Mary Ann Moon

In an average-risk population, screening colonoscopies yield different incidences of colorectal cancer and different cancer-related mortality, depending on the operators’ adenoma detection rates, according to a report published online in JAMA.

Adenoma detection rates vary dramatically among gastroenterologists, and patients of physicians who have lower ADRs are known to have higher rates of both colorectal cancer and fatal colorectal cancer. But little is known about the effect different ADRs have on the lifetime benefits and risks of colonoscopy screening programs on average-risk populations. It is possible that the harms of high ADRs outweigh the benefits. For example, higher ADRs may signal increased detection of small low-risk polyps, leading to more surveillance colonoscopies as well as more complications – all from lesions that may well have been benign, said Reinier G.S. Meester of the department of public health, Erasmus University Medical Center, Rotterdam (the Netherlands), and his associat

©Eraxion/thinkstockphotos.com

They examined various possible outcomes for a colonoscopy screening program at different levels of adenoma detection using microsimulation modeling that incorporated data from a large U.S. HMO concerning 57,588 screening colonoscopies performed by 136 physicians between 1998 and 2010. Adenoma detection rates – the percentage of a physician’s screening colonoscopies that detected at least one histologically confirmed adenoma – ranged from 7.35% to 52.51%. The investigators categorized the data into five equal subsets according to the physicians’ ADRs; the first quintile had a mean ADR of 15.32%; the second quintile, 21.27%; the third quintile, 25.61%; the fourth quintile, 30.89%; and the fifth quintile, 38.66%.

The simulation cohort comprised 10 million men and women, and the investigators performed 1,000 simulation runs, varying 13 relevant parameters with each run. They found that patients of physicians in the first quintile had a lifetime risk of colorectal cancer of 26.6 per 1,000; this decreased in a linear fashion with each quintile, so that patients of physicians in the fifth quintile had a lifetime risk of colorectal cancer of 12.5 per 1,000. Lifetime risks of colorectal cancer death followed the same pattern, decreasing from 5.7 per 1,000 in the first quintile to 2.3 per 1,000 in the fifth quintile.

The simulated lifetime risk of colorectal cancer dropped an average of 11% with every 5% increase in ADR, and the simulated lifetime risk of colorectal cancer death dropped an average of 13% with every 5% increase in ADR. This translates to a 50%-60% lower incidence of colorectal cancer and 50%-60% lower cancer-related mortality for patients of physicians with the highest ADRs, compared with physicians with the lowest ADRs, wrote Mr. Meester and his associates (JAMA 2015 June 16 [doi:10.1001/jama.2015.6251]).

This article was updated July 15, 2015.

In an average-risk population, screening colonoscopies yield different incidences of colorectal cancer and different cancer-related mortality, depending on the operators’ adenoma detection rates, according to a report published online in JAMA.

Adenoma detection rates vary dramatically among gastroenterologists, and patients of physicians who have lower ADRs are known to have higher rates of both colorectal cancer and fatal colorectal cancer. But little is known about the effect different ADRs have on the lifetime benefits and risks of colonoscopy screening programs on average-risk populations. It is possible that the harms of high ADRs outweigh the benefits. For example, higher ADRs may signal increased detection of small low-risk polyps, leading to more surveillance colonoscopies as well as more complications – all from lesions that may well have been benign, said Reinier G.S. Meester of the department of public health, Erasmus University Medical Center, Rotterdam (the Netherlands), and his associat

©Eraxion/thinkstockphotos.com

They examined various possible outcomes for a colonoscopy screening program at different levels of adenoma detection using microsimulation modeling that incorporated data from a large U.S. HMO concerning 57,588 screening colonoscopies performed by 136 physicians between 1998 and 2010. Adenoma detection rates – the percentage of a physician’s screening colonoscopies that detected at least one histologically confirmed adenoma – ranged from 7.35% to 52.51%. The investigators categorized the data into five equal subsets according to the physicians’ ADRs; the first quintile had a mean ADR of 15.32%; the second quintile, 21.27%; the third quintile, 25.61%; the fourth quintile, 30.89%; and the fifth quintile, 38.66%.

The simulation cohort comprised 10 million men and women, and the investigators performed 1,000 simulation runs, varying 13 relevant parameters with each run. They found that patients of physicians in the first quintile had a lifetime risk of colorectal cancer of 26.6 per 1,000; this decreased in a linear fashion with each quintile, so that patients of physicians in the fifth quintile had a lifetime risk of colorectal cancer of 12.5 per 1,000. Lifetime risks of colorectal cancer death followed the same pattern, decreasing from 5.7 per 1,000 in the first quintile to 2.3 per 1,000 in the fifth quintile.

The simulated lifetime risk of colorectal cancer dropped an average of 11% with every 5% increase in ADR, and the simulated lifetime risk of colorectal cancer death dropped an average of 13% with every 5% increase in ADR. This translates to a 50%-60% lower incidence of colorectal cancer and 50%-60% lower cancer-related mortality for patients of physicians with the highest ADRs, compared with physicians with the lowest ADRs, wrote Mr. Meester and his associates (JAMA 2015 June 16 [doi:10.1001/jama.2015.6251]).

This article was updated July 15, 2015.

In an average-risk population, screening colonoscopies yield different incidences of colorectal cancer and different cancer-related mortality, depending on the operators’ adenoma detection rates, according to a report published online in JAMA.

Adenoma detection rates vary dramatically among gastroenterologists, and patients of physicians who have lower ADRs are known to have higher rates of both colorectal cancer and fatal colorectal cancer. But little is known about the effect different ADRs have on the lifetime benefits and risks of colonoscopy screening programs on average-risk populations. It is possible that the harms of high ADRs outweigh the benefits. For example, higher ADRs may signal increased detection of small low-risk polyps, leading to more surveillance colonoscopies as well as more complications – all from lesions that may well have been benign, said Reinier G.S. Meester of the department of public health, Erasmus University Medical Center, Rotterdam (the Netherlands), and his associat

©Eraxion/thinkstockphotos.com

They examined various possible outcomes for a colonoscopy screening program at different levels of adenoma detection using microsimulation modeling that incorporated data from a large U.S. HMO concerning 57,588 screening colonoscopies performed by 136 physicians between 1998 and 2010. Adenoma detection rates – the percentage of a physician’s screening colonoscopies that detected at least one histologically confirmed adenoma – ranged from 7.35% to 52.51%. The investigators categorized the data into five equal subsets according to the physicians’ ADRs; the first quintile had a mean ADR of 15.32%; the second quintile, 21.27%; the third quintile, 25.61%; the fourth quintile, 30.89%; and the fifth quintile, 38.66%.

