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Keep Up to Date with VESAP4
Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related. And the mobile app (Apple products only) for off-line use is expected to be available within days.
The fourth edition launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.
Costs are $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188.
Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related. And the mobile app (Apple products only) for off-line use is expected to be available within days.
The fourth edition launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.
Costs are $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188.
Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related. And the mobile app (Apple products only) for off-line use is expected to be available within days.
The fourth edition launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.
Costs are $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188.
Read SVS Foundation Annual Report
The SVS Foundation highlights innovation and the connection between research bench and patient bedside in its just-published 2017 Annual Report, now available online.
Read about the Foundation’s expanded mission, emphasizing disease prevent and patient education along with the core commitment to fund basic and clinical research. Read why Michael C. Dalsing, MD, gives and how Ulka Sachdev, MD, has utilized her Foundation awards to try to unlock the suffering caused by chronic venous insufficiency. Read about this year’s grant recipients, Foundation financial details, lists of donors to not only the Foundation but also the new Alexander Clowes Lecture Fund, award opportunities and how every gift helps. Read, and donate today.
The SVS Foundation highlights innovation and the connection between research bench and patient bedside in its just-published 2017 Annual Report, now available online.
Read about the Foundation’s expanded mission, emphasizing disease prevent and patient education along with the core commitment to fund basic and clinical research. Read why Michael C. Dalsing, MD, gives and how Ulka Sachdev, MD, has utilized her Foundation awards to try to unlock the suffering caused by chronic venous insufficiency. Read about this year’s grant recipients, Foundation financial details, lists of donors to not only the Foundation but also the new Alexander Clowes Lecture Fund, award opportunities and how every gift helps. Read, and donate today.
The SVS Foundation highlights innovation and the connection between research bench and patient bedside in its just-published 2017 Annual Report, now available online.
Read about the Foundation’s expanded mission, emphasizing disease prevent and patient education along with the core commitment to fund basic and clinical research. Read why Michael C. Dalsing, MD, gives and how Ulka Sachdev, MD, has utilized her Foundation awards to try to unlock the suffering caused by chronic venous insufficiency. Read about this year’s grant recipients, Foundation financial details, lists of donors to not only the Foundation but also the new Alexander Clowes Lecture Fund, award opportunities and how every gift helps. Read, and donate today.
Dues Statements Distributed
Membership dues statements for 2018 were emailed to all members at the beginning of October. Members have until Dec. 31 to pay their dues, ensuring that they continue to receive all the benefits of SVS membership, including discounted registration fees for the Vascular Annual Meeting and the Vascular Research Initiatives Conference as well as educational opportunities; subscriptions to the Journal of Vascular Surgery publications; grant programs; practice resources and reporting standards. Members also get legislative access and advocacy –important as the health care field changes dramatically; branding and public relations to raise public awareness of the specialty; and more.
Visit vascular.org/invoices or call the Membership Department, 312-334-2313, to pay dues.
Membership dues statements for 2018 were emailed to all members at the beginning of October. Members have until Dec. 31 to pay their dues, ensuring that they continue to receive all the benefits of SVS membership, including discounted registration fees for the Vascular Annual Meeting and the Vascular Research Initiatives Conference as well as educational opportunities; subscriptions to the Journal of Vascular Surgery publications; grant programs; practice resources and reporting standards. Members also get legislative access and advocacy –important as the health care field changes dramatically; branding and public relations to raise public awareness of the specialty; and more.
Visit vascular.org/invoices or call the Membership Department, 312-334-2313, to pay dues.
Membership dues statements for 2018 were emailed to all members at the beginning of October. Members have until Dec. 31 to pay their dues, ensuring that they continue to receive all the benefits of SVS membership, including discounted registration fees for the Vascular Annual Meeting and the Vascular Research Initiatives Conference as well as educational opportunities; subscriptions to the Journal of Vascular Surgery publications; grant programs; practice resources and reporting standards. Members also get legislative access and advocacy –important as the health care field changes dramatically; branding and public relations to raise public awareness of the specialty; and more.
