Isolated greater saphenous vein thrombosis is not as benign as generally thought, according to the results of a single institution retrospective study of 61 patients (67 limbs) with isolated GSVT.

Instead, patients had a significant risk of persistent symptoms, recurrence, deep vein thrombosis (DVT), and pulmonary embolism (PE), according to a report published in the Annals of Vascular Surgery by Elizabeth Kudlaty, MD, Ohio State University, Columbus, and her colleagues.

Yale Rosen/Wikimedia Commons

[email protected]

Isolated greater saphenous vein thrombosis is not as benign as generally thought, according to the results of a single institution retrospective study of 61 patients (67 limbs) with isolated GSVT.

Instead, patients had a significant risk of persistent symptoms, recurrence, deep vein thrombosis (DVT), and pulmonary embolism (PE), according to a report published in the Annals of Vascular Surgery by Elizabeth Kudlaty, MD, Ohio State University, Columbus, and her colleagues.

Yale Rosen/Wikimedia Commons

[email protected]

Isolated greater saphenous vein thrombosis is not as benign as generally thought, according to the results of a single institution retrospective study of 61 patients (67 limbs) with isolated GSVT.

Instead, patients had a significant risk of persistent symptoms, recurrence, deep vein thrombosis (DVT), and pulmonary embolism (PE), according to a report published in the Annals of Vascular Surgery by Elizabeth Kudlaty, MD, Ohio State University, Columbus, and her colleagues.

Yale Rosen/Wikimedia Commons

[email protected]

PARIS—When faced with patients with clinically isolated syndrome (CIS) or primary progressive multiple sclerosis (PPMS), diagnosis can be challenging. The 2010 McDonald criteria and the 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria offer sound guidance for relapsing-remitting multiple sclerosis (MS), but for special patient populations, these criteria may fall short. At the Seventh Joint ECTRIMS–ACTRIMS Meeting, two studies looked at the suitability of diagnostic criteria for special MS populations.

Clinically Isolated Syndrome

The recently proposed MAGNIMS dissemination in space criteria include lesions in the optic nerve, cortex, and symptomatic region, in addition to an increase in the required number of periventricular lesions from one to three. Raquel Lamas Pérez, MD, and colleagues aimed to compare the diagnostic performance of the 2010 McDonald and 2016 MAGNIMS MRI criteria for dissemination in space in predicting the conversion to clinically definite MS in patients with CIS. Dr. Lamas Pérez is affiliated with the Hospital Universitario Virgen del Rocío in Sevilla, Spain.

Study inclusion criteria included CIS suggestive of CNS demyelination (since 2008), clinical assessment and baseline brain MRI within six months of CIS onset, availability of spinal cord MRI if patients presented with spinal cord syndrome, and clinical follow-up of at least 24 months.

The researchers included 161 patients with CIS (113 women) with a mean age at onset of 34. After a mean follow-up of 58 months, 102 (63.4%) patients had a diagnosis of MS according to the 2010 McDonald criteria. The overall conversion rate to clinically definite MS was 48.4%. Forty-six (45%) patients initiated a disease-modifying treatment before the second clinical event. The 2010 McDonald dissemination in space criteria were met in 100 (62.1%) and the 2016 MAGNIMS dissemination in space criteria in 95 (59%) patients with CIS. Six patients with one periventricular lesion fulfilled the 2010 McDonald criteria but not the 2016 MAGNIMS criteria. In contrast, when symptomatic infratentorial or spinal cord lesions were included, two more patients met the 2016 dissemination in space criteria than met the 2010 McDonald criteria. The sensitivity, specificity, and positive and negative predictive values of 2010 McDonald criteria were 80.7%, 55.4%, 63%, and 75.4%, respectively, and those for the 2016 MAGNIMS criteria were 75.6%, 56.6%, 62.1%, and 71.2%, respectively. Both dissemination in space criteria identified a subset of patients with CIS who were at high early risk of developing clinically definite MS (hazard ratio: 2.17 for McDonald and 2.07 for MAGNIMS).

“In our CIS patient cohort, 2016 MAGNIMS MRI criteria for dissemination in space showed lower sensitivity with similar specificity than 2010 McDonald criteria in predicting conversion to clinically definite MS, probably related to the increase in the required number of periventricular lesions,” Dr. Lamas Pérez said. “Because disease-modifying therapy can delay or prevent the conversion to clinically definite MS, the high number of patients that initiated these therapies before the second relapse would explain the intermediate specificity values obtained with both MRI criteria.”

