the AAP Council on Quality Improvement and Patient Safety (COQIPS), concurred.

WASHINGTON – Experts in pediatric quality improvement convened at the annual meeting of the American Academy of Pediatrics to discuss important next steps that must occur for quality improvement to advance.

In part 1 of a video roundtable, they described how networks are being formed to spur data sharing and determination of benchmarks in a variety of pediatric conditions, such as urinary tract infections and asthma. Dr. Matt D. Garber, director of pediatric hospitalists and chief quality officer at Palmetto Health Children’s Hospital, Columbia, S.C., representing the American Academy of Pediatrics Quality Improvement Innovation Networks (QUIIN), discussed how one such study on bronchiolitis guidelines enlisted the help of emergency physicians and inpatient physicians.

Dr. Anupam B. Kharbanda, director of research for emergency services at Children’s Minnesota, Minneapolis, and chairman, AAP pediatric emergency medicine collaborative research committee of the section on emergency medicine, questioned whether what third party payers want as benchmarks and what physicians, patients, and parents want in terms of quality of care are the same.

Dr. Joel S. Tieder, a pediatric hospitalist and director of the maintenance of certification program at Seattle Children’s Hospital and vice-chair of the AAP Council on Quality Improvement and Patient Safety (COQIPS), said, “With asthma, now we have a world where patient preferences matter, and they are hard to measure across this complicated health system.”

Dr. Michael L. Rinke, a pediatric hospitalist who is medical director of quality at Children’s Hospital at Montefiore in New York and cochair of the implementation committee of the AAP Council on Quality Improvement and Patient Safety (COQIPS), concurred.

WASHINGTON – Experts in pediatric quality improvement convened at the annual meeting of the American Academy of Pediatrics to discuss important next steps that must occur for quality improvement to advance.

In part 1 of a video roundtable, they described how networks are being formed to spur data sharing and determination of benchmarks in a variety of pediatric conditions, such as urinary tract infections and asthma. Dr. Matt D. Garber, director of pediatric hospitalists and chief quality officer at Palmetto Health Children’s Hospital, Columbia, S.C., representing the American Academy of Pediatrics Quality Improvement Innovation Networks (QUIIN), discussed how one such study on bronchiolitis guidelines enlisted the help of emergency physicians and inpatient physicians.

Dr. Anupam B. Kharbanda, director of research for emergency services at Children’s Minnesota, Minneapolis, and chairman, AAP pediatric emergency medicine collaborative research committee of the section on emergency medicine, questioned whether what third party payers want as benchmarks and what physicians, patients, and parents want in terms of quality of care are the same.

Dr. Joel S. Tieder, a pediatric hospitalist and director of the maintenance of certification program at Seattle Children’s Hospital and vice-chair of the AAP Council on Quality Improvement and Patient Safety (COQIPS), said, “With asthma, now we have a world where patient preferences matter, and they are hard to measure across this complicated health system.”

Dr. Michael L. Rinke, a pediatric hospitalist who is medical director of quality at Children’s Hospital at Montefiore in New York and cochair of the implementation committee of the AAP Council on Quality Improvement and Patient Safety (COQIPS), concurred.

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

WASHINGTON – Youth football coaches and officials should adopt a “zero tolerance” policy regarding dangerous, illegal head-first tackling, according to a policy statement from the American Academy of Pediatrics.

Dr. Gregory L. Landry, a pediatrician at the University of Wisconsin, Madison, presented the policy statement in a plenary session at the AAP annual meeting.

“In looking at the data, we could not find a case for banning tackling in youth football. The injury rate in youth football is relatively low, compared to the older boys and girls,” Dr. Landry, who coauthored the statement, said in a video interview. “We were a little bit worried that if we banned tackling at the youth level it would increase the injury rate when older kids learn how to tackle when they are bigger and more powerful.”

The policy also calls for the following:

• Players must decide whether the benefits of playing outweigh the risks of possible injury.

• Nontackling leagues should be expanded so athletes can choose to participate without the injury risks associated with tackling.

• Skilled athletic trainers should be available on the sidelines, as evidence shows they can reduce the number of injuries for players.

See the video interview with Dr. Landry below.