The simulation cohort comprised 10 million men and women, and the investigators performed 1,000 simulation runs, varying 13 relevant parameters with each run. They found that patients of physicians in the first quintile had a lifetime risk of colorectal cancer of 26.6 per 1,000; this decreased in a linear fashion with each quintile, so that patients of physicians in the fifth quintile had a lifetime risk of colorectal cancer of 12.5 per 1,000. Lifetime risks of colorectal cancer death followed the same pattern, decreasing from 5.7 per 1,000 in the first quintile to 2.3 per 1,000 in the fifth quintile.

The simulated lifetime risk of colorectal cancer dropped an average of 11% with every 5% increase in ADR, and the simulated lifetime risk of colorectal cancer death dropped an average of 13% with every 5% increase in ADR. This translates to a 50%-60% lower incidence of colorectal cancer and 50%-60% lower cancer-related mortality for patients of physicians with the highest ADRs, compared with physicians with the lowest ADRs, wrote Mr. Meester and his associates (JAMA 2015 June 16 [doi:10.1001/jama.2015.6251]).

This article was updated July 15, 2015.

Antibiotic therapy failed to be shown as noninferior to surgery in a study of adults with uncomplicated acute appendicitis, but it did resolve the problem and avert surgery with no adverse effects in 73% of patients, according to a report published online June 15 in JAMA.

Moreover, patients who did require surgery after initial antibiotic treatment did not develop significant complications and arguably were no worse off than were those who were operated on immediately. In fact, the overall complication rate was 2.8% among patients assigned to antibiotics and 7% among those assigned to antibiotics who eventually underwent appendectomy, compared with a 20.5% complication rate among patients assigned to surgery, said Dr. Paulina Salminen of the division of digestive surgery and urology, Turku (Finland) University Hospital, and her associates.

© decade3d/Thinkstockphotos

Their findings indicate that acute uncomplicated appendicitis need no longer be considered a surgical emergency, and that delaying the operation while trying a course of antibiotics “has few consequences,” they noted.

The few previous studies that have compared the two approaches had many limitations, including small study populations.

For their study, the Appendicitis Acuta (AAPAC) trial, Dr. Salminen and her associates included 530 patients aged 18-60 years who presented to six Finnish hospitals with suspected appendicitis during a 2-year period and were followed for 1 year. Appendicitis was confirmed via computed tomography (CT). Patients who had an appendicolith, perforation, abscess, or tumor were excluded from the study.

A total of 273 patients were randomly assigned to undergo immediate open appendectomy (with preoperative prophylactic antibiotics) and the remaining 257 were assigned to a 3-day course of IV ertapenem followed by 7 days of oral levofloxacin and metronidazole. If progressive infection, perforation, or peritonitis was suspected, appendectomy was performed.

Previous studies of uncomplicated appendicitis treated with antibiotics found a 70%-80% success rate, so the researchers prespecified criteria for noninferiority to surgery at 75% for the study group.

The primary endpoint for the antibiotic group – resolution of acute appendicitis with no recurrences for a full year – occurred in 73%. The remaining 27% of patients in this group underwent appendectomy during follow-up, at a median of 102 days after initial presentation. None of these patients developed abscesses or serious infections, “suggesting that the decision to delay appendectomy ... can be made with a low likelihood of major complications,” the investigators said (JAMA 2015 June 15 [doi:10.1001/jama.2015.6154]). Nevertheless, antibiotic treatment did not qualify as noninferior to immediate surgery according to the study’s preset definitions, they said.

This study was supported by a government research grant from the EVO Foundation to Turku University Hospital. Dr. Salminen reported receiving lecture fees from Merck and Roche; there were no other financial disclosures.

Antibiotic therapy failed to be shown as noninferior to surgery in a study of adults with uncomplicated acute appendicitis, but it did resolve the problem and avert surgery with no adverse effects in 73% of patients, according to a report published online June 15 in JAMA.

Moreover, patients who did require surgery after initial antibiotic treatment did not develop significant complications and arguably were no worse off than were those who were operated on immediately. In fact, the overall complication rate was 2.8% among patients assigned to antibiotics and 7% among those assigned to antibiotics who eventually underwent appendectomy, compared with a 20.5% complication rate among patients assigned to surgery, said Dr. Paulina Salminen of the division of digestive surgery and urology, Turku (Finland) University Hospital, and her associates.

© decade3d/Thinkstockphotos

Their findings indicate that acute uncomplicated appendicitis need no longer be considered a surgical emergency, and that delaying the operation while trying a course of antibiotics “has few consequences,” they noted.

The few previous studies that have compared the two approaches had many limitations, including small study populations.

For their study, the Appendicitis Acuta (AAPAC) trial, Dr. Salminen and her associates included 530 patients aged 18-60 years who presented to six Finnish hospitals with suspected appendicitis during a 2-year period and were followed for 1 year. Appendicitis was confirmed via computed tomography (CT). Patients who had an appendicolith, perforation, abscess, or tumor were excluded from the study.

A total of 273 patients were randomly assigned to undergo immediate open appendectomy (with preoperative prophylactic antibiotics) and the remaining 257 were assigned to a 3-day course of IV ertapenem followed by 7 days of oral levofloxacin and metronidazole. If progressive infection, perforation, or peritonitis was suspected, appendectomy was performed.

Previous studies of uncomplicated appendicitis treated with antibiotics found a 70%-80% success rate, so the researchers prespecified criteria for noninferiority to surgery at 75% for the study group.

