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Topical antibiotic decolonizes S. aureus in NICU infants
Application of the topical antibiotic mupirocin to multiple body sites was reported to be safe and efficacious in eradicating Staphylococcus aureus (SA) colonization on infants in the neonatal intensive care unit (NICU), according to researchers at the University of Maryland, Baltimore.
Karen L. Kotloff, MD, and her colleagues conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants between April 2014 and May 2016.
“Staph aureus is a leading cause of sepsis in young children admitted to the NICU. Sepsis, which is systemic infection, can be fatal in infants. Thus, preventing these infections is very important in managing risk for babies in the NICU who are fragile and struggling with multiple medical problems,” said Dr. Kotloff in a university interview.
The researchers examined infants in the NICU at eight study centers who were less than 24 months old who underwent serial screening for nasal SA. Infants colonized with SA and were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Treatment effects were assessed on day 8 (primary decolonization) and day 22 (persistent decolonization) for all three body areas (Pediatrics. 2019 Jan 1. doi: 10.1542/peds.2018-1565).
Primary decolonization occurred in 62/66 (93.9%) of treated infants and 3/64 (4.7%) of the control infants (P less than .001). Persistent decolonization was seen in 21/46 (45.7%) of treated infants compared with 1/48 (2.1%) of the controls (P less than .001).
“This multicenter trial supervised by Dr. Kotloff provides strong support for a safe strategy to minimize Staphylococcus aureus infections in some of the most at-risk patients in any hospital, premature babies,” E. Albert Reece, MD, dean of the University of Maryland School of Medicine, said in a university press release commenting on the study.
Application of the topical antibiotic mupirocin to multiple body sites was reported to be safe and efficacious in eradicating Staphylococcus aureus (SA) colonization on infants in the neonatal intensive care unit (NICU), according to researchers at the University of Maryland, Baltimore.
Karen L. Kotloff, MD, and her colleagues conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants between April 2014 and May 2016.
“Staph aureus is a leading cause of sepsis in young children admitted to the NICU. Sepsis, which is systemic infection, can be fatal in infants. Thus, preventing these infections is very important in managing risk for babies in the NICU who are fragile and struggling with multiple medical problems,” said Dr. Kotloff in a university interview.
The researchers examined infants in the NICU at eight study centers who were less than 24 months old who underwent serial screening for nasal SA. Infants colonized with SA and were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Treatment effects were assessed on day 8 (primary decolonization) and day 22 (persistent decolonization) for all three body areas (Pediatrics. 2019 Jan 1. doi: 10.1542/peds.2018-1565).
Primary decolonization occurred in 62/66 (93.9%) of treated infants and 3/64 (4.7%) of the control infants (P less than .001). Persistent decolonization was seen in 21/46 (45.7%) of treated infants compared with 1/48 (2.1%) of the controls (P less than .001).
“This multicenter trial supervised by Dr. Kotloff provides strong support for a safe strategy to minimize Staphylococcus aureus infections in some of the most at-risk patients in any hospital, premature babies,” E. Albert Reece, MD, dean of the University of Maryland School of Medicine, said in a university press release commenting on the study.
Application of the topical antibiotic mupirocin to multiple body sites was reported to be safe and efficacious in eradicating Staphylococcus aureus (SA) colonization on infants in the neonatal intensive care unit (NICU), according to researchers at the University of Maryland, Baltimore.
Karen L. Kotloff, MD, and her colleagues conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants between April 2014 and May 2016.
“Staph aureus is a leading cause of sepsis in young children admitted to the NICU. Sepsis, which is systemic infection, can be fatal in infants. Thus, preventing these infections is very important in managing risk for babies in the NICU who are fragile and struggling with multiple medical problems,” said Dr. Kotloff in a university interview.
The researchers examined infants in the NICU at eight study centers who were less than 24 months old who underwent serial screening for nasal SA. Infants colonized with SA and were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Treatment effects were assessed on day 8 (primary decolonization) and day 22 (persistent decolonization) for all three body areas (Pediatrics. 2019 Jan 1. doi: 10.1542/peds.2018-1565).
Primary decolonization occurred in 62/66 (93.9%) of treated infants and 3/64 (4.7%) of the control infants (P less than .001). Persistent decolonization was seen in 21/46 (45.7%) of treated infants compared with 1/48 (2.1%) of the controls (P less than .001).
“This multicenter trial supervised by Dr. Kotloff provides strong support for a safe strategy to minimize Staphylococcus aureus infections in some of the most at-risk patients in any hospital, premature babies,” E. Albert Reece, MD, dean of the University of Maryland School of Medicine, said in a university press release commenting on the study.
FROM PEDIATRICS
Risk-based testing missed 35% of HCV-positive prison inmates
Routine testing for hepatitis C virus at inmate entry should be considered by U.S. state prisons, according to Sabrina A. Assoumou, MD, of the Boston Medical Center and her colleagues.
The researchers performed a retrospective analysis of individuals entering the Washington state prison system, which routinely offers hepatitis C virus (HCV) testing, in order to compare routine opt-out testing with current risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized in blood samples from HCV-positive individuals, the investigators wrote in the American Journal of Preventative Medicine.
Between 2012 and 2016, 24,567 (83%) individuals were tested for HCV antibody, and of these, 4,921 (20%) tested positive. A total of 2,403 (49%) of those testing positive had subsequent hepatitis HCV RNA testing, with 1,727 (72%) of these showing chronic infection.
As expected, Dr. Assoumou and her colleagues found that reactive antibodies was more prevalent in individuals born between 1945 and 1965, compared with other years (44% vs. 17%). However, in actual case numbers, most (72%) were outside of this age bracket. Overall, they calculated that up to 35% of positive HCV tests would be missed using testing targeted by birth cohort and risk behavior alone. Among the chronically infected individuals, 23% had showed at least moderate liver fibrosis.
“Routine opt-out testing identified a substantial number of HCV cases that would have been missed by targeted testing. Almost one-quarter of individuals with chronic HCV had significant liver fibrosis and thus a more urgent need for treatment to prevent complications,” Dr Assoumou and her colleagues concluded.
The researchers reported that they had no conflicts of interest.
SOURCE: Assoumou SA et al, Am J Prev Med. 2019;56:8-16.
Routine testing for hepatitis C virus at inmate entry should be considered by U.S. state prisons, according to Sabrina A. Assoumou, MD, of the Boston Medical Center and her colleagues.
The researchers performed a retrospective analysis of individuals entering the Washington state prison system, which routinely offers hepatitis C virus (HCV) testing, in order to compare routine opt-out testing with current risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized in blood samples from HCV-positive individuals, the investigators wrote in the American Journal of Preventative Medicine.
Between 2012 and 2016, 24,567 (83%) individuals were tested for HCV antibody, and of these, 4,921 (20%) tested positive. A total of 2,403 (49%) of those testing positive had subsequent hepatitis HCV RNA testing, with 1,727 (72%) of these showing chronic infection.
