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CHEST Foundation – designated as a Combined Federal Campaign-approved charity
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
Secondary fractures in older men spike soon after first, but exercise may help
Older men have a higher risk than women of sustaining secondary fractures within a few years of their first fracture, but moderate physical activity may improve bone strength, potentially reducing their risk of fractures, according to two studies presented at the annual meeting of the American Society for Bone and Mineral Research in Montreal.
The first study, a matched historical cohort of 57,783 people aged 50 or older (40,062 women and 17,721 men) in Manitoba, Canada, found that men had a threefold higher risk of sustaining a secondary major osteoporotic fracture (MOF) within 1 year of a first fracture, compared with healthy controls. The risk for women, by comparison, was 1.8 times higher than in age-matched controls who did not experience a fracture. These risks declined over time but remained elevated even as much as 15-25 years after the index fracture, according to primary investigator Suzanne N. Morin, MD, of the department of medicine at McGill University in Montreal.
“Often, men and clinicians don’t think men have skeletal fragility – everybody thinks it’s a women’s disease,” Dr. Morin said. “It’s true that it’s more frequent in women, but men do have osteoporosis, and often when they have it, they tend to have more serious complications following the fractures.” This includes higher risk of subsequent fractures and higher mortality, she said. “If you see an older gentleman with a fracture, it really should be some kind of an alarm signal.”
Using administrative health care databases, Dr. Morin and her colleagues reviewed records of patients who had an index MOF between 1989 and 2006. They compared rates of subsequent MOFs until 2016 with those of age- and sex-matched controls (n = 165,965), allowing for between 10 and 25 years of follow-up.
Researchers identified 29,694 index MOF cases (11,028 to the wrist, 9,313 to the hip, 5,799 to the humerus, and 3,554 to the spine). The annual crude rate of subsequent MOFs per 1,000 person-years was 18.5 in men (95% confidence interval, 17.3-19.8) and 29.6 in women (95% CI, 28.8-30.4). The cumulative incidence of subsequent MOFs up to 25 years later was higher in cases versus controls for both sexes and across all ages except those over 80.
Hazard ratios for subsequent MOFs were higher in men than women, particularly in the first year following the index fracture and remained very high for men during the first 3 years of follow-up. Across all follow-up years, men who had fractures were 2.5 times more likely to experience a secondary MOF (95% CI, 2.3-2.7) and women who had fractures were 1.6 times more likely to experience a secondary MOF (95% CI, 1.6-1.7), compared with controls.
To prevent fractures, clinicians should consider gait or balance training for older men and women, especially those who already have experienced a fracture, Dr. Morin said. Physicians also should note any medications such as sedatives that put patients at higher risk for falls and consider medications like bisphosphonates to reduce fracture risk. Additionally, they should ensure there are no underlying causes for skeletal fragility, such as severe vitamin D deficiency or a hormonal imbalance, she said.
Physical activity could reduce risk
In a second, unrelated study, researchers found that moderate physical activity may have a modest effect on bone strength in older men, accounting for up to a 20% lower fracture risk, according to Lisa Langsetmo, PhD, primary investigator and a senior research associate at the University of Minnesota, Minneapolis. She and her colleagues studied physical activity and bone strength in 994 older men (mean age 83.9) participating in the Osteoporotic Fractures in Men (MrOS) Study, a longitudinal, observational study of musculoskeletal health in older American men that initially enrolled about 6,000 participants.
Participants wore armband activity monitors for 5 days during their year-7 and year-14 assessments; investigators averaged their physical activity over the two time points and used armband data along with factors like height, weight, and smoking status to estimate total energy expenditure (TEE), total steps per day, and level of activity, from sedentary to at least moderate. The men also underwent bone microarchitecture assessments of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), a technique that produces detailed pictures of the bones. Investigators used mathematical models to predict failure load, or the force required to break a bone – a predictor of osteoporotic fractures in men. They also computed total, cortical, and trabecular volumetric bone mineral density (BMD).
Overall, researchers found that time spent doing at least moderate activity versus time spent in sedentary activity was related to better bone strength at both sites, whereas time spent in light activity was not. The results suggest that at least moderate physical activity such as vigorous walking averaged over a period of time may have a modest effect on bone strength among older men, Dr. Langsetmo said.
“This is important for older men,” she said. “They may not be able to jog any more but they may be able to do more moderate activity.” Physicians should ask older male patients about their activity levels and any barriers to activity, or consider a referral to a physical therapist to keep them active, she said.
Higher TEE, step count, and peak 30-minute cadence (P30MC), a measure of vigorous activity, were each associated with higher failure load of the distal radius (effect size 0.08-0.13) but not higher volumetric or compartment-specific BMD. These measures also were associated with higher failure load of the distal tibia (effect size 0.19-0.21), higher volumetric BMD (effect size 0.08-0.15), higher trabecular BMD (effect size 0.07-0.11), and higher cortical BMD (0.09-0.13).
The first study was funded internally; Manitoba Health provided the data. The second study was funded by the National Institutes of Health. Dr. Morin and Dr. Langsetmo reported no relevant financial disclosures.
Older men have a higher risk than women of sustaining secondary fractures within a few years of their first fracture, but moderate physical activity may improve bone strength, potentially reducing their risk of fractures, according to two studies presented at the annual meeting of the American Society for Bone and Mineral Research in Montreal.
The first study, a matched historical cohort of 57,783 people aged 50 or older (40,062 women and 17,721 men) in Manitoba, Canada, found that men had a threefold higher risk of sustaining a secondary major osteoporotic fracture (MOF) within 1 year of a first fracture, compared with healthy controls. The risk for women, by comparison, was 1.8 times higher than in age-matched controls who did not experience a fracture. These risks declined over time but remained elevated even as much as 15-25 years after the index fracture, according to primary investigator Suzanne N. Morin, MD, of the department of medicine at McGill University in Montreal.
“Often, men and clinicians don’t think men have skeletal fragility – everybody thinks it’s a women’s disease,” Dr. Morin said. “It’s true that it’s more frequent in women, but men do have osteoporosis, and often when they have it, they tend to have more serious complications following the fractures.” This includes higher risk of subsequent fractures and higher mortality, she said. “If you see an older gentleman with a fracture, it really should be some kind of an alarm signal.”
Using administrative health care databases, Dr. Morin and her colleagues reviewed records of patients who had an index MOF between 1989 and 2006. They compared rates of subsequent MOFs until 2016 with those of age- and sex-matched controls (n = 165,965), allowing for between 10 and 25 years of follow-up.
Researchers identified 29,694 index MOF cases (11,028 to the wrist, 9,313 to the hip, 5,799 to the humerus, and 3,554 to the spine). The annual crude rate of subsequent MOFs per 1,000 person-years was 18.5 in men (95% confidence interval, 17.3-19.8) and 29.6 in women (95% CI, 28.8-30.4). The cumulative incidence of subsequent MOFs up to 25 years later was higher in cases versus controls for both sexes and across all ages except those over 80.
Hazard ratios for subsequent MOFs were higher in men than women, particularly in the first year following the index fracture and remained very high for men during the first 3 years of follow-up. Across all follow-up years, men who had fractures were 2.5 times more likely to experience a secondary MOF (95% CI, 2.3-2.7) and women who had fractures were 1.6 times more likely to experience a secondary MOF (95% CI, 1.6-1.7), compared with controls.
To prevent fractures, clinicians should consider gait or balance training for older men and women, especially those who already have experienced a fracture, Dr. Morin said. Physicians also should note any medications such as sedatives that put patients at higher risk for falls and consider medications like bisphosphonates to reduce fracture risk. Additionally, they should ensure there are no underlying causes for skeletal fragility, such as severe vitamin D deficiency or a hormonal imbalance, she said.
Physical activity could reduce risk
In a second, unrelated study, researchers found that moderate physical activity may have a modest effect on bone strength in older men, accounting for up to a 20% lower fracture risk, according to Lisa Langsetmo, PhD, primary investigator and a senior research associate at the University of Minnesota, Minneapolis. She and her colleagues studied physical activity and bone strength in 994 older men (mean age 83.9) participating in the Osteoporotic Fractures in Men (MrOS) Study, a longitudinal, observational study of musculoskeletal health in older American men that initially enrolled about 6,000 participants.
Participants wore armband activity monitors for 5 days during their year-7 and year-14 assessments; investigators averaged their physical activity over the two time points and used armband data along with factors like height, weight, and smoking status to estimate total energy expenditure (TEE), total steps per day, and level of activity, from sedentary to at least moderate. The men also underwent bone microarchitecture assessments of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), a technique that produces detailed pictures of the bones. Investigators used mathematical models to predict failure load, or the force required to break a bone – a predictor of osteoporotic fractures in men. They also computed total, cortical, and trabecular volumetric bone mineral density (BMD).
Overall, researchers found that time spent doing at least moderate activity versus time spent in sedentary activity was related to better bone strength at both sites, whereas time spent in light activity was not. The results suggest that at least moderate physical activity such as vigorous walking averaged over a period of time may have a modest effect on bone strength among older men, Dr. Langsetmo said.
“This is important for older men,” she said. “They may not be able to jog any more but they may be able to do more moderate activity.” Physicians should ask older male patients about their activity levels and any barriers to activity, or consider a referral to a physical therapist to keep them active, she said.
Higher TEE, step count, and peak 30-minute cadence (P30MC), a measure of vigorous activity, were each associated with higher failure load of the distal radius (effect size 0.08-0.13) but not higher volumetric or compartment-specific BMD. These measures also were associated with higher failure load of the distal tibia (effect size 0.19-0.21), higher volumetric BMD (effect size 0.08-0.15), higher trabecular BMD (effect size 0.07-0.11), and higher cortical BMD (0.09-0.13).