The primary endpoint for the antibiotic group – resolution of acute appendicitis with no recurrences for a full year – occurred in 73%. The remaining 27% of patients in this group underwent appendectomy during follow-up, at a median of 102 days after initial presentation. None of these patients developed abscesses or serious infections, “suggesting that the decision to delay appendectomy ... can be made with a low likelihood of major complications,” the investigators said (JAMA 2015 June 15 [doi:10.1001/jama.2015.6154]). Nevertheless, antibiotic treatment did not qualify as noninferior to immediate surgery according to the study’s preset definitions, they said.

This study was supported by a government research grant from the EVO Foundation to Turku University Hospital. Dr. Salminen reported receiving lecture fees from Merck and Roche; there were no other financial disclosures.

Antibiotic therapy failed to be shown as noninferior to surgery in a study of adults with uncomplicated acute appendicitis, but it did resolve the problem and avert surgery with no adverse effects in 73% of patients, according to a report published online June 15 in JAMA.

Moreover, patients who did require surgery after initial antibiotic treatment did not develop significant complications and arguably were no worse off than were those who were operated on immediately. In fact, the overall complication rate was 2.8% among patients assigned to antibiotics and 7% among those assigned to antibiotics who eventually underwent appendectomy, compared with a 20.5% complication rate among patients assigned to surgery, said Dr. Paulina Salminen of the division of digestive surgery and urology, Turku (Finland) University Hospital, and her associates.

© decade3d/Thinkstockphotos

Their findings indicate that acute uncomplicated appendicitis need no longer be considered a surgical emergency, and that delaying the operation while trying a course of antibiotics “has few consequences,” they noted.

The few previous studies that have compared the two approaches had many limitations, including small study populations.

For their study, the Appendicitis Acuta (AAPAC) trial, Dr. Salminen and her associates included 530 patients aged 18-60 years who presented to six Finnish hospitals with suspected appendicitis during a 2-year period and were followed for 1 year. Appendicitis was confirmed via computed tomography (CT). Patients who had an appendicolith, perforation, abscess, or tumor were excluded from the study.

A total of 273 patients were randomly assigned to undergo immediate open appendectomy (with preoperative prophylactic antibiotics) and the remaining 257 were assigned to a 3-day course of IV ertapenem followed by 7 days of oral levofloxacin and metronidazole. If progressive infection, perforation, or peritonitis was suspected, appendectomy was performed.

Previous studies of uncomplicated appendicitis treated with antibiotics found a 70%-80% success rate, so the researchers prespecified criteria for noninferiority to surgery at 75% for the study group.

The primary endpoint for the antibiotic group – resolution of acute appendicitis with no recurrences for a full year – occurred in 73%. The remaining 27% of patients in this group underwent appendectomy during follow-up, at a median of 102 days after initial presentation. None of these patients developed abscesses or serious infections, “suggesting that the decision to delay appendectomy ... can be made with a low likelihood of major complications,” the investigators said (JAMA 2015 June 15 [doi:10.1001/jama.2015.6154]). Nevertheless, antibiotic treatment did not qualify as noninferior to immediate surgery according to the study’s preset definitions, they said.

This study was supported by a government research grant from the EVO Foundation to Turku University Hospital. Dr. Salminen reported receiving lecture fees from Merck and Roche; there were no other financial disclosures.

Allowing obese patients to choose between a low-carbohydrate or a low-fat diet according to their food preferences did not enhance their weight loss, dietary adherence, or weight-related quality of life, compared with randomly assigning them to one of the diets, according to a report published online June 15 in Annals of Internal Medicine.

Several studies have suggested that offering patients a choice among evidence-based dietary strategies for losing weight would facilitate their adherence and thus improve their results.

Researchers studied a 1-year weight-loss intervention among 207 overweight/obese adults (mean body mass index 36 kg/m²) who completed the Geiselman Food Preference Questionnaire to determine whether their preferences for 72 common foods aligned better with a low-carbohydrate or a low-fat diet.

Among the study participants, 105 were allowed to choose a low-carbohydrate or a low-fat diet, and 102 were randomly assigned to those diets. Mean age of the participants was 55 years; 73% were men; and 51% were African American.

All the participants received verbal and printed information about the efficacy and safety of the diets; sample menus; and a pocket guide to counting calories, fats, and carbohydrates. All were offered up to 19 group counseling sessions and individual telephone counseling from the study dietitian, and all were encouraged to aim for 30 minutes of moderate-intensity aerobic physical activity 5 days per week, said Dr. William S. Yancy Jr. of the Durham (N.C.) Veterans Affairs Medical Center and the VA’s Center for Health Services Research in Primary Care, and his associates.

Dietary adherence was similar between the two study groups. At final follow-up, the estimated mean weight loss for patients who chose their diet was 5.7 kg, or 5.6%, of their baseline body weight, compared with 6.7 kg, or 6.2%, of their baseline body weight, for patients who were assigned to a diet.

Final waist circumference and BMI were not significantly different between the two study groups, nor were scores on two measures of quality of life. “Contrary to expectations, the opportunity to choose a diet did not improve weight loss,” the investigators said (Ann. Intern. Med. 2015 June 15 [doi:10.7326/M14-2358]).

The findings indicate that providing a choice of diets may actually hinder weight loss, the researchers noted.

“One reason may be that persons are more likely to overeat when following a diet that emphasizes foods they find palatable,” Dr. Yancy and his associates explained. “Another reason may be a ‘personal trainer’ effect, in which persons may be more adherent to a fitness program if directed on what exercises to do rather than choosing their own.”

The U.S. Department of Veterans Affairs funded the study. Dr. Yancy reported receiving personal fees from Nutrisystem and the University of Pennsylvania.

Allowing obese patients to choose between a low-carbohydrate or a low-fat diet according to their food preferences did not enhance their weight loss, dietary adherence, or weight-related quality of life, compared with randomly assigning them to one of the diets, according to a report published online June 15 in Annals of Internal Medicine.

Several studies have suggested that offering patients a choice among evidence-based dietary strategies for losing weight would facilitate their adherence and thus improve their results.

Researchers studied a 1-year weight-loss intervention among 207 overweight/obese adults (mean body mass index 36 kg/m²) who completed the Geiselman Food Preference Questionnaire to determine whether their preferences for 72 common foods aligned better with a low-carbohydrate or a low-fat diet.