As expected, Dr. Assoumou and her colleagues found that reactive antibodies was more prevalent in individuals born between 1945 and 1965, compared with other years (44% vs. 17%). However, in actual case numbers, most (72%) were outside of this age bracket. Overall, they calculated that up to 35% of positive HCV tests would be missed using testing targeted by birth cohort and risk behavior alone. Among the chronically infected individuals, 23% had showed at least moderate liver fibrosis.
“Routine opt-out testing identified a substantial number of HCV cases that would have been missed by targeted testing. Almost one-quarter of individuals with chronic HCV had significant liver fibrosis and thus a more urgent need for treatment to prevent complications,” Dr Assoumou and her colleagues concluded.
The researchers reported that they had no conflicts of interest.
SOURCE: Assoumou SA et al, Am J Prev Med. 2019;56:8-16.
Routine testing for hepatitis C virus at inmate entry should be considered by U.S. state prisons, according to Sabrina A. Assoumou, MD, of the Boston Medical Center and her colleagues.
The researchers performed a retrospective analysis of individuals entering the Washington state prison system, which routinely offers hepatitis C virus (HCV) testing, in order to compare routine opt-out testing with current risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized in blood samples from HCV-positive individuals, the investigators wrote in the American Journal of Preventative Medicine.
Between 2012 and 2016, 24,567 (83%) individuals were tested for HCV antibody, and of these, 4,921 (20%) tested positive. A total of 2,403 (49%) of those testing positive had subsequent hepatitis HCV RNA testing, with 1,727 (72%) of these showing chronic infection.
As expected, Dr. Assoumou and her colleagues found that reactive antibodies was more prevalent in individuals born between 1945 and 1965, compared with other years (44% vs. 17%). However, in actual case numbers, most (72%) were outside of this age bracket. Overall, they calculated that up to 35% of positive HCV tests would be missed using testing targeted by birth cohort and risk behavior alone. Among the chronically infected individuals, 23% had showed at least moderate liver fibrosis.
“Routine opt-out testing identified a substantial number of HCV cases that would have been missed by targeted testing. Almost one-quarter of individuals with chronic HCV had significant liver fibrosis and thus a more urgent need for treatment to prevent complications,” Dr Assoumou and her colleagues concluded.
The researchers reported that they had no conflicts of interest.
SOURCE: Assoumou SA et al, Am J Prev Med. 2019;56:8-16.
FROM THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE
Young opioid users in NYC savvy about HCV
Assessing patient knowledge about hepatitis C virus (HCV) transmission knowledge is difficult given the lack of psychometrically tested measures available, according to researchers who developed and validated an HCV injection–risk knowledge scale.
The 5-item, validated HCV Injection-Risk Knowledge Scale may provide educators, care providers, and researchers with critical information for reducing HCV among people who inject drugs (PWID), according to their report.
The researchers analyzed data from 539 New York City opioid users aged 18-29 years who were recruited via respondent-driven sampling in 2014-2016, according to the study published in Drug and Alcohol Dependence.
Principal components analysis (PCA) of nine knowledge items answered true, false, or don’t know identified useful scale items. These were then evaluated for internal consistency and assessed by comparing knowledge levels with those from a previously validated general HCV knowledge scale and by comparing key subgroup knowledge levels.
PCA identified one component with five items that explained 45% of the total variance and had high internal consistency (alpha, 0.91). All of the component items referred to transmission through drug-injection equipment and practices: sharing materials such as cookers, cottons, diluting water, water containers, and cleaning syringes with water.
The mean percent correct was 75%, and was moderately correlated with general HCV knowledge. Knowledge levels were highest for those previously tested for HCV, those with HCV antibody–positive status, PWID, and those who had received harm reduction information in various settings.
“The low percentage correct among those who had never injected [52% vs. 83% correct among injectors] is concerning given the possibility of their experimenting with drug injection as route of administration,” they added.
“These results suggest that primary care providers, drug treatment programs, and syringe exchange programs are important sources of HCV risk knowledge among at-risk populations, similar to other studies’ findings,” the researchers concluded.
The study was funded by the National Institutes of Health and the authors reported no conflicts of interest.
SOURCE: Quinn K et al. Drug Alcohol Depend. 2019;194:453-9.
Assessing patient knowledge about hepatitis C virus (HCV) transmission knowledge is difficult given the lack of psychometrically tested measures available, according to researchers who developed and validated an HCV injection–risk knowledge scale.
The 5-item, validated HCV Injection-Risk Knowledge Scale may provide educators, care providers, and researchers with critical information for reducing HCV among people who inject drugs (PWID), according to their report.
The researchers analyzed data from 539 New York City opioid users aged 18-29 years who were recruited via respondent-driven sampling in 2014-2016, according to the study published in Drug and Alcohol Dependence.
Principal components analysis (PCA) of nine knowledge items answered true, false, or don’t know identified useful scale items. These were then evaluated for internal consistency and assessed by comparing knowledge levels with those from a previously validated general HCV knowledge scale and by comparing key subgroup knowledge levels.
PCA identified one component with five items that explained 45% of the total variance and had high internal consistency (alpha, 0.91). All of the component items referred to transmission through drug-injection equipment and practices: sharing materials such as cookers, cottons, diluting water, water containers, and cleaning syringes with water.
The mean percent correct was 75%, and was moderately correlated with general HCV knowledge. Knowledge levels were highest for those previously tested for HCV, those with HCV antibody–positive status, PWID, and those who had received harm reduction information in various settings.
“The low percentage correct among those who had never injected [52% vs. 83% correct among injectors] is concerning given the possibility of their experimenting with drug injection as route of administration,” they added.
“These results suggest that primary care providers, drug treatment programs, and syringe exchange programs are important sources of HCV risk knowledge among at-risk populations, similar to other studies’ findings,” the researchers concluded.
The study was funded by the National Institutes of Health and the authors reported no conflicts of interest.
SOURCE: Quinn K et al. Drug Alcohol Depend. 2019;194:453-9.
Assessing patient knowledge about hepatitis C virus (HCV) transmission knowledge is difficult given the lack of psychometrically tested measures available, according to researchers who developed and validated an HCV injection–risk knowledge scale.
The 5-item, validated HCV Injection-Risk Knowledge Scale may provide educators, care providers, and researchers with critical information for reducing HCV among people who inject drugs (PWID), according to their report.
The researchers analyzed data from 539 New York City opioid users aged 18-29 years who were recruited via respondent-driven sampling in 2014-2016, according to the study published in Drug and Alcohol Dependence.
Principal components analysis (PCA) of nine knowledge items answered true, false, or don’t know identified useful scale items. These were then evaluated for internal consistency and assessed by comparing knowledge levels with those from a previously validated general HCV knowledge scale and by comparing key subgroup knowledge levels.
PCA identified one component with five items that explained 45% of the total variance and had high internal consistency (alpha, 0.91). All of the component items referred to transmission through drug-injection equipment and practices: sharing materials such as cookers, cottons, diluting water, water containers, and cleaning syringes with water.
The mean percent correct was 75%, and was moderately correlated with general HCV knowledge. Knowledge levels were highest for those previously tested for HCV, those with HCV antibody–positive status, PWID, and those who had received harm reduction information in various settings.