Primary Progressive MS

The 2010 McDonald criteria for PPMS have not been fully validated, while 2016 MAGNIMS MRI guidelines have not been studied in PPMS yet.

To assess the sensitivity and specificity of 2010 McDonald and 2016 MAGNIMS criteria for patients with PPMS, Alberto Gajofatto, MD, PhD, Assistant Professor in Neurology in the Department of Neurological and Movement Sciences at the University of Verona in Italy, and colleagues applied the criteria to two retrospective cohorts.

Patients who were seen at the University of California San Francisco and Verona University MS Centers for suspected PPMS were retrospectively identified from existing databases between November 2015 and October 2016. Data were obtained from review of patient charts with adequate documentation of clinical, MRI, and CSF status to determine the fulfillment of 2010 McDonald criteria for PPMS and 2016 MAGNIMS guidelines for dissemination in space at first visit at study centers. PPMS diagnosis was confirmed at last available visit using stringent criteria (ie, dissemination in space according to 2005 McDonald criteria, dissemination in time according to 2001 McDonald criteria, and exclusion of a better explanation).

Dr. Gajofatto and colleagues included 108 patients with a mean follow-up duration of 10.1 years. The 2010 McDonald criteria had a sensitivity for PPMS of 92.1% and a specificity of 57.9%. The highest combined values of sensitivity and specificity (91.8% and 72.2%) were achieved by combining 2016 MAGNIMS dissemination in space criteria and the presence of oligoclonal bands or increased IgG index in the CSF.

“Our findings suggest that 2010 McDonald criteria for PPMS diagnosis have high sensitivity, while specificity appears to be modest,” Dr. Gajofatto said. “The substitution of 2016 MAGNIMS criteria for dissemination in space plus the incorporation of CSF status increased specificity without compromising sensitivity.”

PARIS—When faced with patients with clinically isolated syndrome (CIS) or primary progressive multiple sclerosis (PPMS), diagnosis can be challenging. The 2010 McDonald criteria and the 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria offer sound guidance for relapsing-remitting multiple sclerosis (MS), but for special patient populations, these criteria may fall short. At the Seventh Joint ECTRIMS–ACTRIMS Meeting, two studies looked at the suitability of diagnostic criteria for special MS populations.

Clinically Isolated Syndrome

The recently proposed MAGNIMS dissemination in space criteria include lesions in the optic nerve, cortex, and symptomatic region, in addition to an increase in the required number of periventricular lesions from one to three. Raquel Lamas Pérez, MD, and colleagues aimed to compare the diagnostic performance of the 2010 McDonald and 2016 MAGNIMS MRI criteria for dissemination in space in predicting the conversion to clinically definite MS in patients with CIS. Dr. Lamas Pérez is affiliated with the Hospital Universitario Virgen del Rocío in Sevilla, Spain.

Study inclusion criteria included CIS suggestive of CNS demyelination (since 2008), clinical assessment and baseline brain MRI within six months of CIS onset, availability of spinal cord MRI if patients presented with spinal cord syndrome, and clinical follow-up of at least 24 months.

The researchers included 161 patients with CIS (113 women) with a mean age at onset of 34. After a mean follow-up of 58 months, 102 (63.4%) patients had a diagnosis of MS according to the 2010 McDonald criteria. The overall conversion rate to clinically definite MS was 48.4%. Forty-six (45%) patients initiated a disease-modifying treatment before the second clinical event. The 2010 McDonald dissemination in space criteria were met in 100 (62.1%) and the 2016 MAGNIMS dissemination in space criteria in 95 (59%) patients with CIS. Six patients with one periventricular lesion fulfilled the 2010 McDonald criteria but not the 2016 MAGNIMS criteria. In contrast, when symptomatic infratentorial or spinal cord lesions were included, two more patients met the 2016 dissemination in space criteria than met the 2010 McDonald criteria. The sensitivity, specificity, and positive and negative predictive values of 2010 McDonald criteria were 80.7%, 55.4%, 63%, and 75.4%, respectively, and those for the 2016 MAGNIMS criteria were 75.6%, 56.6%, 62.1%, and 71.2%, respectively. Both dissemination in space criteria identified a subset of patients with CIS who were at high early risk of developing clinically definite MS (hazard ratio: 2.17 for McDonald and 2.07 for MAGNIMS).

“In our CIS patient cohort, 2016 MAGNIMS MRI criteria for dissemination in space showed lower sensitivity with similar specificity than 2010 McDonald criteria in predicting conversion to clinically definite MS, probably related to the increase in the required number of periventricular lesions,” Dr. Lamas Pérez said. “Because disease-modifying therapy can delay or prevent the conversion to clinically definite MS, the high number of patients that initiated these therapies before the second relapse would explain the intermediate specificity values obtained with both MRI criteria.”