Among the study participants, 105 were allowed to choose a low-carbohydrate or a low-fat diet, and 102 were randomly assigned to those diets. Mean age of the participants was 55 years; 73% were men; and 51% were African American.

All the participants received verbal and printed information about the efficacy and safety of the diets; sample menus; and a pocket guide to counting calories, fats, and carbohydrates. All were offered up to 19 group counseling sessions and individual telephone counseling from the study dietitian, and all were encouraged to aim for 30 minutes of moderate-intensity aerobic physical activity 5 days per week, said Dr. William S. Yancy Jr. of the Durham (N.C.) Veterans Affairs Medical Center and the VA’s Center for Health Services Research in Primary Care, and his associates.

Dietary adherence was similar between the two study groups. At final follow-up, the estimated mean weight loss for patients who chose their diet was 5.7 kg, or 5.6%, of their baseline body weight, compared with 6.7 kg, or 6.2%, of their baseline body weight, for patients who were assigned to a diet.

Final waist circumference and BMI were not significantly different between the two study groups, nor were scores on two measures of quality of life. “Contrary to expectations, the opportunity to choose a diet did not improve weight loss,” the investigators said (Ann. Intern. Med. 2015 June 15 [doi:10.7326/M14-2358]).

The findings indicate that providing a choice of diets may actually hinder weight loss, the researchers noted.

“One reason may be that persons are more likely to overeat when following a diet that emphasizes foods they find palatable,” Dr. Yancy and his associates explained. “Another reason may be a ‘personal trainer’ effect, in which persons may be more adherent to a fitness program if directed on what exercises to do rather than choosing their own.”

The U.S. Department of Veterans Affairs funded the study. Dr. Yancy reported receiving personal fees from Nutrisystem and the University of Pennsylvania.

Allowing obese patients to choose between a low-carbohydrate or a low-fat diet according to their food preferences did not enhance their weight loss, dietary adherence, or weight-related quality of life, compared with randomly assigning them to one of the diets, according to a report published online June 15 in Annals of Internal Medicine.

Several studies have suggested that offering patients a choice among evidence-based dietary strategies for losing weight would facilitate their adherence and thus improve their results.

Researchers studied a 1-year weight-loss intervention among 207 overweight/obese adults (mean body mass index 36 kg/m²) who completed the Geiselman Food Preference Questionnaire to determine whether their preferences for 72 common foods aligned better with a low-carbohydrate or a low-fat diet.

Among the study participants, 105 were allowed to choose a low-carbohydrate or a low-fat diet, and 102 were randomly assigned to those diets. Mean age of the participants was 55 years; 73% were men; and 51% were African American.

All the participants received verbal and printed information about the efficacy and safety of the diets; sample menus; and a pocket guide to counting calories, fats, and carbohydrates. All were offered up to 19 group counseling sessions and individual telephone counseling from the study dietitian, and all were encouraged to aim for 30 minutes of moderate-intensity aerobic physical activity 5 days per week, said Dr. William S. Yancy Jr. of the Durham (N.C.) Veterans Affairs Medical Center and the VA’s Center for Health Services Research in Primary Care, and his associates.

Dietary adherence was similar between the two study groups. At final follow-up, the estimated mean weight loss for patients who chose their diet was 5.7 kg, or 5.6%, of their baseline body weight, compared with 6.7 kg, or 6.2%, of their baseline body weight, for patients who were assigned to a diet.

Final waist circumference and BMI were not significantly different between the two study groups, nor were scores on two measures of quality of life. “Contrary to expectations, the opportunity to choose a diet did not improve weight loss,” the investigators said (Ann. Intern. Med. 2015 June 15 [doi:10.7326/M14-2358]).

The findings indicate that providing a choice of diets may actually hinder weight loss, the researchers noted.

“One reason may be that persons are more likely to overeat when following a diet that emphasizes foods they find palatable,” Dr. Yancy and his associates explained. “Another reason may be a ‘personal trainer’ effect, in which persons may be more adherent to a fitness program if directed on what exercises to do rather than choosing their own.”

The U.S. Department of Veterans Affairs funded the study. Dr. Yancy reported receiving personal fees from Nutrisystem and the University of Pennsylvania.

Hospitalizations for acute gastroenteritis in children aged 5 years and younger plummeted after routine rotavirus vaccination was implemented in 2006, with rotavirus-specific hospitalizations plunging 94% and all-cause gastroenteritis hospitalizations dropping 55% in the most recent year for which data are available, according to a report published online June 9 in JAMA.

Researchers assessed the vaccine’s effect by analyzing information in a Healthcare Cost and Utilization Project database covering community and academic hospitals. They focused on 1,201,458 hospitalizations coded for all-cause acute gastroenteritis, including 199,812 (17%) that were coded specifically for rotavirus, which occurred in 26 states during 2000 through 2012 among children under age 5 years.

CDC/Dr. Erskine Palmer

The mean annual hospitalization rate for all-cause acute gastroenteritis was 76 per 10,000 before the vaccine was introduced, which declined by 31% in 2008, 33% in 2009, 48% in 2010, 47% in 2011, and 55% in 2012. The marked decrease occurred in both boys and girls, across all race/ethnicity categories, and at all ages. The reduction was greatest among children aged 6-23 months, Dr. Eyal Leshem of the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, and his associates said in a research letter.

The mean annual hospitalization rate for rotavirus-specific gastroenteritis dropped even more dramatically, from 16 per 10,000 before the vaccine was introduced by 70% in 2008, 63% in 2009, 90% in 2010, 79% in 2011, and 94% in 2012, the investigators said (JAMA 2015;313:2282-4).

The nonlinear pattern of both declines “might be explained by accumulation of susceptible, nonimmune population during seasons of markedly decreased transmission,” Dr. Leshem and his associates noted.

“Our findings support continued efforts to increase rotavirus vaccine coverage,” they added.

This study was supported by the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality. Dr. Leshem and his associates reported having no relevant financial conflicts of interest.

Hospitalizations for acute gastroenteritis in children aged 5 years and younger plummeted after routine rotavirus vaccination was implemented in 2006, with rotavirus-specific hospitalizations plunging 94% and all-cause gastroenteritis hospitalizations dropping 55% in the most recent year for which data are available, according to a report published online June 9 in JAMA.

