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Psychological analysis skills can lead to safer pain care
Primary care physicians may do well to learn how to screen patients for psychological disorders to lower the risk of improper drug prescriptions when treating pain symptoms, according to Robert McCarron, DO.
The screening process looks for anxiety, mood, psychotic, and substance use disorders (AMPS) that can be used by primary care physicians to determine the best way to treat a patient’s pain symptoms, explained Dr. McCarron, professor in the department of psychiatry at the University of California, Irvine, and president-elect of the California Psychiatric Association.
Nearly 60% of patients with chronic pain also have an affective disorder, with certain psychological disorders exacerbating or even causing physical pain, according to Dr. McCarron. Given that, the need for psychiatric evaluation tools and education in primary care is growing rapidly, especially because primary care physicians provide nearly 60% of all psychiatric care in the United States, he said at a meeting held by the American Pain Society and Global Academy for Medical Education.
“We know that 70% of psychiatrists are over the age of 50, and there also aren’t enough pain medicine doctors,” said Dr. McCarron. As of 2016, there are 4,627 mental health care professional shortage areas, with only 44.2% of those who need mental health care having their needs met, according to the Kaiser Family Foundation.
As primary care physicians shoulder that burden, a common complaint is not having enough time to build a relationship so patients will feel comfortable enough to talk openly about psychiatric symptoms, said Dr, McCarron.
“What I would say is make time for what is most effective,” said Dr. McCarron in an interview. “When it comes to psychiatric disorders and chronic pain management, setting aside some time during the visit to establish a relationship is critically important.”
To help primary care providers feel more comfortable in their ability to diagnose psychological disorders, Dr. McCarron and his colleagues are creating educational tools such as the AMPS assessment.
In addition, “one of the things we’ve done is create a Train New Trainers primary care psychiatry fellowship, where we train practicing primary care providers,” said Dr. McCarron. “We provide a 1-hour longitudinal training in this area, and at the end of that, they know how to diagnose effectively and treat in an evidence-based way, and they know how to train other people in their clinical site or region.”
On top of the fellowship, Dr. McCarron and his colleagues are working on a textbook covering relevant psychiatric material for primary care physicians.
Global Academy and this news organization are owned by the same company.
[email protected]
On Twitter @eaztweets
Primary care physicians may do well to learn how to screen patients for psychological disorders to lower the risk of improper drug prescriptions when treating pain symptoms, according to Robert McCarron, DO.
The screening process looks for anxiety, mood, psychotic, and substance use disorders (AMPS) that can be used by primary care physicians to determine the best way to treat a patient’s pain symptoms, explained Dr. McCarron, professor in the department of psychiatry at the University of California, Irvine, and president-elect of the California Psychiatric Association.
Nearly 60% of patients with chronic pain also have an affective disorder, with certain psychological disorders exacerbating or even causing physical pain, according to Dr. McCarron. Given that, the need for psychiatric evaluation tools and education in primary care is growing rapidly, especially because primary care physicians provide nearly 60% of all psychiatric care in the United States, he said at a meeting held by the American Pain Society and Global Academy for Medical Education.
“We know that 70% of psychiatrists are over the age of 50, and there also aren’t enough pain medicine doctors,” said Dr. McCarron. As of 2016, there are 4,627 mental health care professional shortage areas, with only 44.2% of those who need mental health care having their needs met, according to the Kaiser Family Foundation.
As primary care physicians shoulder that burden, a common complaint is not having enough time to build a relationship so patients will feel comfortable enough to talk openly about psychiatric symptoms, said Dr, McCarron.
“What I would say is make time for what is most effective,” said Dr. McCarron in an interview. “When it comes to psychiatric disorders and chronic pain management, setting aside some time during the visit to establish a relationship is critically important.”
To help primary care providers feel more comfortable in their ability to diagnose psychological disorders, Dr. McCarron and his colleagues are creating educational tools such as the AMPS assessment.
In addition, “one of the things we’ve done is create a Train New Trainers primary care psychiatry fellowship, where we train practicing primary care providers,” said Dr. McCarron. “We provide a 1-hour longitudinal training in this area, and at the end of that, they know how to diagnose effectively and treat in an evidence-based way, and they know how to train other people in their clinical site or region.”
On top of the fellowship, Dr. McCarron and his colleagues are working on a textbook covering relevant psychiatric material for primary care physicians.
Global Academy and this news organization are owned by the same company.
[email protected]
On Twitter @eaztweets
Primary care physicians may do well to learn how to screen patients for psychological disorders to lower the risk of improper drug prescriptions when treating pain symptoms, according to Robert McCarron, DO.
The screening process looks for anxiety, mood, psychotic, and substance use disorders (AMPS) that can be used by primary care physicians to determine the best way to treat a patient’s pain symptoms, explained Dr. McCarron, professor in the department of psychiatry at the University of California, Irvine, and president-elect of the California Psychiatric Association.
Nearly 60% of patients with chronic pain also have an affective disorder, with certain psychological disorders exacerbating or even causing physical pain, according to Dr. McCarron. Given that, the need for psychiatric evaluation tools and education in primary care is growing rapidly, especially because primary care physicians provide nearly 60% of all psychiatric care in the United States, he said at a meeting held by the American Pain Society and Global Academy for Medical Education.
“We know that 70% of psychiatrists are over the age of 50, and there also aren’t enough pain medicine doctors,” said Dr. McCarron. As of 2016, there are 4,627 mental health care professional shortage areas, with only 44.2% of those who need mental health care having their needs met, according to the Kaiser Family Foundation.
As primary care physicians shoulder that burden, a common complaint is not having enough time to build a relationship so patients will feel comfortable enough to talk openly about psychiatric symptoms, said Dr, McCarron.
“What I would say is make time for what is most effective,” said Dr. McCarron in an interview. “When it comes to psychiatric disorders and chronic pain management, setting aside some time during the visit to establish a relationship is critically important.”
To help primary care providers feel more comfortable in their ability to diagnose psychological disorders, Dr. McCarron and his colleagues are creating educational tools such as the AMPS assessment.
In addition, “one of the things we’ve done is create a Train New Trainers primary care psychiatry fellowship, where we train practicing primary care providers,” said Dr. McCarron. “We provide a 1-hour longitudinal training in this area, and at the end of that, they know how to diagnose effectively and treat in an evidence-based way, and they know how to train other people in their clinical site or region.”
On top of the fellowship, Dr. McCarron and his colleagues are working on a textbook covering relevant psychiatric material for primary care physicians.
Global Academy and this news organization are owned by the same company.
[email protected]
On Twitter @eaztweets
FROM PAIN CARE FOR PRIMARY CARE
Bezlotoxumab may lower risk of C. difficile readmissions
Clostridium difficile infection (CDI) patients treated with bezlotoxumab were less likely to be readmitted for recurring symptoms within 30 days of discharge, according to a phase 3 trial funded by Merck.
Recurrent CDI is a burden on both patients and providers, increasing health risks with each recurrence and eating through hospital resources, according to Vimalanand S. Prabhu, PhD, associate principal scientist for Merck.
In a randomized, double-blind, placebo-controlled, study of 1,050 CDI patients, a total of 27 (5%) of 530 of those given bezlotoxumab were re-hospitalized 30 days after discharge, compared with 58 (11%) of 520 patients in the placebo group (Clin Infect Dis. 2017 Aug 11. doi. 10.1093/cid/cix523).
Patients were gathered from 322 sites across 30 countries between November 2011 and May 2015.
When measuring CDI-related readmissions, the investigators found use of bezlotoxumab reduced rCDI hospitalizations by 6%, and by approximately 8% in high-risk patients, such as those over 65 years old or with severe CDI.
Bezlotoxumab works by binding to CDI toxin B, a primary cause of CDI symptoms, according to Dr. Prabhu and fellow investigators. The researchers suggested that bezlotoxumab could be a prevailing factor in fighting the rate of CDI infections, which accounted for 29,000 deaths in 2011 (N Engl J Med. 2015 Jun 11;372[24]:2368-9).
Investigators acknowledged that patients admitted for the study may be healthier than the real-world CDI population.
All investigators reported some financial involvement, whether being a full-time employee or acting as a consultant, for Merck, which funded the study. Individually, investigators reported financial ties to similar medical companies, such as Pfizer and AstraZeneca.
[email protected]
On Twitter @eaztweets
Clostridium difficile infection (CDI) patients treated with bezlotoxumab were less likely to be readmitted for recurring symptoms within 30 days of discharge, according to a phase 3 trial funded by Merck.
Recurrent CDI is a burden on both patients and providers, increasing health risks with each recurrence and eating through hospital resources, according to Vimalanand S. Prabhu, PhD, associate principal scientist for Merck.
In a randomized, double-blind, placebo-controlled, study of 1,050 CDI patients, a total of 27 (5%) of 530 of those given bezlotoxumab were re-hospitalized 30 days after discharge, compared with 58 (11%) of 520 patients in the placebo group (Clin Infect Dis. 2017 Aug 11. doi. 10.1093/cid/cix523).
Patients were gathered from 322 sites across 30 countries between November 2011 and May 2015.
When measuring CDI-related readmissions, the investigators found use of bezlotoxumab reduced rCDI hospitalizations by 6%, and by approximately 8% in high-risk patients, such as those over 65 years old or with severe CDI.
Bezlotoxumab works by binding to CDI toxin B, a primary cause of CDI symptoms, according to Dr. Prabhu and fellow investigators. The researchers suggested that bezlotoxumab could be a prevailing factor in fighting the rate of CDI infections, which accounted for 29,000 deaths in 2011 (N Engl J Med. 2015 Jun 11;372[24]:2368-9).