The first study was funded internally; Manitoba Health provided the data. The second study was funded by the National Institutes of Health. Dr. Morin and Dr. Langsetmo reported no relevant financial disclosures.
Older men have a higher risk than women of sustaining secondary fractures within a few years of their first fracture, but moderate physical activity may improve bone strength, potentially reducing their risk of fractures, according to two studies presented at the annual meeting of the American Society for Bone and Mineral Research in Montreal.
The first study, a matched historical cohort of 57,783 people aged 50 or older (40,062 women and 17,721 men) in Manitoba, Canada, found that men had a threefold higher risk of sustaining a secondary major osteoporotic fracture (MOF) within 1 year of a first fracture, compared with healthy controls. The risk for women, by comparison, was 1.8 times higher than in age-matched controls who did not experience a fracture. These risks declined over time but remained elevated even as much as 15-25 years after the index fracture, according to primary investigator Suzanne N. Morin, MD, of the department of medicine at McGill University in Montreal.
“Often, men and clinicians don’t think men have skeletal fragility – everybody thinks it’s a women’s disease,” Dr. Morin said. “It’s true that it’s more frequent in women, but men do have osteoporosis, and often when they have it, they tend to have more serious complications following the fractures.” This includes higher risk of subsequent fractures and higher mortality, she said. “If you see an older gentleman with a fracture, it really should be some kind of an alarm signal.”
Using administrative health care databases, Dr. Morin and her colleagues reviewed records of patients who had an index MOF between 1989 and 2006. They compared rates of subsequent MOFs until 2016 with those of age- and sex-matched controls (n = 165,965), allowing for between 10 and 25 years of follow-up.
Researchers identified 29,694 index MOF cases (11,028 to the wrist, 9,313 to the hip, 5,799 to the humerus, and 3,554 to the spine). The annual crude rate of subsequent MOFs per 1,000 person-years was 18.5 in men (95% confidence interval, 17.3-19.8) and 29.6 in women (95% CI, 28.8-30.4). The cumulative incidence of subsequent MOFs up to 25 years later was higher in cases versus controls for both sexes and across all ages except those over 80.
Hazard ratios for subsequent MOFs were higher in men than women, particularly in the first year following the index fracture and remained very high for men during the first 3 years of follow-up. Across all follow-up years, men who had fractures were 2.5 times more likely to experience a secondary MOF (95% CI, 2.3-2.7) and women who had fractures were 1.6 times more likely to experience a secondary MOF (95% CI, 1.6-1.7), compared with controls.
To prevent fractures, clinicians should consider gait or balance training for older men and women, especially those who already have experienced a fracture, Dr. Morin said. Physicians also should note any medications such as sedatives that put patients at higher risk for falls and consider medications like bisphosphonates to reduce fracture risk. Additionally, they should ensure there are no underlying causes for skeletal fragility, such as severe vitamin D deficiency or a hormonal imbalance, she said.
Physical activity could reduce risk
In a second, unrelated study, researchers found that moderate physical activity may have a modest effect on bone strength in older men, accounting for up to a 20% lower fracture risk, according to Lisa Langsetmo, PhD, primary investigator and a senior research associate at the University of Minnesota, Minneapolis. She and her colleagues studied physical activity and bone strength in 994 older men (mean age 83.9) participating in the Osteoporotic Fractures in Men (MrOS) Study, a longitudinal, observational study of musculoskeletal health in older American men that initially enrolled about 6,000 participants.
Participants wore armband activity monitors for 5 days during their year-7 and year-14 assessments; investigators averaged their physical activity over the two time points and used armband data along with factors like height, weight, and smoking status to estimate total energy expenditure (TEE), total steps per day, and level of activity, from sedentary to at least moderate. The men also underwent bone microarchitecture assessments of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), a technique that produces detailed pictures of the bones. Investigators used mathematical models to predict failure load, or the force required to break a bone – a predictor of osteoporotic fractures in men. They also computed total, cortical, and trabecular volumetric bone mineral density (BMD).
Overall, researchers found that time spent doing at least moderate activity versus time spent in sedentary activity was related to better bone strength at both sites, whereas time spent in light activity was not. The results suggest that at least moderate physical activity such as vigorous walking averaged over a period of time may have a modest effect on bone strength among older men, Dr. Langsetmo said.
“This is important for older men,” she said. “They may not be able to jog any more but they may be able to do more moderate activity.” Physicians should ask older male patients about their activity levels and any barriers to activity, or consider a referral to a physical therapist to keep them active, she said.
Higher TEE, step count, and peak 30-minute cadence (P30MC), a measure of vigorous activity, were each associated with higher failure load of the distal radius (effect size 0.08-0.13) but not higher volumetric or compartment-specific BMD. These measures also were associated with higher failure load of the distal tibia (effect size 0.19-0.21), higher volumetric BMD (effect size 0.08-0.15), higher trabecular BMD (effect size 0.07-0.11), and higher cortical BMD (0.09-0.13).
The first study was funded internally; Manitoba Health provided the data. The second study was funded by the National Institutes of Health. Dr. Morin and Dr. Langsetmo reported no relevant financial disclosures.
FROM ASBMR 2018
Obesity in early childhood promotes obese adolescence
Most obese adolescents first became obese between the ages of 2 and 6 years, based on data from approximately 50,000 children in Germany.
Identifying periods of weight gain in childhood can help develop intervention and prevention strategies to reduce the risk of obesity in adolescence, wrote Mandy Geserick, MSc, of the University of Leipzig, Germany, and her colleagues in the New England Journal of Medicine.
To assess the timing of weight gain in early childhood, the researchers reviewed data from a German patient registry designed to monitor growth data. The study population included 51,505 children who had at least one visit to a pediatrician between birth and age 14 years and a second visit between age 15 and 19 years.
Overall, the probability of being overweight or obese in adolescence was 29% among children who gained more weight in the preschool years, between the ages of 2 and 6 years (defined as a change in body mass index [BMI] of 0.2 or more to less than 2.0), compared with 20% among children whose preschool weight remained stable (defined as a change in BMI of more than −0.2 to less than 0.2) – a relative risk of 1.43.
“A total of 83% of the children with obesity at the age of 4 were overweight or obese in adolescence, and only 17% returned to a normal weight,” they wrote. In addition, 44% of children who were born large for gestational age were overweight or obese in adolescence.
“A practical clinical implication of our study results would be surveillance for BMI acceleration, which should be recognized before 6 years of age, even in the absence of obesity,” the researchers wrote.
The study findings were limited by several factors including the variation in the number of visits, the lack of data on many children beyond the age of 14 years, and the lack of data on parental weight and perinatal risk factors associated with obesity, the researchers noted. However, the results were strengthened by the large, population-based design, and support the study hypothesis that obesity develops in early childhood and, once present, persists into adolescence.
“The specific dynamics and patterns of BMI in this early childhood period, rather than the absolute BMI, appear to be important factors in identifying children at risk for obesity later in life,” the researchers wrote. “It is therefore important for health care professionals, educational staff, and parents to become more sensitive to this critical time period.”
The study was supported by the German Research Council for the Clinical Research Center; the Federal Ministry of Education and Research; and the University of Leipzig, which was supported by the European Union, the European Regional Development Fund, and the Free State of Saxony within the framework of the excellence initiative. The CrescNet registry infrastructure was supported by grants from Hexal, Novo Nordisk, Merck Serono, Lilly Deutschland, Pfizer, and Ipsen Pharma. Dr. Geserick had no financial conflicts to report.
SOURCE: Geserick M et al. N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMoa1803527.
Most normal-weight children remained in the normal range throughout childhood, but the association between obesity by the age of 5 years and obese adolescence is a “new and important” finding, Michael S. Freemark, MD, wrote in an accompanying editorial (N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMe1811305).
Although body mass index (BMI) generally decreases by age 5-6 years before increasing through adolescence, data from previous studies have shown that “an early or exaggerated ‘adiposity rebound’ portends an increased risk of obesity in later childhood and adolescence,” he wrote.
In this study, BMI increase between age 2 and 6 years was the strongest predictor of obesity in adolescence. Although the study was not designed to show causality, the results support the idea of a window of opportunity for intervention for children at increased risk for obesity, Dr. Freemark wrote. “The finding that the risk of adolescent obesity manifests by 3 to 5 years of age suggests that nutritional counseling should be considered when exaggerated weight gain persists or emerges after 2 years of age; it would be of value to test the efficacy of early dietary intervention in an appropriate trial.
“Counseling could be applied preemptively for families in which the parents are overweight, particularly if there is a history of maternal diabetes or smoking,” he added.
Dr. Freemark is affiliated with the division of pediatric endocrinology and diabetes at Duke University, Durham, N.C. He disclosed grants from Rhythm Pharmaceuticals, the American Heart Association, and the Humanitarian Innovation Fund and European Commission, as well as personal fees from Springer Publishing outside the submitted work.
Most normal-weight children remained in the normal range throughout childhood, but the association between obesity by the age of 5 years and obese adolescence is a “new and important” finding, Michael S. Freemark, MD, wrote in an accompanying editorial (N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMe1811305).
Although body mass index (BMI) generally decreases by age 5-6 years before increasing through adolescence, data from previous studies have shown that “an early or exaggerated ‘adiposity rebound’ portends an increased risk of obesity in later childhood and adolescence,” he wrote.
In this study, BMI increase between age 2 and 6 years was the strongest predictor of obesity in adolescence. Although the study was not designed to show causality, the results support the idea of a window of opportunity for intervention for children at increased risk for obesity, Dr. Freemark wrote. “The finding that the risk of adolescent obesity manifests by 3 to 5 years of age suggests that nutritional counseling should be considered when exaggerated weight gain persists or emerges after 2 years of age; it would be of value to test the efficacy of early dietary intervention in an appropriate trial.
