The number of plans selected at HealthCare.gov through 2 weeks of the 2019 open enrollment is still down from last year, but the gap has closed since week 1, according to the Centers for Medicare & Medicaid Services.

With almost 805,000 plans selected this year during the second week (Nov. 4-10) of open enrollment, the total for the 2019 coverage year stands at nearly 1.18 million for the 39 states that use the HealthCare.gov platform, which is down 20.4% from the 1.48 million plans selected through the first 2 weeks of last year’s enrollment period. After week 1, this year’s total enrollment was down by 38%, compared with last year, CMS data show.

Consumers renewing their insurance plans account for the majority selected for 2019 coverage – 619,000 in week 2 and 901,000 for weeks 1 and 2 (close to 77% in each case) – with the rest coming from new consumers – 186,000 in week 2 and 275,000 overall. The figures reported in the weekly enrollment snapshot could change later since they represent selections only and not “consumers who have paid premiums to effectuate their enrollment,” CMS said.

[email protected]

The number of plans selected at HealthCare.gov through 2 weeks of the 2019 open enrollment is still down from last year, but the gap has closed since week 1, according to the Centers for Medicare & Medicaid Services.

With almost 805,000 plans selected this year during the second week (Nov. 4-10) of open enrollment, the total for the 2019 coverage year stands at nearly 1.18 million for the 39 states that use the HealthCare.gov platform, which is down 20.4% from the 1.48 million plans selected through the first 2 weeks of last year’s enrollment period. After week 1, this year’s total enrollment was down by 38%, compared with last year, CMS data show.

Consumers renewing their insurance plans account for the majority selected for 2019 coverage – 619,000 in week 2 and 901,000 for weeks 1 and 2 (close to 77% in each case) – with the rest coming from new consumers – 186,000 in week 2 and 275,000 overall. The figures reported in the weekly enrollment snapshot could change later since they represent selections only and not “consumers who have paid premiums to effectuate their enrollment,” CMS said.

[email protected]

The number of plans selected at HealthCare.gov through 2 weeks of the 2019 open enrollment is still down from last year, but the gap has closed since week 1, according to the Centers for Medicare & Medicaid Services.

With almost 805,000 plans selected this year during the second week (Nov. 4-10) of open enrollment, the total for the 2019 coverage year stands at nearly 1.18 million for the 39 states that use the HealthCare.gov platform, which is down 20.4% from the 1.48 million plans selected through the first 2 weeks of last year’s enrollment period. After week 1, this year’s total enrollment was down by 38%, compared with last year, CMS data show.

Consumers renewing their insurance plans account for the majority selected for 2019 coverage – 619,000 in week 2 and 901,000 for weeks 1 and 2 (close to 77% in each case) – with the rest coming from new consumers – 186,000 in week 2 and 275,000 overall. The figures reported in the weekly enrollment snapshot could change later since they represent selections only and not “consumers who have paid premiums to effectuate their enrollment,” CMS said.

[email protected]

NEW YORK – Registry data can be used to craft guidance for determining the appropriateness of procedures at vein centers, based on data presented by Thomas W. Wakefield, MD at the 2018 Veith Symposium.

The Vascular Quality Initiative Varicose Vein Registry (VQI-VVR), initiated in 2014 by the Society for Vascular Surgery in conjunction with the American Venous Forum, captures procedures that are performed in vein centers, office-based practices, and ambulatory or inpatient settings. The VVR looks at ablation and phlebectomy techniques and captures data including patient demographics, history, procedure data, plus early and late office-based and patient-reported follow-up in order to benchmark and improve outcomes and develop best practices and to help meet vein center certification requirements. The VVR includes 39 centers and more than 23,000 procedures.

Dr. Wakefield, who heads the VVR, used this registry as a means to illustrate how VQIs could be used to establish whether “the expected health benefit exceeds the expected negative consequences by a sufficiently wide margin that the procedure is worth doing.” This can be considered to be “appropriateness, which is part of ethical treatment.” Dr. Wakefield is the Stanley Professor of Vascular Surgery at the University of Michigan and section head, vascular surgery, University of Michigan Cardiovascular Center, Ann Arbor.

Data from the VQI registry (of which the VVR is a component) are now being used to generate appropriateness reports, said Dr. Wakefield.

The VQI represents a large comprehensive database of long-term data to define appropriate care. In addition, the VQI infrastructure is already geared to producing these reports both at a center and at a surgeon level. One disadvantage of the VVR registry, however, is low participation – only the 39 centers – and that it doesn’t capture cosmetic procedures and lesser (C1) disease. Further, it’s “likely the VQI participants are the ‘good actors,’ ” he added.

Targets for appropriateness include the proportion of patients undergoing ablation C2 or C4 disease or greater, the mean number of ablations per patient, the mean number of ablations per limb, and the proportion of perforated ablations for greater than C4 disease. Plotting out the data for these procedures at the center level can be assessed against current thinking on best practices in the various areas. For example, “the mean number of ablations per patient has been suggested at 1.8 to be about the right number,” and he used the graph of the center performance in this area to show that most of the centers were below this objective.

In an even more appropriate example of how this kind of data could be used to determine appropriateness, Dr. Wakefield described how perforated ablations should be performed for greater than C4 disease, but not for C2 disease. He described how, according to the actual data in the registry, there have been 870 total perforated treatments recorded, 38% for C2 disease, and of these 332 procedures, almost half of these were performed at one center only, with two other centers reporting 30 such procedures. “So clearly there are three centers that are doing perforated ablations for patients that are outside the guidelines,” Dr. Wakefield pointed out.

In future, payer demand is likely to demand that each treating physician provide evidence of the appropriateness of procedures performed, as well as appropriate patient selection and adherence to best practices, and good outcomes, which is part of what a society-based registry such as the VVR can provide.

“I believe the VQI-VVR is well-positioned to meet these needs. And if we ask the question ‘can VQI be used as a benchmark for setting ethical standards,’ I think it can certainly be used to help set appropriate standards, and since appropriateness is one part of ethical standards, I believe it has a role,” he concluded.

Dr. Wakefield reported that he had no disclosures.

[email protected]

NEW YORK – Registry data can be used to craft guidance for determining the appropriateness of procedures at vein centers, based on data presented by Thomas W. Wakefield, MD at the 2018 Veith Symposium.

The Vascular Quality Initiative Varicose Vein Registry (VQI-VVR), initiated in 2014 by the Society for Vascular Surgery in conjunction with the American Venous Forum, captures procedures that are performed in vein centers, office-based practices, and ambulatory or inpatient settings. The VVR looks at ablation and phlebectomy techniques and captures data including patient demographics, history, procedure data, plus early and late office-based and patient-reported follow-up in order to benchmark and improve outcomes and develop best practices and to help meet vein center certification requirements. The VVR includes 39 centers and more than 23,000 procedures.

Dr. Wakefield, who heads the VVR, used this registry as a means to illustrate how VQIs could be used to establish whether “the expected health benefit exceeds the expected negative consequences by a sufficiently wide margin that the procedure is worth doing.” This can be considered to be “appropriateness, which is part of ethical treatment.” Dr. Wakefield is the Stanley Professor of Vascular Surgery at the University of Michigan and section head, vascular surgery, University of Michigan Cardiovascular Center, Ann Arbor.

Data from the VQI registry (of which the VVR is a component) are now being used to generate appropriateness reports, said Dr. Wakefield.

The VQI represents a large comprehensive database of long-term data to define appropriate care. In addition, the VQI infrastructure is already geared to producing these reports both at a center and at a surgeon level. One disadvantage of the VVR registry, however, is low participation – only the 39 centers – and that it doesn’t capture cosmetic procedures and lesser (C1) disease. Further, it’s “likely the VQI participants are the ‘good actors,’ ” he added.