Primary Progressive MS

The 2010 McDonald criteria for PPMS have not been fully validated, while 2016 MAGNIMS MRI guidelines have not been studied in PPMS yet.

To assess the sensitivity and specificity of 2010 McDonald and 2016 MAGNIMS criteria for patients with PPMS, Alberto Gajofatto, MD, PhD, Assistant Professor in Neurology in the Department of Neurological and Movement Sciences at the University of Verona in Italy, and colleagues applied the criteria to two retrospective cohorts.

Patients who were seen at the University of California San Francisco and Verona University MS Centers for suspected PPMS were retrospectively identified from existing databases between November 2015 and October 2016. Data were obtained from review of patient charts with adequate documentation of clinical, MRI, and CSF status to determine the fulfillment of 2010 McDonald criteria for PPMS and 2016 MAGNIMS guidelines for dissemination in space at first visit at study centers. PPMS diagnosis was confirmed at last available visit using stringent criteria (ie, dissemination in space according to 2005 McDonald criteria, dissemination in time according to 2001 McDonald criteria, and exclusion of a better explanation).

Dr. Gajofatto and colleagues included 108 patients with a mean follow-up duration of 10.1 years. The 2010 McDonald criteria had a sensitivity for PPMS of 92.1% and a specificity of 57.9%. The highest combined values of sensitivity and specificity (91.8% and 72.2%) were achieved by combining 2016 MAGNIMS dissemination in space criteria and the presence of oligoclonal bands or increased IgG index in the CSF.

“Our findings suggest that 2010 McDonald criteria for PPMS diagnosis have high sensitivity, while specificity appears to be modest,” Dr. Gajofatto said. “The substitution of 2016 MAGNIMS criteria for dissemination in space plus the incorporation of CSF status increased specificity without compromising sensitivity.”

PARIS—When faced with patients with clinically isolated syndrome (CIS) or primary progressive multiple sclerosis (PPMS), diagnosis can be challenging. The 2010 McDonald criteria and the 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria offer sound guidance for relapsing-remitting multiple sclerosis (MS), but for special patient populations, these criteria may fall short. At the Seventh Joint ECTRIMS–ACTRIMS Meeting, two studies looked at the suitability of diagnostic criteria for special MS populations.

Clinically Isolated Syndrome

The recently proposed MAGNIMS dissemination in space criteria include lesions in the optic nerve, cortex, and symptomatic region, in addition to an increase in the required number of periventricular lesions from one to three. Raquel Lamas Pérez, MD, and colleagues aimed to compare the diagnostic performance of the 2010 McDonald and 2016 MAGNIMS MRI criteria for dissemination in space in predicting the conversion to clinically definite MS in patients with CIS. Dr. Lamas Pérez is affiliated with the Hospital Universitario Virgen del Rocío in Sevilla, Spain.

Study inclusion criteria included CIS suggestive of CNS demyelination (since 2008), clinical assessment and baseline brain MRI within six months of CIS onset, availability of spinal cord MRI if patients presented with spinal cord syndrome, and clinical follow-up of at least 24 months.

The researchers included 161 patients with CIS (113 women) with a mean age at onset of 34. After a mean follow-up of 58 months, 102 (63.4%) patients had a diagnosis of MS according to the 2010 McDonald criteria. The overall conversion rate to clinically definite MS was 48.4%. Forty-six (45%) patients initiated a disease-modifying treatment before the second clinical event. The 2010 McDonald dissemination in space criteria were met in 100 (62.1%) and the 2016 MAGNIMS dissemination in space criteria in 95 (59%) patients with CIS. Six patients with one periventricular lesion fulfilled the 2010 McDonald criteria but not the 2016 MAGNIMS criteria. In contrast, when symptomatic infratentorial or spinal cord lesions were included, two more patients met the 2016 dissemination in space criteria than met the 2010 McDonald criteria. The sensitivity, specificity, and positive and negative predictive values of 2010 McDonald criteria were 80.7%, 55.4%, 63%, and 75.4%, respectively, and those for the 2016 MAGNIMS criteria were 75.6%, 56.6%, 62.1%, and 71.2%, respectively. Both dissemination in space criteria identified a subset of patients with CIS who were at high early risk of developing clinically definite MS (hazard ratio: 2.17 for McDonald and 2.07 for MAGNIMS).