“Counseling could be applied preemptively for families in which the parents are overweight, particularly if there is a history of maternal diabetes or smoking,” he added.
Dr. Freemark is affiliated with the division of pediatric endocrinology and diabetes at Duke University, Durham, N.C. He disclosed grants from Rhythm Pharmaceuticals, the American Heart Association, and the Humanitarian Innovation Fund and European Commission, as well as personal fees from Springer Publishing outside the submitted work.
Most normal-weight children remained in the normal range throughout childhood, but the association between obesity by the age of 5 years and obese adolescence is a “new and important” finding, Michael S. Freemark, MD, wrote in an accompanying editorial (N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMe1811305).
Although body mass index (BMI) generally decreases by age 5-6 years before increasing through adolescence, data from previous studies have shown that “an early or exaggerated ‘adiposity rebound’ portends an increased risk of obesity in later childhood and adolescence,” he wrote.
In this study, BMI increase between age 2 and 6 years was the strongest predictor of obesity in adolescence. Although the study was not designed to show causality, the results support the idea of a window of opportunity for intervention for children at increased risk for obesity, Dr. Freemark wrote. “The finding that the risk of adolescent obesity manifests by 3 to 5 years of age suggests that nutritional counseling should be considered when exaggerated weight gain persists or emerges after 2 years of age; it would be of value to test the efficacy of early dietary intervention in an appropriate trial.
“Counseling could be applied preemptively for families in which the parents are overweight, particularly if there is a history of maternal diabetes or smoking,” he added.
Dr. Freemark is affiliated with the division of pediatric endocrinology and diabetes at Duke University, Durham, N.C. He disclosed grants from Rhythm Pharmaceuticals, the American Heart Association, and the Humanitarian Innovation Fund and European Commission, as well as personal fees from Springer Publishing outside the submitted work.
Most obese adolescents first became obese between the ages of 2 and 6 years, based on data from approximately 50,000 children in Germany.
Identifying periods of weight gain in childhood can help develop intervention and prevention strategies to reduce the risk of obesity in adolescence, wrote Mandy Geserick, MSc, of the University of Leipzig, Germany, and her colleagues in the New England Journal of Medicine.
To assess the timing of weight gain in early childhood, the researchers reviewed data from a German patient registry designed to monitor growth data. The study population included 51,505 children who had at least one visit to a pediatrician between birth and age 14 years and a second visit between age 15 and 19 years.
Overall, the probability of being overweight or obese in adolescence was 29% among children who gained more weight in the preschool years, between the ages of 2 and 6 years (defined as a change in body mass index [BMI] of 0.2 or more to less than 2.0), compared with 20% among children whose preschool weight remained stable (defined as a change in BMI of more than −0.2 to less than 0.2) – a relative risk of 1.43.
“A total of 83% of the children with obesity at the age of 4 were overweight or obese in adolescence, and only 17% returned to a normal weight,” they wrote. In addition, 44% of children who were born large for gestational age were overweight or obese in adolescence.
“A practical clinical implication of our study results would be surveillance for BMI acceleration, which should be recognized before 6 years of age, even in the absence of obesity,” the researchers wrote.
The study findings were limited by several factors including the variation in the number of visits, the lack of data on many children beyond the age of 14 years, and the lack of data on parental weight and perinatal risk factors associated with obesity, the researchers noted. However, the results were strengthened by the large, population-based design, and support the study hypothesis that obesity develops in early childhood and, once present, persists into adolescence.
“The specific dynamics and patterns of BMI in this early childhood period, rather than the absolute BMI, appear to be important factors in identifying children at risk for obesity later in life,” the researchers wrote. “It is therefore important for health care professionals, educational staff, and parents to become more sensitive to this critical time period.”
The study was supported by the German Research Council for the Clinical Research Center; the Federal Ministry of Education and Research; and the University of Leipzig, which was supported by the European Union, the European Regional Development Fund, and the Free State of Saxony within the framework of the excellence initiative. The CrescNet registry infrastructure was supported by grants from Hexal, Novo Nordisk, Merck Serono, Lilly Deutschland, Pfizer, and Ipsen Pharma. Dr. Geserick had no financial conflicts to report.
SOURCE: Geserick M et al. N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMoa1803527.
Most obese adolescents first became obese between the ages of 2 and 6 years, based on data from approximately 50,000 children in Germany.
Identifying periods of weight gain in childhood can help develop intervention and prevention strategies to reduce the risk of obesity in adolescence, wrote Mandy Geserick, MSc, of the University of Leipzig, Germany, and her colleagues in the New England Journal of Medicine.
To assess the timing of weight gain in early childhood, the researchers reviewed data from a German patient registry designed to monitor growth data. The study population included 51,505 children who had at least one visit to a pediatrician between birth and age 14 years and a second visit between age 15 and 19 years.
Overall, the probability of being overweight or obese in adolescence was 29% among children who gained more weight in the preschool years, between the ages of 2 and 6 years (defined as a change in body mass index [BMI] of 0.2 or more to less than 2.0), compared with 20% among children whose preschool weight remained stable (defined as a change in BMI of more than −0.2 to less than 0.2) – a relative risk of 1.43.
“A total of 83% of the children with obesity at the age of 4 were overweight or obese in adolescence, and only 17% returned to a normal weight,” they wrote. In addition, 44% of children who were born large for gestational age were overweight or obese in adolescence.
“A practical clinical implication of our study results would be surveillance for BMI acceleration, which should be recognized before 6 years of age, even in the absence of obesity,” the researchers wrote.
The study findings were limited by several factors including the variation in the number of visits, the lack of data on many children beyond the age of 14 years, and the lack of data on parental weight and perinatal risk factors associated with obesity, the researchers noted. However, the results were strengthened by the large, population-based design, and support the study hypothesis that obesity develops in early childhood and, once present, persists into adolescence.
“The specific dynamics and patterns of BMI in this early childhood period, rather than the absolute BMI, appear to be important factors in identifying children at risk for obesity later in life,” the researchers wrote. “It is therefore important for health care professionals, educational staff, and parents to become more sensitive to this critical time period.”
The study was supported by the German Research Council for the Clinical Research Center; the Federal Ministry of Education and Research; and the University of Leipzig, which was supported by the European Union, the European Regional Development Fund, and the Free State of Saxony within the framework of the excellence initiative. The CrescNet registry infrastructure was supported by grants from Hexal, Novo Nordisk, Merck Serono, Lilly Deutschland, Pfizer, and Ipsen Pharma. Dr. Geserick had no financial conflicts to report.
SOURCE: Geserick M et al. N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMoa1803527.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point:
Major finding: Of children who were obese at age 4 years, 83% were overweight or obese in adolescence.
Study details: The data come from a retrospective study of 51,505 children in Germany.
Disclosures: The study was supported by the German Research Council for the Clinical Research Center; the Federal Ministry of Education and Research; and the University of Leipzig, which was supported by the European Union, the European Regional Development Fund, and the Free State of Saxony within the framework of the excellence initiative. The CrescNet registry infrastructure was supported by grants from Hexal, Novo Nordisk, Merck Serono, Lilly Deutschland, Pfizer, and Ipsen Pharma. Dr. Geserick had no financial conflicts to report.
Source: Geserick M et al. N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMoa1803527.
Addressing your patient's sexual function after cancer
Recommended Resources:
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
Dr. Lindau is Professor of Obstetrics/Gynecology and Medicine-Geriatrics. She is also Director of the Program in Integrative Sexual Medicine and WomanLab at University of Chicago Medicine in Chicago, Illinois.
The author reports no financial relationships related to this audio.
Dr. Lindau is Professor of Obstetrics/Gynecology and Medicine-Geriatrics. She is also Director of the Program in Integrative Sexual Medicine and WomanLab at University of Chicago Medicine in Chicago, Illinois.
The author reports no financial relationships related to this audio.
Dr. Lindau is Professor of Obstetrics/Gynecology and Medicine-Geriatrics. She is also Director of the Program in Integrative Sexual Medicine and WomanLab at University of Chicago Medicine in Chicago, Illinois.
The author reports no financial relationships related to this audio.
Recommended Resources:
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
Recommended Resources:
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
Platelet-rich plasma injections yield substantial improvement in androgenetic alopecia
Autologous treatment with injected (AGA) after three monthly treatments, in a study that compared two treatment regimens.
PRP is gaining popularity because of its efficacy in stimulating fibroblast proliferation, triggering the production of collagen and elastin, and boosting the quantity and quality of the extracellular matrix, noted the investigators, Amelia K. Hausauer, MD, in private practice in Campbell, Calif., and Derek H. Jones, MD, in private practice in Los Angeles. Both are also with the department of dermatology at the University of California, Los Angeles.
They undertook this study to determine the optimal number and timing of treatments in patients with AGA, comparing two different injection protocols over a 6-month period. The study evaluated 40 healthy men (30) and women (10), whose mean age was 44 years, with AGA stages Norwood-Hamilton II-V (in men) and Ludwig I2-II1 (in women), recruited from a private practice in Los Angeles between November 2016 and January 2017. They were randomly assigned to one of two treatment groups: three monthly sessions followed by a fourth injection 3 months later (group 1), or two treatments, one at baseline and the second 3 months later (group 2). One of the men dropped out for reasons unrelated to the treatment.
Those with clinically stable effects of Food and Drug Administration–approved AGA treatments for 12 months were permitted to participate while continuing those treatments (topical minoxidil and/or oral finasteride), since PRP is often coadministered with other therapies. But additional products, devices, or medications used for hair regrowth were not allowed. The washout period for antiandrogen therapies was 90 days.