Targets for appropriateness include the proportion of patients undergoing ablation C2 or C4 disease or greater, the mean number of ablations per patient, the mean number of ablations per limb, and the proportion of perforated ablations for greater than C4 disease. Plotting out the data for these procedures at the center level can be assessed against current thinking on best practices in the various areas. For example, “the mean number of ablations per patient has been suggested at 1.8 to be about the right number,” and he used the graph of the center performance in this area to show that most of the centers were below this objective.

In an even more appropriate example of how this kind of data could be used to determine appropriateness, Dr. Wakefield described how perforated ablations should be performed for greater than C4 disease, but not for C2 disease. He described how, according to the actual data in the registry, there have been 870 total perforated treatments recorded, 38% for C2 disease, and of these 332 procedures, almost half of these were performed at one center only, with two other centers reporting 30 such procedures. “So clearly there are three centers that are doing perforated ablations for patients that are outside the guidelines,” Dr. Wakefield pointed out.

In future, payer demand is likely to demand that each treating physician provide evidence of the appropriateness of procedures performed, as well as appropriate patient selection and adherence to best practices, and good outcomes, which is part of what a society-based registry such as the VVR can provide.

“I believe the VQI-VVR is well-positioned to meet these needs. And if we ask the question ‘can VQI be used as a benchmark for setting ethical standards,’ I think it can certainly be used to help set appropriate standards, and since appropriateness is one part of ethical standards, I believe it has a role,” he concluded.

Dr. Wakefield reported that he had no disclosures.

[email protected]

NEW YORK – Registry data can be used to craft guidance for determining the appropriateness of procedures at vein centers, based on data presented by Thomas W. Wakefield, MD at the 2018 Veith Symposium.

The Vascular Quality Initiative Varicose Vein Registry (VQI-VVR), initiated in 2014 by the Society for Vascular Surgery in conjunction with the American Venous Forum, captures procedures that are performed in vein centers, office-based practices, and ambulatory or inpatient settings. The VVR looks at ablation and phlebectomy techniques and captures data including patient demographics, history, procedure data, plus early and late office-based and patient-reported follow-up in order to benchmark and improve outcomes and develop best practices and to help meet vein center certification requirements. The VVR includes 39 centers and more than 23,000 procedures.

Dr. Wakefield, who heads the VVR, used this registry as a means to illustrate how VQIs could be used to establish whether “the expected health benefit exceeds the expected negative consequences by a sufficiently wide margin that the procedure is worth doing.” This can be considered to be “appropriateness, which is part of ethical treatment.” Dr. Wakefield is the Stanley Professor of Vascular Surgery at the University of Michigan and section head, vascular surgery, University of Michigan Cardiovascular Center, Ann Arbor.

Data from the VQI registry (of which the VVR is a component) are now being used to generate appropriateness reports, said Dr. Wakefield.

The VQI represents a large comprehensive database of long-term data to define appropriate care. In addition, the VQI infrastructure is already geared to producing these reports both at a center and at a surgeon level. One disadvantage of the VVR registry, however, is low participation – only the 39 centers – and that it doesn’t capture cosmetic procedures and lesser (C1) disease. Further, it’s “likely the VQI participants are the ‘good actors,’ ” he added.

Targets for appropriateness include the proportion of patients undergoing ablation C2 or C4 disease or greater, the mean number of ablations per patient, the mean number of ablations per limb, and the proportion of perforated ablations for greater than C4 disease. Plotting out the data for these procedures at the center level can be assessed against current thinking on best practices in the various areas. For example, “the mean number of ablations per patient has been suggested at 1.8 to be about the right number,” and he used the graph of the center performance in this area to show that most of the centers were below this objective.

In an even more appropriate example of how this kind of data could be used to determine appropriateness, Dr. Wakefield described how perforated ablations should be performed for greater than C4 disease, but not for C2 disease. He described how, according to the actual data in the registry, there have been 870 total perforated treatments recorded, 38% for C2 disease, and of these 332 procedures, almost half of these were performed at one center only, with two other centers reporting 30 such procedures. “So clearly there are three centers that are doing perforated ablations for patients that are outside the guidelines,” Dr. Wakefield pointed out.

In future, payer demand is likely to demand that each treating physician provide evidence of the appropriateness of procedures performed, as well as appropriate patient selection and adherence to best practices, and good outcomes, which is part of what a society-based registry such as the VVR can provide.

“I believe the VQI-VVR is well-positioned to meet these needs. And if we ask the question ‘can VQI be used as a benchmark for setting ethical standards,’ I think it can certainly be used to help set appropriate standards, and since appropriateness is one part of ethical standards, I believe it has a role,” he concluded.

Dr. Wakefield reported that he had no disclosures.

[email protected]

Johns Hopkins Medicine

Education can improve adherence to venous thromboembolism (VTE) prophylaxis among hospitalized patients, according to researchers.

They assessed data from more than 19,000 hospital stays and found that “real-time” educational interventions directed toward patients and nurses significantly reduced nonadministration of prescribed VTE prophylaxis.

However, this did not translate to a significant reduction in VTE incidence.

Elliott Haut, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these results in JAMA Network Open.

For this study, the researchers evaluated patients who were prescribed VTE prophylaxis while admitted to Johns Hopkins Hospital between April 1, 2015, and December 31, 2015.

The researchers evaluated patients in 16 hospital units. Four units were targeted for educational intervention, and the remaining 12 units served as controls.

The educational interventions were given only when patients did not receive prescribed VTE prophylaxis. A bedside nurse would document nonadministration, and an alert built into the hospital’s electronic medical record would email and page a health educator.

If the patient had refused prophylaxis, the patient would receive an educational bundle on VTE, which could consist of any or all of the following (patient’s choice):

• A one-on-one discussion with the health educator
• A two-page paper handout (available in eight languages)
• A 10-minute educational video (on a tablet).

If the nonadministration of prophylaxis was not due to patient refusal or contraindication, the health educator would educate the bedside nurse about the importance of giving all prescribed doses of VTE prophylaxis.

The study included 19,652 patient visits during which VTE prophylaxis was prescribed.

Of these, 726 visits were targeted for educational intervention. In 272 visits, the intervention was administered to a nurse alone (n=45) or the nurse and the patient (n=227).

For the remaining 454 visits, the patient was discharged before the intervention (n=123), there was an order to discontinue prophylaxis (n=111), there was a technical error (n=55), the patient (n=43) or health educator (n=41) was off unit, or “other” reasons (n=81).

Results

The proportion of nonadministered doses of VTE prophylaxis declined significantly in the hospital units targeted with educational intervention—from 9.1% pre-intervention to 5.6% post-intervention (odds ratio [OR]=0.57, P<0.001).

However, there was no significant change in the control units—13.6% and 13.3%, respectively (OR=0.98, P=0.62).

The proportion of nonadministered doses for reasons other than patient refusal decreased significantly in the intervention units—from 2.3% to 1.7% (OR, 0.74, P=0.01)—but not in control units—from 3.4% to 3.3% (OR=0.98, P=0.69).

The proportion of nonadministered doses due to patient refusal decreased significantly in the intervention units—from 5.9% to 3.4% (OR=0.53, P<0.001)—but not in control units—from 8.7% to 8.5% (OR=0.98, P=0.71).

“Our study demonstrates that educating patients quickly, as soon as we learn about a missed dose, is not only possible to implement at a large hospital but is effective in ensuring that patients take the drugs that can save their lives,” Dr. Haut said.

“The educational bundles we created are effective and optimize busy clinicians’ already packed schedules,” added study author Brandyn Lau, of the Johns Hopkins University School of Medicine.