[email protected]

On Twitter @denisefulton

WASHINGTON – Youth football coaches and officials should adopt a “zero tolerance” policy regarding dangerous, illegal head-first tackling, according to a policy statement from the American Academy of Pediatrics.

Dr. Gregory L. Landry, a pediatrician at the University of Wisconsin, Madison, presented the policy statement in a plenary session at the AAP annual meeting.

“In looking at the data, we could not find a case for banning tackling in youth football. The injury rate in youth football is relatively low, compared to the older boys and girls,” Dr. Landry, who coauthored the statement, said in a video interview. “We were a little bit worried that if we banned tackling at the youth level it would increase the injury rate when older kids learn how to tackle when they are bigger and more powerful.”

The policy also calls for the following:

• Players must decide whether the benefits of playing outweigh the risks of possible injury.

• Nontackling leagues should be expanded so athletes can choose to participate without the injury risks associated with tackling.

• Skilled athletic trainers should be available on the sidelines, as evidence shows they can reduce the number of injuries for players.

See the video interview with Dr. Landry below.

[email protected]

On Twitter @denisefulton

WASHINGTON – Youth football coaches and officials should adopt a “zero tolerance” policy regarding dangerous, illegal head-first tackling, according to a policy statement from the American Academy of Pediatrics.

Dr. Gregory L. Landry, a pediatrician at the University of Wisconsin, Madison, presented the policy statement in a plenary session at the AAP annual meeting.

“In looking at the data, we could not find a case for banning tackling in youth football. The injury rate in youth football is relatively low, compared to the older boys and girls,” Dr. Landry, who coauthored the statement, said in a video interview. “We were a little bit worried that if we banned tackling at the youth level it would increase the injury rate when older kids learn how to tackle when they are bigger and more powerful.”

The policy also calls for the following:

• Players must decide whether the benefits of playing outweigh the risks of possible injury.

• Nontackling leagues should be expanded so athletes can choose to participate without the injury risks associated with tackling.

• Skilled athletic trainers should be available on the sidelines, as evidence shows they can reduce the number of injuries for players.

See the video interview with Dr. Landry below.

[email protected]

On Twitter @denisefulton

SAN FRANCISCO – Drug-coated balloons have become a widely used option in Europe for treating coronary in-stent restenosis, and the scoring-balloon pretreatment tested in ISAR-DESIRE 4 appeared to boost the efficacy of a drug-coated balloon in a clinically meaningful way, Dr. Marco Valgimigli said in an interview at the Transcatheter Cardiovascular Therapeutics annual meeting.

When patients develop restenosis within a coronary stent, many times it’s because the stent was not properly expanded during initial placement. An advantage to a drug-coated balloon is that it pairs well with therapeutic reexpansion of the existing stent to its proper, fully open position.

In addition, this approach spares the patient from receiving a second stent inside the first stent, said Dr. Valgimigli, an interventional cardiologist at Inselspital in Bern, Switzerland.

Often when patients develop in-stent restenosis, it tends to keep recurring. And when that happens, eventually the only remaining option for effective revascularization of the patient’s coronary arteries is coronary bypass surgery.

Pretreating in-stent restenosis with a scoring balloon prior to treatment with a drug-coated balloon improved efficacy in the ISAR-DESIRE 4 trial by a modest amount. But if this treatment strategy can successfully defer or obviate just a few cases that might otherwise require coronary bypass surgery, then using the scoring balloon is a reasonable approach, Dr. Valgimigli said at the meeting, sponsored by the Cardiovascular Research Foundation.

[email protected]

On Twitter @mitchelzoler

SAN FRANCISCO – Drug-coated balloons have become a widely used option in Europe for treating coronary in-stent restenosis, and the scoring-balloon pretreatment tested in ISAR-DESIRE 4 appeared to boost the efficacy of a drug-coated balloon in a clinically meaningful way, Dr. Marco Valgimigli said in an interview at the Transcatheter Cardiovascular Therapeutics annual meeting.

When patients develop restenosis within a coronary stent, many times it’s because the stent was not properly expanded during initial placement. An advantage to a drug-coated balloon is that it pairs well with therapeutic reexpansion of the existing stent to its proper, fully open position.

In addition, this approach spares the patient from receiving a second stent inside the first stent, said Dr. Valgimigli, an interventional cardiologist at Inselspital in Bern, Switzerland.