At 3 months, the mean increase in hair counts was significant in the first group only, but at 6 months, both groups experienced significant increases in hair count (P less than .001). However, those in the first group had superior results at 6 months, with a mean 30% increase in hair counts from baseline, compared with a 7% increase in the second group (P less than .001).
Both groups had significant increases in the mean hair shaft caliber at 3 and 6 months.
Overall, 82% of participants who completed treatment reported being satisfied or highly satisfied, and 72% expressed interest in continuing treatment after the study period; almost two-thirds considered the procedure “tolerable.”
While the authors stipulated that they did not undertake the study primarily to predict treatment response to PRP, they uncovered some significant trends that they said warranted further evaluation, including the finding that those who had experienced hair loss for less than 5-6 years were more likely to have rapid and pronounced treatment response.
Their overall findings correlated with those of previous studies supporting the increase in density of hair or hair numbers, but the existing literature draws from studies that have been open label or unblinded, which makes it difficult to evaluate them head to head. The novel, subdermal injection technique used in the study “allows for fewer, more widely spaced injection points than the traditional nappage procedure ... because PRP can diffuse further once in the deeper, subgaleal space,” they wrote. The investigators noted similar response between men and women, which is important given sparse data on the efficacy of PRP in women.
Weaknesses of the study included its small sample size and short follow-up period, the authors noted. Longer-duration studies have reported relapse between 3 and 12 months.
This study is the first of its kind to directly compare efficacy rates of two injection protocols, the authors wrote, cautioning that future studies are necessary to “fine-tune preparation methods, determine optimal maintenance schedule(s), and parse out clinical predictors of efficacy.”
Eclipse Aesthetics (the manufacturer of the PRP preparation kits) provided funding for this study, but the authors acknowledged no significant interest with commercial supporters.
SOURCE: Hausauer A et al. Dermatol Surg. 2018 Sep;44(9):1191-200.
Autologous treatment with injected (AGA) after three monthly treatments, in a study that compared two treatment regimens.
PRP is gaining popularity because of its efficacy in stimulating fibroblast proliferation, triggering the production of collagen and elastin, and boosting the quantity and quality of the extracellular matrix, noted the investigators, Amelia K. Hausauer, MD, in private practice in Campbell, Calif., and Derek H. Jones, MD, in private practice in Los Angeles. Both are also with the department of dermatology at the University of California, Los Angeles.
They undertook this study to determine the optimal number and timing of treatments in patients with AGA, comparing two different injection protocols over a 6-month period. The study evaluated 40 healthy men (30) and women (10), whose mean age was 44 years, with AGA stages Norwood-Hamilton II-V (in men) and Ludwig I2-II1 (in women), recruited from a private practice in Los Angeles between November 2016 and January 2017. They were randomly assigned to one of two treatment groups: three monthly sessions followed by a fourth injection 3 months later (group 1), or two treatments, one at baseline and the second 3 months later (group 2). One of the men dropped out for reasons unrelated to the treatment.
Those with clinically stable effects of Food and Drug Administration–approved AGA treatments for 12 months were permitted to participate while continuing those treatments (topical minoxidil and/or oral finasteride), since PRP is often coadministered with other therapies. But additional products, devices, or medications used for hair regrowth were not allowed. The washout period for antiandrogen therapies was 90 days.
At 3 months, the mean increase in hair counts was significant in the first group only, but at 6 months, both groups experienced significant increases in hair count (P less than .001). However, those in the first group had superior results at 6 months, with a mean 30% increase in hair counts from baseline, compared with a 7% increase in the second group (P less than .001).
Both groups had significant increases in the mean hair shaft caliber at 3 and 6 months.
Overall, 82% of participants who completed treatment reported being satisfied or highly satisfied, and 72% expressed interest in continuing treatment after the study period; almost two-thirds considered the procedure “tolerable.”
While the authors stipulated that they did not undertake the study primarily to predict treatment response to PRP, they uncovered some significant trends that they said warranted further evaluation, including the finding that those who had experienced hair loss for less than 5-6 years were more likely to have rapid and pronounced treatment response.
Their overall findings correlated with those of previous studies supporting the increase in density of hair or hair numbers, but the existing literature draws from studies that have been open label or unblinded, which makes it difficult to evaluate them head to head. The novel, subdermal injection technique used in the study “allows for fewer, more widely spaced injection points than the traditional nappage procedure ... because PRP can diffuse further once in the deeper, subgaleal space,” they wrote. The investigators noted similar response between men and women, which is important given sparse data on the efficacy of PRP in women.
Weaknesses of the study included its small sample size and short follow-up period, the authors noted. Longer-duration studies have reported relapse between 3 and 12 months.
This study is the first of its kind to directly compare efficacy rates of two injection protocols, the authors wrote, cautioning that future studies are necessary to “fine-tune preparation methods, determine optimal maintenance schedule(s), and parse out clinical predictors of efficacy.”
Eclipse Aesthetics (the manufacturer of the PRP preparation kits) provided funding for this study, but the authors acknowledged no significant interest with commercial supporters.
SOURCE: Hausauer A et al. Dermatol Surg. 2018 Sep;44(9):1191-200.
Autologous treatment with injected (AGA) after three monthly treatments, in a study that compared two treatment regimens.
PRP is gaining popularity because of its efficacy in stimulating fibroblast proliferation, triggering the production of collagen and elastin, and boosting the quantity and quality of the extracellular matrix, noted the investigators, Amelia K. Hausauer, MD, in private practice in Campbell, Calif., and Derek H. Jones, MD, in private practice in Los Angeles. Both are also with the department of dermatology at the University of California, Los Angeles.
They undertook this study to determine the optimal number and timing of treatments in patients with AGA, comparing two different injection protocols over a 6-month period. The study evaluated 40 healthy men (30) and women (10), whose mean age was 44 years, with AGA stages Norwood-Hamilton II-V (in men) and Ludwig I2-II1 (in women), recruited from a private practice in Los Angeles between November 2016 and January 2017. They were randomly assigned to one of two treatment groups: three monthly sessions followed by a fourth injection 3 months later (group 1), or two treatments, one at baseline and the second 3 months later (group 2). One of the men dropped out for reasons unrelated to the treatment.
Those with clinically stable effects of Food and Drug Administration–approved AGA treatments for 12 months were permitted to participate while continuing those treatments (topical minoxidil and/or oral finasteride), since PRP is often coadministered with other therapies. But additional products, devices, or medications used for hair regrowth were not allowed. The washout period for antiandrogen therapies was 90 days.
At 3 months, the mean increase in hair counts was significant in the first group only, but at 6 months, both groups experienced significant increases in hair count (P less than .001). However, those in the first group had superior results at 6 months, with a mean 30% increase in hair counts from baseline, compared with a 7% increase in the second group (P less than .001).
Both groups had significant increases in the mean hair shaft caliber at 3 and 6 months.
Overall, 82% of participants who completed treatment reported being satisfied or highly satisfied, and 72% expressed interest in continuing treatment after the study period; almost two-thirds considered the procedure “tolerable.”
While the authors stipulated that they did not undertake the study primarily to predict treatment response to PRP, they uncovered some significant trends that they said warranted further evaluation, including the finding that those who had experienced hair loss for less than 5-6 years were more likely to have rapid and pronounced treatment response.
Their overall findings correlated with those of previous studies supporting the increase in density of hair or hair numbers, but the existing literature draws from studies that have been open label or unblinded, which makes it difficult to evaluate them head to head. The novel, subdermal injection technique used in the study “allows for fewer, more widely spaced injection points than the traditional nappage procedure ... because PRP can diffuse further once in the deeper, subgaleal space,” they wrote. The investigators noted similar response between men and women, which is important given sparse data on the efficacy of PRP in women.
Weaknesses of the study included its small sample size and short follow-up period, the authors noted. Longer-duration studies have reported relapse between 3 and 12 months.
This study is the first of its kind to directly compare efficacy rates of two injection protocols, the authors wrote, cautioning that future studies are necessary to “fine-tune preparation methods, determine optimal maintenance schedule(s), and parse out clinical predictors of efficacy.”
Eclipse Aesthetics (the manufacturer of the PRP preparation kits) provided funding for this study, but the authors acknowledged no significant interest with commercial supporters.
SOURCE: Hausauer A et al. Dermatol Surg. 2018 Sep;44(9):1191-200.
FROM DERMATOLOGIC SURGERY
Key clinical point: Starting off with monthly PRP injections may yield more hair growth than a protocol that uses less frequently administered injections.
Major finding: Of the patients who completed treatment, 82% were satisfied with the results.
Study details: A prospective, randomized trial comparing two early-phase treatment protocols in 40 patients.
Disclosures: Eclipse Aesthetics provided funding for this study; the authors said they had no significant interest with commercial supporters.
Source: Hausauer A et al. Dermatol Surg. 2018 Sep;44(9):1191-200.
Teens who vape are likely to add cigarette smoking
instead of substituting one for the other, according to research published in Nicotine & Tobacco Research.
“Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future,” Michael S. Dunbar, PhD, a behavioral scientist at the RAND Corp. stated in a press release. “This study also suggests that teens don’t substitute vaping products for cigarettes. Instead, they go on to use both products more frequently as they get older.”
Dr. Dunbar and his colleagues followed 2,039 adolescents aged 16-20 years who were originally enrolled in a Los Angeles–based substance use prevention program in sixth and seventh grade (2008) and completed annual Web-based surveys during 2015-2017 on their use of e-cigarettes (EC), cigarettes, alcohol, and marijuana. They also answered questions about their mental health with questions about anxiety and depression. The researchers used two models to measures associations between different factors.
The first model showed an association between EC and cigarette use. Then other factors, such as alcohol use, were introduced. Alcohol use was associated with increased cigarette use, and cigarette use was associated with increased use of alcohol. When introducing marijuana as a factor, associations remained between cigarette use and EC use, with higher EC use associated with greater marijuana use and vice versa. Greater cigarette use, however, was not predictive of later marijuana use. There was no association between EC use and mental health, but more cigarette use was associated with poorer mental health.