Researchers assessed the vaccine’s effect by analyzing information in a Healthcare Cost and Utilization Project database covering community and academic hospitals. They focused on 1,201,458 hospitalizations coded for all-cause acute gastroenteritis, including 199,812 (17%) that were coded specifically for rotavirus, which occurred in 26 states during 2000 through 2012 among children under age 5 years.

CDC/Dr. Erskine Palmer

The mean annual hospitalization rate for all-cause acute gastroenteritis was 76 per 10,000 before the vaccine was introduced, which declined by 31% in 2008, 33% in 2009, 48% in 2010, 47% in 2011, and 55% in 2012. The marked decrease occurred in both boys and girls, across all race/ethnicity categories, and at all ages. The reduction was greatest among children aged 6-23 months, Dr. Eyal Leshem of the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, and his associates said in a research letter.

The mean annual hospitalization rate for rotavirus-specific gastroenteritis dropped even more dramatically, from 16 per 10,000 before the vaccine was introduced by 70% in 2008, 63% in 2009, 90% in 2010, 79% in 2011, and 94% in 2012, the investigators said (JAMA 2015;313:2282-4).

The nonlinear pattern of both declines “might be explained by accumulation of susceptible, nonimmune population during seasons of markedly decreased transmission,” Dr. Leshem and his associates noted.

“Our findings support continued efforts to increase rotavirus vaccine coverage,” they added.

This study was supported by the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality. Dr. Leshem and his associates reported having no relevant financial conflicts of interest.

Hospitalizations for acute gastroenteritis in children aged 5 years and younger plummeted after routine rotavirus vaccination was implemented in 2006, with rotavirus-specific hospitalizations plunging 94% and all-cause gastroenteritis hospitalizations dropping 55% in the most recent year for which data are available, according to a report published online June 9 in JAMA.

Researchers assessed the vaccine’s effect by analyzing information in a Healthcare Cost and Utilization Project database covering community and academic hospitals. They focused on 1,201,458 hospitalizations coded for all-cause acute gastroenteritis, including 199,812 (17%) that were coded specifically for rotavirus, which occurred in 26 states during 2000 through 2012 among children under age 5 years.

CDC/Dr. Erskine Palmer

The mean annual hospitalization rate for all-cause acute gastroenteritis was 76 per 10,000 before the vaccine was introduced, which declined by 31% in 2008, 33% in 2009, 48% in 2010, 47% in 2011, and 55% in 2012. The marked decrease occurred in both boys and girls, across all race/ethnicity categories, and at all ages. The reduction was greatest among children aged 6-23 months, Dr. Eyal Leshem of the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, and his associates said in a research letter.

The mean annual hospitalization rate for rotavirus-specific gastroenteritis dropped even more dramatically, from 16 per 10,000 before the vaccine was introduced by 70% in 2008, 63% in 2009, 90% in 2010, 79% in 2011, and 94% in 2012, the investigators said (JAMA 2015;313:2282-4).

The nonlinear pattern of both declines “might be explained by accumulation of susceptible, nonimmune population during seasons of markedly decreased transmission,” Dr. Leshem and his associates noted.

“Our findings support continued efforts to increase rotavirus vaccine coverage,” they added.

This study was supported by the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality. Dr. Leshem and his associates reported having no relevant financial conflicts of interest.

Triple-agent bortezomib-based regimens yielded no survival or other advantages over a double-agent regimen in a phase-III clinical trial involving transplant-ineligible patients with multiple myeloma. The study was published online June 8 in the Journal of Clinical Oncology.

As the optimal therapy for transplant-ineligible patients has not yet been determined, researchers performed what they described as the first randomized trial comparing several bortezomib-based regimens. For this study, the researchers wanted to assess the regimens in more typical patients: elderly men and women of diverse ethnic and economic backgrounds who have common comorbidities and are treated in community oncology practices.

The 502 participants (mean age, 73 years) in this industry-sponsored study were treated at 159 oncology practices across the country during a 3-year period and followed up for a median of 43 months. Half had serious comorbidities such as diabetes, renal disease, and chronic pulmonary disease. They were randomly assigned to receive eight 21-day cycles of bortezomib-dexamethasone, bortezomib-thalidomide-dexamethasone, or bortezomib-melphalan-prednisone combination induction therapy, followed by five 35-day cycles of maintenance bortezomib, said Dr. Ruben Niesvizky of the myeloma center at New York Presbyterian Hospital and his associates.

The primary efficacy outcome – progression-free survival – was not significantly different among the three study groups at 14.7 months, 15.4 months, and 17.3 months, respectively. Overall response rates were 73%, 80%, and 70%, respectively; complete response rates were 3%, 4%, and 4%, respectively. Also not significantly different between the three groups were duration of response (18.3 months, 22.4 months, and 19.8 months) and median overall survival (49.8 months, 51.5 months, and 53.1 months), the researchers said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.58.7618]).

Peripheral neuropathy was the most common adverse effect in all three regimens and the most common reason for discontinuing therapy. Both the rates of adverse events and discontinuations due to adverse events were higher for bortezomib-thalidomide-dexamethasone treatment than for the other two regimens. Because of toxicity, only 30% of the total study population completed the full 13 cycles of treatment and only 40% received bortezomib maintenance therapy.

“Our results indicate that the type and number of agents(s) included in combination therapy for elderly persons are important, and offer caution to the current trend of incorporating 3 or even 4 agents into anti-multiple myeloma regimens to boost efficacy without confirmatory randomized studies,” Dr. Niesvizky and his associates noted.

Triple-agent bortezomib-based regimens yielded no survival or other advantages over a double-agent regimen in a phase-III clinical trial involving transplant-ineligible patients with multiple myeloma. The study was published online June 8 in the Journal of Clinical Oncology.

As the optimal therapy for transplant-ineligible patients has not yet been determined, researchers performed what they described as the first randomized trial comparing several bortezomib-based regimens. For this study, the researchers wanted to assess the regimens in more typical patients: elderly men and women of diverse ethnic and economic backgrounds who have common comorbidities and are treated in community oncology practices.