“At the end of the day, we’re here to deliver high quality care and keep patients safe, and this is one method of achieving that mission.”

However, the improved adherence to VTE prophylaxis did not translate to a significant reduction in VTE in this study.

The incidence of VTE decreased from 0.30% to 0.18% (OR=0.60) in intervention units and from 0.24% to 0.20% in control units (OR=0.81).

For all patients, the incidence of VTE was 0.26% pre-intervention and 0.19% post-intervention (P=0.46).

This research was supported by a contract from the Patient-Centered Outcomes Research Institute. The study authors reported support from various government agencies and private organizations.

Johns Hopkins Medicine

Education can improve adherence to venous thromboembolism (VTE) prophylaxis among hospitalized patients, according to researchers.

They assessed data from more than 19,000 hospital stays and found that “real-time” educational interventions directed toward patients and nurses significantly reduced nonadministration of prescribed VTE prophylaxis.

However, this did not translate to a significant reduction in VTE incidence.

Elliott Haut, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these results in JAMA Network Open.

For this study, the researchers evaluated patients who were prescribed VTE prophylaxis while admitted to Johns Hopkins Hospital between April 1, 2015, and December 31, 2015.

The researchers evaluated patients in 16 hospital units. Four units were targeted for educational intervention, and the remaining 12 units served as controls.

The educational interventions were given only when patients did not receive prescribed VTE prophylaxis. A bedside nurse would document nonadministration, and an alert built into the hospital’s electronic medical record would email and page a health educator.

If the patient had refused prophylaxis, the patient would receive an educational bundle on VTE, which could consist of any or all of the following (patient’s choice):

• A one-on-one discussion with the health educator
• A two-page paper handout (available in eight languages)
• A 10-minute educational video (on a tablet).

If the nonadministration of prophylaxis was not due to patient refusal or contraindication, the health educator would educate the bedside nurse about the importance of giving all prescribed doses of VTE prophylaxis.

The study included 19,652 patient visits during which VTE prophylaxis was prescribed.

Of these, 726 visits were targeted for educational intervention. In 272 visits, the intervention was administered to a nurse alone (n=45) or the nurse and the patient (n=227).

For the remaining 454 visits, the patient was discharged before the intervention (n=123), there was an order to discontinue prophylaxis (n=111), there was a technical error (n=55), the patient (n=43) or health educator (n=41) was off unit, or “other” reasons (n=81).

Results

The proportion of nonadministered doses of VTE prophylaxis declined significantly in the hospital units targeted with educational intervention—from 9.1% pre-intervention to 5.6% post-intervention (odds ratio [OR]=0.57, P<0.001).

However, there was no significant change in the control units—13.6% and 13.3%, respectively (OR=0.98, P=0.62).

The proportion of nonadministered doses for reasons other than patient refusal decreased significantly in the intervention units—from 2.3% to 1.7% (OR, 0.74, P=0.01)—but not in control units—from 3.4% to 3.3% (OR=0.98, P=0.69).

The proportion of nonadministered doses due to patient refusal decreased significantly in the intervention units—from 5.9% to 3.4% (OR=0.53, P<0.001)—but not in control units—from 8.7% to 8.5% (OR=0.98, P=0.71).

“Our study demonstrates that educating patients quickly, as soon as we learn about a missed dose, is not only possible to implement at a large hospital but is effective in ensuring that patients take the drugs that can save their lives,” Dr. Haut said.

“The educational bundles we created are effective and optimize busy clinicians’ already packed schedules,” added study author Brandyn Lau, of the Johns Hopkins University School of Medicine.

“At the end of the day, we’re here to deliver high quality care and keep patients safe, and this is one method of achieving that mission.”

However, the improved adherence to VTE prophylaxis did not translate to a significant reduction in VTE in this study.

The incidence of VTE decreased from 0.30% to 0.18% (OR=0.60) in intervention units and from 0.24% to 0.20% in control units (OR=0.81).

For all patients, the incidence of VTE was 0.26% pre-intervention and 0.19% post-intervention (P=0.46).

This research was supported by a contract from the Patient-Centered Outcomes Research Institute. The study authors reported support from various government agencies and private organizations.

Johns Hopkins Medicine

Education can improve adherence to venous thromboembolism (VTE) prophylaxis among hospitalized patients, according to researchers.

They assessed data from more than 19,000 hospital stays and found that “real-time” educational interventions directed toward patients and nurses significantly reduced nonadministration of prescribed VTE prophylaxis.

However, this did not translate to a significant reduction in VTE incidence.

Elliott Haut, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these results in JAMA Network Open.

For this study, the researchers evaluated patients who were prescribed VTE prophylaxis while admitted to Johns Hopkins Hospital between April 1, 2015, and December 31, 2015.

The researchers evaluated patients in 16 hospital units. Four units were targeted for educational intervention, and the remaining 12 units served as controls.

The educational interventions were given only when patients did not receive prescribed VTE prophylaxis. A bedside nurse would document nonadministration, and an alert built into the hospital’s electronic medical record would email and page a health educator.

If the patient had refused prophylaxis, the patient would receive an educational bundle on VTE, which could consist of any or all of the following (patient’s choice):

• A one-on-one discussion with the health educator
• A two-page paper handout (available in eight languages)
• A 10-minute educational video (on a tablet).

If the nonadministration of prophylaxis was not due to patient refusal or contraindication, the health educator would educate the bedside nurse about the importance of giving all prescribed doses of VTE prophylaxis.

The study included 19,652 patient visits during which VTE prophylaxis was prescribed.

Of these, 726 visits were targeted for educational intervention. In 272 visits, the intervention was administered to a nurse alone (n=45) or the nurse and the patient (n=227).

For the remaining 454 visits, the patient was discharged before the intervention (n=123), there was an order to discontinue prophylaxis (n=111), there was a technical error (n=55), the patient (n=43) or health educator (n=41) was off unit, or “other” reasons (n=81).

Results

The proportion of nonadministered doses of VTE prophylaxis declined significantly in the hospital units targeted with educational intervention—from 9.1% pre-intervention to 5.6% post-intervention (odds ratio [OR]=0.57, P<0.001).

However, there was no significant change in the control units—13.6% and 13.3%, respectively (OR=0.98, P=0.62).

The proportion of nonadministered doses for reasons other than patient refusal decreased significantly in the intervention units—from 2.3% to 1.7% (OR, 0.74, P=0.01)—but not in control units—from 3.4% to 3.3% (OR=0.98, P=0.69).

The proportion of nonadministered doses due to patient refusal decreased significantly in the intervention units—from 5.9% to 3.4% (OR=0.53, P<0.001)—but not in control units—from 8.7% to 8.5% (OR=0.98, P=0.71).

“Our study demonstrates that educating patients quickly, as soon as we learn about a missed dose, is not only possible to implement at a large hospital but is effective in ensuring that patients take the drugs that can save their lives,” Dr. Haut said.

“The educational bundles we created are effective and optimize busy clinicians’ already packed schedules,” added study author Brandyn Lau, of the Johns Hopkins University School of Medicine.

“At the end of the day, we’re here to deliver high quality care and keep patients safe, and this is one method of achieving that mission.”

However, the improved adherence to VTE prophylaxis did not translate to a significant reduction in VTE in this study.

The incidence of VTE decreased from 0.30% to 0.18% (OR=0.60) in intervention units and from 0.24% to 0.20% in control units (OR=0.81).

For all patients, the incidence of VTE was 0.26% pre-intervention and 0.19% post-intervention (P=0.46).

This research was supported by a contract from the Patient-Centered Outcomes Research Institute. The study authors reported support from various government agencies and private organizations.

Clinical question: Does testing procalcitonin for lower respiratory tract infections (LRTIs) decrease total antibiotic days without a resultant increase in adverse events?