Visit vascular.org/invoices or call the Membership Department, 312-334-2313, to pay dues.
Rio Olympics tally for U.S. athletes is 6% West Nile infections, no Zika
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
SAN DIEGO – When compared with pretravel blood screening, new arboviral infections were detected in 7% of U.S. athletes and support staff who attended the 2016 Olympic Games in Rio de Janeiro, according to study results revealed at an annual scientific meeting on infectious diseases.
Although the prospective screening program was largely set up and driven by concern about the risk of Zika virus infection, this was not among the arboviral infections identified, reported Krow Ampofo, MD, professor of pediatrics in the division of pediatric infectious diseases, University of Utah, Salt Lake City.
“The stories and images of children with microencephalopathy and other complications of the Zika syndrome were a major concern of athletes,” said Dr. Ampofo, who noted that many were threatening not to attend. The concern was reasonable, he said, given the scope of the epidemic and the fact that the majority of female athletes were of reproductive age.
At the time the screening program was being planned, the Zika virus epidemic in Brazil had, in fact, already peaked. Although it was not then known that the peak had been reached, the incidence rates began falling sharply beginning in about March 2016. New cases still were being reported, but the threat was greatly diminished by the time that the summer games were held.
In the screening program, blood samples were obtained prior to the games from 950 U.S. athletes and support staff. In most cases, these samples were obtained in Houston, where the Olympic team was processed just prior to departure. At that same time, the U.S. Centers for Disease Control and Prevention provided pretravel counseling about infection risk prevention.
For follow-up, the goal was to obtain blood samples within 2-12 weeks after return of all those who participated in the pretravel screening. Completion of a post-travel survey about activities in Rio de Janeiro, particularly their participation in risk prevention strategies, also was requested.
Blood samples were evaluated for four arboviral infections: Zika virus, dengue virus, chikungunya virus, and West Nile virus. The calculation of infection rates was based on the 457 (48%) of those screened prior to travel who provided blood samples after their return. Of these, 11% had antibody evidence of arboviral infections, but new infections were confirmed in only 7%.
The post-games survey was completed by 169 of those evaluated. A comparison of risk prevention behaviors in those who were and were not infected suggested that use of mosquito repellent did provide risk reduction, said Dr. Ampofo.
The substantial rate of new West Nile virus infections was “surprising,” Dr. Ampofo said. He recounted that there were no prior warnings from Brazilian authorities that West Nile virus was circulating. Infection with West Nile virus in Houston prior to departure was not considered an alternative explanation. According to Dr. Ampofo, Houston was not an endemic area for West Nile virus, and the stay in Houston for most athletes was 2 or 3 days.
AT ID WEEK 2017
Key clinical point: Prospective surveillance among U.S. athletes and staff attending the 2016 Olympics documented several arboviral infections, but not Zika.
Major finding: When pre- versus post-Olympics blood studies were evaluated, 6% had developed West Nile virus while no other arboviral infection incidence exceeded 1%.
Data source: Prospective and post-Olympics blood studies of 457 U.S. athletes and staff and survey results.
Disclosures: Dr. Ampofo reported no financial relationships relevant to this study.
Deep learning can assist real-time polyp detection during colonoscopies
A deep-learning algorithm for automatic polyp detection during colonoscopies showed both high sensitivity and high specificity, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
The algorithm was set up using a retrospective set of 5,545 images annotated by colonoscopists, while the validation set used for the study consisted of 27,461 colonoscopy images from 1,235 patients, according to Pu Wang, MD, of the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China, and his associates.
At the high-sensitivity operating point, the algorithm had a sensitivity of 94.96% and a specificity of 92.01%, and at the low–false positive rate operating point, the algorithm had a sensitivity of 92.35% and a specificity of 97.05%. The area under the curve was 0.958 in a receiver operating characteristic curve analysis.
In subgroup analyses of flat polyps, polyps less than or equal to 0.5 cm, and isochromatic polyps, the algorithm had areas under the curve of 0.943, 0.957, and 0.957 respectively.