Often when patients develop in-stent restenosis, it tends to keep recurring. And when that happens, eventually the only remaining option for effective revascularization of the patient’s coronary arteries is coronary bypass surgery.

Pretreating in-stent restenosis with a scoring balloon prior to treatment with a drug-coated balloon improved efficacy in the ISAR-DESIRE 4 trial by a modest amount. But if this treatment strategy can successfully defer or obviate just a few cases that might otherwise require coronary bypass surgery, then using the scoring balloon is a reasonable approach, Dr. Valgimigli said at the meeting, sponsored by the Cardiovascular Research Foundation.

[email protected]

On Twitter @mitchelzoler

SAN FRANCISCO – Drug-coated balloons have become a widely used option in Europe for treating coronary in-stent restenosis, and the scoring-balloon pretreatment tested in ISAR-DESIRE 4 appeared to boost the efficacy of a drug-coated balloon in a clinically meaningful way, Dr. Marco Valgimigli said in an interview at the Transcatheter Cardiovascular Therapeutics annual meeting.

When patients develop restenosis within a coronary stent, many times it’s because the stent was not properly expanded during initial placement. An advantage to a drug-coated balloon is that it pairs well with therapeutic reexpansion of the existing stent to its proper, fully open position.

In addition, this approach spares the patient from receiving a second stent inside the first stent, said Dr. Valgimigli, an interventional cardiologist at Inselspital in Bern, Switzerland.

Often when patients develop in-stent restenosis, it tends to keep recurring. And when that happens, eventually the only remaining option for effective revascularization of the patient’s coronary arteries is coronary bypass surgery.

Pretreating in-stent restenosis with a scoring balloon prior to treatment with a drug-coated balloon improved efficacy in the ISAR-DESIRE 4 trial by a modest amount. But if this treatment strategy can successfully defer or obviate just a few cases that might otherwise require coronary bypass surgery, then using the scoring balloon is a reasonable approach, Dr. Valgimigli said at the meeting, sponsored by the Cardiovascular Research Foundation.

[email protected]

On Twitter @mitchelzoler

WASHINGTON – Integrated, patient-centered care can help young people with serious mental illness stay productive and find meaning in their lives, according to new data from the RAISE (Recovery After an Initial Schizophrenia Episode) studies, sponsored by the National Institute of Mental Health.

With early intervention and the right medication, a combination of goal-oriented psychotherapy, family psychoeducation, and support for helping people with first-episode psychosis stay in school and work is more effective than standard community-based care, explained Robert Heinssen, Ph.D., director of the division of services and intervention research at NIMH.

This video report explores how primary care and psychiatry can work together to help people with schizophrenia, like Maggie Harrigan, aged 20 years, stay in nursing school and function in society.

 [email protected]

On Twitter @whitneymcknight

WASHINGTON – Integrated, patient-centered care can help young people with serious mental illness stay productive and find meaning in their lives, according to new data from the RAISE (Recovery After an Initial Schizophrenia Episode) studies, sponsored by the National Institute of Mental Health.

With early intervention and the right medication, a combination of goal-oriented psychotherapy, family psychoeducation, and support for helping people with first-episode psychosis stay in school and work is more effective than standard community-based care, explained Robert Heinssen, Ph.D., director of the division of services and intervention research at NIMH.

This video report explores how primary care and psychiatry can work together to help people with schizophrenia, like Maggie Harrigan, aged 20 years, stay in nursing school and function in society.

 [email protected]

On Twitter @whitneymcknight

WASHINGTON – Integrated, patient-centered care can help young people with serious mental illness stay productive and find meaning in their lives, according to new data from the RAISE (Recovery After an Initial Schizophrenia Episode) studies, sponsored by the National Institute of Mental Health.

With early intervention and the right medication, a combination of goal-oriented psychotherapy, family psychoeducation, and support for helping people with first-episode psychosis stay in school and work is more effective than standard community-based care, explained Robert Heinssen, Ph.D., director of the division of services and intervention research at NIMH.

This video report explores how primary care and psychiatry can work together to help people with schizophrenia, like Maggie Harrigan, aged 20 years, stay in nursing school and function in society.

 [email protected]

On Twitter @whitneymcknight