Background: LRTIs are frequently overtreated with antibiotics. Procalcitonin may indicate bacterial infection and promote antibacterial stewardship. Studies to evaluate how testing procalcitonin affects antibiotic use for suspected lower respiratory tract infections are limited.

Study design: Randomized 1:1 intention-to-treat, multicenter trial.

Setting: 14 U.S. urban academic hospitals.

Image

Dr. Naderi is assistant professor in the division of hospital medicine, University of Colorado, Denver.

Clinical question: Does testing procalcitonin for lower respiratory tract infections (LRTIs) decrease total antibiotic days without a resultant increase in adverse events?

Background: LRTIs are frequently overtreated with antibiotics. Procalcitonin may indicate bacterial infection and promote antibacterial stewardship. Studies to evaluate how testing procalcitonin affects antibiotic use for suspected lower respiratory tract infections are limited.

Study design: Randomized 1:1 intention-to-treat, multicenter trial.

Setting: 14 U.S. urban academic hospitals.

Image

Dr. Naderi is assistant professor in the division of hospital medicine, University of Colorado, Denver.

Clinical question: Does testing procalcitonin for lower respiratory tract infections (LRTIs) decrease total antibiotic days without a resultant increase in adverse events?

Background: LRTIs are frequently overtreated with antibiotics. Procalcitonin may indicate bacterial infection and promote antibacterial stewardship. Studies to evaluate how testing procalcitonin affects antibiotic use for suspected lower respiratory tract infections are limited.

Study design: Randomized 1:1 intention-to-treat, multicenter trial.

Setting: 14 U.S. urban academic hospitals.

Image

Dr. Naderi is assistant professor in the division of hospital medicine, University of Colorado, Denver.

In this Episode, Nick Andrews (@tribnic) welcomes the first med student and the first muggle to join the program. Thomas Jefferson University in Philadelphia partnered with the Lantern Theater Company to offer a class that teaches staging, acting, and playwriting. The class is designed specifically for med students, current residents, attending physicians, and any other medical professionals. The class eliminates hierarchy, encourages artistic exploration, and can lead to increased empathy when dealing with patients and their families. Nick, Luis, and Craig recognize the similarities between medicine and art but also highlight what we can learn from different passions. 

Apple Podcasts
Google Podcasts


 

In this Episode, Nick Andrews (@tribnic) welcomes the first med student and the first muggle to join the program. Thomas Jefferson University in Philadelphia partnered with the Lantern Theater Company to offer a class that teaches staging, acting, and playwriting. The class is designed specifically for med students, current residents, attending physicians, and any other medical professionals. The class eliminates hierarchy, encourages artistic exploration, and can lead to increased empathy when dealing with patients and their families. Nick, Luis, and Craig recognize the similarities between medicine and art but also highlight what we can learn from different passions. 

Apple Podcasts
Google Podcasts


 

In this Episode, Nick Andrews (@tribnic) welcomes the first med student and the first muggle to join the program. Thomas Jefferson University in Philadelphia partnered with the Lantern Theater Company to offer a class that teaches staging, acting, and playwriting. The class is designed specifically for med students, current residents, attending physicians, and any other medical professionals. The class eliminates hierarchy, encourages artistic exploration, and can lead to increased empathy when dealing with patients and their families. Nick, Luis, and Craig recognize the similarities between medicine and art but also highlight what we can learn from different passions. 

Apple Podcasts
Google Podcasts


 

The National Multiple Sclerosis (MS) Society has developed recommendations for the identification and management of cognitive impairment in MS. The recommendations, which were endorsed by the Consortium of MS Centers and the International MS Cognition Society, were published online ahead of print October 10 in Multiple Sclerosis Journal.

Cognitive change may affect between 34% and 65% of adults with MS. Decreases in information processing and memory are the most common changes, and cognitive impairment may arise before MRI abnormalities that indicate MS. These changes can affect patients’ ability to work, drive, manage money, and participate in activities.

Patients and Clinicians Need Information

Patients and caregivers should receive information about common cognitive changes in MS and how they affect everyday life, said Rosalind Kalb, PhD, Vice President of the Professional Resource Center at the National MS Society in New York, and coauthors. Patients and caregivers also should be told about the high prevalence of cognitive symptoms in MS and the need for ongoing assessments. Similarly, clinicians need information about how cognitive impairments affect medical decision-making and adherence, said the authors. Clinicians also need referral resources for cognitive assessment and treatment.

All adults and children age 8 or older diagnosed with MS should, as a minimum, undergo early baseline screening with the Symbol Digit Modalities Test (SDMT) or another validated screening tool, according to the recommendations. These patients should be reassessed with the same instrument annually or more often, as needed, to detect disease activity, assess for treatment effects or relapse recovery, monitor progression of cognitive impairment, and screen for new cognitive problems.

In addition to the SDMT, screening tools that have been validated in patients with MS include the Processing Speed Test, Computerized Speed Cognitive Test, MS Neuropsychological Screening Questionnaire, Brief International Cognitive Assessment for MS, Brief Repeatable Neuropsychological Battery, and Minimal Assessment of Cognitive Function in MS.

Interventions May Improve or Maintain Function

An adult who tests positive for cognitive impairment on initial screening should undergo a more comprehensive assessment, especially if the person has comorbidities that raise concerns or is applying for disability due to cognitive impairment. A child with an unexplained change in school performance should receive a neuropsychologic evaluation, said Dr. Kalb and colleagues.

Furthermore, adults and children should be offered remedial interventions or accommodations to improve function at home, work, or school. Appropriately trained professionals should deliver these interventions to address “objectively measured deficits in attention, processing speed, memory and learning, and performance of everyday functional tasks,” said the authors. Clinicians can consider contextualized treatment (eg, self-generated learning tasks) and noncontextualized treatment (eg, memory-retrieval practice and computer-based attention interventions) for remediation of everyday activities, according to the recommendations.

Emerging research supports the potential for exercise to benefit cognitive processing speed in patients with MS. Trials of symptomatic pharmacologic treatments for cognitive impairment related to MS have yielded inconclusive results, however. In addition, few pivotal trials of disease-modifying therapies have incorporated cognitive outcome measures.

—Erik Greb

Suggested Reading

Kalb R, Beier M, Benedict RH, et al. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler. 2018 Oct 10 [Epub ahead of print].

The National Multiple Sclerosis (MS) Society has developed recommendations for the identification and management of cognitive impairment in MS. The recommendations, which were endorsed by the Consortium of MS Centers and the International MS Cognition Society, were published online ahead of print October 10 in Multiple Sclerosis Journal.

Cognitive change may affect between 34% and 65% of adults with MS. Decreases in information processing and memory are the most common changes, and cognitive impairment may arise before MRI abnormalities that indicate MS. These changes can affect patients’ ability to work, drive, manage money, and participate in activities.

Patients and Clinicians Need Information

Patients and caregivers should receive information about common cognitive changes in MS and how they affect everyday life, said Rosalind Kalb, PhD, Vice President of the Professional Resource Center at the National MS Society in New York, and coauthors. Patients and caregivers also should be told about the high prevalence of cognitive symptoms in MS and the need for ongoing assessments. Similarly, clinicians need information about how cognitive impairments affect medical decision-making and adherence, said the authors. Clinicians also need referral resources for cognitive assessment and treatment.

All adults and children age 8 or older diagnosed with MS should, as a minimum, undergo early baseline screening with the Symbol Digit Modalities Test (SDMT) or another validated screening tool, according to the recommendations. These patients should be reassessed with the same instrument annually or more often, as needed, to detect disease activity, assess for treatment effects or relapse recovery, monitor progression of cognitive impairment, and screen for new cognitive problems.