Investigators acknowledged that patients admitted for the study may be healthier than the real-world CDI population.
All investigators reported some financial involvement, whether being a full-time employee or acting as a consultant, for Merck, which funded the study. Individually, investigators reported financial ties to similar medical companies, such as Pfizer and AstraZeneca.
[email protected]
On Twitter @eaztweets
Clostridium difficile infection (CDI) patients treated with bezlotoxumab were less likely to be readmitted for recurring symptoms within 30 days of discharge, according to a phase 3 trial funded by Merck.
Recurrent CDI is a burden on both patients and providers, increasing health risks with each recurrence and eating through hospital resources, according to Vimalanand S. Prabhu, PhD, associate principal scientist for Merck.
In a randomized, double-blind, placebo-controlled, study of 1,050 CDI patients, a total of 27 (5%) of 530 of those given bezlotoxumab were re-hospitalized 30 days after discharge, compared with 58 (11%) of 520 patients in the placebo group (Clin Infect Dis. 2017 Aug 11. doi. 10.1093/cid/cix523).
Patients were gathered from 322 sites across 30 countries between November 2011 and May 2015.
When measuring CDI-related readmissions, the investigators found use of bezlotoxumab reduced rCDI hospitalizations by 6%, and by approximately 8% in high-risk patients, such as those over 65 years old or with severe CDI.
Bezlotoxumab works by binding to CDI toxin B, a primary cause of CDI symptoms, according to Dr. Prabhu and fellow investigators. The researchers suggested that bezlotoxumab could be a prevailing factor in fighting the rate of CDI infections, which accounted for 29,000 deaths in 2011 (N Engl J Med. 2015 Jun 11;372[24]:2368-9).
Investigators acknowledged that patients admitted for the study may be healthier than the real-world CDI population.
All investigators reported some financial involvement, whether being a full-time employee or acting as a consultant, for Merck, which funded the study. Individually, investigators reported financial ties to similar medical companies, such as Pfizer and AstraZeneca.
[email protected]
On Twitter @eaztweets
FROM CLINICAL INFECTIOUS DISEASES
Key clinical point:
Major finding: A total of 27 of 530 (5%) bezlotoxumab patients were readmitted within 30 days of discharge compared with 58 of 520 (11%) placebo patients.
Data source: Randomized, double-blind, placebo-controlled, multicenter, global phase 3 trials conducted from November 2011-May 2015 at 322 sites in 30 countries.
Disclosures: All investigators report employment or financial support with Merck and have individually reported financial ties to similar companies like Astellas, AstraZeneca, Pfizer, and others.
Alcohol misuse universal screening effective and efficient
Universal screening for alcohol misuse in acute medical admissions is feasible and can reduce readmissions for liver disease, according to a new study.
Detecting patients’ alcohol misuse early can help treat or prevent alcohol-related liver disease, such as cirrhosis; however, screening is not being used in a routine, effective way, according to Greta Westwood, PhD, head of Nursing, Midwifery, and AHP Research at Portsmouth (England) Hospitals and her fellow investigators.
“In primary care, screening is highly variable, and treatment rates are low, often focusing on patients who already have advanced psychiatric or physical illness,” Dr. Westwood and her colleagues wrote. “In addition, many patients with alcohol use disorders do not fully engage with primary care services for a variety of reasons, often leading to excessive use of the hospital ED as the first point of contact.”
Investigators conducted a retrospective, observational study of 53,165 patients who were admitted to the acute medical unit at Queen Alexandra Hospital, Portsmouth, England, between July 2011 and March 2014 (J Hepatol. 2017 Sep;67[3]:559-67).
More than half of patients were male (52%), the average patient age was 67 years, and the patients had an average of three previous hospital admissions.
Of the patients observed, 48,211 (90.68%) completed the screening test, while the remaining 4,934 (9.32%) did not.
Those who were not screened had a higher mortality rate than did those who were (8.30% vs 6.17%; P less than .001), were more likely to be discharged the same day (3.37% vs. 1.87%; P less than .001), and were more likely to discharge themselves (29.67% vs. 13.31%; P less than .001).
The screening process, an electronic modified version of the Paddington Alcohol Test, consisted of the nurses’ asking a series of questions about types of alcohol consumed, frequency and maximum daily amount, whether the admission was considered alcohol related, and they documented signs of alcohol withdrawal.
Patients were then given a score based on how the answers compared with the healthy level of alcohol consumption, with 0-2 points considered “low risk,” 3-5 points considered “increasing risk,” and 6-10 points considered “high risk.”
Those assigned a low-risk status were not referred to intervention, but doctors recommended increasing-risk patients attend a community alcohol intervention team for brief intervention, while high-risk patients were automatically referred to an Alcohol Specialist Nursing Service (ASNS).
Of those screened, there were 1,135 patients (2.33%) considered at increasing risk of alcohol misuse and 1,921 (3.98%) at high risk.
While 68.5% of patients with a high-risk score were referred to the ASNS, all those who were referred completed the medical detoxification course, according to investigators.
High-risk patients were found to have had, on average, more hospital visits than increasing- and low-risk patients – 4.74 visits, compared with 2.92 and 3.00, respectively; they also reported more ED trips – 7.68 visits, compared with 3.81 and 2.64, respectively.
Dr. Westwood and her colleagues found that, when using the screening tool, investigators were more likely to find signs of alcohol-related liver disease among those with higher scores.
Liver, pancreatic, and digestive disorders accounted for 22.1% of primary admission codes of high-risk patients, compared with 3.2% of low-risk patients.
Investigators wrote that this tool can help doctors identify at-risk patients early and attack the problem of alcohol misuse head on and in a timely manner.
“It is vital that patients with cirrhosis who continue to drink are identified and referred to dedicated hospital alcohol care teams,” Dr. Westwood and her colleagues wrote. “Screening can identify patients at an increased risk of alcohol-related harm whose range of diagnoses is not dissimilar to lower-risk patients and whose misuse of alcohol might otherwise have not been identified.”
Investigators did not account for decreased scores or testing effectiveness in patients readmitted and retested. Additionally, the long-term impact of ASNS care is still being studied.
Two investigators reported affiliations with the Learning Clinic, which created and licensed the analysis program that is part of the screening tool. All other investigators, including Dr. Westwood, reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
Universal screening for alcohol misuse in acute medical admissions is feasible and can reduce readmissions for liver disease, according to a new study.
Detecting patients’ alcohol misuse early can help treat or prevent alcohol-related liver disease, such as cirrhosis; however, screening is not being used in a routine, effective way, according to Greta Westwood, PhD, head of Nursing, Midwifery, and AHP Research at Portsmouth (England) Hospitals and her fellow investigators.
“In primary care, screening is highly variable, and treatment rates are low, often focusing on patients who already have advanced psychiatric or physical illness,” Dr. Westwood and her colleagues wrote. “In addition, many patients with alcohol use disorders do not fully engage with primary care services for a variety of reasons, often leading to excessive use of the hospital ED as the first point of contact.”
Investigators conducted a retrospective, observational study of 53,165 patients who were admitted to the acute medical unit at Queen Alexandra Hospital, Portsmouth, England, between July 2011 and March 2014 (J Hepatol. 2017 Sep;67[3]:559-67).
More than half of patients were male (52%), the average patient age was 67 years, and the patients had an average of three previous hospital admissions.
Of the patients observed, 48,211 (90.68%) completed the screening test, while the remaining 4,934 (9.32%) did not.
Those who were not screened had a higher mortality rate than did those who were (8.30% vs 6.17%; P less than .001), were more likely to be discharged the same day (3.37% vs. 1.87%; P less than .001), and were more likely to discharge themselves (29.67% vs. 13.31%; P less than .001).
The screening process, an electronic modified version of the Paddington Alcohol Test, consisted of the nurses’ asking a series of questions about types of alcohol consumed, frequency and maximum daily amount, whether the admission was considered alcohol related, and they documented signs of alcohol withdrawal.
Patients were then given a score based on how the answers compared with the healthy level of alcohol consumption, with 0-2 points considered “low risk,” 3-5 points considered “increasing risk,” and 6-10 points considered “high risk.”
Those assigned a low-risk status were not referred to intervention, but doctors recommended increasing-risk patients attend a community alcohol intervention team for brief intervention, while high-risk patients were automatically referred to an Alcohol Specialist Nursing Service (ASNS).
Of those screened, there were 1,135 patients (2.33%) considered at increasing risk of alcohol misuse and 1,921 (3.98%) at high risk.
While 68.5% of patients with a high-risk score were referred to the ASNS, all those who were referred completed the medical detoxification course, according to investigators.
High-risk patients were found to have had, on average, more hospital visits than increasing- and low-risk patients – 4.74 visits, compared with 2.92 and 3.00, respectively; they also reported more ED trips – 7.68 visits, compared with 3.81 and 2.64, respectively.
Dr. Westwood and her colleagues found that, when using the screening tool, investigators were more likely to find signs of alcohol-related liver disease among those with higher scores.
Liver, pancreatic, and digestive disorders accounted for 22.1% of primary admission codes of high-risk patients, compared with 3.2% of low-risk patients.
Investigators wrote that this tool can help doctors identify at-risk patients early and attack the problem of alcohol misuse head on and in a timely manner.
“It is vital that patients with cirrhosis who continue to drink are identified and referred to dedicated hospital alcohol care teams,” Dr. Westwood and her colleagues wrote. “Screening can identify patients at an increased risk of alcohol-related harm whose range of diagnoses is not dissimilar to lower-risk patients and whose misuse of alcohol might otherwise have not been identified.”
Investigators did not account for decreased scores or testing effectiveness in patients readmitted and retested. Additionally, the long-term impact of ASNS care is still being studied.