“The low percentage correct among those who had never injected [52% vs. 83% correct among injectors] is concerning given the possibility of their experimenting with drug injection as route of administration,” they added.
“These results suggest that primary care providers, drug treatment programs, and syringe exchange programs are important sources of HCV risk knowledge among at-risk populations, similar to other studies’ findings,” the researchers concluded.
The study was funded by the National Institutes of Health and the authors reported no conflicts of interest.
SOURCE: Quinn K et al. Drug Alcohol Depend. 2019;194:453-9.
FROM DRUG AND ALCOHOL DEPENDENCE
Check for neuromyelitis optica spectrum disorder in suspect HIV patients
HIV-associated neuromyelitis optica spectrum disorder (NMOSD) is a recently recognized entity and high index of suspicion is needed to diagnose these patients, according to Thomas Mathew, MD, and his colleagues at St. John’s Medical College Hospital, Bengaluru, India.
“NMOSD can be associated with a wide range of autoimmune diseases but clinicians rarely diagnose NMOSD in cases of HIV infection and HIV-associated NMOSD is rarely mentioned in the conventional classification of NMOSD,” they stated.
Dr. Mathew and his colleagues reported the results of a case study they made of six cases of HIV-NMOSD identified from the literature and 1 HIV-infected patient from a registry for NMOSD that they had established, which had a total of 25 patients with the condition.
There were four men and three women in the study, ranging from 8 years to 49 years of age. The duration of HIV infection in these patients ranged from newly detected to 15 years, according to the report, published in Multiple Sclerosis and Related Disorders (2019 Jan;27:289-93).
Optic neuritis followed by myelitis was the commonest presentation, occurring in five of the seven patients. Of these, six patients were assayed for anti–aquaporin 4 antibodies, which are considered a serological marker of neuromyelitis optica; three patients were positive and three were negative.
All patients received immunomodulatory treatment. Five of the seven patients had a poor recovery from acute attacks, but no patient had further relapses while on immunomodulatory treatment and antiretroviral therapy.
Dr. Mathew and his colleagues suggested that all patients with HIV infection presenting with optic neuritis or/and myelitis, should have their anti–aquaporin 4 antibody status checked and in all patients of NMOSD, HIV infection should be ruled out.
“Prognosis of these patients is variable; residual neurological deficits were common but treatment prevented further attacks. Increased awareness of this association will lead to earlier diagnosis, early treatment and prevention of disability,” the researchers concluded.
The authors reported that they had no conflicts.
SOURCE: Mathew T et al. Mult Scler Relat Disord. 2019 Jan;27:289-93.
HIV-associated neuromyelitis optica spectrum disorder (NMOSD) is a recently recognized entity and high index of suspicion is needed to diagnose these patients, according to Thomas Mathew, MD, and his colleagues at St. John’s Medical College Hospital, Bengaluru, India.
“NMOSD can be associated with a wide range of autoimmune diseases but clinicians rarely diagnose NMOSD in cases of HIV infection and HIV-associated NMOSD is rarely mentioned in the conventional classification of NMOSD,” they stated.
Dr. Mathew and his colleagues reported the results of a case study they made of six cases of HIV-NMOSD identified from the literature and 1 HIV-infected patient from a registry for NMOSD that they had established, which had a total of 25 patients with the condition.
There were four men and three women in the study, ranging from 8 years to 49 years of age. The duration of HIV infection in these patients ranged from newly detected to 15 years, according to the report, published in Multiple Sclerosis and Related Disorders (2019 Jan;27:289-93).
Optic neuritis followed by myelitis was the commonest presentation, occurring in five of the seven patients. Of these, six patients were assayed for anti–aquaporin 4 antibodies, which are considered a serological marker of neuromyelitis optica; three patients were positive and three were negative.
All patients received immunomodulatory treatment. Five of the seven patients had a poor recovery from acute attacks, but no patient had further relapses while on immunomodulatory treatment and antiretroviral therapy.
Dr. Mathew and his colleagues suggested that all patients with HIV infection presenting with optic neuritis or/and myelitis, should have their anti–aquaporin 4 antibody status checked and in all patients of NMOSD, HIV infection should be ruled out.
“Prognosis of these patients is variable; residual neurological deficits were common but treatment prevented further attacks. Increased awareness of this association will lead to earlier diagnosis, early treatment and prevention of disability,” the researchers concluded.
The authors reported that they had no conflicts.
SOURCE: Mathew T et al. Mult Scler Relat Disord. 2019 Jan;27:289-93.
HIV-associated neuromyelitis optica spectrum disorder (NMOSD) is a recently recognized entity and high index of suspicion is needed to diagnose these patients, according to Thomas Mathew, MD, and his colleagues at St. John’s Medical College Hospital, Bengaluru, India.
“NMOSD can be associated with a wide range of autoimmune diseases but clinicians rarely diagnose NMOSD in cases of HIV infection and HIV-associated NMOSD is rarely mentioned in the conventional classification of NMOSD,” they stated.
Dr. Mathew and his colleagues reported the results of a case study they made of six cases of HIV-NMOSD identified from the literature and 1 HIV-infected patient from a registry for NMOSD that they had established, which had a total of 25 patients with the condition.
There were four men and three women in the study, ranging from 8 years to 49 years of age. The duration of HIV infection in these patients ranged from newly detected to 15 years, according to the report, published in Multiple Sclerosis and Related Disorders (2019 Jan;27:289-93).
Optic neuritis followed by myelitis was the commonest presentation, occurring in five of the seven patients. Of these, six patients were assayed for anti–aquaporin 4 antibodies, which are considered a serological marker of neuromyelitis optica; three patients were positive and three were negative.
All patients received immunomodulatory treatment. Five of the seven patients had a poor recovery from acute attacks, but no patient had further relapses while on immunomodulatory treatment and antiretroviral therapy.
Dr. Mathew and his colleagues suggested that all patients with HIV infection presenting with optic neuritis or/and myelitis, should have their anti–aquaporin 4 antibody status checked and in all patients of NMOSD, HIV infection should be ruled out.
“Prognosis of these patients is variable; residual neurological deficits were common but treatment prevented further attacks. Increased awareness of this association will lead to earlier diagnosis, early treatment and prevention of disability,” the researchers concluded.
The authors reported that they had no conflicts.
SOURCE: Mathew T et al. Mult Scler Relat Disord. 2019 Jan;27:289-93.
FROM MULTIPLE SCLEROSIS AND RELATED DISORDERS
PAD guidelines: Consensus needed between U.S. and Europe
Recent advances in the management of peripheral artery disease (PAD) have resulted in new guideline creation in both the United States and Europe.
While there is considerable consensus between the guidelines, there are multiple differences in emphasis and a differing approach to the types and quality of evidence used to back recommendations, according to a comparative review published in the Journal of the American College of Cardiology. The American Heart Association and American College of Cardiology, together with other organizations, issued an update to their previous guidelines on the management and diagnosis of lower extremity PAD in 2016. In 2017, the European Society of Cardiology in conjunction with the European Society for Vascular Surgery updated their own comprehensive guidelines.