In addition to the SDMT, screening tools that have been validated in patients with MS include the Processing Speed Test, Computerized Speed Cognitive Test, MS Neuropsychological Screening Questionnaire, Brief International Cognitive Assessment for MS, Brief Repeatable Neuropsychological Battery, and Minimal Assessment of Cognitive Function in MS.

Interventions May Improve or Maintain Function

An adult who tests positive for cognitive impairment on initial screening should undergo a more comprehensive assessment, especially if the person has comorbidities that raise concerns or is applying for disability due to cognitive impairment. A child with an unexplained change in school performance should receive a neuropsychologic evaluation, said Dr. Kalb and colleagues.

Furthermore, adults and children should be offered remedial interventions or accommodations to improve function at home, work, or school. Appropriately trained professionals should deliver these interventions to address “objectively measured deficits in attention, processing speed, memory and learning, and performance of everyday functional tasks,” said the authors. Clinicians can consider contextualized treatment (eg, self-generated learning tasks) and noncontextualized treatment (eg, memory-retrieval practice and computer-based attention interventions) for remediation of everyday activities, according to the recommendations.

Emerging research supports the potential for exercise to benefit cognitive processing speed in patients with MS. Trials of symptomatic pharmacologic treatments for cognitive impairment related to MS have yielded inconclusive results, however. In addition, few pivotal trials of disease-modifying therapies have incorporated cognitive outcome measures.

—Erik Greb

Suggested Reading

Kalb R, Beier M, Benedict RH, et al. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler. 2018 Oct 10 [Epub ahead of print].

The National Multiple Sclerosis (MS) Society has developed recommendations for the identification and management of cognitive impairment in MS. The recommendations, which were endorsed by the Consortium of MS Centers and the International MS Cognition Society, were published online ahead of print October 10 in Multiple Sclerosis Journal.

Cognitive change may affect between 34% and 65% of adults with MS. Decreases in information processing and memory are the most common changes, and cognitive impairment may arise before MRI abnormalities that indicate MS. These changes can affect patients’ ability to work, drive, manage money, and participate in activities.

Patients and Clinicians Need Information

Patients and caregivers should receive information about common cognitive changes in MS and how they affect everyday life, said Rosalind Kalb, PhD, Vice President of the Professional Resource Center at the National MS Society in New York, and coauthors. Patients and caregivers also should be told about the high prevalence of cognitive symptoms in MS and the need for ongoing assessments. Similarly, clinicians need information about how cognitive impairments affect medical decision-making and adherence, said the authors. Clinicians also need referral resources for cognitive assessment and treatment.

All adults and children age 8 or older diagnosed with MS should, as a minimum, undergo early baseline screening with the Symbol Digit Modalities Test (SDMT) or another validated screening tool, according to the recommendations. These patients should be reassessed with the same instrument annually or more often, as needed, to detect disease activity, assess for treatment effects or relapse recovery, monitor progression of cognitive impairment, and screen for new cognitive problems.

In addition to the SDMT, screening tools that have been validated in patients with MS include the Processing Speed Test, Computerized Speed Cognitive Test, MS Neuropsychological Screening Questionnaire, Brief International Cognitive Assessment for MS, Brief Repeatable Neuropsychological Battery, and Minimal Assessment of Cognitive Function in MS.

Interventions May Improve or Maintain Function

An adult who tests positive for cognitive impairment on initial screening should undergo a more comprehensive assessment, especially if the person has comorbidities that raise concerns or is applying for disability due to cognitive impairment. A child with an unexplained change in school performance should receive a neuropsychologic evaluation, said Dr. Kalb and colleagues.

Furthermore, adults and children should be offered remedial interventions or accommodations to improve function at home, work, or school. Appropriately trained professionals should deliver these interventions to address “objectively measured deficits in attention, processing speed, memory and learning, and performance of everyday functional tasks,” said the authors. Clinicians can consider contextualized treatment (eg, self-generated learning tasks) and noncontextualized treatment (eg, memory-retrieval practice and computer-based attention interventions) for remediation of everyday activities, according to the recommendations.

Emerging research supports the potential for exercise to benefit cognitive processing speed in patients with MS. Trials of symptomatic pharmacologic treatments for cognitive impairment related to MS have yielded inconclusive results, however. In addition, few pivotal trials of disease-modifying therapies have incorporated cognitive outcome measures.

—Erik Greb

Suggested Reading

Kalb R, Beier M, Benedict RH, et al. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler. 2018 Oct 10 [Epub ahead of print].

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

CHICAGO – The newly released comprehensive second edition of the federal physical activity guidelines have a lofty goal.

“Our overarching vision is to transform the current sick care system into a health promoting system,” Adm. Brett P. Giroir, MD, declared in introducing the recommendations at the American Heart Association scientific sessions.

Bruce Jancin/MDedge News

Bruce Jancin/MDedge News

“We’re hoping to spur more research in this area, so that the next time we make recommendations, that can be incorporated,” added Dr. Kraus, a professor of medicine and cardiologist at Duke University, Durham, N.C., as well as president-elect of the American College of Sports Medicine.

What’s new in the guidelines

“This edition tells us that it’s easier to meet the recommendations in the physical activity guidelines,” according to Adm. Giroir. “The new guidelines demonstrate, based on the best science, everyone can dramatically improve their health just by moving: anytime, anywhere, and by any means that gets you active.” He broke the guidelines down as follows:

• We have new evidence about the risks of sedentary behavior, and new evidence that any amount – any amount – of moderate to vigorous physical activity, like walking, dancing, line dancing if you’re from Texas, and household chores is beneficial,” Adm. Giroir observed.
• While the first edition of the federal guidelines cited strong evidence that physical activity reduces the risk of two types of cancer, breast and colon, the intervening decade has brought forth strong evidence of a protective effect against an additional six types of cancer: bladder, endometrial, kidney, stomach, esophageal, and lung cancer.
• The guidelines formulate for the first time physical activity standards for children aged 3-5 years. The recommended target is at least 3 hr/day of varied physical activity, consistent with existing guidelines in Australia Canada, and the United Kingdom.
• Updated recommendations for children aged 6-17 years call for an hour or more/day of moderate- or vigorous-intensity physical activity on a daily basis, with that activity level falling within the vigorous category on at least 3 days/week. Plus, it recommends bone- and muscle-strengthening activity on at least 3 days.
• The pediatric guidelines are linked to a planned HHS national strategy to expand children’s participation in youth sports as part of an effort to curb childhood obesity, rates of which have more than tripled since the 1970s.

“We’ll soon announce funding opportunities for communities to increase participation in sports among children and teens through participation in affordable programs with trained coaches,” said Dr. Giroir, a pediatrician.

The new guidelines endorse what is called “the comprehensive school physical activity model.”

“I strongly believe our schools should take action to implement this approach. There is a lot of interest right now to affect change in the schools across our country. Part of the answer, I think, is to provide kids with high-quality physical education, but I think we recognize that alone will not be enough.” The comprehensive school activity model calls for not only enriching school PE programs but also incorporating active transport to school, classroom activity, active learning, and after school programs – activity in all settings during the school day. “I’m very hopeful that this model, which is endorsed in the guidelines document, will be widely adopted by schools in this country over the next decade,” Dr. Giroir said.

The first edition declared that only bouts of physical activity of at least 10 minutes duration should count toward meeting the guidelines. That requirement is gone in the second edition. It was an impediment to being active, and upon close examination it wasn’t based on scientific evidence. That means taking the stairs instead of the escalator or parking farther away from the store count toward the weekly physical activity goal, Dr. Kraus said.

“It makes it easier to achieve the guidelines and to encourage Americans to move more and sit less just by making a better choice at many times during the day,” observed Dr. Giroir, a four-star admiral in the U.S. Public Health Service Commissioned Corps.