Two investigators reported affiliations with the Learning Clinic, which created and licensed the analysis program that is part of the screening tool. All other investigators, including Dr. Westwood, reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
Universal screening for alcohol misuse in acute medical admissions is feasible and can reduce readmissions for liver disease, according to a new study.
Detecting patients’ alcohol misuse early can help treat or prevent alcohol-related liver disease, such as cirrhosis; however, screening is not being used in a routine, effective way, according to Greta Westwood, PhD, head of Nursing, Midwifery, and AHP Research at Portsmouth (England) Hospitals and her fellow investigators.
“In primary care, screening is highly variable, and treatment rates are low, often focusing on patients who already have advanced psychiatric or physical illness,” Dr. Westwood and her colleagues wrote. “In addition, many patients with alcohol use disorders do not fully engage with primary care services for a variety of reasons, often leading to excessive use of the hospital ED as the first point of contact.”
Investigators conducted a retrospective, observational study of 53,165 patients who were admitted to the acute medical unit at Queen Alexandra Hospital, Portsmouth, England, between July 2011 and March 2014 (J Hepatol. 2017 Sep;67[3]:559-67).
More than half of patients were male (52%), the average patient age was 67 years, and the patients had an average of three previous hospital admissions.
Of the patients observed, 48,211 (90.68%) completed the screening test, while the remaining 4,934 (9.32%) did not.
Those who were not screened had a higher mortality rate than did those who were (8.30% vs 6.17%; P less than .001), were more likely to be discharged the same day (3.37% vs. 1.87%; P less than .001), and were more likely to discharge themselves (29.67% vs. 13.31%; P less than .001).
The screening process, an electronic modified version of the Paddington Alcohol Test, consisted of the nurses’ asking a series of questions about types of alcohol consumed, frequency and maximum daily amount, whether the admission was considered alcohol related, and they documented signs of alcohol withdrawal.
Patients were then given a score based on how the answers compared with the healthy level of alcohol consumption, with 0-2 points considered “low risk,” 3-5 points considered “increasing risk,” and 6-10 points considered “high risk.”
Those assigned a low-risk status were not referred to intervention, but doctors recommended increasing-risk patients attend a community alcohol intervention team for brief intervention, while high-risk patients were automatically referred to an Alcohol Specialist Nursing Service (ASNS).
Of those screened, there were 1,135 patients (2.33%) considered at increasing risk of alcohol misuse and 1,921 (3.98%) at high risk.
While 68.5% of patients with a high-risk score were referred to the ASNS, all those who were referred completed the medical detoxification course, according to investigators.
High-risk patients were found to have had, on average, more hospital visits than increasing- and low-risk patients – 4.74 visits, compared with 2.92 and 3.00, respectively; they also reported more ED trips – 7.68 visits, compared with 3.81 and 2.64, respectively.
Dr. Westwood and her colleagues found that, when using the screening tool, investigators were more likely to find signs of alcohol-related liver disease among those with higher scores.
Liver, pancreatic, and digestive disorders accounted for 22.1% of primary admission codes of high-risk patients, compared with 3.2% of low-risk patients.
Investigators wrote that this tool can help doctors identify at-risk patients early and attack the problem of alcohol misuse head on and in a timely manner.
“It is vital that patients with cirrhosis who continue to drink are identified and referred to dedicated hospital alcohol care teams,” Dr. Westwood and her colleagues wrote. “Screening can identify patients at an increased risk of alcohol-related harm whose range of diagnoses is not dissimilar to lower-risk patients and whose misuse of alcohol might otherwise have not been identified.”
Investigators did not account for decreased scores or testing effectiveness in patients readmitted and retested. Additionally, the long-term impact of ASNS care is still being studied.
Two investigators reported affiliations with the Learning Clinic, which created and licensed the analysis program that is part of the screening tool. All other investigators, including Dr. Westwood, reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
FROM JOURNAL OF HEPATOLOGY
Key clinical point:
Major finding: Patients who were admitted and were not screened for alcohol misuse risk had a higher mortality rate, compared with those who were screened (8.3% vs. 6.17%; P less than .001).
Data source: Retrospective observational study of 53,165 patients admitted to the acute medical clinic of the Queen Alexandra Hospital, Portsmouth, England, between July 2011 and March 2014.
Disclosures: Two investigators reported affiliations with the Learning Clinic, which created and licensed the analysis program that is part of the screening tool. All other investigators, including Dr. Westwood, reported no relevant financial disclosures.
Florida health officials prepare for Hurricane Irma
As Irma, the most powerful Atlantic hurricane in recorded history, approaches south Florida, the state’s Department of Health is moving quickly to prepare.
Once Gov. Rick Scott (R) declared a state of emergency in all 67 counties Sept. 4, the department swung into action.
“Florida has a robust emergency operation system and once activated, Florida Department of Health is the lead for State Emergency Function 8 or ESF-8. Hospital evacuations, special needs sheltering, and other tasks are coordinated through that function,” Mara Gambineri, communications director for the department, said in an interview. “We have plans in place and exercise those frequently to prepare for these situations.”
Hospitals near Miami are putting together skeleton crews, making sure there will be adequate personnel for the height of the storm.
“All the hospitals are going into this type of military, alpha team, bravo team approach,” Rodolfo Oviedo, MD, FACS, assistant professor of surgery at Florida State University and surgical fellow at Baptist Hospital of Miami, said in an interview. “We’ll have one specialist per specialty, and we’ll have emergency medical technicians volunteering as well.”
Despite the forecast of Hurricane Irma’s size and strength, Dr. Oviedo said that he is not concerned about local hospitals succumbing to the storm or being caught unprepared.
“This is a city that is used to this, they all have plenty of experience with hurricanes,” Dr. Oviedo said. “These buildings are built to withstand hurricanes, especially the hospitals, and even the older hospitals have been renovated for that.”
Florida adopted new building codes to improve hurricane resilience, including special exterior glazing that can handle high winds, after Hurricane Andrew tore across the state in 1992.
Others already have started to look ahead to when after the storm has passed. The Red Cross is issuing volunteer applications for Irma relief, and has committed to sending enough supplies to shelter 120,000 people by Sept. 8-9, according to a Red Cross update.
FEMA Administrator Brock Long noted that despite the intense recovery efforts ongoing in Texas and Louisiana from Hurricane Harvey, his agency is primed to assist with the impact of Hurricane Irma as well.
“We’re not going to let money get in the way of saving lives,” Mr. Long said in an interview on “CBS This Morning” Sept. 6.
Sen. Marco Rubio (R-Fla.) and Sen. Bill Nelson (D-Fla.) on Sept. 6 requested that additional FEMA funding be added to the Hurricane Harvey disaster relief package currently being considered by Congress.
Floridians “need to know that the federal government is both ready and willing to direct the necessary resources needed to help them in the recovery process,” the senators wrote in a joint letter to Senate leaders. “We strongly urge you to include additional funding in the Hurricane Harvey aid package to account for the additional costs FEMA will likely incur responding to Hurricane Irma.”
At press time, Hurricane Irma was expected to make landfall in south Florida on Sept. 10.
[email protected]
On Twitter @eaztweets
As Irma, the most powerful Atlantic hurricane in recorded history, approaches south Florida, the state’s Department of Health is moving quickly to prepare.
Once Gov. Rick Scott (R) declared a state of emergency in all 67 counties Sept. 4, the department swung into action.
“Florida has a robust emergency operation system and once activated, Florida Department of Health is the lead for State Emergency Function 8 or ESF-8. Hospital evacuations, special needs sheltering, and other tasks are coordinated through that function,” Mara Gambineri, communications director for the department, said in an interview. “We have plans in place and exercise those frequently to prepare for these situations.”
Hospitals near Miami are putting together skeleton crews, making sure there will be adequate personnel for the height of the storm.
“All the hospitals are going into this type of military, alpha team, bravo team approach,” Rodolfo Oviedo, MD, FACS, assistant professor of surgery at Florida State University and surgical fellow at Baptist Hospital of Miami, said in an interview. “We’ll have one specialist per specialty, and we’ll have emergency medical technicians volunteering as well.”
Despite the forecast of Hurricane Irma’s size and strength, Dr. Oviedo said that he is not concerned about local hospitals succumbing to the storm or being caught unprepared.
“This is a city that is used to this, they all have plenty of experience with hurricanes,” Dr. Oviedo said. “These buildings are built to withstand hurricanes, especially the hospitals, and even the older hospitals have been renovated for that.”
Florida adopted new building codes to improve hurricane resilience, including special exterior glazing that can handle high winds, after Hurricane Andrew tore across the state in 1992.
Others already have started to look ahead to when after the storm has passed. The Red Cross is issuing volunteer applications for Irma relief, and has committed to sending enough supplies to shelter 120,000 people by Sept. 8-9, according to a Red Cross update.
FEMA Administrator Brock Long noted that despite the intense recovery efforts ongoing in Texas and Louisiana from Hurricane Harvey, his agency is primed to assist with the impact of Hurricane Irma as well.
“We’re not going to let money get in the way of saving lives,” Mr. Long said in an interview on “CBS This Morning” Sept. 6.
Sen. Marco Rubio (R-Fla.) and Sen. Bill Nelson (D-Fla.) on Sept. 6 requested that additional FEMA funding be added to the Hurricane Harvey disaster relief package currently being considered by Congress.
Floridians “need to know that the federal government is both ready and willing to direct the necessary resources needed to help them in the recovery process,” the senators wrote in a joint letter to Senate leaders. “We strongly urge you to include additional funding in the Hurricane Harvey aid package to account for the additional costs FEMA will likely incur responding to Hurricane Irma.”