Under the second model, there was a moderate to strong association between EC use and cigarette use, and participants with greater EC use and greater cigarette use also reported higher alcohol use. There also was a significant between-person association with higher EC use, cigarette use, and marijuana use. There was a small negative association between mental health and cigarette use, but not with mental health and EC use,the researchers said.
“For young people, using these products may actually lead to more harm in the long run,” Dr. Dunbar said in the press release. “This highlights the importance of taking steps to prevent youth from vaping in the first place. One way to do this could be to limit e-cigarette and other tobacco advertising in kid-accessible spaces.”
This study was funded by grants from the National Institute of Alcohol Abuse and Alcoholism. The authors reported no relevant conflicts of interest.
SOURCE: Dunbar MS et al. Nicotine Tob Res. 2018 Oct 3. doi: 10.1093/ntr/nty179.
instead of substituting one for the other, according to research published in Nicotine & Tobacco Research.
“Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future,” Michael S. Dunbar, PhD, a behavioral scientist at the RAND Corp. stated in a press release. “This study also suggests that teens don’t substitute vaping products for cigarettes. Instead, they go on to use both products more frequently as they get older.”
Dr. Dunbar and his colleagues followed 2,039 adolescents aged 16-20 years who were originally enrolled in a Los Angeles–based substance use prevention program in sixth and seventh grade (2008) and completed annual Web-based surveys during 2015-2017 on their use of e-cigarettes (EC), cigarettes, alcohol, and marijuana. They also answered questions about their mental health with questions about anxiety and depression. The researchers used two models to measures associations between different factors.
The first model showed an association between EC and cigarette use. Then other factors, such as alcohol use, were introduced. Alcohol use was associated with increased cigarette use, and cigarette use was associated with increased use of alcohol. When introducing marijuana as a factor, associations remained between cigarette use and EC use, with higher EC use associated with greater marijuana use and vice versa. Greater cigarette use, however, was not predictive of later marijuana use. There was no association between EC use and mental health, but more cigarette use was associated with poorer mental health.
Under the second model, there was a moderate to strong association between EC use and cigarette use, and participants with greater EC use and greater cigarette use also reported higher alcohol use. There also was a significant between-person association with higher EC use, cigarette use, and marijuana use. There was a small negative association between mental health and cigarette use, but not with mental health and EC use,the researchers said.
“For young people, using these products may actually lead to more harm in the long run,” Dr. Dunbar said in the press release. “This highlights the importance of taking steps to prevent youth from vaping in the first place. One way to do this could be to limit e-cigarette and other tobacco advertising in kid-accessible spaces.”
This study was funded by grants from the National Institute of Alcohol Abuse and Alcoholism. The authors reported no relevant conflicts of interest.
SOURCE: Dunbar MS et al. Nicotine Tob Res. 2018 Oct 3. doi: 10.1093/ntr/nty179.
instead of substituting one for the other, according to research published in Nicotine & Tobacco Research.
“Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future,” Michael S. Dunbar, PhD, a behavioral scientist at the RAND Corp. stated in a press release. “This study also suggests that teens don’t substitute vaping products for cigarettes. Instead, they go on to use both products more frequently as they get older.”
Dr. Dunbar and his colleagues followed 2,039 adolescents aged 16-20 years who were originally enrolled in a Los Angeles–based substance use prevention program in sixth and seventh grade (2008) and completed annual Web-based surveys during 2015-2017 on their use of e-cigarettes (EC), cigarettes, alcohol, and marijuana. They also answered questions about their mental health with questions about anxiety and depression. The researchers used two models to measures associations between different factors.
The first model showed an association between EC and cigarette use. Then other factors, such as alcohol use, were introduced. Alcohol use was associated with increased cigarette use, and cigarette use was associated with increased use of alcohol. When introducing marijuana as a factor, associations remained between cigarette use and EC use, with higher EC use associated with greater marijuana use and vice versa. Greater cigarette use, however, was not predictive of later marijuana use. There was no association between EC use and mental health, but more cigarette use was associated with poorer mental health.
Under the second model, there was a moderate to strong association between EC use and cigarette use, and participants with greater EC use and greater cigarette use also reported higher alcohol use. There also was a significant between-person association with higher EC use, cigarette use, and marijuana use. There was a small negative association between mental health and cigarette use, but not with mental health and EC use,the researchers said.
“For young people, using these products may actually lead to more harm in the long run,” Dr. Dunbar said in the press release. “This highlights the importance of taking steps to prevent youth from vaping in the first place. One way to do this could be to limit e-cigarette and other tobacco advertising in kid-accessible spaces.”
This study was funded by grants from the National Institute of Alcohol Abuse and Alcoholism. The authors reported no relevant conflicts of interest.
SOURCE: Dunbar MS et al. Nicotine Tob Res. 2018 Oct 3. doi: 10.1093/ntr/nty179.
FROM NICOTINE & TOBACCO RESEARCH
Key clinical point: Adolescents who use e-cigarettes are more likely to progress to cigarette use, while continuing to vape.
Major finding: There was a significant bidirectional association between e-cigarette use and cigarette use, and some third factors such as alcohol use, marijuana use, and mental health.
Study details: A longitudinal study of adolescents aged 16-20 years enrolled in a substance use prevention program.
Disclosures: This study was funded by grants from the National Institute of Alcohol Abuse and Alcoholism. The authors reported no relevant conflicts of interest.
Source: Dunbar MS et al. Nicotine Tob Res. 2018 Oct 3. doi: 10.1093/ntr/nty179.
Get ready for high-sensitivity troponin tests in the ED
SAN DIEGO – The rule-in cutoff level for high-sensitivity cardiac troponin measures in the diagnosis of acute MI have been established by the European Society of Cardiology, but the value might not be applicable to a U.S. population.
In a video interview at the annual scientific assembly of the American College of Emergency Physicians, Richard M. Nowak, MD, of the department of emergency medicine at Henry Ford Hospital, Detroit, explains why the rule-in cutoff is not likely to apply to American patients and may be associated with a higher risk of false positives.
Since high-sensitivity troponin measures will soon be coming to every ED, each institution may have to arrive at their own rule-in cutoff value in order to diagnose acute MI with an acceptable number of false positives, he said. Dr. Nowak explains how to begin addressing that process.
SAN DIEGO – The rule-in cutoff level for high-sensitivity cardiac troponin measures in the diagnosis of acute MI have been established by the European Society of Cardiology, but the value might not be applicable to a U.S. population.
In a video interview at the annual scientific assembly of the American College of Emergency Physicians, Richard M. Nowak, MD, of the department of emergency medicine at Henry Ford Hospital, Detroit, explains why the rule-in cutoff is not likely to apply to American patients and may be associated with a higher risk of false positives.
Since high-sensitivity troponin measures will soon be coming to every ED, each institution may have to arrive at their own rule-in cutoff value in order to diagnose acute MI with an acceptable number of false positives, he said. Dr. Nowak explains how to begin addressing that process.
SAN DIEGO – The rule-in cutoff level for high-sensitivity cardiac troponin measures in the diagnosis of acute MI have been established by the European Society of Cardiology, but the value might not be applicable to a U.S. population.
In a video interview at the annual scientific assembly of the American College of Emergency Physicians, Richard M. Nowak, MD, of the department of emergency medicine at Henry Ford Hospital, Detroit, explains why the rule-in cutoff is not likely to apply to American patients and may be associated with a higher risk of false positives.
Since high-sensitivity troponin measures will soon be coming to every ED, each institution may have to arrive at their own rule-in cutoff value in order to diagnose acute MI with an acceptable number of false positives, he said. Dr. Nowak explains how to begin addressing that process.
REPORTING FROM ACEP18
Proximal adenoma location does not predict high-grade dysplasia
Proximal adenoma location did not predict high-grade dysplasia in a large registry study.
In fact, the odds of high-grade dysplasia were about 25% lower for proximal versus distal adenomas (odds ratio, 0.75), reported Thomas Rösch, MD, of University Hospital Hamburg-Eppendorf, Hamburg, Germany, and his associates. A third of adenomas in the study lacked location data, but in sensitivity analyses, the odds of high-grade dysplasia fell to 0.72 when these lesions were assumed to be proximal and rose to 0.96 when they were assumed to be distal.
Interval colorectal cancers probably are more likely to be proximal than distal because of a “combination of endoscopy-related factors and biology,” not because of histologic differences alone, the researchers wrote. The report was published in Clinical Gastroenterology and Hepatology.
Interval cancers are more common in the right colon, as several studies have noted. However, it was unclear whether this phenomenon represented a higher miss rate, a lower rate of successful polypectomy, or an increased risk of malignant histology in the proximal colon, the researchers wrote. Accordingly, they analyzed data on 594,614 index adenomas detected during more than 2.5 million screening colonoscopies performed between 2007 and 2012 and entered into the German National Screening Colonoscopy Registry.
A total of 3.5% of index adenomas showed high-grade dysplasia, which correlated most strongly with larger size, said the researchers. In fact, the odds of high-grade dysplasia were 10-fold higher when index adenomas measured at least 1 cm than when they were smaller. High-grade dysplasia also was significantly more frequent when patients were older than 64 years, were male, and when they had pedunculated versus flat lesions. Given the large size of the dataset, all these associations were statistically significant.
Sessile lesions were slightly more likely to be high-grade compared with flat lesions, the investigators noted. Many proximal interval cancers arise from sessile serrated polyps, which may be subtle and difficult to detect or to resect completely, they continued. At the same time, colonoscopy also might be more likely to miss flat, serrated lesions when they are located proximally, and these lesions can become more aggressive over time. Thus, “[e]ndoscopist factors, such as missed lesions or incompletely removed lesions, may account for the predominance of proximal interval colorectal cancers.”