“In our CIS patient cohort, 2016 MAGNIMS MRI criteria for dissemination in space showed lower sensitivity with similar specificity than 2010 McDonald criteria in predicting conversion to clinically definite MS, probably related to the increase in the required number of periventricular lesions,” Dr. Lamas Pérez said. “Because disease-modifying therapy can delay or prevent the conversion to clinically definite MS, the high number of patients that initiated these therapies before the second relapse would explain the intermediate specificity values obtained with both MRI criteria.”

Primary Progressive MS

The 2010 McDonald criteria for PPMS have not been fully validated, while 2016 MAGNIMS MRI guidelines have not been studied in PPMS yet.

To assess the sensitivity and specificity of 2010 McDonald and 2016 MAGNIMS criteria for patients with PPMS, Alberto Gajofatto, MD, PhD, Assistant Professor in Neurology in the Department of Neurological and Movement Sciences at the University of Verona in Italy, and colleagues applied the criteria to two retrospective cohorts.

Patients who were seen at the University of California San Francisco and Verona University MS Centers for suspected PPMS were retrospectively identified from existing databases between November 2015 and October 2016. Data were obtained from review of patient charts with adequate documentation of clinical, MRI, and CSF status to determine the fulfillment of 2010 McDonald criteria for PPMS and 2016 MAGNIMS guidelines for dissemination in space at first visit at study centers. PPMS diagnosis was confirmed at last available visit using stringent criteria (ie, dissemination in space according to 2005 McDonald criteria, dissemination in time according to 2001 McDonald criteria, and exclusion of a better explanation).

Dr. Gajofatto and colleagues included 108 patients with a mean follow-up duration of 10.1 years. The 2010 McDonald criteria had a sensitivity for PPMS of 92.1% and a specificity of 57.9%. The highest combined values of sensitivity and specificity (91.8% and 72.2%) were achieved by combining 2016 MAGNIMS dissemination in space criteria and the presence of oligoclonal bands or increased IgG index in the CSF.

“Our findings suggest that 2010 McDonald criteria for PPMS diagnosis have high sensitivity, while specificity appears to be modest,” Dr. Gajofatto said. “The substitution of 2016 MAGNIMS criteria for dissemination in space plus the incorporation of CSF status increased specificity without compromising sensitivity.”

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.

Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.

Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.

Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.

The struggle against mandatory maintenance of certification (MOC) is working its way across the country. Personally, I have always been opposed to mandatory MOC, and based on my experience with the Board of Directors of the American Academy of Dermatology, most of them also are opposed. . Practically, I have not wanted dermatologists to be the first specialty group to break ranks, refuse to participate and be branded as anti-quality and anti-improvement, although there is no good evidence MOC improves quality of care.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].

The struggle against mandatory maintenance of certification (MOC) is working its way across the country. Personally, I have always been opposed to mandatory MOC, and based on my experience with the Board of Directors of the American Academy of Dermatology, most of them also are opposed. . Practically, I have not wanted dermatologists to be the first specialty group to break ranks, refuse to participate and be branded as anti-quality and anti-improvement, although there is no good evidence MOC improves quality of care.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].

The struggle against mandatory maintenance of certification (MOC) is working its way across the country. Personally, I have always been opposed to mandatory MOC, and based on my experience with the Board of Directors of the American Academy of Dermatology, most of them also are opposed. . Practically, I have not wanted dermatologists to be the first specialty group to break ranks, refuse to participate and be branded as anti-quality and anti-improvement, although there is no good evidence MOC improves quality of care.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].

Only a small percentage of pregnant women with symptoms of preterm labor who are admitted to emergency departments or labor and delivery units receive fetal fibronectin testing, suggesting the test may not be fully utilized, according to results from a retrospective study.

Using data collected from the Medical Outcomes Research for Effectiveness and Economics Registry, 23,062 patients were included in the study, of whom just 12% received fetal fibronectin (fFN) testing, according to Sean C. Blackwell, MD, of the department of obstetrics, gynecology and reproductive sciences at the University of Texas, Houston, and his associates (Clinicoecon Outcomes Res. 2017 Oct 3;9:585-94. doi: 10.2147/CEOR.S141061).

The rate of fFN testing was even lower – 4.2% – among women who were discharged home but gave birth within 3 days, compared with the testing rate of 16.7% in women who were discharged and did not give birth within 3 days, which suggests “that there may be opportunities to improve the care management of these patients with the use of such screening tools as fFN testing,” the researchers wrote.