At press time, Hurricane Irma was expected to make landfall in south Florida on Sept. 10.
[email protected]
On Twitter @eaztweets
As Irma, the most powerful Atlantic hurricane in recorded history, approaches south Florida, the state’s Department of Health is moving quickly to prepare.
Once Gov. Rick Scott (R) declared a state of emergency in all 67 counties Sept. 4, the department swung into action.
“Florida has a robust emergency operation system and once activated, Florida Department of Health is the lead for State Emergency Function 8 or ESF-8. Hospital evacuations, special needs sheltering, and other tasks are coordinated through that function,” Mara Gambineri, communications director for the department, said in an interview. “We have plans in place and exercise those frequently to prepare for these situations.”
Hospitals near Miami are putting together skeleton crews, making sure there will be adequate personnel for the height of the storm.
“All the hospitals are going into this type of military, alpha team, bravo team approach,” Rodolfo Oviedo, MD, FACS, assistant professor of surgery at Florida State University and surgical fellow at Baptist Hospital of Miami, said in an interview. “We’ll have one specialist per specialty, and we’ll have emergency medical technicians volunteering as well.”
Despite the forecast of Hurricane Irma’s size and strength, Dr. Oviedo said that he is not concerned about local hospitals succumbing to the storm or being caught unprepared.
“This is a city that is used to this, they all have plenty of experience with hurricanes,” Dr. Oviedo said. “These buildings are built to withstand hurricanes, especially the hospitals, and even the older hospitals have been renovated for that.”
Florida adopted new building codes to improve hurricane resilience, including special exterior glazing that can handle high winds, after Hurricane Andrew tore across the state in 1992.
Others already have started to look ahead to when after the storm has passed. The Red Cross is issuing volunteer applications for Irma relief, and has committed to sending enough supplies to shelter 120,000 people by Sept. 8-9, according to a Red Cross update.
FEMA Administrator Brock Long noted that despite the intense recovery efforts ongoing in Texas and Louisiana from Hurricane Harvey, his agency is primed to assist with the impact of Hurricane Irma as well.
“We’re not going to let money get in the way of saving lives,” Mr. Long said in an interview on “CBS This Morning” Sept. 6.
Sen. Marco Rubio (R-Fla.) and Sen. Bill Nelson (D-Fla.) on Sept. 6 requested that additional FEMA funding be added to the Hurricane Harvey disaster relief package currently being considered by Congress.
Floridians “need to know that the federal government is both ready and willing to direct the necessary resources needed to help them in the recovery process,” the senators wrote in a joint letter to Senate leaders. “We strongly urge you to include additional funding in the Hurricane Harvey aid package to account for the additional costs FEMA will likely incur responding to Hurricane Irma.”
At press time, Hurricane Irma was expected to make landfall in south Florida on Sept. 10.
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On Twitter @eaztweets
Hurricane Harvey tests Houston physicians’ mettle
As Houston-area citizens evacuated or hunkered down at home in anticipation of Hurricane Harvey, doctors like Mary L. Brandt, MD, FACS, packed a bag and headed to work.
“I came in on Saturday morning [Aug. 23] – I was on call – and so I packed a big suitcase and a big bag of food because I anticipated I would be here until Thursday,” Dr. Brandt said in an interview, “So I became part of the ‘ride-out crew.’ ”
Hospitals were hit hard by Hurricane Harvey, and many struggled against the effects of the Category 4 storm, which made landfall then stalled over Texas for almost a week, pummeling the area.
“We all know this [flooding] could happen, so all the facilities in the medical center have flood gates, and generators are out of the basement so that there is not any risk of losing all electricity, but then the issue becomes the staff,” Dr. Brandt said. “They can’t get to and from the facility, and that’s particularly true if they live in the periphery of Houston, which is common.”
The situation was the same for many area hospitals. Just 2 miles away from Texas Children’s Hospital, SreyRam Kuy, MD, FACS, associate chief of staff at the Michael E DeBakey VA Medical Center, and her colleagues prepared to run the hospital with a skeleton crew.
“We were preparing when it was still a tropical storm, and we talked to the staff ahead of time to let them know this would be a marathon, not a sprint,” Dr. Kuy said in an interview. “We had people staying in the hospital ahead of time because we were worried that when the hurricane hit, we would not be able to have people return.”
But when Harvey made landfall with Category 4 intensity, many medical facilities were caught by surprise.
“We didn’t know how bad it would be, I honestly don’t think anyone in the city or the state had any idea of how tremendous the impact would be, particularly with the flooding,” Dr. Kuy said. “We had staff going 5, 6 days here at the hospital, working continuously, sleeping on the floor, and because of that, we were able to perform multiple emergency surgeries during the disaster, including laparoscopic treatment of ruptured appendicitis and replacement of an infection aortic graft, which required massive transfusion.” The VA hospital broke from its core mission of caring for veterans, treating “homeless folks and nonveterans who were brought here by the Coast Guard, or the ambulances, or by air.”
At Texas Children’s Hospital, Dr. Brandt and her colleagues were dealing with similar situations, staying on their feet and moving quickly as rescued patients arrived by air.
“We were near the area that was flooding really terribly, and so the Coast Guard had been coming in and bringing kids,” Dr. Brandt said. “Sometimes, we knew what was coming and sometimes we didn’t. It was pretty much controlled chaos.”
Staff shared responsibilities, often taking on tasks far outside their usual roles.
“We didn’t have enough people working the cafeteria, and so, at one point, I put on my hair net, grabbed a ladle, and served in the lunch line,” Dr. Kuy said.
Throughout the storm and flooding, medical professionals fought through exhaustion and depleting supplies, all with little or no knowledge of how their own homes and families were faring.
“We had people here for so long, and they had no idea what was happening in their own homes,” Dr. Kuy said. “They were watching on the news, seeing the reports and watching their own neighborhoods flooded.”
Dr. Brandt and her colleagues would watch as reports came in of what was happening beyond the hospital walls.
“We have some meeting areas, we would watch the weather together and that goes from the janitors to the head of the hospital who was in the hospital with us,” she said.
Despite the chaos outside, morale did not waiver for either Dr. Kuy’s or Dr. Brandt’s crew.
“I remember walking throughout the hospital, doing my rounds, checking up on the units. I went to talk with some of the staff nurses, and what struck me was as I walk in I see these big smiles on their faces, I absolutely did not expect that,” Dr. Kuy said. “They had been in the hospital for 5 days, they were exhausted. It just makes me so proud to serve along these kinds of people.”
As travel became possible, Dr. Kuy and other area physicians – as well as volunteers from across the country – began to shift their focus to evacuation shelters, treating ambulatory patients there.
“The response has been phenomenal,” said Dr. Kuy. “I met an ER doctor from North Carolina who came to volunteer, we have FEMA [Federal Emergency Management Agency] doctors from all across the state, and then of course, all the people from the different VA [hospitals].”
Pediatricians have sent their support as well, offering time and supplies to help take care of the patients at Texas Children’s Hospital, Dr. Brandt said.
At presstime, volunteers were still needed. The Texas Department of State Health Services opened a web portal for volunteer opportunities, and lifted restriction on out-of-state doctors from practicing medicine without state registration.
While there is still much that needs to be done to recover, those on the ground said that they feel an overwhelming feeling of community as people face what will inevitably be a tough road ahead.
“Houston has a reputation and a culture of helping neighbors and it has been astounding to watch what’s happening,” said Dr. Brandt. “No matter how tired people are or how stressful any cases are, everyone’s morale stays high.”
[email protected]
On Twitter @eaztweets
As Houston-area citizens evacuated or hunkered down at home in anticipation of Hurricane Harvey, doctors like Mary L. Brandt, MD, FACS, packed a bag and headed to work.
“I came in on Saturday morning [Aug. 23] – I was on call – and so I packed a big suitcase and a big bag of food because I anticipated I would be here until Thursday,” Dr. Brandt said in an interview, “So I became part of the ‘ride-out crew.’ ”
Hospitals were hit hard by Hurricane Harvey, and many struggled against the effects of the Category 4 storm, which made landfall then stalled over Texas for almost a week, pummeling the area.
“We all know this [flooding] could happen, so all the facilities in the medical center have flood gates, and generators are out of the basement so that there is not any risk of losing all electricity, but then the issue becomes the staff,” Dr. Brandt said. “They can’t get to and from the facility, and that’s particularly true if they live in the periphery of Houston, which is common.”
The situation was the same for many area hospitals. Just 2 miles away from Texas Children’s Hospital, SreyRam Kuy, MD, FACS, associate chief of staff at the Michael E DeBakey VA Medical Center, and her colleagues prepared to run the hospital with a skeleton crew.
“We were preparing when it was still a tropical storm, and we talked to the staff ahead of time to let them know this would be a marathon, not a sprint,” Dr. Kuy said in an interview. “We had people staying in the hospital ahead of time because we were worried that when the hurricane hit, we would not be able to have people return.”
But when Harvey made landfall with Category 4 intensity, many medical facilities were caught by surprise.
“We didn’t know how bad it would be, I honestly don’t think anyone in the city or the state had any idea of how tremendous the impact would be, particularly with the flooding,” Dr. Kuy said. “We had staff going 5, 6 days here at the hospital, working continuously, sleeping on the floor, and because of that, we were able to perform multiple emergency surgeries during the disaster, including laparoscopic treatment of ruptured appendicitis and replacement of an infection aortic graft, which required massive transfusion.” The VA hospital broke from its core mission of caring for veterans, treating “homeless folks and nonveterans who were brought here by the Coast Guard, or the ambulances, or by air.”
At Texas Children’s Hospital, Dr. Brandt and her colleagues were dealing with similar situations, staying on their feet and moving quickly as rescued patients arrived by air.