The latest guidelines contain up-to-date information on the benefits of regular physical activity in terms of brain health, including reduced risk of developing Alzheimer’s disease, and improved cognition, including performance on academic achievement tests and measures of executive function, memory, and processing speed, in preadolescent children as well as older adults. Solid evidence also is cited for improved cognition in patients with MS, dementia, ADHD, and Parkinson’s disease.

The guidelines provide new recommendations for physical activity for women during pregnancy and post partum.

A section of the guidelines is devoted to proven evidence-based strategies to promote physical activity at the individual, small group, and community level.

Physicians now have a resource to aid them in prescribing an individualized physical activity prescription for their patients with existing health conditions, including osteoarthritis, type 2 diabetes, cancer survivors, and physical disabilities.

The new physical activity guidelines and related resources for health care professionals are available at the Health.gov website.
 

[email protected]

SOURCE: Giroir BP. AHA Scientific Sessions, Session ME.05.

CHICAGO – The newly released comprehensive second edition of the federal physical activity guidelines have a lofty goal.

“Our overarching vision is to transform the current sick care system into a health promoting system,” Adm. Brett P. Giroir, MD, declared in introducing the recommendations at the American Heart Association scientific sessions.

Bruce Jancin/MDedge News

Bruce Jancin/MDedge News

“We’re hoping to spur more research in this area, so that the next time we make recommendations, that can be incorporated,” added Dr. Kraus, a professor of medicine and cardiologist at Duke University, Durham, N.C., as well as president-elect of the American College of Sports Medicine.

What’s new in the guidelines

“This edition tells us that it’s easier to meet the recommendations in the physical activity guidelines,” according to Adm. Giroir. “The new guidelines demonstrate, based on the best science, everyone can dramatically improve their health just by moving: anytime, anywhere, and by any means that gets you active.” He broke the guidelines down as follows:

• We have new evidence about the risks of sedentary behavior, and new evidence that any amount – any amount – of moderate to vigorous physical activity, like walking, dancing, line dancing if you’re from Texas, and household chores is beneficial,” Adm. Giroir observed.
• While the first edition of the federal guidelines cited strong evidence that physical activity reduces the risk of two types of cancer, breast and colon, the intervening decade has brought forth strong evidence of a protective effect against an additional six types of cancer: bladder, endometrial, kidney, stomach, esophageal, and lung cancer.
• The guidelines formulate for the first time physical activity standards for children aged 3-5 years. The recommended target is at least 3 hr/day of varied physical activity, consistent with existing guidelines in Australia Canada, and the United Kingdom.
• Updated recommendations for children aged 6-17 years call for an hour or more/day of moderate- or vigorous-intensity physical activity on a daily basis, with that activity level falling within the vigorous category on at least 3 days/week. Plus, it recommends bone- and muscle-strengthening activity on at least 3 days.
• The pediatric guidelines are linked to a planned HHS national strategy to expand children’s participation in youth sports as part of an effort to curb childhood obesity, rates of which have more than tripled since the 1970s.

“We’ll soon announce funding opportunities for communities to increase participation in sports among children and teens through participation in affordable programs with trained coaches,” said Dr. Giroir, a pediatrician.

The new guidelines endorse what is called “the comprehensive school physical activity model.”

“I strongly believe our schools should take action to implement this approach. There is a lot of interest right now to affect change in the schools across our country. Part of the answer, I think, is to provide kids with high-quality physical education, but I think we recognize that alone will not be enough.” The comprehensive school activity model calls for not only enriching school PE programs but also incorporating active transport to school, classroom activity, active learning, and after school programs – activity in all settings during the school day. “I’m very hopeful that this model, which is endorsed in the guidelines document, will be widely adopted by schools in this country over the next decade,” Dr. Giroir said.

The first edition declared that only bouts of physical activity of at least 10 minutes duration should count toward meeting the guidelines. That requirement is gone in the second edition. It was an impediment to being active, and upon close examination it wasn’t based on scientific evidence. That means taking the stairs instead of the escalator or parking farther away from the store count toward the weekly physical activity goal, Dr. Kraus said.

“It makes it easier to achieve the guidelines and to encourage Americans to move more and sit less just by making a better choice at many times during the day,” observed Dr. Giroir, a four-star admiral in the U.S. Public Health Service Commissioned Corps.

The latest guidelines contain up-to-date information on the benefits of regular physical activity in terms of brain health, including reduced risk of developing Alzheimer’s disease, and improved cognition, including performance on academic achievement tests and measures of executive function, memory, and processing speed, in preadolescent children as well as older adults. Solid evidence also is cited for improved cognition in patients with MS, dementia, ADHD, and Parkinson’s disease.

The guidelines provide new recommendations for physical activity for women during pregnancy and post partum.

A section of the guidelines is devoted to proven evidence-based strategies to promote physical activity at the individual, small group, and community level.

Physicians now have a resource to aid them in prescribing an individualized physical activity prescription for their patients with existing health conditions, including osteoarthritis, type 2 diabetes, cancer survivors, and physical disabilities.

The new physical activity guidelines and related resources for health care professionals are available at the Health.gov website.
 

[email protected]

SOURCE: Giroir BP. AHA Scientific Sessions, Session ME.05.

CHICAGO – The newly released comprehensive second edition of the federal physical activity guidelines have a lofty goal.

“Our overarching vision is to transform the current sick care system into a health promoting system,” Adm. Brett P. Giroir, MD, declared in introducing the recommendations at the American Heart Association scientific sessions.

Bruce Jancin/MDedge News

Bruce Jancin/MDedge News

“We’re hoping to spur more research in this area, so that the next time we make recommendations, that can be incorporated,” added Dr. Kraus, a professor of medicine and cardiologist at Duke University, Durham, N.C., as well as president-elect of the American College of Sports Medicine.

What’s new in the guidelines

“This edition tells us that it’s easier to meet the recommendations in the physical activity guidelines,” according to Adm. Giroir. “The new guidelines demonstrate, based on the best science, everyone can dramatically improve their health just by moving: anytime, anywhere, and by any means that gets you active.” He broke the guidelines down as follows:

• We have new evidence about the risks of sedentary behavior, and new evidence that any amount – any amount – of moderate to vigorous physical activity, like walking, dancing, line dancing if you’re from Texas, and household chores is beneficial,” Adm. Giroir observed.
• While the first edition of the federal guidelines cited strong evidence that physical activity reduces the risk of two types of cancer, breast and colon, the intervening decade has brought forth strong evidence of a protective effect against an additional six types of cancer: bladder, endometrial, kidney, stomach, esophageal, and lung cancer.
• The guidelines formulate for the first time physical activity standards for children aged 3-5 years. The recommended target is at least 3 hr/day of varied physical activity, consistent with existing guidelines in Australia Canada, and the United Kingdom.
• Updated recommendations for children aged 6-17 years call for an hour or more/day of moderate- or vigorous-intensity physical activity on a daily basis, with that activity level falling within the vigorous category on at least 3 days/week. Plus, it recommends bone- and muscle-strengthening activity on at least 3 days.
• The pediatric guidelines are linked to a planned HHS national strategy to expand children’s participation in youth sports as part of an effort to curb childhood obesity, rates of which have more than tripled since the 1970s.

“We’ll soon announce funding opportunities for communities to increase participation in sports among children and teens through participation in affordable programs with trained coaches,” said Dr. Giroir, a pediatrician.

The new guidelines endorse what is called “the comprehensive school physical activity model.”