Both the U.S. and the European guidelines stress the importance of lowering risk factors for PAD. This includes stopping smoking, lipid and blood pressure management, and controlling glucose, according to Aaron P. Kithcart, MD, of Brigham and Women’s Hospital, Boston, and Joshua A. Beckman, MD, of Vanderbilt University, Nashville, Tenn.
However, the U.S. guidelines focus more on moderating lifestyle factors, including the pursuit of regular physical activity and the use of supervised exercise, whereas the European guidelines focus considerable attention on recommendations for revascularization in patients with limb-threatening ischemia.
Perhaps the major source of variation between the two sets of guidelines, according to the reviewers, are based upon the intended audiences: “The American document limits its focus to PAD but is applicable to practitioners of every background, whereas the European guideline extends the discussion to all PADs to include carotid and vertebral, upper extremities, mesenteric, and renal arteries in addition to lower-extremity artery disease; but is designed to be a source for cardiologists.”
Accordingly, the ESC/ESVS guidelines approach medical therapy with a more holistic flavor, whereas the ACC/AHA guidelines are specific to the lower-extremity complications of atherosclerosis, according to the reviewers.
Both sets of guidelines come to the conclusion that there is a need for more evidence to identify patients who are at the greatest risk of tissue loss, but overall they differ in their approach to available data. The ACC/AHA is more inclusive of smaller, well-done nonrandomized studies, whereas the ESC/ESVS relegates small studies to Level of Evidence: C. “We believe this difference drives the variation of therapeutic recommendations more than any other factor,” the authors note.
More randomized studies would align recommendations across both organizations, according to Dr. Kithcart and Dr. Beckman (JACC 2018;72:2789-801).
“The management of PAD has progressed a great deal over the last decade. ... Several clinical trials over the coming years should help clarify how revascularization should be approached, and which patients are most likely to benefit. Until then, maintaining good cardiovascular health, including regular physical activity, smoking cessation, lipid-lowering therapy, blood pressure management, and glucose control have the most benefit in patients with PAD,” the researchers concluded.
Dr. Beckman served as a consultant for several pharmaceutical companies, and on the data and safety monitoring board for Bayer and Novartis. Dr. Kithcart reported that he has no relevant conflicts.
SOURCE: Kithcart, AP et al. JACC 2018;72:2789-801.
Recent advances in the management of peripheral artery disease (PAD) have resulted in new guideline creation in both the United States and Europe.
While there is considerable consensus between the guidelines, there are multiple differences in emphasis and a differing approach to the types and quality of evidence used to back recommendations, according to a comparative review published in the Journal of the American College of Cardiology. The American Heart Association and American College of Cardiology, together with other organizations, issued an update to their previous guidelines on the management and diagnosis of lower extremity PAD in 2016. In 2017, the European Society of Cardiology in conjunction with the European Society for Vascular Surgery updated their own comprehensive guidelines.
Both the U.S. and the European guidelines stress the importance of lowering risk factors for PAD. This includes stopping smoking, lipid and blood pressure management, and controlling glucose, according to Aaron P. Kithcart, MD, of Brigham and Women’s Hospital, Boston, and Joshua A. Beckman, MD, of Vanderbilt University, Nashville, Tenn.
However, the U.S. guidelines focus more on moderating lifestyle factors, including the pursuit of regular physical activity and the use of supervised exercise, whereas the European guidelines focus considerable attention on recommendations for revascularization in patients with limb-threatening ischemia.
Perhaps the major source of variation between the two sets of guidelines, according to the reviewers, are based upon the intended audiences: “The American document limits its focus to PAD but is applicable to practitioners of every background, whereas the European guideline extends the discussion to all PADs to include carotid and vertebral, upper extremities, mesenteric, and renal arteries in addition to lower-extremity artery disease; but is designed to be a source for cardiologists.”
Accordingly, the ESC/ESVS guidelines approach medical therapy with a more holistic flavor, whereas the ACC/AHA guidelines are specific to the lower-extremity complications of atherosclerosis, according to the reviewers.
Both sets of guidelines come to the conclusion that there is a need for more evidence to identify patients who are at the greatest risk of tissue loss, but overall they differ in their approach to available data. The ACC/AHA is more inclusive of smaller, well-done nonrandomized studies, whereas the ESC/ESVS relegates small studies to Level of Evidence: C. “We believe this difference drives the variation of therapeutic recommendations more than any other factor,” the authors note.
More randomized studies would align recommendations across both organizations, according to Dr. Kithcart and Dr. Beckman (JACC 2018;72:2789-801).
“The management of PAD has progressed a great deal over the last decade. ... Several clinical trials over the coming years should help clarify how revascularization should be approached, and which patients are most likely to benefit. Until then, maintaining good cardiovascular health, including regular physical activity, smoking cessation, lipid-lowering therapy, blood pressure management, and glucose control have the most benefit in patients with PAD,” the researchers concluded.
Dr. Beckman served as a consultant for several pharmaceutical companies, and on the data and safety monitoring board for Bayer and Novartis. Dr. Kithcart reported that he has no relevant conflicts.
SOURCE: Kithcart, AP et al. JACC 2018;72:2789-801.
Recent advances in the management of peripheral artery disease (PAD) have resulted in new guideline creation in both the United States and Europe.
While there is considerable consensus between the guidelines, there are multiple differences in emphasis and a differing approach to the types and quality of evidence used to back recommendations, according to a comparative review published in the Journal of the American College of Cardiology. The American Heart Association and American College of Cardiology, together with other organizations, issued an update to their previous guidelines on the management and diagnosis of lower extremity PAD in 2016. In 2017, the European Society of Cardiology in conjunction with the European Society for Vascular Surgery updated their own comprehensive guidelines.
Both the U.S. and the European guidelines stress the importance of lowering risk factors for PAD. This includes stopping smoking, lipid and blood pressure management, and controlling glucose, according to Aaron P. Kithcart, MD, of Brigham and Women’s Hospital, Boston, and Joshua A. Beckman, MD, of Vanderbilt University, Nashville, Tenn.
However, the U.S. guidelines focus more on moderating lifestyle factors, including the pursuit of regular physical activity and the use of supervised exercise, whereas the European guidelines focus considerable attention on recommendations for revascularization in patients with limb-threatening ischemia.
Perhaps the major source of variation between the two sets of guidelines, according to the reviewers, are based upon the intended audiences: “The American document limits its focus to PAD but is applicable to practitioners of every background, whereas the European guideline extends the discussion to all PADs to include carotid and vertebral, upper extremities, mesenteric, and renal arteries in addition to lower-extremity artery disease; but is designed to be a source for cardiologists.”
Accordingly, the ESC/ESVS guidelines approach medical therapy with a more holistic flavor, whereas the ACC/AHA guidelines are specific to the lower-extremity complications of atherosclerosis, according to the reviewers.