[email protected]

Only a small percentage of pregnant women with symptoms of preterm labor who are admitted to emergency departments or labor and delivery units receive fetal fibronectin testing, suggesting the test may not be fully utilized, according to results from a retrospective study.

Using data collected from the Medical Outcomes Research for Effectiveness and Economics Registry, 23,062 patients were included in the study, of whom just 12% received fetal fibronectin (fFN) testing, according to Sean C. Blackwell, MD, of the department of obstetrics, gynecology and reproductive sciences at the University of Texas, Houston, and his associates (Clinicoecon Outcomes Res. 2017 Oct 3;9:585-94. doi: 10.2147/CEOR.S141061).

The rate of fFN testing was even lower – 4.2% – among women who were discharged home but gave birth within 3 days, compared with the testing rate of 16.7% in women who were discharged and did not give birth within 3 days, which suggests “that there may be opportunities to improve the care management of these patients with the use of such screening tools as fFN testing,” the researchers wrote.

[email protected]

Only a small percentage of pregnant women with symptoms of preterm labor who are admitted to emergency departments or labor and delivery units receive fetal fibronectin testing, suggesting the test may not be fully utilized, according to results from a retrospective study.

Using data collected from the Medical Outcomes Research for Effectiveness and Economics Registry, 23,062 patients were included in the study, of whom just 12% received fetal fibronectin (fFN) testing, according to Sean C. Blackwell, MD, of the department of obstetrics, gynecology and reproductive sciences at the University of Texas, Houston, and his associates (Clinicoecon Outcomes Res. 2017 Oct 3;9:585-94. doi: 10.2147/CEOR.S141061).

The rate of fFN testing was even lower – 4.2% – among women who were discharged home but gave birth within 3 days, compared with the testing rate of 16.7% in women who were discharged and did not give birth within 3 days, which suggests “that there may be opportunities to improve the care management of these patients with the use of such screening tools as fFN testing,” the researchers wrote.

[email protected]

Biosimilars could reduce overall spending on biologic products by $54 billion from 2017 to 2026, according to new research from the Rand Corp.

Given the level of uncertainty surrounding the biosimilars market, however, the range of savings could be as low at $24 billion or as high as $150 billion.

“Because of limited U.S. experience with biosimilars, the key assumptions on market share and biosimilar prices are ‘best guesses’ based on anecdotes or professional opinion,” Andrew Mulcahy, PhD, a health policy researcher at Rand, and his colleagues, wrote in a perspective report.

Mathier/Thinkstock

[email protected]

Biosimilars could reduce overall spending on biologic products by $54 billion from 2017 to 2026, according to new research from the Rand Corp.

Given the level of uncertainty surrounding the biosimilars market, however, the range of savings could be as low at $24 billion or as high as $150 billion.

“Because of limited U.S. experience with biosimilars, the key assumptions on market share and biosimilar prices are ‘best guesses’ based on anecdotes or professional opinion,” Andrew Mulcahy, PhD, a health policy researcher at Rand, and his colleagues, wrote in a perspective report.

Mathier/Thinkstock

[email protected]

Biosimilars could reduce overall spending on biologic products by $54 billion from 2017 to 2026, according to new research from the Rand Corp.

Given the level of uncertainty surrounding the biosimilars market, however, the range of savings could be as low at $24 billion or as high as $150 billion.

“Because of limited U.S. experience with biosimilars, the key assumptions on market share and biosimilar prices are ‘best guesses’ based on anecdotes or professional opinion,” Andrew Mulcahy, PhD, a health policy researcher at Rand, and his colleagues, wrote in a perspective report.

Mathier/Thinkstock

[email protected]

From the battlefront to the home front, the face of federal health is changing. Federal Practitioner recently talked with VADM Michael Cowan, MD, executive director of AMSUS, as he prepares for its upcoming 2017 annual meeting. The meeting will focus on the continuation of care from the DoD to VA and PHS.

"When an injury or illness is successfully treated, the responsibility of the health system to that person is not done," VADM Cowan said. "We have seen a revolution in health care, and we are celebrating that revolution. Survival is a wonderful thing, but wouldn't we be cruel if we only saved those people and were done?"

According to VADM Cowan, the meeting will be structured to have frontline and battlefield topics early in the week. Later in the week the focus will turn to providing long-term health care. The meeting will conclude by bringing in patients so that the focus remains patient centered.