Like other registry studies, this study lacked uniform histopathologic definitions or central histopathology review. The dataset also covered only the largest or most histologically remarkable adenoma for each patient. However, the study findings did not change substantially after the researchers controlled for patients with missing location data, which presumably included patients with multiple polyps in both proximal and distal locations.
The researchers did not disclose external funding sources. They reported having no conflicts of interest.
SOURCE: Rösch T et al. Clin Gastroenterol Hepatol. 2018 Jun 11. doi: 10.1016/j.cgh.2018.05.043.
Colorectal cancers detected in a short interval after a complete and clearing colonoscopy are referred to as postcolonoscopy colon cancers or interval cancers, and are approximately three times more likely to occur in the proximal colon compared with the distal colon. Reasons for this difference are not known and possible explanations include alternate and accelerated tumor biology and rapid cancer progression, such as through the CpG island methylation phenotype pathway, missed cancers or precursor lesions in the proximal colon, or incomplete polyp resection. In the current study, the authors address whether the biology of polyps removed in the proximal colon is different, i.e., are these adenomas more likely to exhibit high-grade dysplasia compared to adenomas in the distal colon in approximately 2.5 million screening colonoscopies performed between 2007 and 2012, obtained from a screening colonoscopy registry in Germany. The authors did not find a difference in frequency of high-grade dysplasia between proximal and distal polyps. As expected, adenoma size, male sex, and older age were associated with finding of high-grade dysplasia, but contrary to current literature, the authors found that distal location and pedunculated (versus sessile) form were associated with high-grade dysplasia. A major limitation of the study is that sessile serrated polyps were not included, and the authors did not have information on villous histology. The study reinforces the hypothesis that missed and incompletely resected adenomas play a bigger role in missed proximal cancers, and that the goal of high-quality colonoscopy should be to detect and completely resect adenomas with equal vigilance in both the proximal and distal colon.
Aasma Shaukat, MD, MPH, AGAF, is professor of medicine in the division of gastroenterology and hepatology at the University of Minnesota, Minneapolis, and the GI Section Chief at the Minneapolis VA Medical Center. She has no conflicts of interest.
Colorectal cancers detected in a short interval after a complete and clearing colonoscopy are referred to as postcolonoscopy colon cancers or interval cancers, and are approximately three times more likely to occur in the proximal colon compared with the distal colon. Reasons for this difference are not known and possible explanations include alternate and accelerated tumor biology and rapid cancer progression, such as through the CpG island methylation phenotype pathway, missed cancers or precursor lesions in the proximal colon, or incomplete polyp resection. In the current study, the authors address whether the biology of polyps removed in the proximal colon is different, i.e., are these adenomas more likely to exhibit high-grade dysplasia compared to adenomas in the distal colon in approximately 2.5 million screening colonoscopies performed between 2007 and 2012, obtained from a screening colonoscopy registry in Germany. The authors did not find a difference in frequency of high-grade dysplasia between proximal and distal polyps. As expected, adenoma size, male sex, and older age were associated with finding of high-grade dysplasia, but contrary to current literature, the authors found that distal location and pedunculated (versus sessile) form were associated with high-grade dysplasia. A major limitation of the study is that sessile serrated polyps were not included, and the authors did not have information on villous histology. The study reinforces the hypothesis that missed and incompletely resected adenomas play a bigger role in missed proximal cancers, and that the goal of high-quality colonoscopy should be to detect and completely resect adenomas with equal vigilance in both the proximal and distal colon.
Aasma Shaukat, MD, MPH, AGAF, is professor of medicine in the division of gastroenterology and hepatology at the University of Minnesota, Minneapolis, and the GI Section Chief at the Minneapolis VA Medical Center. She has no conflicts of interest.
Colorectal cancers detected in a short interval after a complete and clearing colonoscopy are referred to as postcolonoscopy colon cancers or interval cancers, and are approximately three times more likely to occur in the proximal colon compared with the distal colon. Reasons for this difference are not known and possible explanations include alternate and accelerated tumor biology and rapid cancer progression, such as through the CpG island methylation phenotype pathway, missed cancers or precursor lesions in the proximal colon, or incomplete polyp resection. In the current study, the authors address whether the biology of polyps removed in the proximal colon is different, i.e., are these adenomas more likely to exhibit high-grade dysplasia compared to adenomas in the distal colon in approximately 2.5 million screening colonoscopies performed between 2007 and 2012, obtained from a screening colonoscopy registry in Germany. The authors did not find a difference in frequency of high-grade dysplasia between proximal and distal polyps. As expected, adenoma size, male sex, and older age were associated with finding of high-grade dysplasia, but contrary to current literature, the authors found that distal location and pedunculated (versus sessile) form were associated with high-grade dysplasia. A major limitation of the study is that sessile serrated polyps were not included, and the authors did not have information on villous histology. The study reinforces the hypothesis that missed and incompletely resected adenomas play a bigger role in missed proximal cancers, and that the goal of high-quality colonoscopy should be to detect and completely resect adenomas with equal vigilance in both the proximal and distal colon.
Aasma Shaukat, MD, MPH, AGAF, is professor of medicine in the division of gastroenterology and hepatology at the University of Minnesota, Minneapolis, and the GI Section Chief at the Minneapolis VA Medical Center. She has no conflicts of interest.
Proximal adenoma location did not predict high-grade dysplasia in a large registry study.
In fact, the odds of high-grade dysplasia were about 25% lower for proximal versus distal adenomas (odds ratio, 0.75), reported Thomas Rösch, MD, of University Hospital Hamburg-Eppendorf, Hamburg, Germany, and his associates. A third of adenomas in the study lacked location data, but in sensitivity analyses, the odds of high-grade dysplasia fell to 0.72 when these lesions were assumed to be proximal and rose to 0.96 when they were assumed to be distal.
Interval colorectal cancers probably are more likely to be proximal than distal because of a “combination of endoscopy-related factors and biology,” not because of histologic differences alone, the researchers wrote. The report was published in Clinical Gastroenterology and Hepatology.
Interval cancers are more common in the right colon, as several studies have noted. However, it was unclear whether this phenomenon represented a higher miss rate, a lower rate of successful polypectomy, or an increased risk of malignant histology in the proximal colon, the researchers wrote. Accordingly, they analyzed data on 594,614 index adenomas detected during more than 2.5 million screening colonoscopies performed between 2007 and 2012 and entered into the German National Screening Colonoscopy Registry.
A total of 3.5% of index adenomas showed high-grade dysplasia, which correlated most strongly with larger size, said the researchers. In fact, the odds of high-grade dysplasia were 10-fold higher when index adenomas measured at least 1 cm than when they were smaller. High-grade dysplasia also was significantly more frequent when patients were older than 64 years, were male, and when they had pedunculated versus flat lesions. Given the large size of the dataset, all these associations were statistically significant.
Sessile lesions were slightly more likely to be high-grade compared with flat lesions, the investigators noted. Many proximal interval cancers arise from sessile serrated polyps, which may be subtle and difficult to detect or to resect completely, they continued. At the same time, colonoscopy also might be more likely to miss flat, serrated lesions when they are located proximally, and these lesions can become more aggressive over time. Thus, “[e]ndoscopist factors, such as missed lesions or incompletely removed lesions, may account for the predominance of proximal interval colorectal cancers.”
Like other registry studies, this study lacked uniform histopathologic definitions or central histopathology review. The dataset also covered only the largest or most histologically remarkable adenoma for each patient. However, the study findings did not change substantially after the researchers controlled for patients with missing location data, which presumably included patients with multiple polyps in both proximal and distal locations.
The researchers did not disclose external funding sources. They reported having no conflicts of interest.
SOURCE: Rösch T et al. Clin Gastroenterol Hepatol. 2018 Jun 11. doi: 10.1016/j.cgh.2018.05.043.
Proximal adenoma location did not predict high-grade dysplasia in a large registry study.
In fact, the odds of high-grade dysplasia were about 25% lower for proximal versus distal adenomas (odds ratio, 0.75), reported Thomas Rösch, MD, of University Hospital Hamburg-Eppendorf, Hamburg, Germany, and his associates. A third of adenomas in the study lacked location data, but in sensitivity analyses, the odds of high-grade dysplasia fell to 0.72 when these lesions were assumed to be proximal and rose to 0.96 when they were assumed to be distal.
Interval colorectal cancers probably are more likely to be proximal than distal because of a “combination of endoscopy-related factors and biology,” not because of histologic differences alone, the researchers wrote. The report was published in Clinical Gastroenterology and Hepatology.
Interval cancers are more common in the right colon, as several studies have noted. However, it was unclear whether this phenomenon represented a higher miss rate, a lower rate of successful polypectomy, or an increased risk of malignant histology in the proximal colon, the researchers wrote. Accordingly, they analyzed data on 594,614 index adenomas detected during more than 2.5 million screening colonoscopies performed between 2007 and 2012 and entered into the German National Screening Colonoscopy Registry.
A total of 3.5% of index adenomas showed high-grade dysplasia, which correlated most strongly with larger size, said the researchers. In fact, the odds of high-grade dysplasia were 10-fold higher when index adenomas measured at least 1 cm than when they were smaller. High-grade dysplasia also was significantly more frequent when patients were older than 64 years, were male, and when they had pedunculated versus flat lesions. Given the large size of the dataset, all these associations were statistically significant.
Sessile lesions were slightly more likely to be high-grade compared with flat lesions, the investigators noted. Many proximal interval cancers arise from sessile serrated polyps, which may be subtle and difficult to detect or to resect completely, they continued. At the same time, colonoscopy also might be more likely to miss flat, serrated lesions when they are located proximally, and these lesions can become more aggressive over time. Thus, “[e]ndoscopist factors, such as missed lesions or incompletely removed lesions, may account for the predominance of proximal interval colorectal cancers.”