Both sets of guidelines come to the conclusion that there is a need for more evidence to identify patients who are at the greatest risk of tissue loss, but overall they differ in their approach to available data. The ACC/AHA is more inclusive of smaller, well-done nonrandomized studies, whereas the ESC/ESVS relegates small studies to Level of Evidence: C. “We believe this difference drives the variation of therapeutic recommendations more than any other factor,” the authors note.
More randomized studies would align recommendations across both organizations, according to Dr. Kithcart and Dr. Beckman (JACC 2018;72:2789-801).
“The management of PAD has progressed a great deal over the last decade. ... Several clinical trials over the coming years should help clarify how revascularization should be approached, and which patients are most likely to benefit. Until then, maintaining good cardiovascular health, including regular physical activity, smoking cessation, lipid-lowering therapy, blood pressure management, and glucose control have the most benefit in patients with PAD,” the researchers concluded.
Dr. Beckman served as a consultant for several pharmaceutical companies, and on the data and safety monitoring board for Bayer and Novartis. Dr. Kithcart reported that he has no relevant conflicts.
SOURCE: Kithcart, AP et al. JACC 2018;72:2789-801.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Vitamin D–binding protein polymorphisms affect HCV susceptibility
Two specific polymorphisms within the vitamin D–binding protein (VDBP) gene may contribute to susceptibility to hepatitis C virus (HCV) infection in a high-risk Chinese Han population, according to the results of a case-control study published in Gene.
Previous research has indicated that vitamin D deficiency may have an impact on the antiviral response in chronic HCV, and VDBP has been shown to transport vitamin D and its metabolites, thereby influencing vitamin D status. This made VDBP a valid candidate for study as to its effects on HCV infection.
The current study initially recruited around 2,500 Chinese subjects over the period October 2008 to January 2016. The majority were women, and the average age of the subjects was 49-50 years.
The researchers genotyped seven genetic variants in the VDBP gene in 886 patients with HCV persistent infection, 539 subjects with spontaneous clearance, and 1,081 uninfected controls, according to Chao-Nan Xie of the department of epidemiology and biostatistics, Nanjing (China) Medical University, and colleagues.
The researchers found that two variants (rs7041-G and rs3733359-T alleles) were significantly associated with an increased susceptibility of HCV infection. In addition, the combined effect of having the two unfavorable alleles was related to an elevated risk of HCV infection in a locus-dosage manner (P = .000816).
Haplotype analysis suggested that the GT haplotype showed an increased risk effect of HCV infection (odds ratio, 1.464), compared with the most frequent TC haplotype.
“Taken together, polymorphisms within the VDBP gene (rs4588 and rs3733359) may contribute to susceptibility to HCV infection in a high-risk Chinese Han population, which implicates a role of VDR genetic polymorphisms and vitamin D levels in the immune regulation and course of HCV infection,” the researchers concluded.
The authors reported that they had no conflicts of interest.
SOURCE: Xie C-N et al. Gene 2018;679:405-11.
Two specific polymorphisms within the vitamin D–binding protein (VDBP) gene may contribute to susceptibility to hepatitis C virus (HCV) infection in a high-risk Chinese Han population, according to the results of a case-control study published in Gene.
Previous research has indicated that vitamin D deficiency may have an impact on the antiviral response in chronic HCV, and VDBP has been shown to transport vitamin D and its metabolites, thereby influencing vitamin D status. This made VDBP a valid candidate for study as to its effects on HCV infection.
The current study initially recruited around 2,500 Chinese subjects over the period October 2008 to January 2016. The majority were women, and the average age of the subjects was 49-50 years.
The researchers genotyped seven genetic variants in the VDBP gene in 886 patients with HCV persistent infection, 539 subjects with spontaneous clearance, and 1,081 uninfected controls, according to Chao-Nan Xie of the department of epidemiology and biostatistics, Nanjing (China) Medical University, and colleagues.
The researchers found that two variants (rs7041-G and rs3733359-T alleles) were significantly associated with an increased susceptibility of HCV infection. In addition, the combined effect of having the two unfavorable alleles was related to an elevated risk of HCV infection in a locus-dosage manner (P = .000816).
Haplotype analysis suggested that the GT haplotype showed an increased risk effect of HCV infection (odds ratio, 1.464), compared with the most frequent TC haplotype.
“Taken together, polymorphisms within the VDBP gene (rs4588 and rs3733359) may contribute to susceptibility to HCV infection in a high-risk Chinese Han population, which implicates a role of VDR genetic polymorphisms and vitamin D levels in the immune regulation and course of HCV infection,” the researchers concluded.
The authors reported that they had no conflicts of interest.
SOURCE: Xie C-N et al. Gene 2018;679:405-11.
Two specific polymorphisms within the vitamin D–binding protein (VDBP) gene may contribute to susceptibility to hepatitis C virus (HCV) infection in a high-risk Chinese Han population, according to the results of a case-control study published in Gene.
Previous research has indicated that vitamin D deficiency may have an impact on the antiviral response in chronic HCV, and VDBP has been shown to transport vitamin D and its metabolites, thereby influencing vitamin D status. This made VDBP a valid candidate for study as to its effects on HCV infection.
The current study initially recruited around 2,500 Chinese subjects over the period October 2008 to January 2016. The majority were women, and the average age of the subjects was 49-50 years.
The researchers genotyped seven genetic variants in the VDBP gene in 886 patients with HCV persistent infection, 539 subjects with spontaneous clearance, and 1,081 uninfected controls, according to Chao-Nan Xie of the department of epidemiology and biostatistics, Nanjing (China) Medical University, and colleagues.
The researchers found that two variants (rs7041-G and rs3733359-T alleles) were significantly associated with an increased susceptibility of HCV infection. In addition, the combined effect of having the two unfavorable alleles was related to an elevated risk of HCV infection in a locus-dosage manner (P = .000816).
Haplotype analysis suggested that the GT haplotype showed an increased risk effect of HCV infection (odds ratio, 1.464), compared with the most frequent TC haplotype.
“Taken together, polymorphisms within the VDBP gene (rs4588 and rs3733359) may contribute to susceptibility to HCV infection in a high-risk Chinese Han population, which implicates a role of VDR genetic polymorphisms and vitamin D levels in the immune regulation and course of HCV infection,” the researchers concluded.
The authors reported that they had no conflicts of interest.
SOURCE: Xie C-N et al. Gene 2018;679:405-11.
FROM GENE
Key clinical point: VDBP alleles influence susceptibility to HCV infection in a Chinese population.
Major finding: The GT haplotype showed an increased risk effect of HCV infection (odds ratio 1.464) compared to the most frequent TC haplotype.
Study details: Case-control study of 886 HIV-infected, 539 spontaneously cleared, and 1,081 control patients.
Disclosures: The authors reported that they had no conflicts of interest.
Source: Xie C-N et al. Gene. 2018;679:405-11.
Missed HIV screening opportunities found among subsequently infected youth
In the year prior to HIV diagnosis, there were high rates of missed opportunities for HIV testing and sexual history documentation, according to a retrospective study of youth with HIV aged 14-26 years who were treated at an HIV clinic. These results demonstrate a failed need for routine HIV screening and counseling in adolescents, according to Nellie Riendeau Lazar, MPH, of Children’s Hospital of Philadelphia, and her colleagues.