The algorithm reported results in 60-80 ms, offering real-time assistance with polyp detection during colonoscopies, Dr. Wang and his colleagues noted.
The study was not funded by industry grants, and no disclosures were reported.
A deep-learning algorithm for automatic polyp detection during colonoscopies showed both high sensitivity and high specificity, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
The algorithm was set up using a retrospective set of 5,545 images annotated by colonoscopists, while the validation set used for the study consisted of 27,461 colonoscopy images from 1,235 patients, according to Pu Wang, MD, of the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China, and his associates.
At the high-sensitivity operating point, the algorithm had a sensitivity of 94.96% and a specificity of 92.01%, and at the low–false positive rate operating point, the algorithm had a sensitivity of 92.35% and a specificity of 97.05%. The area under the curve was 0.958 in a receiver operating characteristic curve analysis.
In subgroup analyses of flat polyps, polyps less than or equal to 0.5 cm, and isochromatic polyps, the algorithm had areas under the curve of 0.943, 0.957, and 0.957 respectively.
The algorithm reported results in 60-80 ms, offering real-time assistance with polyp detection during colonoscopies, Dr. Wang and his colleagues noted.
The study was not funded by industry grants, and no disclosures were reported.
A deep-learning algorithm for automatic polyp detection during colonoscopies showed both high sensitivity and high specificity, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
The algorithm was set up using a retrospective set of 5,545 images annotated by colonoscopists, while the validation set used for the study consisted of 27,461 colonoscopy images from 1,235 patients, according to Pu Wang, MD, of the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China, and his associates.
At the high-sensitivity operating point, the algorithm had a sensitivity of 94.96% and a specificity of 92.01%, and at the low–false positive rate operating point, the algorithm had a sensitivity of 92.35% and a specificity of 97.05%. The area under the curve was 0.958 in a receiver operating characteristic curve analysis.
In subgroup analyses of flat polyps, polyps less than or equal to 0.5 cm, and isochromatic polyps, the algorithm had areas under the curve of 0.943, 0.957, and 0.957 respectively.
The algorithm reported results in 60-80 ms, offering real-time assistance with polyp detection during colonoscopies, Dr. Wang and his colleagues noted.
The study was not funded by industry grants, and no disclosures were reported.
FROM WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: The deep-learning algorithm had a sensitivity of 95% and a specificity of 92% when adjusted to the high-sensitivity operating point.
Data source: A set of 27,461 colonoscopy images from 1,235 patients.
Disclosures: The study was not funded by industry grants, and no disclosures were reported.
Better care reduces time to successful refeeding in acute pancreatitis
Enhanced recovery approaches were safe and effective at promoting earlier restoration of gut function in acute pancreatitis patients, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Patients recruited for the trial were admitted directly from an emergency department and received either enhanced care consisting of patient-directed oral intake, early ambulation, and nonopioid analgesia or received normal care consisting of opioid analgesia, physician-directed diet, and nursing parameters, Elizabeth Dong, MD, of the Kaiser Permanente Los Angeles Medical Center and her associates said.
Among the 46 patients included in the study, 61% had an etiology of gallstones, 15% had an etiology of alcohol, 13% had hyperglyceridemia, and 11% had a different etiology. Median age was 53.1 years, Dr. Dong and her associates noted.
Time to successful oral refeeding, the primary study endpoint, was significantly reduced in the enhanced treatment group, with a median time of 13.8 hours, compared with the normal treatment group, in which median time to oral refeeding was 124.8 hours. In addition, patients in the enhanced care group had a mean pancreatitis activity score of 43.5 after 48-72 hours, while patients in the control group had a mean score of 72.1.
Length of stay and frequency of 30-day readmission did not differ significantly between study groups.
The study was not funded by industry grants, and no disclosures were reported.
Enhanced recovery approaches were safe and effective at promoting earlier restoration of gut function in acute pancreatitis patients, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Patients recruited for the trial were admitted directly from an emergency department and received either enhanced care consisting of patient-directed oral intake, early ambulation, and nonopioid analgesia or received normal care consisting of opioid analgesia, physician-directed diet, and nursing parameters, Elizabeth Dong, MD, of the Kaiser Permanente Los Angeles Medical Center and her associates said.