In addition to keynote addresses from VA leaders like Secretary David J. Shulkin, MD, and Deputy Under Secretary for Health for Organizational Excellence Carolyn Clancy, MD, the meeting will include presentations on hurricane relief efforts, a keynote address from Surgeon General VADM Jerome M. Adams, MD, MH; and the CDC's new global rapid response team. More information on the conference can be found at amsusmeeting.org.  

From the battlefront to the home front, the face of federal health is changing. Federal Practitioner recently talked with VADM Michael Cowan, MD, executive director of AMSUS, as he prepares for its upcoming 2017 annual meeting. The meeting will focus on the continuation of care from the DoD to VA and PHS.

"When an injury or illness is successfully treated, the responsibility of the health system to that person is not done," VADM Cowan said. "We have seen a revolution in health care, and we are celebrating that revolution. Survival is a wonderful thing, but wouldn't we be cruel if we only saved those people and were done?"

According to VADM Cowan, the meeting will be structured to have frontline and battlefield topics early in the week. Later in the week the focus will turn to providing long-term health care. The meeting will conclude by bringing in patients so that the focus remains patient centered.

In addition to keynote addresses from VA leaders like Secretary David J. Shulkin, MD, and Deputy Under Secretary for Health for Organizational Excellence Carolyn Clancy, MD, the meeting will include presentations on hurricane relief efforts, a keynote address from Surgeon General VADM Jerome M. Adams, MD, MH; and the CDC's new global rapid response team. More information on the conference can be found at amsusmeeting.org.  

From the battlefront to the home front, the face of federal health is changing. Federal Practitioner recently talked with VADM Michael Cowan, MD, executive director of AMSUS, as he prepares for its upcoming 2017 annual meeting. The meeting will focus on the continuation of care from the DoD to VA and PHS.

"When an injury or illness is successfully treated, the responsibility of the health system to that person is not done," VADM Cowan said. "We have seen a revolution in health care, and we are celebrating that revolution. Survival is a wonderful thing, but wouldn't we be cruel if we only saved those people and were done?"

According to VADM Cowan, the meeting will be structured to have frontline and battlefield topics early in the week. Later in the week the focus will turn to providing long-term health care. The meeting will conclude by bringing in patients so that the focus remains patient centered.

In addition to keynote addresses from VA leaders like Secretary David J. Shulkin, MD, and Deputy Under Secretary for Health for Organizational Excellence Carolyn Clancy, MD, the meeting will include presentations on hurricane relief efforts, a keynote address from Surgeon General VADM Jerome M. Adams, MD, MH; and the CDC's new global rapid response team. More information on the conference can be found at amsusmeeting.org.  

NEW ORLEANS – How do you manage surgical pain when someone is in treatment for opioid addiction? And how do you manage chronic pain?

It is possible to give patients opioids for post-op pain without increasing the risk of relapse, according to Margaret Chaplin, MD, a staff psychiatrist at Community Mental Health Affiliates in New Britain, Conn.

Dr. Chaplin generally uses buprenorphine and naloxone (Suboxone) for opioid use disorder, and she likes to keep her patients on it for surgery. That often means, however, talking with skeptical surgeons and anesthesiologists beforehand, and reminding them that buprenorphine itself has analgesic effects. Meanwhile, when her patients have chronic pain, sometimes they need help understanding that aspirin and acetaminophen help, even if they don’t give patients a warm, fuzzy feeling.

Dr. Chaplin shared those tips and more about pain management in opioid addiction in an interview at the American Psychiatric Association’s Institute on Psychiatric Services.

[email protected]

NEW ORLEANS – How do you manage surgical pain when someone is in treatment for opioid addiction? And how do you manage chronic pain?

It is possible to give patients opioids for post-op pain without increasing the risk of relapse, according to Margaret Chaplin, MD, a staff psychiatrist at Community Mental Health Affiliates in New Britain, Conn.

Dr. Chaplin generally uses buprenorphine and naloxone (Suboxone) for opioid use disorder, and she likes to keep her patients on it for surgery. That often means, however, talking with skeptical surgeons and anesthesiologists beforehand, and reminding them that buprenorphine itself has analgesic effects. Meanwhile, when her patients have chronic pain, sometimes they need help understanding that aspirin and acetaminophen help, even if they don’t give patients a warm, fuzzy feeling.

Dr. Chaplin shared those tips and more about pain management in opioid addiction in an interview at the American Psychiatric Association’s Institute on Psychiatric Services.

[email protected]

NEW ORLEANS – How do you manage surgical pain when someone is in treatment for opioid addiction? And how do you manage chronic pain?

It is possible to give patients opioids for post-op pain without increasing the risk of relapse, according to Margaret Chaplin, MD, a staff psychiatrist at Community Mental Health Affiliates in New Britain, Conn.