“We were near the area that was flooding really terribly, and so the Coast Guard had been coming in and bringing kids,” Dr. Brandt said. “Sometimes, we knew what was coming and sometimes we didn’t. It was pretty much controlled chaos.”
Staff shared responsibilities, often taking on tasks far outside their usual roles.
“We didn’t have enough people working the cafeteria, and so, at one point, I put on my hair net, grabbed a ladle, and served in the lunch line,” Dr. Kuy said.
Throughout the storm and flooding, medical professionals fought through exhaustion and depleting supplies, all with little or no knowledge of how their own homes and families were faring.
“We had people here for so long, and they had no idea what was happening in their own homes,” Dr. Kuy said. “They were watching on the news, seeing the reports and watching their own neighborhoods flooded.”
Dr. Brandt and her colleagues would watch as reports came in of what was happening beyond the hospital walls.
“We have some meeting areas, we would watch the weather together and that goes from the janitors to the head of the hospital who was in the hospital with us,” she said.
Despite the chaos outside, morale did not waiver for either Dr. Kuy’s or Dr. Brandt’s crew.
“I remember walking throughout the hospital, doing my rounds, checking up on the units. I went to talk with some of the staff nurses, and what struck me was as I walk in I see these big smiles on their faces, I absolutely did not expect that,” Dr. Kuy said. “They had been in the hospital for 5 days, they were exhausted. It just makes me so proud to serve along these kinds of people.”
As travel became possible, Dr. Kuy and other area physicians – as well as volunteers from across the country – began to shift their focus to evacuation shelters, treating ambulatory patients there.
“The response has been phenomenal,” said Dr. Kuy. “I met an ER doctor from North Carolina who came to volunteer, we have FEMA [Federal Emergency Management Agency] doctors from all across the state, and then of course, all the people from the different VA [hospitals].”
Pediatricians have sent their support as well, offering time and supplies to help take care of the patients at Texas Children’s Hospital, Dr. Brandt said.
At presstime, volunteers were still needed. The Texas Department of State Health Services opened a web portal for volunteer opportunities, and lifted restriction on out-of-state doctors from practicing medicine without state registration.
While there is still much that needs to be done to recover, those on the ground said that they feel an overwhelming feeling of community as people face what will inevitably be a tough road ahead.
“Houston has a reputation and a culture of helping neighbors and it has been astounding to watch what’s happening,” said Dr. Brandt. “No matter how tired people are or how stressful any cases are, everyone’s morale stays high.”
[email protected]
On Twitter @eaztweets
As Houston-area citizens evacuated or hunkered down at home in anticipation of Hurricane Harvey, doctors like Mary L. Brandt, MD, FACS, packed a bag and headed to work.
“I came in on Saturday morning [Aug. 23] – I was on call – and so I packed a big suitcase and a big bag of food because I anticipated I would be here until Thursday,” Dr. Brandt said in an interview, “So I became part of the ‘ride-out crew.’ ”
Hospitals were hit hard by Hurricane Harvey, and many struggled against the effects of the Category 4 storm, which made landfall then stalled over Texas for almost a week, pummeling the area.
“We all know this [flooding] could happen, so all the facilities in the medical center have flood gates, and generators are out of the basement so that there is not any risk of losing all electricity, but then the issue becomes the staff,” Dr. Brandt said. “They can’t get to and from the facility, and that’s particularly true if they live in the periphery of Houston, which is common.”
The situation was the same for many area hospitals. Just 2 miles away from Texas Children’s Hospital, SreyRam Kuy, MD, FACS, associate chief of staff at the Michael E DeBakey VA Medical Center, and her colleagues prepared to run the hospital with a skeleton crew.
“We were preparing when it was still a tropical storm, and we talked to the staff ahead of time to let them know this would be a marathon, not a sprint,” Dr. Kuy said in an interview. “We had people staying in the hospital ahead of time because we were worried that when the hurricane hit, we would not be able to have people return.”
But when Harvey made landfall with Category 4 intensity, many medical facilities were caught by surprise.
“We didn’t know how bad it would be, I honestly don’t think anyone in the city or the state had any idea of how tremendous the impact would be, particularly with the flooding,” Dr. Kuy said. “We had staff going 5, 6 days here at the hospital, working continuously, sleeping on the floor, and because of that, we were able to perform multiple emergency surgeries during the disaster, including laparoscopic treatment of ruptured appendicitis and replacement of an infection aortic graft, which required massive transfusion.” The VA hospital broke from its core mission of caring for veterans, treating “homeless folks and nonveterans who were brought here by the Coast Guard, or the ambulances, or by air.”
At Texas Children’s Hospital, Dr. Brandt and her colleagues were dealing with similar situations, staying on their feet and moving quickly as rescued patients arrived by air.
“We were near the area that was flooding really terribly, and so the Coast Guard had been coming in and bringing kids,” Dr. Brandt said. “Sometimes, we knew what was coming and sometimes we didn’t. It was pretty much controlled chaos.”
Staff shared responsibilities, often taking on tasks far outside their usual roles.
“We didn’t have enough people working the cafeteria, and so, at one point, I put on my hair net, grabbed a ladle, and served in the lunch line,” Dr. Kuy said.
Throughout the storm and flooding, medical professionals fought through exhaustion and depleting supplies, all with little or no knowledge of how their own homes and families were faring.
“We had people here for so long, and they had no idea what was happening in their own homes,” Dr. Kuy said. “They were watching on the news, seeing the reports and watching their own neighborhoods flooded.”
Dr. Brandt and her colleagues would watch as reports came in of what was happening beyond the hospital walls.
“We have some meeting areas, we would watch the weather together and that goes from the janitors to the head of the hospital who was in the hospital with us,” she said.
Despite the chaos outside, morale did not waiver for either Dr. Kuy’s or Dr. Brandt’s crew.
“I remember walking throughout the hospital, doing my rounds, checking up on the units. I went to talk with some of the staff nurses, and what struck me was as I walk in I see these big smiles on their faces, I absolutely did not expect that,” Dr. Kuy said. “They had been in the hospital for 5 days, they were exhausted. It just makes me so proud to serve along these kinds of people.”
As travel became possible, Dr. Kuy and other area physicians – as well as volunteers from across the country – began to shift their focus to evacuation shelters, treating ambulatory patients there.
“The response has been phenomenal,” said Dr. Kuy. “I met an ER doctor from North Carolina who came to volunteer, we have FEMA [Federal Emergency Management Agency] doctors from all across the state, and then of course, all the people from the different VA [hospitals].”
Pediatricians have sent their support as well, offering time and supplies to help take care of the patients at Texas Children’s Hospital, Dr. Brandt said.
At presstime, volunteers were still needed. The Texas Department of State Health Services opened a web portal for volunteer opportunities, and lifted restriction on out-of-state doctors from practicing medicine without state registration.
While there is still much that needs to be done to recover, those on the ground said that they feel an overwhelming feeling of community as people face what will inevitably be a tough road ahead.
“Houston has a reputation and a culture of helping neighbors and it has been astounding to watch what’s happening,” said Dr. Brandt. “No matter how tired people are or how stressful any cases are, everyone’s morale stays high.”
[email protected]
On Twitter @eaztweets
Burden of HCV-induced cirrhosis expected to shift from men to women
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
AGA Resource
Through the HCV Clinical Service Line, AGA offers tools to help you become more efficient, understand quality standards and improve the process of care for patients. Learn more at http://www.gastro.org/patient-care/conditions-diseases/hepatitis-c
[email protected]
On Twitter @eaztweets
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
AGA Resource
Through the HCV Clinical Service Line, AGA offers tools to help you become more efficient, understand quality standards and improve the process of care for patients. Learn more at http://www.gastro.org/patient-care/conditions-diseases/hepatitis-c
[email protected]
On Twitter @eaztweets
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
AGA Resource
Through the HCV Clinical Service Line, AGA offers tools to help you become more efficient, understand quality standards and improve the process of care for patients. Learn more at http://www.gastro.org/patient-care/conditions-diseases/hepatitis-c
[email protected]
On Twitter @eaztweets
FROM JOURNAL OF VIRAL HEPATITIS
Key clinical point:
Major finding: Average annual change of cirrhosis prevalence in women was 15.2% for women and 13.1% for men, while total mortality was 15.5% compared with 28.7% for women and men, respectively.
Data source: Retrospective cohort study of 264,409 veterans diagnosed with HCV, from the Veterans Affairs corporate wellness data for January 2000 to December 2013.
Disclosures: The investigators reported no relevant financial disclosures.
Burden of HCV-induced cirrhosis expected to shift from men to women
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.
While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.
“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”
The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).
Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.
Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).
While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.
As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.
Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.
Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.
“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”
Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.
While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.
“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”
Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.
The researchers reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
FROM THE JOURNAL OF VIRAL HEPATITIS
Key clinical point:
Major finding: Average annual change of cirrhosis prevalence in women was 15.2% for women and 13.1% for men, while total mortality was 15.5% compared with 28.7% for women and men, respectively.
Data source: Retrospective cohort study of 264,409 veterans diagnosed with HCV, from the Veterans Affairs corporate wellness data for January 2000 to December 2013.
Disclosures: The investigators reported no relevant financial disclosures.
CDC: Flu vaccine recommendations broaden for pregnant women and children
, according to new recommendations from the Centers for Disease Control and Prevention.
This change from the CDC’s previous guidance that pregnant women receive a seasonal inactivated influenza vaccine (IIV) was recommended by the Advisory Committee on Immunization Practices after some heated debate among committee members over evidence presented to support the change in wording (MMWR. 2017 Aug 25;66[(RR-2]:1-20). 