“I strongly believe our schools should take action to implement this approach. There is a lot of interest right now to affect change in the schools across our country. Part of the answer, I think, is to provide kids with high-quality physical education, but I think we recognize that alone will not be enough.” The comprehensive school activity model calls for not only enriching school PE programs but also incorporating active transport to school, classroom activity, active learning, and after school programs – activity in all settings during the school day. “I’m very hopeful that this model, which is endorsed in the guidelines document, will be widely adopted by schools in this country over the next decade,” Dr. Giroir said.

The first edition declared that only bouts of physical activity of at least 10 minutes duration should count toward meeting the guidelines. That requirement is gone in the second edition. It was an impediment to being active, and upon close examination it wasn’t based on scientific evidence. That means taking the stairs instead of the escalator or parking farther away from the store count toward the weekly physical activity goal, Dr. Kraus said.

“It makes it easier to achieve the guidelines and to encourage Americans to move more and sit less just by making a better choice at many times during the day,” observed Dr. Giroir, a four-star admiral in the U.S. Public Health Service Commissioned Corps.

The latest guidelines contain up-to-date information on the benefits of regular physical activity in terms of brain health, including reduced risk of developing Alzheimer’s disease, and improved cognition, including performance on academic achievement tests and measures of executive function, memory, and processing speed, in preadolescent children as well as older adults. Solid evidence also is cited for improved cognition in patients with MS, dementia, ADHD, and Parkinson’s disease.

The guidelines provide new recommendations for physical activity for women during pregnancy and post partum.

A section of the guidelines is devoted to proven evidence-based strategies to promote physical activity at the individual, small group, and community level.

Physicians now have a resource to aid them in prescribing an individualized physical activity prescription for their patients with existing health conditions, including osteoarthritis, type 2 diabetes, cancer survivors, and physical disabilities.

The new physical activity guidelines and related resources for health care professionals are available at the Health.gov website.
 

[email protected]

SOURCE: Giroir BP. AHA Scientific Sessions, Session ME.05.

Kids with poor cardiorespiratory fitness are at increased risk of developing type 2 diabetes and cardiovascular disease, according to the analysis of an ongoing Finnish study of physical activity and dietary intervention in school children.

“Our results are in agreement with previous findings that cardiorespiratory fitness measured in exercise test laboratories or using field tests and scaled by body mass (BM) using the ratio standard method had a strong inverse association with cardiometabolic risk in children,” lead author Andrew O. Agbaje, MD, MPH, and his coauthors wrote in the Scandinavian Journal of Medicine & Science in Sports.

The coauthors assessed the cardiorespiratory fitness of 352 primary school children – 186 boys and 166 girls – from Kuopio, Finland, all of whom were already participating in the ongoing PANIC (Physical Activity and Nutrition in Children) Study. The children were asked to perform a maximal exercise test, upon which fitness was assessed by measuring peak oxygen uptake (VO_{2 peak}), noted Dr. Agbaje, a PhD student at the University of Eastern Finland’s Institute of Biomedicine in Kuopio, and his colleagues.

Body mass and lean mass were also measured by bioelectrical impedance and used to scale VO_{2 peak}, while variables such as waist circumference, insulin, glucose, HDL cholesterol, and triglycerides were used to calculate a continuous cardiometabolic risk score. Upon analysis, VO_{2 peak} less than 45.8 mL/kg BM^-1 min^-1 in boys and less than 44.1 mL/kg BM-¹ min-¹ in girls was associated with increased cardiometabolic risk.

The coauthors noted that cardiorespiratory fitness can be influenced by genetics and that adjustments for puberty had “no effect on the relationships between VO_{2 peak} and cardiometabolic risk.” As such, they recommended that “longitudinal studies are needed to clarify the role of CRF in cardiometabolic health during growth and maturation.”

That said, despite advocating caution in regard to determining proper CRF thresholds, the coauthors suggested that CRF scaled by BM could be used to screen children and improve prevention efforts. “Cardiometabolic risk tracks from childhood into adulthood and the early identification of individuals at increased risk is essential in developing public health actions targeted at preventing cardiometabolic diseases,” they wrote.

The study was funded by grants from the Ministry of Education and Culture of Finland, Ministry of Social Affairs and Health of Finland, Research Committee of the Kuopio University Hospital Catchment Area (State Research Funding), Finnish Innovation Fund Sitra, Social Insurance Institution of Finland, Finnish Cultural Foundation, Foundation for Paediatric Research, Diabetes Research Foundation in Finland, Finnish Foundation for Cardiovascular Research, Juho Vainio Foundation, Paavo Nurmi Foundation, and the Yrjö Jahnsson Foundation. Dr. Agbaje reported grant support from the Olvi Foundation and the Urho Känkanen Foundation.

SOURCE: Agbaje AO et al. Scand J Med Sci Sports. 2018 Sep 19. doi: 10.1111/sms.13307.

Kids with poor cardiorespiratory fitness are at increased risk of developing type 2 diabetes and cardiovascular disease, according to the analysis of an ongoing Finnish study of physical activity and dietary intervention in school children.

“Our results are in agreement with previous findings that cardiorespiratory fitness measured in exercise test laboratories or using field tests and scaled by body mass (BM) using the ratio standard method had a strong inverse association with cardiometabolic risk in children,” lead author Andrew O. Agbaje, MD, MPH, and his coauthors wrote in the Scandinavian Journal of Medicine & Science in Sports.

The coauthors assessed the cardiorespiratory fitness of 352 primary school children – 186 boys and 166 girls – from Kuopio, Finland, all of whom were already participating in the ongoing PANIC (Physical Activity and Nutrition in Children) Study. The children were asked to perform a maximal exercise test, upon which fitness was assessed by measuring peak oxygen uptake (VO_{2 peak}), noted Dr. Agbaje, a PhD student at the University of Eastern Finland’s Institute of Biomedicine in Kuopio, and his colleagues.

Body mass and lean mass were also measured by bioelectrical impedance and used to scale VO_{2 peak}, while variables such as waist circumference, insulin, glucose, HDL cholesterol, and triglycerides were used to calculate a continuous cardiometabolic risk score. Upon analysis, VO_{2 peak} less than 45.8 mL/kg BM^-1 min^-1 in boys and less than 44.1 mL/kg BM-¹ min-¹ in girls was associated with increased cardiometabolic risk.

The coauthors noted that cardiorespiratory fitness can be influenced by genetics and that adjustments for puberty had “no effect on the relationships between VO_{2 peak} and cardiometabolic risk.” As such, they recommended that “longitudinal studies are needed to clarify the role of CRF in cardiometabolic health during growth and maturation.”

That said, despite advocating caution in regard to determining proper CRF thresholds, the coauthors suggested that CRF scaled by BM could be used to screen children and improve prevention efforts. “Cardiometabolic risk tracks from childhood into adulthood and the early identification of individuals at increased risk is essential in developing public health actions targeted at preventing cardiometabolic diseases,” they wrote.

The study was funded by grants from the Ministry of Education and Culture of Finland, Ministry of Social Affairs and Health of Finland, Research Committee of the Kuopio University Hospital Catchment Area (State Research Funding), Finnish Innovation Fund Sitra, Social Insurance Institution of Finland, Finnish Cultural Foundation, Foundation for Paediatric Research, Diabetes Research Foundation in Finland, Finnish Foundation for Cardiovascular Research, Juho Vainio Foundation, Paavo Nurmi Foundation, and the Yrjö Jahnsson Foundation. Dr. Agbaje reported grant support from the Olvi Foundation and the Urho Känkanen Foundation.

SOURCE: Agbaje AO et al. Scand J Med Sci Sports. 2018 Sep 19. doi: 10.1111/sms.13307.

Kids with poor cardiorespiratory fitness are at increased risk of developing type 2 diabetes and cardiovascular disease, according to the analysis of an ongoing Finnish study of physical activity and dietary intervention in school children.