The researchers retrospectively identified 301 subjects between January 2009 and April 2015 who met their study criteria. A total of 58 of these (19%) had at least one visit in the care network in the year prior to diagnosis and their entry into the adolescent HIV clinic, and they were analyzed for missed diagnosis. The adolescent HIV clinic is part of a large care network in the Philadelphia area that includes a pediatric emergency department and a tertiary care hospital. At the time of the study, there were 31 primary care sites, according to the authors.
The mean age of the subjects in the study was 17. The majority (80%) were young men, African-American (93%), and men who have sex with men (81%). There were no significant differences seen in demographics between those with and without prior visits in the health system (J Adolesc Health. 2018;63:799-802).
The 58 subjects were seen in 179 health care visits in the year prior to their diagnosis: 56% outpatient, 40% emergency department, and 4% inpatient visits. Only 59% of these visits had any documentation of sexual history and “the overwhelming majority of those noting sexual activity included no other information,” such as number of partners, sex of partners, or condom use, according to the researchers.
Among the total cohort, 183 of 301 had never had an HIV test prior to their first positive test, even though 26% had been seen in the care network in the 3 years prior to their diagnosis. Among the 58 in the missed opportunity analysis, only 48% had HIV testing, even though 88% (51) had documented symptoms in their visits that could have been consistent with acute infection.
“Our findings support the most recent guidelines from the Centers for Disease Control and Prevention, American Academy of Pediatrics (AAP), and United States Preventive Services Task Force (USPSTF), recommending routine HIV screening for all adolescents, regardless of risk,” the researchers stated. “Adolescents may not always disclose sexual activity during routine assessment, and provider level barriers limit the reach of risk-based testing algorithms,” they added.
The authors reported that they had no conflicts of interest.
SOURCE: Lazar NR et al. J Adolesc Health. 2018;63:799-802.
In the year prior to HIV diagnosis, there were high rates of missed opportunities for HIV testing and sexual history documentation, according to a retrospective study of youth with HIV aged 14-26 years who were treated at an HIV clinic. These results demonstrate a failed need for routine HIV screening and counseling in adolescents, according to Nellie Riendeau Lazar, MPH, of Children’s Hospital of Philadelphia, and her colleagues.
The researchers retrospectively identified 301 subjects between January 2009 and April 2015 who met their study criteria. A total of 58 of these (19%) had at least one visit in the care network in the year prior to diagnosis and their entry into the adolescent HIV clinic, and they were analyzed for missed diagnosis. The adolescent HIV clinic is part of a large care network in the Philadelphia area that includes a pediatric emergency department and a tertiary care hospital. At the time of the study, there were 31 primary care sites, according to the authors.
The mean age of the subjects in the study was 17. The majority (80%) were young men, African-American (93%), and men who have sex with men (81%). There were no significant differences seen in demographics between those with and without prior visits in the health system (J Adolesc Health. 2018;63:799-802).
The 58 subjects were seen in 179 health care visits in the year prior to their diagnosis: 56% outpatient, 40% emergency department, and 4% inpatient visits. Only 59% of these visits had any documentation of sexual history and “the overwhelming majority of those noting sexual activity included no other information,” such as number of partners, sex of partners, or condom use, according to the researchers.
Among the total cohort, 183 of 301 had never had an HIV test prior to their first positive test, even though 26% had been seen in the care network in the 3 years prior to their diagnosis. Among the 58 in the missed opportunity analysis, only 48% had HIV testing, even though 88% (51) had documented symptoms in their visits that could have been consistent with acute infection.
“Our findings support the most recent guidelines from the Centers for Disease Control and Prevention, American Academy of Pediatrics (AAP), and United States Preventive Services Task Force (USPSTF), recommending routine HIV screening for all adolescents, regardless of risk,” the researchers stated. “Adolescents may not always disclose sexual activity during routine assessment, and provider level barriers limit the reach of risk-based testing algorithms,” they added.
The authors reported that they had no conflicts of interest.
SOURCE: Lazar NR et al. J Adolesc Health. 2018;63:799-802.
In the year prior to HIV diagnosis, there were high rates of missed opportunities for HIV testing and sexual history documentation, according to a retrospective study of youth with HIV aged 14-26 years who were treated at an HIV clinic. These results demonstrate a failed need for routine HIV screening and counseling in adolescents, according to Nellie Riendeau Lazar, MPH, of Children’s Hospital of Philadelphia, and her colleagues.
The researchers retrospectively identified 301 subjects between January 2009 and April 2015 who met their study criteria. A total of 58 of these (19%) had at least one visit in the care network in the year prior to diagnosis and their entry into the adolescent HIV clinic, and they were analyzed for missed diagnosis. The adolescent HIV clinic is part of a large care network in the Philadelphia area that includes a pediatric emergency department and a tertiary care hospital. At the time of the study, there were 31 primary care sites, according to the authors.
The mean age of the subjects in the study was 17. The majority (80%) were young men, African-American (93%), and men who have sex with men (81%). There were no significant differences seen in demographics between those with and without prior visits in the health system (J Adolesc Health. 2018;63:799-802).
The 58 subjects were seen in 179 health care visits in the year prior to their diagnosis: 56% outpatient, 40% emergency department, and 4% inpatient visits. Only 59% of these visits had any documentation of sexual history and “the overwhelming majority of those noting sexual activity included no other information,” such as number of partners, sex of partners, or condom use, according to the researchers.
Among the total cohort, 183 of 301 had never had an HIV test prior to their first positive test, even though 26% had been seen in the care network in the 3 years prior to their diagnosis. Among the 58 in the missed opportunity analysis, only 48% had HIV testing, even though 88% (51) had documented symptoms in their visits that could have been consistent with acute infection.
“Our findings support the most recent guidelines from the Centers for Disease Control and Prevention, American Academy of Pediatrics (AAP), and United States Preventive Services Task Force (USPSTF), recommending routine HIV screening for all adolescents, regardless of risk,” the researchers stated. “Adolescents may not always disclose sexual activity during routine assessment, and provider level barriers limit the reach of risk-based testing algorithms,” they added.
The authors reported that they had no conflicts of interest.
SOURCE: Lazar NR et al. J Adolesc Health. 2018;63:799-802.
FROM THE JOURNAL OF ADOLESCENT HEALTH
Key clinical point: Only 51% of youth with symptoms suggesting acute retroviral syndrome were tested.
Major finding: HIV testing was performed in only 48% of the subjects seen in the year prior to their diagnosis.
Study details: Retrospective review of subjects with HIV aged 14-26 years, comparing those with and without HIV screening within the year prior to diagnosis.
Disclosures: The authors reported that they had no conflicts of interest.
Source: Lazar NR et al. J Adolesc Health. 2018;63:799-802.