The new update gives women the ability to choose between receiving an IIV and FluBlok, a recombinant influenza vaccine (RIV) that is not egg based and can be manufactured more quickly, making it ideal in cases of pandemic or supply shortages, according to the CDC.
Although pregnant women may choose to receive a vaccination during the first trimester, the CDC warns there may be some risk involved.
“Although experience with the use of IIVs is substantial, and data from observational studies are available to support the safety of these vaccines in pregnancy, data are more limited for vaccination during the first trimester,” according to the CDC. “Moreover, there is substantially less experience with more recently licensed IIV products (e.g., quadrivalent, cell culture-based, and adjuvanted vaccines) during pregnancy in general.”
Data also are limited regarding RIVs, the CDC said, with the data used to determine safety among pregnant women “limited to reports of pregnancies occurring incidentally during clinical trials, Vaccine Adverse Event Reporting System (VAERS) reports, and pregnancy registry reports.”
Changes for children
The CDC chose to accept ACIP recommendations regarding Afluria (IIV3), expanding the age of children who can receive the vaccine from 9 years and older to 5 years and older.
Similar labeling changes were accepted for FluLaval Quadrivalent (IIV4), which had previously been given to children 3 years and older but now but will be available for children starting at 6 months of age.
New products
Recent product licensures included in the MMWR report are Afluria Quadrivalent (IIV4) and Flublok Quadrivalent (RIV4), both for persons over 18 years.
According to the CDC, Flublok Quadrivalent (an RIV) met noninferiority measures, compared with a similar IIV quadrivalent vaccine, for the A(H3H2) and B/Yamagata viruses but not for A(H1N1) or B/Victoria viruses.
Vaccine composition for 2017-2018
Approved viruses for the 2017-2018 season trivalent vaccines are an A/Michigan/45/2015 (H1N1) pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage), according to the MMWR. Quadrivalent vaccines will include those viruses, with the addition of an B/Phuket/3073/2013–like virus (Yamagata lineage).
The CDC continues to recommend that the quadrivalent live attenuated influenza vaccine FluMist not be used by anyone for the 2017-2018 season, a decision that was made after evidence showed poor effectiveness against influenza A(H1N1)pdm09 viruses in the 2013-2014 and 2015-2016 seasons.
Vaccine updates published in this report were recommended by ACIP during meetings held in October 2016 and February and June 2017.
[email protected]
On Twitter @eaztweets
, according to new recommendations from the Centers for Disease Control and Prevention.
This change from the CDC’s previous guidance that pregnant women receive a seasonal inactivated influenza vaccine (IIV) was recommended by the Advisory Committee on Immunization Practices after some heated debate among committee members over evidence presented to support the change in wording (MMWR. 2017 Aug 25;66[(RR-2]:1-20).
The new update gives women the ability to choose between receiving an IIV and FluBlok, a recombinant influenza vaccine (RIV) that is not egg based and can be manufactured more quickly, making it ideal in cases of pandemic or supply shortages, according to the CDC.
Although pregnant women may choose to receive a vaccination during the first trimester, the CDC warns there may be some risk involved.
“Although experience with the use of IIVs is substantial, and data from observational studies are available to support the safety of these vaccines in pregnancy, data are more limited for vaccination during the first trimester,” according to the CDC. “Moreover, there is substantially less experience with more recently licensed IIV products (e.g., quadrivalent, cell culture-based, and adjuvanted vaccines) during pregnancy in general.”
Data also are limited regarding RIVs, the CDC said, with the data used to determine safety among pregnant women “limited to reports of pregnancies occurring incidentally during clinical trials, Vaccine Adverse Event Reporting System (VAERS) reports, and pregnancy registry reports.”
Changes for children
The CDC chose to accept ACIP recommendations regarding Afluria (IIV3), expanding the age of children who can receive the vaccine from 9 years and older to 5 years and older.
Similar labeling changes were accepted for FluLaval Quadrivalent (IIV4), which had previously been given to children 3 years and older but now but will be available for children starting at 6 months of age.
New products
Recent product licensures included in the MMWR report are Afluria Quadrivalent (IIV4) and Flublok Quadrivalent (RIV4), both for persons over 18 years.
According to the CDC, Flublok Quadrivalent (an RIV) met noninferiority measures, compared with a similar IIV quadrivalent vaccine, for the A(H3H2) and B/Yamagata viruses but not for A(H1N1) or B/Victoria viruses.
Vaccine composition for 2017-2018
Approved viruses for the 2017-2018 season trivalent vaccines are an A/Michigan/45/2015 (H1N1) pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage), according to the MMWR. Quadrivalent vaccines will include those viruses, with the addition of an B/Phuket/3073/2013–like virus (Yamagata lineage).
The CDC continues to recommend that the quadrivalent live attenuated influenza vaccine FluMist not be used by anyone for the 2017-2018 season, a decision that was made after evidence showed poor effectiveness against influenza A(H1N1)pdm09 viruses in the 2013-2014 and 2015-2016 seasons.
Vaccine updates published in this report were recommended by ACIP during meetings held in October 2016 and February and June 2017.
[email protected]
On Twitter @eaztweets
, according to new recommendations from the Centers for Disease Control and Prevention.
This change from the CDC’s previous guidance that pregnant women receive a seasonal inactivated influenza vaccine (IIV) was recommended by the Advisory Committee on Immunization Practices after some heated debate among committee members over evidence presented to support the change in wording (MMWR. 2017 Aug 25;66[(RR-2]:1-20).
The new update gives women the ability to choose between receiving an IIV and FluBlok, a recombinant influenza vaccine (RIV) that is not egg based and can be manufactured more quickly, making it ideal in cases of pandemic or supply shortages, according to the CDC.
Although pregnant women may choose to receive a vaccination during the first trimester, the CDC warns there may be some risk involved.
“Although experience with the use of IIVs is substantial, and data from observational studies are available to support the safety of these vaccines in pregnancy, data are more limited for vaccination during the first trimester,” according to the CDC. “Moreover, there is substantially less experience with more recently licensed IIV products (e.g., quadrivalent, cell culture-based, and adjuvanted vaccines) during pregnancy in general.”
Data also are limited regarding RIVs, the CDC said, with the data used to determine safety among pregnant women “limited to reports of pregnancies occurring incidentally during clinical trials, Vaccine Adverse Event Reporting System (VAERS) reports, and pregnancy registry reports.”
Changes for children
The CDC chose to accept ACIP recommendations regarding Afluria (IIV3), expanding the age of children who can receive the vaccine from 9 years and older to 5 years and older.
Similar labeling changes were accepted for FluLaval Quadrivalent (IIV4), which had previously been given to children 3 years and older but now but will be available for children starting at 6 months of age.
New products
Recent product licensures included in the MMWR report are Afluria Quadrivalent (IIV4) and Flublok Quadrivalent (RIV4), both for persons over 18 years.
According to the CDC, Flublok Quadrivalent (an RIV) met noninferiority measures, compared with a similar IIV quadrivalent vaccine, for the A(H3H2) and B/Yamagata viruses but not for A(H1N1) or B/Victoria viruses.
Vaccine composition for 2017-2018
Approved viruses for the 2017-2018 season trivalent vaccines are an A/Michigan/45/2015 (H1N1) pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage), according to the MMWR. Quadrivalent vaccines will include those viruses, with the addition of an B/Phuket/3073/2013–like virus (Yamagata lineage).
The CDC continues to recommend that the quadrivalent live attenuated influenza vaccine FluMist not be used by anyone for the 2017-2018 season, a decision that was made after evidence showed poor effectiveness against influenza A(H1N1)pdm09 viruses in the 2013-2014 and 2015-2016 seasons.
Vaccine updates published in this report were recommended by ACIP during meetings held in October 2016 and February and June 2017.
[email protected]
On Twitter @eaztweets
FROM MMWR
Noninvasive NASH test could help monitor hepatotoxicity in patients on methotrexate
A noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis could be used to help detect worsening hepatic fibrosis in psoriasis patients who are on long-term methotrexate therapy, according to the authors of a retrospective study published online Aug. 23.
To evaluate the use of the noninvasive test to monitor for hepatic fibrosis in this group of patients and guide the management of methotrexate (MTX) without a liver biopsy, investigators conducted an analysis of 107 patients with psoriasis who were on long-term MTX treatment, for whom the NASH FibroSure test was used between January 2007 and December 2013. All the patients were white, fifty were men, the mean age was 83 years, and almost all of the patients had a body mass index of 28 or more (16% had a BMI between 28 and 30, and 81% had a BMI over 30).
The NASH FibroSure test, which was developed for use in patients suspected of having nonalcoholic fatty liver disease (NAFLD), combines analyses of 10 biochemical markers combined with age, sex, height, and weight to calculate the degree of hepatic fibrosis. The test has a reported sensitivity of 83% and a specificity of 78% in detecting risk of significant fibrosis, according to Bruce Bauer, MD, of Pariser Dermatology Specialists, Norfolk, Va., and his coinvestigators (JAMA Dermatol. 2017 Aug 23. doi: 10.1001/jamadermatol.2017.2083).
Among the 107 patients, the investigators found a statistically significant correlation “between worsening fibrosis scores and cumulative methotrexate” dose among women (P = .02), but not among men (P = .11). In addition, women with a BMI of 28 or more were more likely to have worsening fibrosis scores (P = .03). “There were no differences between men and women with regard to prevalence of a BMI of 28 or more, diabetes, age older than 65 years, or chronic kidney disease,” which they said, suggests that among women, “obesity influences the progression of fibrosis scores.”