The 502 participants (mean age, 73 years) in this industry-sponsored study were treated at 159 oncology practices across the country during a 3-year period and followed up for a median of 43 months. Half had serious comorbidities such as diabetes, renal disease, and chronic pulmonary disease. They were randomly assigned to receive eight 21-day cycles of bortezomib-dexamethasone, bortezomib-thalidomide-dexamethasone, or bortezomib-melphalan-prednisone combination induction therapy, followed by five 35-day cycles of maintenance bortezomib, said Dr. Ruben Niesvizky of the myeloma center at New York Presbyterian Hospital and his associates.

The primary efficacy outcome – progression-free survival – was not significantly different among the three study groups at 14.7 months, 15.4 months, and 17.3 months, respectively. Overall response rates were 73%, 80%, and 70%, respectively; complete response rates were 3%, 4%, and 4%, respectively. Also not significantly different between the three groups were duration of response (18.3 months, 22.4 months, and 19.8 months) and median overall survival (49.8 months, 51.5 months, and 53.1 months), the researchers said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.58.7618]).

Peripheral neuropathy was the most common adverse effect in all three regimens and the most common reason for discontinuing therapy. Both the rates of adverse events and discontinuations due to adverse events were higher for bortezomib-thalidomide-dexamethasone treatment than for the other two regimens. Because of toxicity, only 30% of the total study population completed the full 13 cycles of treatment and only 40% received bortezomib maintenance therapy.

“Our results indicate that the type and number of agents(s) included in combination therapy for elderly persons are important, and offer caution to the current trend of incorporating 3 or even 4 agents into anti-multiple myeloma regimens to boost efficacy without confirmatory randomized studies,” Dr. Niesvizky and his associates noted.

Triple-agent bortezomib-based regimens yielded no survival or other advantages over a double-agent regimen in a phase-III clinical trial involving transplant-ineligible patients with multiple myeloma. The study was published online June 8 in the Journal of Clinical Oncology.

As the optimal therapy for transplant-ineligible patients has not yet been determined, researchers performed what they described as the first randomized trial comparing several bortezomib-based regimens. For this study, the researchers wanted to assess the regimens in more typical patients: elderly men and women of diverse ethnic and economic backgrounds who have common comorbidities and are treated in community oncology practices.

The 502 participants (mean age, 73 years) in this industry-sponsored study were treated at 159 oncology practices across the country during a 3-year period and followed up for a median of 43 months. Half had serious comorbidities such as diabetes, renal disease, and chronic pulmonary disease. They were randomly assigned to receive eight 21-day cycles of bortezomib-dexamethasone, bortezomib-thalidomide-dexamethasone, or bortezomib-melphalan-prednisone combination induction therapy, followed by five 35-day cycles of maintenance bortezomib, said Dr. Ruben Niesvizky of the myeloma center at New York Presbyterian Hospital and his associates.

The primary efficacy outcome – progression-free survival – was not significantly different among the three study groups at 14.7 months, 15.4 months, and 17.3 months, respectively. Overall response rates were 73%, 80%, and 70%, respectively; complete response rates were 3%, 4%, and 4%, respectively. Also not significantly different between the three groups were duration of response (18.3 months, 22.4 months, and 19.8 months) and median overall survival (49.8 months, 51.5 months, and 53.1 months), the researchers said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.58.7618]).

Peripheral neuropathy was the most common adverse effect in all three regimens and the most common reason for discontinuing therapy. Both the rates of adverse events and discontinuations due to adverse events were higher for bortezomib-thalidomide-dexamethasone treatment than for the other two regimens. Because of toxicity, only 30% of the total study population completed the full 13 cycles of treatment and only 40% received bortezomib maintenance therapy.

“Our results indicate that the type and number of agents(s) included in combination therapy for elderly persons are important, and offer caution to the current trend of incorporating 3 or even 4 agents into anti-multiple myeloma regimens to boost efficacy without confirmatory randomized studies,” Dr. Niesvizky and his associates noted.

Two newly developed agents, nab-paclitaxel and ixabepilone, both proved inferior to standard once-weekly paclitaxel and caused more toxicities in a phase III trial involving 783 patients with advanced chemotherapy-naive breast cancer, which was reported online June 8 in Journal of Clinical Oncology.

“On the basis of our data, once-per-week paclitaxel should remain the preferred microtubule inhibitor for patients with metastatic breast cancer in the first-line setting,” said Dr. Hope S. Rugo of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center and her associates.

Nab-paclitaxel is a novel, solvent-free formulation of paclitaxel in albumin-bound nanoparticles, which precludes the need for premedication to prevent hypersensitivity reactions. Ixabepilone is a semisynthetic analog of epothilone B that binds to the same beta-tubulin site as does paclitaxel.

In phase II studies, both agents appeared to be more potent than paclitaxel and to have similar or superior toxicity profiles. In this trial, patients with metastatic or recurrent breast cancer not amenable to local therapy were randomly assigned to receive nab-paclitaxel (267 participants), ixabepilone (241 participants), or standard paclitaxel (275 participants) as well as bevacizumab; they were followed for a median of 25 months (maximum, 50 months).

The trial was halted early when interim analyses showed that both of the new agents crossed the futility boundary for superiority. The primary endpoint, progression-free survival, was 11 months with paclitaxel. Ixabepilone was clearly inferior, with a median progression-free survival of 7.4 months (HR, 1.59), and nab-paclitaxel trended toward inferiority, with a median progression-free survival of 9.3 months (HR, 1.20). Overall survival rates followed the same pattern. In addition, treatment response rates were lower with both new agents than with paclitaxel, as was palliation of disease-related symptoms.

Both hematologic and nonhematologic toxicities were more severe with the novel drugs than with paclitaxel. These included neutropenia, anemia, sensory neuropathy, fatigue, hypertension, motor neuropathy, pain, and nausea, the investigators said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.59.5298]).

Unfortunately, before these negative findings were published, the promising results of the phase II studies “led to widespread use of more costly and higher-dose nab-paclitaxel in many clinical practices,” Dr. Rugo and her associates noted.

“Our trial illustrates the importance of adequately powered prospective trials to confirm phase II reports. In addition, these results remind clinicians to be cautious when incorporating new agents, particularly those that are more expensive and potentially more toxic,” they added.