“Our results are in agreement with previous findings that cardiorespiratory fitness measured in exercise test laboratories or using field tests and scaled by body mass (BM) using the ratio standard method had a strong inverse association with cardiometabolic risk in children,” lead author Andrew O. Agbaje, MD, MPH, and his coauthors wrote in the Scandinavian Journal of Medicine & Science in Sports.

The coauthors assessed the cardiorespiratory fitness of 352 primary school children – 186 boys and 166 girls – from Kuopio, Finland, all of whom were already participating in the ongoing PANIC (Physical Activity and Nutrition in Children) Study. The children were asked to perform a maximal exercise test, upon which fitness was assessed by measuring peak oxygen uptake (VO_{2 peak}), noted Dr. Agbaje, a PhD student at the University of Eastern Finland’s Institute of Biomedicine in Kuopio, and his colleagues.

Body mass and lean mass were also measured by bioelectrical impedance and used to scale VO_{2 peak}, while variables such as waist circumference, insulin, glucose, HDL cholesterol, and triglycerides were used to calculate a continuous cardiometabolic risk score. Upon analysis, VO_{2 peak} less than 45.8 mL/kg BM^-1 min^-1 in boys and less than 44.1 mL/kg BM-¹ min-¹ in girls was associated with increased cardiometabolic risk.

The coauthors noted that cardiorespiratory fitness can be influenced by genetics and that adjustments for puberty had “no effect on the relationships between VO_{2 peak} and cardiometabolic risk.” As such, they recommended that “longitudinal studies are needed to clarify the role of CRF in cardiometabolic health during growth and maturation.”

That said, despite advocating caution in regard to determining proper CRF thresholds, the coauthors suggested that CRF scaled by BM could be used to screen children and improve prevention efforts. “Cardiometabolic risk tracks from childhood into adulthood and the early identification of individuals at increased risk is essential in developing public health actions targeted at preventing cardiometabolic diseases,” they wrote.

The study was funded by grants from the Ministry of Education and Culture of Finland, Ministry of Social Affairs and Health of Finland, Research Committee of the Kuopio University Hospital Catchment Area (State Research Funding), Finnish Innovation Fund Sitra, Social Insurance Institution of Finland, Finnish Cultural Foundation, Foundation for Paediatric Research, Diabetes Research Foundation in Finland, Finnish Foundation for Cardiovascular Research, Juho Vainio Foundation, Paavo Nurmi Foundation, and the Yrjö Jahnsson Foundation. Dr. Agbaje reported grant support from the Olvi Foundation and the Urho Känkanen Foundation.

SOURCE: Agbaje AO et al. Scand J Med Sci Sports. 2018 Sep 19. doi: 10.1111/sms.13307.

Diagnoses of primary and secondary syphilis, the most infectious stages of the disease, jumped 76% from 2013 to 2017. And reported cases of congenital syphilis—passed from mother to infant during pregnancy—rose 44% between 2016 and 2017, from 16 cases to 23 cases per 100,000 live births, according to the CDC’s annual Sexually Transmitted Disease Surveillance Report. Those data highlight the need for better prenatal care that includes syphilis testing at the first visit and follow-up testing for women at high risk of the infection, the CDC says. Syphilis can cause miscarriage, newborn death, and severe lifelong physical and mental health problems.

The 918 cases reported in 2017 represent the highest number of recorded cases in 20 years. Cases were reported in 37 states, primarily western and southern states. The report notes that the surge in cases parallels similar increases in syphilis among women of reproductive age and outpaces national increases in sexually transmitted dieseases (STDs) overall.

Syphilis during pregnancy is easily cured with the right antibiotics. Left untreated, a pregnant woman with syphilis has as much as an 80% chance of passing it to the baby.

Early testing, prompt treatment, and follow-up are key. Recent CDC research found that 1 in 3 women who gave birth to a baby with syphilis in 2016 had in fact been tested during pregnancy but either acquired syphilis after that test or was not treated in time to cure the infection in the fetus.

“Too many women are falling through the cracks of the system,” said Gail Bolan, MD, director of the CDC’s Division of STD Prevention. The CDC recommends that all pregnant women be treated for syphilis at the first prenatal visit. But for many women, 1 test may not be enough. Woman at high risk, or those who live in high-prevalence areas, should be tested again early in the third trimester and at delivery.

“To protect every baby,” Bolan says, “we have to start by protecting every mother.”

Diagnoses of primary and secondary syphilis, the most infectious stages of the disease, jumped 76% from 2013 to 2017. And reported cases of congenital syphilis—passed from mother to infant during pregnancy—rose 44% between 2016 and 2017, from 16 cases to 23 cases per 100,000 live births, according to the CDC’s annual Sexually Transmitted Disease Surveillance Report. Those data highlight the need for better prenatal care that includes syphilis testing at the first visit and follow-up testing for women at high risk of the infection, the CDC says. Syphilis can cause miscarriage, newborn death, and severe lifelong physical and mental health problems.

The 918 cases reported in 2017 represent the highest number of recorded cases in 20 years. Cases were reported in 37 states, primarily western and southern states. The report notes that the surge in cases parallels similar increases in syphilis among women of reproductive age and outpaces national increases in sexually transmitted dieseases (STDs) overall.

Syphilis during pregnancy is easily cured with the right antibiotics. Left untreated, a pregnant woman with syphilis has as much as an 80% chance of passing it to the baby.

Early testing, prompt treatment, and follow-up are key. Recent CDC research found that 1 in 3 women who gave birth to a baby with syphilis in 2016 had in fact been tested during pregnancy but either acquired syphilis after that test or was not treated in time to cure the infection in the fetus.

“Too many women are falling through the cracks of the system,” said Gail Bolan, MD, director of the CDC’s Division of STD Prevention. The CDC recommends that all pregnant women be treated for syphilis at the first prenatal visit. But for many women, 1 test may not be enough. Woman at high risk, or those who live in high-prevalence areas, should be tested again early in the third trimester and at delivery.

“To protect every baby,” Bolan says, “we have to start by protecting every mother.”

Diagnoses of primary and secondary syphilis, the most infectious stages of the disease, jumped 76% from 2013 to 2017. And reported cases of congenital syphilis—passed from mother to infant during pregnancy—rose 44% between 2016 and 2017, from 16 cases to 23 cases per 100,000 live births, according to the CDC’s annual Sexually Transmitted Disease Surveillance Report. Those data highlight the need for better prenatal care that includes syphilis testing at the first visit and follow-up testing for women at high risk of the infection, the CDC says. Syphilis can cause miscarriage, newborn death, and severe lifelong physical and mental health problems.

The 918 cases reported in 2017 represent the highest number of recorded cases in 20 years. Cases were reported in 37 states, primarily western and southern states. The report notes that the surge in cases parallels similar increases in syphilis among women of reproductive age and outpaces national increases in sexually transmitted dieseases (STDs) overall.

Syphilis during pregnancy is easily cured with the right antibiotics. Left untreated, a pregnant woman with syphilis has as much as an 80% chance of passing it to the baby.

Early testing, prompt treatment, and follow-up are key. Recent CDC research found that 1 in 3 women who gave birth to a baby with syphilis in 2016 had in fact been tested during pregnancy but either acquired syphilis after that test or was not treated in time to cure the infection in the fetus.

“Too many women are falling through the cracks of the system,” said Gail Bolan, MD, director of the CDC’s Division of STD Prevention. The CDC recommends that all pregnant women be treated for syphilis at the first prenatal visit. But for many women, 1 test may not be enough. Woman at high risk, or those who live in high-prevalence areas, should be tested again early in the third trimester and at delivery.

“To protect every baby,” Bolan says, “we have to start by protecting every mother.”