HCV antibodies linked to poorer cardiac outcomes in ACHD patients
Among patients with adult congenital heart disease (ACHD), hepatitis C virus antibody positivity was significantly associated with a composite end point that comprised cardiac death, heart failure hospitalization, lethal ventricular arrhythmias, and cardiac reoperation, according to a report published online in the American Journal of Cardiology.
The study retrospectively enrolled 243 ACHD patients (mean age 26 years) who underwent cardiac surgery before 1992 and visited a single hospital during 1995-2015. Clinical characteristics, including cardiac function and long-term prognosis, were compared between HCV antibody–positive (48) and –negative (195) patients, according to Ryo Konno, MD, of Tohoku University, Sendai, Japan, and his colleagues.
They found that the prevalence of reduced systemic ventricular ejection fraction less than 50% was significantly higher in the HCV antibody–positive group than in the HCV antibody–negative group (17 vs. 5.4%; P = .014), and that during a mean follow-up of 10 years the composite end point occurred in 51 patients.
Overall, Kaplan-Meier analysis showed the HCV antibody–positive group had significantly poorer event-free survival than the HCV antibody–negative group (P = .002). In addition, HCV antibody positivity was significantly associated with the composite end point in both univariable and multivariable Cox regression models (hazard ratio, 2.37; P = .005 and HR, 1.96; P = .032, respectively).
“These results indicate that screening for HCV should be performed in all ACHD patients with a history of heart surgery before 1992. Further, cardiac functions should be monitored more frequently to detect [stroke volume] dysfunction earlier in case of a positive result. These management strategies may have a beneficial impact on the long-term prognosis in this population,” Dr. Konno and his colleagues concluded.
The research was supported by the Japan Agency for Medical Research and the authors had no conflicts of interest to disclose.
SOURCE: Konno R. et al. Am J Card. 2018;122:1965-71.
Among patients with adult congenital heart disease (ACHD), hepatitis C virus antibody positivity was significantly associated with a composite end point that comprised cardiac death, heart failure hospitalization, lethal ventricular arrhythmias, and cardiac reoperation, according to a report published online in the American Journal of Cardiology.
The study retrospectively enrolled 243 ACHD patients (mean age 26 years) who underwent cardiac surgery before 1992 and visited a single hospital during 1995-2015. Clinical characteristics, including cardiac function and long-term prognosis, were compared between HCV antibody–positive (48) and –negative (195) patients, according to Ryo Konno, MD, of Tohoku University, Sendai, Japan, and his colleagues.
They found that the prevalence of reduced systemic ventricular ejection fraction less than 50% was significantly higher in the HCV antibody–positive group than in the HCV antibody–negative group (17 vs. 5.4%; P = .014), and that during a mean follow-up of 10 years the composite end point occurred in 51 patients.
Overall, Kaplan-Meier analysis showed the HCV antibody–positive group had significantly poorer event-free survival than the HCV antibody–negative group (P = .002). In addition, HCV antibody positivity was significantly associated with the composite end point in both univariable and multivariable Cox regression models (hazard ratio, 2.37; P = .005 and HR, 1.96; P = .032, respectively).
“These results indicate that screening for HCV should be performed in all ACHD patients with a history of heart surgery before 1992. Further, cardiac functions should be monitored more frequently to detect [stroke volume] dysfunction earlier in case of a positive result. These management strategies may have a beneficial impact on the long-term prognosis in this population,” Dr. Konno and his colleagues concluded.
The research was supported by the Japan Agency for Medical Research and the authors had no conflicts of interest to disclose.
SOURCE: Konno R. et al. Am J Card. 2018;122:1965-71.
Among patients with adult congenital heart disease (ACHD), hepatitis C virus antibody positivity was significantly associated with a composite end point that comprised cardiac death, heart failure hospitalization, lethal ventricular arrhythmias, and cardiac reoperation, according to a report published online in the American Journal of Cardiology.
The study retrospectively enrolled 243 ACHD patients (mean age 26 years) who underwent cardiac surgery before 1992 and visited a single hospital during 1995-2015. Clinical characteristics, including cardiac function and long-term prognosis, were compared between HCV antibody–positive (48) and –negative (195) patients, according to Ryo Konno, MD, of Tohoku University, Sendai, Japan, and his colleagues.
They found that the prevalence of reduced systemic ventricular ejection fraction less than 50% was significantly higher in the HCV antibody–positive group than in the HCV antibody–negative group (17 vs. 5.4%; P = .014), and that during a mean follow-up of 10 years the composite end point occurred in 51 patients.
Overall, Kaplan-Meier analysis showed the HCV antibody–positive group had significantly poorer event-free survival than the HCV antibody–negative group (P = .002). In addition, HCV antibody positivity was significantly associated with the composite end point in both univariable and multivariable Cox regression models (hazard ratio, 2.37; P = .005 and HR, 1.96; P = .032, respectively).
“These results indicate that screening for HCV should be performed in all ACHD patients with a history of heart surgery before 1992. Further, cardiac functions should be monitored more frequently to detect [stroke volume] dysfunction earlier in case of a positive result. These management strategies may have a beneficial impact on the long-term prognosis in this population,” Dr. Konno and his colleagues concluded.
The research was supported by the Japan Agency for Medical Research and the authors had no conflicts of interest to disclose.
SOURCE: Konno R. et al. Am J Card. 2018;122:1965-71.
FROM THE AMERICAN JOURNAL OF CARDIOLOGY
Key clinical point: Adults with congenital heart disease and HCV antibody positivity had significantly worse cardiac outcomes than those without.
Major finding: The HCV antibody–positive group had significantly poorer event-free survival (P = .002).
Study details: A retrospective study of 243 ACHD patients; 48 had HCV antibody positivity.
Disclosures: The research was supported by the Japan Agency for Medical Research; the authors had no conflicts of interest to disclose.
Source: Konno R et al. Am J Card. 2018;122:1965-71.
SVS guidelines address scope of practice concerns
NEW YORK – Vascular surgeons are the only specialty qualified to treat all vascular disorders with open surgery and/or endovascular treatment, including the thoracic aorta, according to the updated “Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.”
The guidelines, published in May’s Journal of Vascular Surgery, were last updated in 2008, said Keith D. Calligaro, MD, who spoke on their importance and potential benefits to vascular surgeons during his presentation at the VEITHsymposium.
The thoracic aorta component of the guidelines addresses scope of practice concerns between vascular and thoracic surgeons, said Dr. Calligaro, who is a clinical professor of surgery, University of Pennsylvania, and chief of vascular surgery and endovascular therapy at Pennsylvania Hospital, both in Philadelphia.
The guidelines relied on training requirements to provide some of the data to define vascular surgeons and privileges. The open vascular surgery training requirements still are defined by the Residency Review Committee for surgery, and those requirements include 250 major open vascular cases during training, including 30 open abdominal operations, 25 carotid, 45 peripheral open surgery cases, and 10 complex vascular surgeries, said Dr. Calligaro. “In terms of endovascular treatment, the training requirements are over 100 diagnostic caths and over 80 therapeutic interventions, and during training you would have had to have done more than 20 EVARs [endovascular aneurysm repairs].” That number jumped up from five EVARs in the previous guidelines.