This study was supported by grants from the National Cancer Institute, the Alliance for Clinical Trials in Oncology’s Statistics and Data Center, and the Breast Cancer Research Foundation. Dr. Rugo reported ties to Genomic Health, Plexxikon, MacroGenics, OBI Pharma, Eisai, Pfizer, Novartis, Eli Lilly, GlaxoSmithKline, Genentech, Celsion, Nektar, Merck, Roche, OBI Ontology, and Mylan; her associates reported ties to some of those companies and to Myriad Genetics, Amgen, Celgene, and Verastem.

Two newly developed agents, nab-paclitaxel and ixabepilone, both proved inferior to standard once-weekly paclitaxel and caused more toxicities in a phase III trial involving 783 patients with advanced chemotherapy-naive breast cancer, which was reported online June 8 in Journal of Clinical Oncology.

“On the basis of our data, once-per-week paclitaxel should remain the preferred microtubule inhibitor for patients with metastatic breast cancer in the first-line setting,” said Dr. Hope S. Rugo of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center and her associates.

Nab-paclitaxel is a novel, solvent-free formulation of paclitaxel in albumin-bound nanoparticles, which precludes the need for premedication to prevent hypersensitivity reactions. Ixabepilone is a semisynthetic analog of epothilone B that binds to the same beta-tubulin site as does paclitaxel.

In phase II studies, both agents appeared to be more potent than paclitaxel and to have similar or superior toxicity profiles. In this trial, patients with metastatic or recurrent breast cancer not amenable to local therapy were randomly assigned to receive nab-paclitaxel (267 participants), ixabepilone (241 participants), or standard paclitaxel (275 participants) as well as bevacizumab; they were followed for a median of 25 months (maximum, 50 months).

The trial was halted early when interim analyses showed that both of the new agents crossed the futility boundary for superiority. The primary endpoint, progression-free survival, was 11 months with paclitaxel. Ixabepilone was clearly inferior, with a median progression-free survival of 7.4 months (HR, 1.59), and nab-paclitaxel trended toward inferiority, with a median progression-free survival of 9.3 months (HR, 1.20). Overall survival rates followed the same pattern. In addition, treatment response rates were lower with both new agents than with paclitaxel, as was palliation of disease-related symptoms.

Both hematologic and nonhematologic toxicities were more severe with the novel drugs than with paclitaxel. These included neutropenia, anemia, sensory neuropathy, fatigue, hypertension, motor neuropathy, pain, and nausea, the investigators said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.59.5298]).

Unfortunately, before these negative findings were published, the promising results of the phase II studies “led to widespread use of more costly and higher-dose nab-paclitaxel in many clinical practices,” Dr. Rugo and her associates noted.

“Our trial illustrates the importance of adequately powered prospective trials to confirm phase II reports. In addition, these results remind clinicians to be cautious when incorporating new agents, particularly those that are more expensive and potentially more toxic,” they added.

This study was supported by grants from the National Cancer Institute, the Alliance for Clinical Trials in Oncology’s Statistics and Data Center, and the Breast Cancer Research Foundation. Dr. Rugo reported ties to Genomic Health, Plexxikon, MacroGenics, OBI Pharma, Eisai, Pfizer, Novartis, Eli Lilly, GlaxoSmithKline, Genentech, Celsion, Nektar, Merck, Roche, OBI Ontology, and Mylan; her associates reported ties to some of those companies and to Myriad Genetics, Amgen, Celgene, and Verastem.

Two newly developed agents, nab-paclitaxel and ixabepilone, both proved inferior to standard once-weekly paclitaxel and caused more toxicities in a phase III trial involving 783 patients with advanced chemotherapy-naive breast cancer, which was reported online June 8 in Journal of Clinical Oncology.

“On the basis of our data, once-per-week paclitaxel should remain the preferred microtubule inhibitor for patients with metastatic breast cancer in the first-line setting,” said Dr. Hope S. Rugo of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center and her associates.

Nab-paclitaxel is a novel, solvent-free formulation of paclitaxel in albumin-bound nanoparticles, which precludes the need for premedication to prevent hypersensitivity reactions. Ixabepilone is a semisynthetic analog of epothilone B that binds to the same beta-tubulin site as does paclitaxel.

In phase II studies, both agents appeared to be more potent than paclitaxel and to have similar or superior toxicity profiles. In this trial, patients with metastatic or recurrent breast cancer not amenable to local therapy were randomly assigned to receive nab-paclitaxel (267 participants), ixabepilone (241 participants), or standard paclitaxel (275 participants) as well as bevacizumab; they were followed for a median of 25 months (maximum, 50 months).

The trial was halted early when interim analyses showed that both of the new agents crossed the futility boundary for superiority. The primary endpoint, progression-free survival, was 11 months with paclitaxel. Ixabepilone was clearly inferior, with a median progression-free survival of 7.4 months (HR, 1.59), and nab-paclitaxel trended toward inferiority, with a median progression-free survival of 9.3 months (HR, 1.20). Overall survival rates followed the same pattern. In addition, treatment response rates were lower with both new agents than with paclitaxel, as was palliation of disease-related symptoms.

Both hematologic and nonhematologic toxicities were more severe with the novel drugs than with paclitaxel. These included neutropenia, anemia, sensory neuropathy, fatigue, hypertension, motor neuropathy, pain, and nausea, the investigators said (J. Clin. Oncol. 2015 June 8 [doi:10.1200/JCO.2014.59.5298]).

Unfortunately, before these negative findings were published, the promising results of the phase II studies “led to widespread use of more costly and higher-dose nab-paclitaxel in many clinical practices,” Dr. Rugo and her associates noted.

“Our trial illustrates the importance of adequately powered prospective trials to confirm phase II reports. In addition, these results remind clinicians to be cautious when incorporating new agents, particularly those that are more expensive and potentially more toxic,” they added.