The investigators advised providers not to disregard any potential warning signs when using FibroSure on men. “No differences between the cohorts were observed that would explain the association of worsening fibrosis scores and cumulative MTX dose among women but not men,” they wrote. “However, given the implications of the progression of hepatic fibrosis, we still recommend discontinuing MTX for male patients who demonstrate worsening fibrosis scores.”
While the test may not be able to replace liver biopsy, based on these results, the investigators noted that noninvasive tests such as this one could help significantly reduce the number of liver biopsies needed.
They pointed out that because the study was conducted at one center, the next step is to conduct “a prospective, randomized, multi-institutional analysis of NASH FibroSure and liver biopsies for patients with psoriasis receiving MTX vs. other treatments, including a larger cohort of men and women with different racial and ethnic backgrounds.”
One of the four authors reported receiving research funding from T2 Biosystems. Dr. Bauer and the two other authors reported no relevant financial disclosures. The study was funded by the Marshfield Clinic Resident Research Program.
[email protected]
On Twitter @eaztweets
A noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis could be used to help detect worsening hepatic fibrosis in psoriasis patients who are on long-term methotrexate therapy, according to the authors of a retrospective study published online Aug. 23.
To evaluate the use of the noninvasive test to monitor for hepatic fibrosis in this group of patients and guide the management of methotrexate (MTX) without a liver biopsy, investigators conducted an analysis of 107 patients with psoriasis who were on long-term MTX treatment, for whom the NASH FibroSure test was used between January 2007 and December 2013. All the patients were white, fifty were men, the mean age was 83 years, and almost all of the patients had a body mass index of 28 or more (16% had a BMI between 28 and 30, and 81% had a BMI over 30).
The NASH FibroSure test, which was developed for use in patients suspected of having nonalcoholic fatty liver disease (NAFLD), combines analyses of 10 biochemical markers combined with age, sex, height, and weight to calculate the degree of hepatic fibrosis. The test has a reported sensitivity of 83% and a specificity of 78% in detecting risk of significant fibrosis, according to Bruce Bauer, MD, of Pariser Dermatology Specialists, Norfolk, Va., and his coinvestigators (JAMA Dermatol. 2017 Aug 23. doi: 10.1001/jamadermatol.2017.2083).
Among the 107 patients, the investigators found a statistically significant correlation “between worsening fibrosis scores and cumulative methotrexate” dose among women (P = .02), but not among men (P = .11). In addition, women with a BMI of 28 or more were more likely to have worsening fibrosis scores (P = .03). “There were no differences between men and women with regard to prevalence of a BMI of 28 or more, diabetes, age older than 65 years, or chronic kidney disease,” which they said, suggests that among women, “obesity influences the progression of fibrosis scores.”
The investigators advised providers not to disregard any potential warning signs when using FibroSure on men. “No differences between the cohorts were observed that would explain the association of worsening fibrosis scores and cumulative MTX dose among women but not men,” they wrote. “However, given the implications of the progression of hepatic fibrosis, we still recommend discontinuing MTX for male patients who demonstrate worsening fibrosis scores.”
While the test may not be able to replace liver biopsy, based on these results, the investigators noted that noninvasive tests such as this one could help significantly reduce the number of liver biopsies needed.
They pointed out that because the study was conducted at one center, the next step is to conduct “a prospective, randomized, multi-institutional analysis of NASH FibroSure and liver biopsies for patients with psoriasis receiving MTX vs. other treatments, including a larger cohort of men and women with different racial and ethnic backgrounds.”
One of the four authors reported receiving research funding from T2 Biosystems. Dr. Bauer and the two other authors reported no relevant financial disclosures. The study was funded by the Marshfield Clinic Resident Research Program.
[email protected]
On Twitter @eaztweets
A noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis could be used to help detect worsening hepatic fibrosis in psoriasis patients who are on long-term methotrexate therapy, according to the authors of a retrospective study published online Aug. 23.
To evaluate the use of the noninvasive test to monitor for hepatic fibrosis in this group of patients and guide the management of methotrexate (MTX) without a liver biopsy, investigators conducted an analysis of 107 patients with psoriasis who were on long-term MTX treatment, for whom the NASH FibroSure test was used between January 2007 and December 2013. All the patients were white, fifty were men, the mean age was 83 years, and almost all of the patients had a body mass index of 28 or more (16% had a BMI between 28 and 30, and 81% had a BMI over 30).
The NASH FibroSure test, which was developed for use in patients suspected of having nonalcoholic fatty liver disease (NAFLD), combines analyses of 10 biochemical markers combined with age, sex, height, and weight to calculate the degree of hepatic fibrosis. The test has a reported sensitivity of 83% and a specificity of 78% in detecting risk of significant fibrosis, according to Bruce Bauer, MD, of Pariser Dermatology Specialists, Norfolk, Va., and his coinvestigators (JAMA Dermatol. 2017 Aug 23. doi: 10.1001/jamadermatol.2017.2083).
Among the 107 patients, the investigators found a statistically significant correlation “between worsening fibrosis scores and cumulative methotrexate” dose among women (P = .02), but not among men (P = .11). In addition, women with a BMI of 28 or more were more likely to have worsening fibrosis scores (P = .03). “There were no differences between men and women with regard to prevalence of a BMI of 28 or more, diabetes, age older than 65 years, or chronic kidney disease,” which they said, suggests that among women, “obesity influences the progression of fibrosis scores.”
The investigators advised providers not to disregard any potential warning signs when using FibroSure on men. “No differences between the cohorts were observed that would explain the association of worsening fibrosis scores and cumulative MTX dose among women but not men,” they wrote. “However, given the implications of the progression of hepatic fibrosis, we still recommend discontinuing MTX for male patients who demonstrate worsening fibrosis scores.”
While the test may not be able to replace liver biopsy, based on these results, the investigators noted that noninvasive tests such as this one could help significantly reduce the number of liver biopsies needed.
They pointed out that because the study was conducted at one center, the next step is to conduct “a prospective, randomized, multi-institutional analysis of NASH FibroSure and liver biopsies for patients with psoriasis receiving MTX vs. other treatments, including a larger cohort of men and women with different racial and ethnic backgrounds.”
One of the four authors reported receiving research funding from T2 Biosystems. Dr. Bauer and the two other authors reported no relevant financial disclosures. The study was funded by the Marshfield Clinic Resident Research Program.
[email protected]
On Twitter @eaztweets
FROM JAMA DERMATOLOGY
Key clinical point:
Major finding: There was a significant correlation between worsening fibrosis scores on the test and cumulative methotrexate dose among women (P = .02), but not among men (P = .11).
Data source: A retrospective single-center study analyzing the test in 107 psoriasis patients on methotrexate, collected between January 2007 and December 2013.
Disclosures: One of the four authors received research funding from T2 Biosystems. There were no other financial disclosures.
Remediation for surgical trainees may lower attrition
Remediation programs and program director attitudes can make the difference in attrition rates among general surgery residents, according to a survey-based study.
A study by the Association of American Medical Colleges, projects a shortage of 29,000 general surgeons by 2030. Some residency programs are taking steps lower program dropout rates, which has been reported as high as 26% in some programs, according to Alexander Schwed, MD, general surgeon at Harbor–University of California, Los Angeles Medical Center.
Dr. Schwed and his colleagues conducted a survey of 21 general surgery residency program directors. In those programs, the overall attrition rate was found to be much lower than expected – 8.8% over a 5-year period (JAMA Surg. 2017 Aug 16. doi: 10.1001/jamasurg.2017.2656).
The survey showed that programs that implemented resident remediation had lower attrition rates, (21.0% vs 6.8%; P less than .001).
“The association between increased use of remediation by residency programs and low rates of resident attrition is novel,” the investigators wrote. “Nevertheless, based on our findings, high-attrition programs could lower their attrition rates through the increased use of resident remediation and increased focus on resident education.”
Both high- and low-attrition programs selected to participate in the study showed relatively similar median numbers of residents, with low-attrition programs reporting a median of 28 participants per year, and high-attrition programs reporting with 35.
Other similarities between low- and high-attrition programs include percentage of female and minority residents, median of 33.3% and 39.8% respectively, and the number of cases performed by first-, second-, and third-year residents.
The other difference between the six low-attrition programs and the five high-attrition programs was the attitude of the program directors regarding their role in the training of residents, according to researchers.
Investigators asked directors a series of questions using a Likert scale with 1 representing “strongly disagree” and 4 representing “strongly agree.”
Program directors from high- and low-attrition programs tended to agree strongly (scoring 3.8 and 3.2, respectively) with the statement that one of their main roles as a program leader was to “redirect residents who should not be surgeons.”
When asked whether “some degree of resident attrition is a necessary phenomenon,” directors from low-attrition programs scored 2.2, while those from high-attrition programs indicated stronger agreement with an overall score of 3.2.
Directors from programs with high dropout rates were also more likely to consider a 6% dropout rate to be too low, compared with directors from low-attrition programs who thought it was too high.
“When we recruit residents, we are very careful to recruit those who seem to buy into our mission, our vision, and our ideals and fit in well with our culture,” said Sharmila Dissanaike, MD, FACS, department of surgery chair at Texas Tech University Health Sciences Center, Lubbock, in an interview. “We emphasize teamwork, collegiality, and an ‘all for one and one for all’ type of mentality.”
This kind of recruitment includes having current residents be a part of the process, Dr. Dissanaike explained, and encouraging current and potential residents to have an informal dinner to get to know one another better.
For the department of surgery at Texas Tech, the collaborative culture combined with a remediation program has resulted in a drop in attrition from 20% down to 7% in recent years, Dr. Dissanaike said. In addition, the current success of her program can be partly attributed to a recent decision to maintain the number of incoming residents at five, she said.*
Larger programs can achieve similar improvement, she noted and the rising demand for surgeons makes it essential to find a solution that incorporates the benefits of both types of programs.