Ultimately, “the SVS is basically saying ‘you need to be a vascular surgeon to perform vascular surgery,’ and you need have to have completed an Accreditation Council for Graduate Medical Education–accredited vascular residency.
“So if you are a general surgeon or a heart surgeon and you go to a new hospital and say ‘I want to do vascular,’ the vascular surgeon at that institution can refer to this document and say ‘no, the SVS is saying [the surgeon doesn’t] have the training.’ And I think that’s a pretty gutsy and important call,” said Dr. Calligaro.
It is a different case for endovascular surgery, he said. In this case, the requirement is to have completed an ACGME-accredited program in either vascular surgery, interventional radiology, or interventional cardiology to indicate the appropriate level of training. But SVS agreed with the recommendation by the American College of Cardiology that cardiologists not only had to complete 1 year of coronary interventions but also 1 year of peripheral intervention training, as well.
“So if you are at your hospital and have a cardiologist who is starting to do peripheral vascular stuff, now at least you can wave part of this document and say ‘Hey, look, the most important vascular society in the country is saying that, unless this individual had a year of peripheral training, this cardiologist should not be allowed to do endovascular peripheral interventions,’ ” Dr. Calligaro said.
SOURCE: Calligaro KD et al. J Vasc Surg. 2018 May;67(5):1337-44.
NEW YORK – Vascular surgeons are the only specialty qualified to treat all vascular disorders with open surgery and/or endovascular treatment, including the thoracic aorta, according to the updated “Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.”
The guidelines, published in May’s Journal of Vascular Surgery, were last updated in 2008, said Keith D. Calligaro, MD, who spoke on their importance and potential benefits to vascular surgeons during his presentation at the VEITHsymposium.
The thoracic aorta component of the guidelines addresses scope of practice concerns between vascular and thoracic surgeons, said Dr. Calligaro, who is a clinical professor of surgery, University of Pennsylvania, and chief of vascular surgery and endovascular therapy at Pennsylvania Hospital, both in Philadelphia.
The guidelines relied on training requirements to provide some of the data to define vascular surgeons and privileges. The open vascular surgery training requirements still are defined by the Residency Review Committee for surgery, and those requirements include 250 major open vascular cases during training, including 30 open abdominal operations, 25 carotid, 45 peripheral open surgery cases, and 10 complex vascular surgeries, said Dr. Calligaro. “In terms of endovascular treatment, the training requirements are over 100 diagnostic caths and over 80 therapeutic interventions, and during training you would have had to have done more than 20 EVARs [endovascular aneurysm repairs].” That number jumped up from five EVARs in the previous guidelines.
Ultimately, “the SVS is basically saying ‘you need to be a vascular surgeon to perform vascular surgery,’ and you need have to have completed an Accreditation Council for Graduate Medical Education–accredited vascular residency.
“So if you are a general surgeon or a heart surgeon and you go to a new hospital and say ‘I want to do vascular,’ the vascular surgeon at that institution can refer to this document and say ‘no, the SVS is saying [the surgeon doesn’t] have the training.’ And I think that’s a pretty gutsy and important call,” said Dr. Calligaro.
It is a different case for endovascular surgery, he said. In this case, the requirement is to have completed an ACGME-accredited program in either vascular surgery, interventional radiology, or interventional cardiology to indicate the appropriate level of training. But SVS agreed with the recommendation by the American College of Cardiology that cardiologists not only had to complete 1 year of coronary interventions but also 1 year of peripheral intervention training, as well.
“So if you are at your hospital and have a cardiologist who is starting to do peripheral vascular stuff, now at least you can wave part of this document and say ‘Hey, look, the most important vascular society in the country is saying that, unless this individual had a year of peripheral training, this cardiologist should not be allowed to do endovascular peripheral interventions,’ ” Dr. Calligaro said.
SOURCE: Calligaro KD et al. J Vasc Surg. 2018 May;67(5):1337-44.
NEW YORK – Vascular surgeons are the only specialty qualified to treat all vascular disorders with open surgery and/or endovascular treatment, including the thoracic aorta, according to the updated “Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.”
The guidelines, published in May’s Journal of Vascular Surgery, were last updated in 2008, said Keith D. Calligaro, MD, who spoke on their importance and potential benefits to vascular surgeons during his presentation at the VEITHsymposium.
The thoracic aorta component of the guidelines addresses scope of practice concerns between vascular and thoracic surgeons, said Dr. Calligaro, who is a clinical professor of surgery, University of Pennsylvania, and chief of vascular surgery and endovascular therapy at Pennsylvania Hospital, both in Philadelphia.
The guidelines relied on training requirements to provide some of the data to define vascular surgeons and privileges. The open vascular surgery training requirements still are defined by the Residency Review Committee for surgery, and those requirements include 250 major open vascular cases during training, including 30 open abdominal operations, 25 carotid, 45 peripheral open surgery cases, and 10 complex vascular surgeries, said Dr. Calligaro. “In terms of endovascular treatment, the training requirements are over 100 diagnostic caths and over 80 therapeutic interventions, and during training you would have had to have done more than 20 EVARs [endovascular aneurysm repairs].” That number jumped up from five EVARs in the previous guidelines.
Ultimately, “the SVS is basically saying ‘you need to be a vascular surgeon to perform vascular surgery,’ and you need have to have completed an Accreditation Council for Graduate Medical Education–accredited vascular residency.
“So if you are a general surgeon or a heart surgeon and you go to a new hospital and say ‘I want to do vascular,’ the vascular surgeon at that institution can refer to this document and say ‘no, the SVS is saying [the surgeon doesn’t] have the training.’ And I think that’s a pretty gutsy and important call,” said Dr. Calligaro.
It is a different case for endovascular surgery, he said. In this case, the requirement is to have completed an ACGME-accredited program in either vascular surgery, interventional radiology, or interventional cardiology to indicate the appropriate level of training. But SVS agreed with the recommendation by the American College of Cardiology that cardiologists not only had to complete 1 year of coronary interventions but also 1 year of peripheral intervention training, as well.
“So if you are at your hospital and have a cardiologist who is starting to do peripheral vascular stuff, now at least you can wave part of this document and say ‘Hey, look, the most important vascular society in the country is saying that, unless this individual had a year of peripheral training, this cardiologist should not be allowed to do endovascular peripheral interventions,’ ” Dr. Calligaro said.
SOURCE: Calligaro KD et al. J Vasc Surg. 2018 May;67(5):1337-44.
REPORTING FROM THE VEITHSYMPOSIUM
Will AI or robotics steal your job?
NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.
AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.
The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.
AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.
Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.
Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.
Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.
Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.
“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.
Dr. Weinberg reported no conflicts relevant to his talk.
NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.
AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.
The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.
AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.
Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.
Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.
Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.
Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.
“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.
Dr. Weinberg reported no conflicts relevant to his talk.
NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.
AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.
The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.
AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.
Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.
Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.
Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.
Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.
“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.
Dr. Weinberg reported no conflicts relevant to his talk.
REPORTING FROM THE VEITHSYMPOSIUM