Dr. Chaplin generally uses buprenorphine and naloxone (Suboxone) for opioid use disorder, and she likes to keep her patients on it for surgery. That often means, however, talking with skeptical surgeons and anesthesiologists beforehand, and reminding them that buprenorphine itself has analgesic effects. Meanwhile, when her patients have chronic pain, sometimes they need help understanding that aspirin and acetaminophen help, even if they don’t give patients a warm, fuzzy feeling.

Dr. Chaplin shared those tips and more about pain management in opioid addiction in an interview at the American Psychiatric Association’s Institute on Psychiatric Services.

[email protected]

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

Photo from UAB Hospital

Early blood transfusion is associated with improved survival among people with severe trauma sustained during combat, according to research published in JAMA.

Researchers studied medically evacuated US military personnel fighting in Afghanistan and found that patients who received blood products prior to hospitalization or within 15 minutes of medical evacuation were more likely to be alive at 24 hours and 30 days, when compared to patients who had delayed transfusions or did not receive transfusions.

Stacy A. Shackelford, MD, of Ft. Sam Houston in San Antonio, Texas, and her colleagues conducted this study to examine the association of prehospital transfusion and time to initial transfusion with injury survival.

The study included US military combat casualties in Afghanistan between April 1, 2012, and August 7, 2015. Eligible patients were rescued alive by medical evacuation from the point of injury with either:

• A traumatic limb amputation at or above the knee or elbow
• Shock, defined as a systolic blood pressure of less than 90 mm Hg or a heart rate greater than 120 beats per minute.

The study included 502, mostly male (98%), patients with a median age of 25 (range, 22 to 29). There were 55 patients who received prehospital transfusions (of red blood cells and/or plasma) and 447 who did not.

The rate of death within 24 hours of medical evacuation was 5% (3/55) among prehospital transfusion recipients and 19% (85/447) among nonrecipients (P=0.01). The rate of death by day 30 was 11% (6/55) and 23% (102/447), respectively (P=0.04).

The researchers also matched nonrecipients and recipients of prehospital transfusion by mechanism of injury, prehospital shock, severity of limb amputation, head injury, and torso hemorrhage. And the team adjusted their analyses for patient age, injury year, transport team, tourniquet use, and time to medical evacuation.

There were 386 matched patients with complete covariate data. Among these patients, the association of survival with prehospital transfusion remained significant at 24 hours and 30 days.

At 24 hours, the adjusted hazard ratio (aHR) for mortality was 0.26 (P=0.02). There were 3 deaths among the 54 prehospital transfusion recipients and 67 deaths among the 332 matched nonrecipients.

At 30 days, the aHR was 0.39 (P=0.03). There were 6 deaths among the 54 prehospital transfusion recipients and 76 deaths among the 332 matched nonrecipients.

The researchers also found that shorter time to initial transfusion, whether it occurred prior to or during hospitalization, was associated with reduced 24-hour mortality.

Transfusions occurring within 15 minutes of medical evacuation (a median of 36 minutes after injury) were associated with reduced mortality at 24 hours.

The aHR was 0.17 (P=0.02). There were 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation and 68 deaths among the 324 patients who received delayed transfusions or did not receive transfusions.

When the researchers eliminated patients who did not receive transfusions, the aHR was 0.23 (P=0.04). There were 47 deaths among the 303 patients who received delayed transfusions (compared to 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation).

Photo from UAB Hospital

Early blood transfusion is associated with improved survival among people with severe trauma sustained during combat, according to research published in JAMA.

Researchers studied medically evacuated US military personnel fighting in Afghanistan and found that patients who received blood products prior to hospitalization or within 15 minutes of medical evacuation were more likely to be alive at 24 hours and 30 days, when compared to patients who had delayed transfusions or did not receive transfusions.

Stacy A. Shackelford, MD, of Ft. Sam Houston in San Antonio, Texas, and her colleagues conducted this study to examine the association of prehospital transfusion and time to initial transfusion with injury survival.

The study included US military combat casualties in Afghanistan between April 1, 2012, and August 7, 2015. Eligible patients were rescued alive by medical evacuation from the point of injury with either:

• A traumatic limb amputation at or above the knee or elbow
• Shock, defined as a systolic blood pressure of less than 90 mm Hg or a heart rate greater than 120 beats per minute.

The study included 502, mostly male (98%), patients with a median age of 25 (range, 22 to 29). There were 55 patients who received prehospital transfusions (of red blood cells and/or plasma) and 447 who did not.