Like other registry studies, this study lacked uniform histopathologic definitions or central histopathology review. The dataset also covered only the largest or most histologically remarkable adenoma for each patient. However, the study findings did not change substantially after the researchers controlled for patients with missing location data, which presumably included patients with multiple polyps in both proximal and distal locations.
The researchers did not disclose external funding sources. They reported having no conflicts of interest.
SOURCE: Rösch T et al. Clin Gastroenterol Hepatol. 2018 Jun 11. doi: 10.1016/j.cgh.2018.05.043.
FROM CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Key clinical point: Proximal adenoma location did not predict high-grade dysplasia.
Major finding: The odds of high-grade dysplasia were about 25% lower for proximal versus distal adenomas (odds ratio, 0.75).
Study details: Registry study of 594,614 adenomas identified during more than 2.5 million screening colonoscopies between 2007 and 2012.
Disclosures: The researchers did not disclose external funding sources. They reported having no conflicts of interest.
Source: Rösch T et al. Clin Gastroenterol Hepatol. 2018 Jun 11. doi: 10.1016/j.cgh.2018.05.043.
Targeted lung denervation for COPD found safe and effective
PARIS – In a sham-controlled randomized trial that enrolled patients with moderate to severe was not only found safe, which was the primary goal of the study, but effective, according to data presented at the annual congress of the European Respiratory Society.
Within the first year of follow-up, “the positive benefit in those randomized to TLD persisted with a more than 50% reduction in the number of patients hospitalized for respiratory complications,” reported Dirk-Jan Slebos, MD, department of lung diseases and tuberculosis, University of Gröningen, the Netherlands.
In this phase 2 trial, called AIRFLOW-2, 82 patients were randomized to receive TLD, which ablates nerves with radiofrequency energy, or a sham procedure. The study enrolled patients with moderate to severe COPD and forced expiratory volume in 1 second of 30%-60% predicted. All patients were treated with the long-acting muscarinic antagonist (LAMA) tiotropium.
The primary endpoint was a composite of respiratory-related adverse events, such as respiratory failure, worsening bronchitis, or worsening dyspnea. Secondary endpoints included serious adverse events of any kind as well as a variety of measures of efficacy, including changes in quality of life as measured with standardized tools such as the St. George’s Respiratory Questionnaire (SGRQ).
Within 6 months of the procedure, 71% of those randomized to the sham procedure and 32% of those treated with TLD experienced one of the predefined respiratory adverse events (P = .0008). At 1 year, 25% of patients in the sham group versus 12% in the TLD group were hospitalized for an exacerbation (P = .039). In addition to achieving greater improvement in several of the individual symptoms, such as dyspnea, those randomized to TLD also achieved numerical improvements in SGRQ scores (–8.3 vs. –3.8) at 12 months.
Gastrointestinal adverse events were more common in the TLD group (15% vs. 5%). Although the higher rate of GI events, which included nausea, bloating, and abdominal discomfort, did not reach statistical significance, it was attributed to off-target exposure of nerves in the GI system to the radiofrequency energy.
“We are improving our imaging process in order to implement additional measures to avoid these nerves,” said Dr. Slebos, who added that this potential risk can be modified. In this study, all of the GI symptoms resolved.
Dr. Slebos emphasized that the 12-month follow-up permitted the study to “confirm that TLD is safe and technically feasible with no late-onset safety signals.” It has set the stage for AIRFLOW-3, a phase 3 trial that is expected to lead to regulatory approval of the catheter if it shows similar safety and efficacy.
The principle of TLD is to deliver energy to ablate parasympathetic pulmonary nerves. The exact mechanism of benefit has not been proved, but it is believed that inhibiting release of acetylcholine that induces smooth muscle constriction has several beneficial downstream effects, including prevention of hyperinflation and reduced mucus production. AIRFLOW-3, like AIRFLOW-2, will evaluate a proprietary catheter developed for this purpose.
“TLD will not replace pharmaceutical therapy. Rather, it appears to have a synergistic effect,” explained Dr. Slebos, who said the procedure is performed on an outpatient basis. The average procedure time for TLD in AIRFLOW-2 was 42 minutes.
The first human study of TLD, also led by Dr. Slebos, was published in 2015. While several subsequent patient series support efficacy and benefit, Daiana Stolz, MD, Clinic for Respiratory Medicine and Pulmonary Cell Research, University of Basel (Switzerland), called the data from this sham-controlled trial “really exciting and important.” However, she said, the larger AIRFLOW-3 trial is needed “to confirm this is an effective and safe treatment.”
Dr. Slebos receives consultancy fees from Aeris Therapeutics, Boston Scientific, Broncus Technologies, CSA Medical. Olympus, Portaero, PulmonX, PneumRx/BTG, and Nuvaira, which provided the funding for this study.
PARIS – In a sham-controlled randomized trial that enrolled patients with moderate to severe was not only found safe, which was the primary goal of the study, but effective, according to data presented at the annual congress of the European Respiratory Society.
Within the first year of follow-up, “the positive benefit in those randomized to TLD persisted with a more than 50% reduction in the number of patients hospitalized for respiratory complications,” reported Dirk-Jan Slebos, MD, department of lung diseases and tuberculosis, University of Gröningen, the Netherlands.
In this phase 2 trial, called AIRFLOW-2, 82 patients were randomized to receive TLD, which ablates nerves with radiofrequency energy, or a sham procedure. The study enrolled patients with moderate to severe COPD and forced expiratory volume in 1 second of 30%-60% predicted. All patients were treated with the long-acting muscarinic antagonist (LAMA) tiotropium.
The primary endpoint was a composite of respiratory-related adverse events, such as respiratory failure, worsening bronchitis, or worsening dyspnea. Secondary endpoints included serious adverse events of any kind as well as a variety of measures of efficacy, including changes in quality of life as measured with standardized tools such as the St. George’s Respiratory Questionnaire (SGRQ).
Within 6 months of the procedure, 71% of those randomized to the sham procedure and 32% of those treated with TLD experienced one of the predefined respiratory adverse events (P = .0008). At 1 year, 25% of patients in the sham group versus 12% in the TLD group were hospitalized for an exacerbation (P = .039). In addition to achieving greater improvement in several of the individual symptoms, such as dyspnea, those randomized to TLD also achieved numerical improvements in SGRQ scores (–8.3 vs. –3.8) at 12 months.
Gastrointestinal adverse events were more common in the TLD group (15% vs. 5%). Although the higher rate of GI events, which included nausea, bloating, and abdominal discomfort, did not reach statistical significance, it was attributed to off-target exposure of nerves in the GI system to the radiofrequency energy.
“We are improving our imaging process in order to implement additional measures to avoid these nerves,” said Dr. Slebos, who added that this potential risk can be modified. In this study, all of the GI symptoms resolved.
Dr. Slebos emphasized that the 12-month follow-up permitted the study to “confirm that TLD is safe and technically feasible with no late-onset safety signals.” It has set the stage for AIRFLOW-3, a phase 3 trial that is expected to lead to regulatory approval of the catheter if it shows similar safety and efficacy.
The principle of TLD is to deliver energy to ablate parasympathetic pulmonary nerves. The exact mechanism of benefit has not been proved, but it is believed that inhibiting release of acetylcholine that induces smooth muscle constriction has several beneficial downstream effects, including prevention of hyperinflation and reduced mucus production. AIRFLOW-3, like AIRFLOW-2, will evaluate a proprietary catheter developed for this purpose.
“TLD will not replace pharmaceutical therapy. Rather, it appears to have a synergistic effect,” explained Dr. Slebos, who said the procedure is performed on an outpatient basis. The average procedure time for TLD in AIRFLOW-2 was 42 minutes.
The first human study of TLD, also led by Dr. Slebos, was published in 2015. While several subsequent patient series support efficacy and benefit, Daiana Stolz, MD, Clinic for Respiratory Medicine and Pulmonary Cell Research, University of Basel (Switzerland), called the data from this sham-controlled trial “really exciting and important.” However, she said, the larger AIRFLOW-3 trial is needed “to confirm this is an effective and safe treatment.”
Dr. Slebos receives consultancy fees from Aeris Therapeutics, Boston Scientific, Broncus Technologies, CSA Medical. Olympus, Portaero, PulmonX, PneumRx/BTG, and Nuvaira, which provided the funding for this study.
PARIS – In a sham-controlled randomized trial that enrolled patients with moderate to severe was not only found safe, which was the primary goal of the study, but effective, according to data presented at the annual congress of the European Respiratory Society.
Within the first year of follow-up, “the positive benefit in those randomized to TLD persisted with a more than 50% reduction in the number of patients hospitalized for respiratory complications,” reported Dirk-Jan Slebos, MD, department of lung diseases and tuberculosis, University of Gröningen, the Netherlands.
In this phase 2 trial, called AIRFLOW-2, 82 patients were randomized to receive TLD, which ablates nerves with radiofrequency energy, or a sham procedure. The study enrolled patients with moderate to severe COPD and forced expiratory volume in 1 second of 30%-60% predicted. All patients were treated with the long-acting muscarinic antagonist (LAMA) tiotropium.
The primary endpoint was a composite of respiratory-related adverse events, such as respiratory failure, worsening bronchitis, or worsening dyspnea. Secondary endpoints included serious adverse events of any kind as well as a variety of measures of efficacy, including changes in quality of life as measured with standardized tools such as the St. George’s Respiratory Questionnaire (SGRQ).