“We need more surgeons, we need more Graduate Medical Education spots, we need more training spots for general surgeons,” said Dr. Dissanaike. “I think within those large programs we need to find ways to structure smaller groups, maybe little pods, to help support residents so they don’t get lost.”
Dr. Schwed and his colleagues expressed concern that institutional barriers, such as the focus on test scores, may impede directors from embracing remediation.
“Greater emphasis on the written and oral General Surgery Qualifying Examination pass rates, which are now publicly posted and used by residency review committees, will likely exert pressure on program directors, who may fear that attempting to remediate a resident with poor medical knowledge may affect their program’s 5-year board pass rates,” the investigators wrote. “Our study suggests that such fears may be unfounded because programs with high levels of remediation and low attrition had similar board pass rates as those with high attrition.”
Dr. Schwed and his coinvestigators acknowledged that the programs studied may not be representative of U.S. residencies and selection bias may have affected the findings.
Researchers reported no relevant financial disclosures.
*Correction, 10/26/17: An earlier version of this article misstated the number of incoming residents in the program.
[email protected]
On Twitter @eaztweets
Remediation programs and program director attitudes can make the difference in attrition rates among general surgery residents, according to a survey-based study.
A study by the Association of American Medical Colleges, projects a shortage of 29,000 general surgeons by 2030. Some residency programs are taking steps lower program dropout rates, which has been reported as high as 26% in some programs, according to Alexander Schwed, MD, general surgeon at Harbor–University of California, Los Angeles Medical Center.
Dr. Schwed and his colleagues conducted a survey of 21 general surgery residency program directors. In those programs, the overall attrition rate was found to be much lower than expected – 8.8% over a 5-year period (JAMA Surg. 2017 Aug 16. doi: 10.1001/jamasurg.2017.2656).
The survey showed that programs that implemented resident remediation had lower attrition rates, (21.0% vs 6.8%; P less than .001).
“The association between increased use of remediation by residency programs and low rates of resident attrition is novel,” the investigators wrote. “Nevertheless, based on our findings, high-attrition programs could lower their attrition rates through the increased use of resident remediation and increased focus on resident education.”
Both high- and low-attrition programs selected to participate in the study showed relatively similar median numbers of residents, with low-attrition programs reporting a median of 28 participants per year, and high-attrition programs reporting with 35.
Other similarities between low- and high-attrition programs include percentage of female and minority residents, median of 33.3% and 39.8% respectively, and the number of cases performed by first-, second-, and third-year residents.
The other difference between the six low-attrition programs and the five high-attrition programs was the attitude of the program directors regarding their role in the training of residents, according to researchers.
Investigators asked directors a series of questions using a Likert scale with 1 representing “strongly disagree” and 4 representing “strongly agree.”
Program directors from high- and low-attrition programs tended to agree strongly (scoring 3.8 and 3.2, respectively) with the statement that one of their main roles as a program leader was to “redirect residents who should not be surgeons.”
When asked whether “some degree of resident attrition is a necessary phenomenon,” directors from low-attrition programs scored 2.2, while those from high-attrition programs indicated stronger agreement with an overall score of 3.2.
Directors from programs with high dropout rates were also more likely to consider a 6% dropout rate to be too low, compared with directors from low-attrition programs who thought it was too high.
“When we recruit residents, we are very careful to recruit those who seem to buy into our mission, our vision, and our ideals and fit in well with our culture,” said Sharmila Dissanaike, MD, FACS, department of surgery chair at Texas Tech University Health Sciences Center, Lubbock, in an interview. “We emphasize teamwork, collegiality, and an ‘all for one and one for all’ type of mentality.”
This kind of recruitment includes having current residents be a part of the process, Dr. Dissanaike explained, and encouraging current and potential residents to have an informal dinner to get to know one another better.
For the department of surgery at Texas Tech, the collaborative culture combined with a remediation program has resulted in a drop in attrition from 20% down to 7% in recent years, Dr. Dissanaike said. In addition, the current success of her program can be partly attributed to a recent decision to maintain the number of incoming residents at five, she said.*
Larger programs can achieve similar improvement, she noted and the rising demand for surgeons makes it essential to find a solution that incorporates the benefits of both types of programs.
“We need more surgeons, we need more Graduate Medical Education spots, we need more training spots for general surgeons,” said Dr. Dissanaike. “I think within those large programs we need to find ways to structure smaller groups, maybe little pods, to help support residents so they don’t get lost.”
Dr. Schwed and his colleagues expressed concern that institutional barriers, such as the focus on test scores, may impede directors from embracing remediation.
“Greater emphasis on the written and oral General Surgery Qualifying Examination pass rates, which are now publicly posted and used by residency review committees, will likely exert pressure on program directors, who may fear that attempting to remediate a resident with poor medical knowledge may affect their program’s 5-year board pass rates,” the investigators wrote. “Our study suggests that such fears may be unfounded because programs with high levels of remediation and low attrition had similar board pass rates as those with high attrition.”
Dr. Schwed and his coinvestigators acknowledged that the programs studied may not be representative of U.S. residencies and selection bias may have affected the findings.
Researchers reported no relevant financial disclosures.
*Correction, 10/26/17: An earlier version of this article misstated the number of incoming residents in the program.
[email protected]
On Twitter @eaztweets
Remediation programs and program director attitudes can make the difference in attrition rates among general surgery residents, according to a survey-based study.
A study by the Association of American Medical Colleges, projects a shortage of 29,000 general surgeons by 2030. Some residency programs are taking steps lower program dropout rates, which has been reported as high as 26% in some programs, according to Alexander Schwed, MD, general surgeon at Harbor–University of California, Los Angeles Medical Center.
Dr. Schwed and his colleagues conducted a survey of 21 general surgery residency program directors. In those programs, the overall attrition rate was found to be much lower than expected – 8.8% over a 5-year period (JAMA Surg. 2017 Aug 16. doi: 10.1001/jamasurg.2017.2656).
The survey showed that programs that implemented resident remediation had lower attrition rates, (21.0% vs 6.8%; P less than .001).
“The association between increased use of remediation by residency programs and low rates of resident attrition is novel,” the investigators wrote. “Nevertheless, based on our findings, high-attrition programs could lower their attrition rates through the increased use of resident remediation and increased focus on resident education.”
Both high- and low-attrition programs selected to participate in the study showed relatively similar median numbers of residents, with low-attrition programs reporting a median of 28 participants per year, and high-attrition programs reporting with 35.
Other similarities between low- and high-attrition programs include percentage of female and minority residents, median of 33.3% and 39.8% respectively, and the number of cases performed by first-, second-, and third-year residents.
The other difference between the six low-attrition programs and the five high-attrition programs was the attitude of the program directors regarding their role in the training of residents, according to researchers.
Investigators asked directors a series of questions using a Likert scale with 1 representing “strongly disagree” and 4 representing “strongly agree.”
Program directors from high- and low-attrition programs tended to agree strongly (scoring 3.8 and 3.2, respectively) with the statement that one of their main roles as a program leader was to “redirect residents who should not be surgeons.”
When asked whether “some degree of resident attrition is a necessary phenomenon,” directors from low-attrition programs scored 2.2, while those from high-attrition programs indicated stronger agreement with an overall score of 3.2.
Directors from programs with high dropout rates were also more likely to consider a 6% dropout rate to be too low, compared with directors from low-attrition programs who thought it was too high.
“When we recruit residents, we are very careful to recruit those who seem to buy into our mission, our vision, and our ideals and fit in well with our culture,” said Sharmila Dissanaike, MD, FACS, department of surgery chair at Texas Tech University Health Sciences Center, Lubbock, in an interview. “We emphasize teamwork, collegiality, and an ‘all for one and one for all’ type of mentality.”
This kind of recruitment includes having current residents be a part of the process, Dr. Dissanaike explained, and encouraging current and potential residents to have an informal dinner to get to know one another better.
For the department of surgery at Texas Tech, the collaborative culture combined with a remediation program has resulted in a drop in attrition from 20% down to 7% in recent years, Dr. Dissanaike said. In addition, the current success of her program can be partly attributed to a recent decision to maintain the number of incoming residents at five, she said.*
Larger programs can achieve similar improvement, she noted and the rising demand for surgeons makes it essential to find a solution that incorporates the benefits of both types of programs.
“We need more surgeons, we need more Graduate Medical Education spots, we need more training spots for general surgeons,” said Dr. Dissanaike. “I think within those large programs we need to find ways to structure smaller groups, maybe little pods, to help support residents so they don’t get lost.”
Dr. Schwed and his colleagues expressed concern that institutional barriers, such as the focus on test scores, may impede directors from embracing remediation.
“Greater emphasis on the written and oral General Surgery Qualifying Examination pass rates, which are now publicly posted and used by residency review committees, will likely exert pressure on program directors, who may fear that attempting to remediate a resident with poor medical knowledge may affect their program’s 5-year board pass rates,” the investigators wrote. “Our study suggests that such fears may be unfounded because programs with high levels of remediation and low attrition had similar board pass rates as those with high attrition.”
Dr. Schwed and his coinvestigators acknowledged that the programs studied may not be representative of U.S. residencies and selection bias may have affected the findings.
Researchers reported no relevant financial disclosures.
*Correction, 10/26/17: An earlier version of this article misstated the number of incoming residents in the program.
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FROM JAMA SURGERY
Key clinical point:
Major finding: Of the 21 programs surveyed, there was an average attrition rate of 8.8% over 5 years.
Data source: Survey of 21 general surgery residency program directors between July 2010 and June 2015.
Disclosures: Investigators report no relevant financial disclosures.