The rate of death within 24 hours of medical evacuation was 5% (3/55) among prehospital transfusion recipients and 19% (85/447) among nonrecipients (P=0.01). The rate of death by day 30 was 11% (6/55) and 23% (102/447), respectively (P=0.04).

The researchers also matched nonrecipients and recipients of prehospital transfusion by mechanism of injury, prehospital shock, severity of limb amputation, head injury, and torso hemorrhage. And the team adjusted their analyses for patient age, injury year, transport team, tourniquet use, and time to medical evacuation.

There were 386 matched patients with complete covariate data. Among these patients, the association of survival with prehospital transfusion remained significant at 24 hours and 30 days.

At 24 hours, the adjusted hazard ratio (aHR) for mortality was 0.26 (P=0.02). There were 3 deaths among the 54 prehospital transfusion recipients and 67 deaths among the 332 matched nonrecipients.

At 30 days, the aHR was 0.39 (P=0.03). There were 6 deaths among the 54 prehospital transfusion recipients and 76 deaths among the 332 matched nonrecipients.

The researchers also found that shorter time to initial transfusion, whether it occurred prior to or during hospitalization, was associated with reduced 24-hour mortality.

Transfusions occurring within 15 minutes of medical evacuation (a median of 36 minutes after injury) were associated with reduced mortality at 24 hours.

The aHR was 0.17 (P=0.02). There were 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation and 68 deaths among the 324 patients who received delayed transfusions or did not receive transfusions.

When the researchers eliminated patients who did not receive transfusions, the aHR was 0.23 (P=0.04). There were 47 deaths among the 303 patients who received delayed transfusions (compared to 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation).

Photo from UAB Hospital

Early blood transfusion is associated with improved survival among people with severe trauma sustained during combat, according to research published in JAMA.

Researchers studied medically evacuated US military personnel fighting in Afghanistan and found that patients who received blood products prior to hospitalization or within 15 minutes of medical evacuation were more likely to be alive at 24 hours and 30 days, when compared to patients who had delayed transfusions or did not receive transfusions.

Stacy A. Shackelford, MD, of Ft. Sam Houston in San Antonio, Texas, and her colleagues conducted this study to examine the association of prehospital transfusion and time to initial transfusion with injury survival.

The study included US military combat casualties in Afghanistan between April 1, 2012, and August 7, 2015. Eligible patients were rescued alive by medical evacuation from the point of injury with either:

• A traumatic limb amputation at or above the knee or elbow
• Shock, defined as a systolic blood pressure of less than 90 mm Hg or a heart rate greater than 120 beats per minute.

The study included 502, mostly male (98%), patients with a median age of 25 (range, 22 to 29). There were 55 patients who received prehospital transfusions (of red blood cells and/or plasma) and 447 who did not.

The rate of death within 24 hours of medical evacuation was 5% (3/55) among prehospital transfusion recipients and 19% (85/447) among nonrecipients (P=0.01). The rate of death by day 30 was 11% (6/55) and 23% (102/447), respectively (P=0.04).

The researchers also matched nonrecipients and recipients of prehospital transfusion by mechanism of injury, prehospital shock, severity of limb amputation, head injury, and torso hemorrhage. And the team adjusted their analyses for patient age, injury year, transport team, tourniquet use, and time to medical evacuation.

There were 386 matched patients with complete covariate data. Among these patients, the association of survival with prehospital transfusion remained significant at 24 hours and 30 days.

At 24 hours, the adjusted hazard ratio (aHR) for mortality was 0.26 (P=0.02). There were 3 deaths among the 54 prehospital transfusion recipients and 67 deaths among the 332 matched nonrecipients.

At 30 days, the aHR was 0.39 (P=0.03). There were 6 deaths among the 54 prehospital transfusion recipients and 76 deaths among the 332 matched nonrecipients.

The researchers also found that shorter time to initial transfusion, whether it occurred prior to or during hospitalization, was associated with reduced 24-hour mortality.

Transfusions occurring within 15 minutes of medical evacuation (a median of 36 minutes after injury) were associated with reduced mortality at 24 hours.

The aHR was 0.17 (P=0.02). There were 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation and 68 deaths among the 324 patients who received delayed transfusions or did not receive transfusions.

When the researchers eliminated patients who did not receive transfusions, the aHR was 0.23 (P=0.04). There were 47 deaths among the 303 patients who received delayed transfusions (compared to 2 deaths among the 62 patients who received a transfusion within 15 minutes of medical evacuation).