Within 6 months of the procedure, 71% of those randomized to the sham procedure and 32% of those treated with TLD experienced one of the predefined respiratory adverse events (P = .0008). At 1 year, 25% of patients in the sham group versus 12% in the TLD group were hospitalized for an exacerbation (P = .039). In addition to achieving greater improvement in several of the individual symptoms, such as dyspnea, those randomized to TLD also achieved numerical improvements in SGRQ scores (–8.3 vs. –3.8) at 12 months.
Gastrointestinal adverse events were more common in the TLD group (15% vs. 5%). Although the higher rate of GI events, which included nausea, bloating, and abdominal discomfort, did not reach statistical significance, it was attributed to off-target exposure of nerves in the GI system to the radiofrequency energy.
“We are improving our imaging process in order to implement additional measures to avoid these nerves,” said Dr. Slebos, who added that this potential risk can be modified. In this study, all of the GI symptoms resolved.
Dr. Slebos emphasized that the 12-month follow-up permitted the study to “confirm that TLD is safe and technically feasible with no late-onset safety signals.” It has set the stage for AIRFLOW-3, a phase 3 trial that is expected to lead to regulatory approval of the catheter if it shows similar safety and efficacy.
The principle of TLD is to deliver energy to ablate parasympathetic pulmonary nerves. The exact mechanism of benefit has not been proved, but it is believed that inhibiting release of acetylcholine that induces smooth muscle constriction has several beneficial downstream effects, including prevention of hyperinflation and reduced mucus production. AIRFLOW-3, like AIRFLOW-2, will evaluate a proprietary catheter developed for this purpose.
“TLD will not replace pharmaceutical therapy. Rather, it appears to have a synergistic effect,” explained Dr. Slebos, who said the procedure is performed on an outpatient basis. The average procedure time for TLD in AIRFLOW-2 was 42 minutes.
The first human study of TLD, also led by Dr. Slebos, was published in 2015. While several subsequent patient series support efficacy and benefit, Daiana Stolz, MD, Clinic for Respiratory Medicine and Pulmonary Cell Research, University of Basel (Switzerland), called the data from this sham-controlled trial “really exciting and important.” However, she said, the larger AIRFLOW-3 trial is needed “to confirm this is an effective and safe treatment.”
Dr. Slebos receives consultancy fees from Aeris Therapeutics, Boston Scientific, Broncus Technologies, CSA Medical. Olympus, Portaero, PulmonX, PneumRx/BTG, and Nuvaira, which provided the funding for this study.
REPORTING FROM THE ERS CONGRESS 2018
Key clinical point: Targeted lung denervation (TLD) in patients with moderate to severe COPD is safe and associated with improved disease control.
Major finding: In 1 year of follow-up, 12% of those treated with TLD versus 25% of sham patients had a severe exacerbation.
Study details: Randomized, sham-controlled trial.
Disclosures: Dr. Slebos receives consultancy fees from Aeris Therapeutics, Boston Scientific, Broncus Technologies, CSA Medical, Olympus, Portaero, PulmonX, PneumRx/BTG, and Nuvaira, which provided the funding for this study.
Source: European Respiratory Society 2018 International Congress.
Ice pops improved parents’ ratings of ED quality
SAN DIEGO – Simply offering an ice pop to children who are receiving care in an ED boosts satisfaction scores and physician ratings by their children’s parents, according to data presented at the annual meeting of the American College of Emergency Physicians.
Patient experience and subsequently patient satisfaction scores “have become an increasingly important component of health care delivery. ... Does [the act of] administering Popsicles actually make us better clinicians?” asked Ryan Finn, MD, of the Mayo Clinic, Rochester, Minn., who presented these data.
Exploring low-cost ways to improve patient experience and, by extension, patient satisfaction led to this study of an ice pop intervention, Dr. Finn explained. The study design was simple. During a 3-month period, all children under the age of 14 years (mean age, 6 years) who visited the ED on an even numbered date were offered an ice pop. On odd numbered dates, no ice pop was given. There were no other differences in care.
Parent perceptions of care were assessed with the proprietary Press Ganey patient satisfaction survey. Although a completed survey was submitted for less than 5% of the more than 4,500 patients treated during the study period, differences between the groups still reached statistical significance.
When parents were asked to rate physicians on concern for their child’s comfort, 74% of the group given ice pops and 58% of the group given no ice pops gave favorable responses (P less than.05). The parents of children in the ice pop group also were significantly more likely to rate physicians favorably for their courtesy (77% vs. 62%; P less than .04) and for their willingness to take the time to listen (84% vs. 57%; P less than .03).
Overall rating of care (64% vs. 61%) and likelihood of recommending the ED to others (66% vs. 59%) did not approach statistical significance, according to Dr. Finn.
There are numerous potential advantages to improving the patient experience and boosting patient satisfaction in the ED, as is the case in other areas of the hospital. Even if medical care is of high quality, patient satisfaction does not necessarily follow. Although this single-center study had limitations, such as the low survey completion rate, the measurable effects of the ice pop intervention encourages this direction of research.
“Further studies should increase sample size, assess age group subsets, and assess return on investment for this and other low-cost interventions with the potential to alter patient perceptions,” Dr. Finn said. Because patient satisfaction can be reasonably expected to favorably affect quality of care assessments, he indicated that this is a reasonable target for quality improvement strategies.
SAN DIEGO – Simply offering an ice pop to children who are receiving care in an ED boosts satisfaction scores and physician ratings by their children’s parents, according to data presented at the annual meeting of the American College of Emergency Physicians.
Patient experience and subsequently patient satisfaction scores “have become an increasingly important component of health care delivery. ... Does [the act of] administering Popsicles actually make us better clinicians?” asked Ryan Finn, MD, of the Mayo Clinic, Rochester, Minn., who presented these data.
Exploring low-cost ways to improve patient experience and, by extension, patient satisfaction led to this study of an ice pop intervention, Dr. Finn explained. The study design was simple. During a 3-month period, all children under the age of 14 years (mean age, 6 years) who visited the ED on an even numbered date were offered an ice pop. On odd numbered dates, no ice pop was given. There were no other differences in care.
Parent perceptions of care were assessed with the proprietary Press Ganey patient satisfaction survey. Although a completed survey was submitted for less than 5% of the more than 4,500 patients treated during the study period, differences between the groups still reached statistical significance.
When parents were asked to rate physicians on concern for their child’s comfort, 74% of the group given ice pops and 58% of the group given no ice pops gave favorable responses (P less than.05). The parents of children in the ice pop group also were significantly more likely to rate physicians favorably for their courtesy (77% vs. 62%; P less than .04) and for their willingness to take the time to listen (84% vs. 57%; P less than .03).
Overall rating of care (64% vs. 61%) and likelihood of recommending the ED to others (66% vs. 59%) did not approach statistical significance, according to Dr. Finn.
There are numerous potential advantages to improving the patient experience and boosting patient satisfaction in the ED, as is the case in other areas of the hospital. Even if medical care is of high quality, patient satisfaction does not necessarily follow. Although this single-center study had limitations, such as the low survey completion rate, the measurable effects of the ice pop intervention encourages this direction of research.
“Further studies should increase sample size, assess age group subsets, and assess return on investment for this and other low-cost interventions with the potential to alter patient perceptions,” Dr. Finn said. Because patient satisfaction can be reasonably expected to favorably affect quality of care assessments, he indicated that this is a reasonable target for quality improvement strategies.
SAN DIEGO – Simply offering an ice pop to children who are receiving care in an ED boosts satisfaction scores and physician ratings by their children’s parents, according to data presented at the annual meeting of the American College of Emergency Physicians.
Patient experience and subsequently patient satisfaction scores “have become an increasingly important component of health care delivery. ... Does [the act of] administering Popsicles actually make us better clinicians?” asked Ryan Finn, MD, of the Mayo Clinic, Rochester, Minn., who presented these data.
Exploring low-cost ways to improve patient experience and, by extension, patient satisfaction led to this study of an ice pop intervention, Dr. Finn explained. The study design was simple. During a 3-month period, all children under the age of 14 years (mean age, 6 years) who visited the ED on an even numbered date were offered an ice pop. On odd numbered dates, no ice pop was given. There were no other differences in care.
Parent perceptions of care were assessed with the proprietary Press Ganey patient satisfaction survey. Although a completed survey was submitted for less than 5% of the more than 4,500 patients treated during the study period, differences between the groups still reached statistical significance.
When parents were asked to rate physicians on concern for their child’s comfort, 74% of the group given ice pops and 58% of the group given no ice pops gave favorable responses (P less than.05). The parents of children in the ice pop group also were significantly more likely to rate physicians favorably for their courtesy (77% vs. 62%; P less than .04) and for their willingness to take the time to listen (84% vs. 57%; P less than .03).
Overall rating of care (64% vs. 61%) and likelihood of recommending the ED to others (66% vs. 59%) did not approach statistical significance, according to Dr. Finn.
There are numerous potential advantages to improving the patient experience and boosting patient satisfaction in the ED, as is the case in other areas of the hospital. Even if medical care is of high quality, patient satisfaction does not necessarily follow. Although this single-center study had limitations, such as the low survey completion rate, the measurable effects of the ice pop intervention encourages this direction of research.
“Further studies should increase sample size, assess age group subsets, and assess return on investment for this and other low-cost interventions with the potential to alter patient perceptions,” Dr. Finn said. Because patient satisfaction can be reasonably expected to favorably affect quality of care assessments, he indicated that this is a reasonable target for quality improvement strategies.
FROM ACEP18
Key clinical point: Providing an ice pop to children in the ED boosted satisfaction scores.
Major finding: The parents of children given ice pops ranked physicians higher on measures of courtesy and concern.
Study details: Prospective, controlled study of survey results completed by 5% of more than 4,500 patients.
Disclosures: Dr. Finn reported no financial relationships relevant to this study.