This study was supported by grants from the National Cancer Institute, the Alliance for Clinical Trials in Oncology’s Statistics and Data Center, and the Breast Cancer Research Foundation. Dr. Rugo reported ties to Genomic Health, Plexxikon, MacroGenics, OBI Pharma, Eisai, Pfizer, Novartis, Eli Lilly, GlaxoSmithKline, Genentech, Celsion, Nektar, Merck, Roche, OBI Ontology, and Mylan; her associates reported ties to some of those companies and to Myriad Genetics, Amgen, Celgene, and Verastem.

Approximately 2 million basal cell carcinomas occur in the United States each year, a number that has increased only modestly during the past 15 years, according to a report published online June 3 in JAMA Dermatology.

The epidemiology of BCCs has been difficult to pin down because these tumors are excluded from cancer registries and national cancer surveillance programs, and because when they are tracked they are usually lumped together with squamous cell carcinomas. The most recent National Cancer Institute–funded survey of BCC was done more than 30 years ago.

©Kelly Nelson/National Cancer Institute

So the current incidence of BCC “is not well characterized.” Nevertheless. some researchers have posited that the incidence has risen 80%-200% during the past 10-20 years, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and the department of dermatology at the University of California, San Francisco.

To estimate incidence more accurately, Dr. Asgari and her associates analyzed data from every electronic pathology report in a registry covering the 3.2 million participants in the HMO from 1998 through 2012. They identified 221,624 cases of BCC in patients aged 2-105 years. The annual incidence increased from 513 to 600 cases per 100,000 population during the study period – a 17% rise that was deemed “not remarkable.”

“In extrapolating our data to the United States, we estimate that approximately 2 million individuals develop at least one BCC in the U.S. in a given year,” Dr. Asgari and her associates wrote (JAMA Dermatol. 2015 June 3 [doi:10.1001/jamadermatol.2015.1188]).

This total is higher than that cited on the National Institutes of Health website, which estimates the annual incidence of all nonmelanoma skin cancers, not just BCC, at 2 million per year.

Males were at higher risk than were females for developing BCC (incidence rate ratio, 1.65), and risk increased with increasing patient age. As expected, whites were at 8- to 70-fold greater risk than were Hispanics, Asians, or blacks. Contrary to one previous report, the incidence of BCC did not increase among Hispanics during the study period.

The National Cancer Institute and the National Institutes of Health supported the study. Dr. Asgari reported receiving research grants from Kaiser Permanente, Pfizer, and Valeant Pharmaceuticals, but not for this project.

Approximately 2 million basal cell carcinomas occur in the United States each year, a number that has increased only modestly during the past 15 years, according to a report published online June 3 in JAMA Dermatology.

The epidemiology of BCCs has been difficult to pin down because these tumors are excluded from cancer registries and national cancer surveillance programs, and because when they are tracked they are usually lumped together with squamous cell carcinomas. The most recent National Cancer Institute–funded survey of BCC was done more than 30 years ago.

©Kelly Nelson/National Cancer Institute

So the current incidence of BCC “is not well characterized.” Nevertheless. some researchers have posited that the incidence has risen 80%-200% during the past 10-20 years, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and the department of dermatology at the University of California, San Francisco.

To estimate incidence more accurately, Dr. Asgari and her associates analyzed data from every electronic pathology report in a registry covering the 3.2 million participants in the HMO from 1998 through 2012. They identified 221,624 cases of BCC in patients aged 2-105 years. The annual incidence increased from 513 to 600 cases per 100,000 population during the study period – a 17% rise that was deemed “not remarkable.”

“In extrapolating our data to the United States, we estimate that approximately 2 million individuals develop at least one BCC in the U.S. in a given year,” Dr. Asgari and her associates wrote (JAMA Dermatol. 2015 June 3 [doi:10.1001/jamadermatol.2015.1188]).

This total is higher than that cited on the National Institutes of Health website, which estimates the annual incidence of all nonmelanoma skin cancers, not just BCC, at 2 million per year.

Males were at higher risk than were females for developing BCC (incidence rate ratio, 1.65), and risk increased with increasing patient age. As expected, whites were at 8- to 70-fold greater risk than were Hispanics, Asians, or blacks. Contrary to one previous report, the incidence of BCC did not increase among Hispanics during the study period.

The National Cancer Institute and the National Institutes of Health supported the study. Dr. Asgari reported receiving research grants from Kaiser Permanente, Pfizer, and Valeant Pharmaceuticals, but not for this project.

Approximately 2 million basal cell carcinomas occur in the United States each year, a number that has increased only modestly during the past 15 years, according to a report published online June 3 in JAMA Dermatology.

The epidemiology of BCCs has been difficult to pin down because these tumors are excluded from cancer registries and national cancer surveillance programs, and because when they are tracked they are usually lumped together with squamous cell carcinomas. The most recent National Cancer Institute–funded survey of BCC was done more than 30 years ago.

©Kelly Nelson/National Cancer Institute

So the current incidence of BCC “is not well characterized.” Nevertheless. some researchers have posited that the incidence has risen 80%-200% during the past 10-20 years, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and the department of dermatology at the University of California, San Francisco.

To estimate incidence more accurately, Dr. Asgari and her associates analyzed data from every electronic pathology report in a registry covering the 3.2 million participants in the HMO from 1998 through 2012. They identified 221,624 cases of BCC in patients aged 2-105 years. The annual incidence increased from 513 to 600 cases per 100,000 population during the study period – a 17% rise that was deemed “not remarkable.”

“In extrapolating our data to the United States, we estimate that approximately 2 million individuals develop at least one BCC in the U.S. in a given year,” Dr. Asgari and her associates wrote (JAMA Dermatol. 2015 June 3 [doi:10.1001/jamadermatol.2015.1188]).

This total is higher than that cited on the National Institutes of Health website, which estimates the annual incidence of all nonmelanoma skin cancers, not just BCC, at 2 million per year.

Males were at higher risk than were females for developing BCC (incidence rate ratio, 1.65), and risk increased with increasing patient age. As expected, whites were at 8- to 70-fold greater risk than were Hispanics, Asians, or blacks. Contrary to one previous report, the incidence of BCC did not increase among Hispanics during the study period.

The National Cancer Institute and the National Institutes of Health supported the study. Dr. Asgari reported receiving research grants from Kaiser Permanente, Pfizer, and Valeant Pharmaceuticals, but not for this project.