Among the 46 patients included in the study, 61% had an etiology of gallstones, 15% had an etiology of alcohol, 13% had hyperglyceridemia, and 11% had a different etiology. Median age was 53.1 years, Dr. Dong and her associates noted.
Time to successful oral refeeding, the primary study endpoint, was significantly reduced in the enhanced treatment group, with a median time of 13.8 hours, compared with the normal treatment group, in which median time to oral refeeding was 124.8 hours. In addition, patients in the enhanced care group had a mean pancreatitis activity score of 43.5 after 48-72 hours, while patients in the control group had a mean score of 72.1.
Length of stay and frequency of 30-day readmission did not differ significantly between study groups.
The study was not funded by industry grants, and no disclosures were reported.
Enhanced recovery approaches were safe and effective at promoting earlier restoration of gut function in acute pancreatitis patients, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Patients recruited for the trial were admitted directly from an emergency department and received either enhanced care consisting of patient-directed oral intake, early ambulation, and nonopioid analgesia or received normal care consisting of opioid analgesia, physician-directed diet, and nursing parameters, Elizabeth Dong, MD, of the Kaiser Permanente Los Angeles Medical Center and her associates said.
Among the 46 patients included in the study, 61% had an etiology of gallstones, 15% had an etiology of alcohol, 13% had hyperglyceridemia, and 11% had a different etiology. Median age was 53.1 years, Dr. Dong and her associates noted.
Time to successful oral refeeding, the primary study endpoint, was significantly reduced in the enhanced treatment group, with a median time of 13.8 hours, compared with the normal treatment group, in which median time to oral refeeding was 124.8 hours. In addition, patients in the enhanced care group had a mean pancreatitis activity score of 43.5 after 48-72 hours, while patients in the control group had a mean score of 72.1.
Length of stay and frequency of 30-day readmission did not differ significantly between study groups.
The study was not funded by industry grants, and no disclosures were reported.
FROM WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: Median time to successful oral refeeding was more than 4 days faster in patients who received enhanced care.
Data source: A pilot single-blind, randomized, controlled trial of 46 patients admitted from an emergency department between July 2016 and April 2017.
Disclosures: The study was not funded by industry grants, and no disclosures were reported.
Serrated polyps alone not associated with future high-risk adenomas
The presence of serrated polyps on index colonoscopies without low-risk adenomas was not associated with metachronous high-risk adenomas on surveillance exams, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Data for the study were collected from 4,616 adults who had two colonoscopies on record with the New Hampshire Colonoscopy Registry. Patients with high-risk adenomas at the index colonoscopy were excluded from the study. The median time between index and surveillance exams was 4.9 years, and median age was 61 years, according to Joseph Anderson, MD, of Geisel School of Medicine at Dartmouth, Hanover, N.H., and his associates.
Overall, the risk for metachronous high-risk adenomas in the study group was 6.3% and the risk of large serrated polyps greater than or equal to 1 cm was 1.2%. After patient age, sex, smoking, body mass index, and time between the two exams were adjusted for, low-risk adenomas at the time of the index colonoscopy were associated with an increased metachronous risk of high-risk adenomas, Dr. Anderson and his colleagues noted.
Large serrated polyps and the presence of sessile serrated polyps or traditional serrated adenomas at index exam increased the risk of metachronous serrated polyps at the surveillance colonoscopy 10-fold and 14-fold, respectively, but did not increase the risk of high-risk adenomas. The presence of both low-risk adenomas and significant serrated polyps was not associated with an increased risk of high-risk adenomas over the presence of low-risk adenomas alone.
The study was not funded by industry grants, and no disclosures were reported.
The presence of serrated polyps on index colonoscopies without low-risk adenomas was not associated with metachronous high-risk adenomas on surveillance exams, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Data for the study were collected from 4,616 adults who had two colonoscopies on record with the New Hampshire Colonoscopy Registry. Patients with high-risk adenomas at the index colonoscopy were excluded from the study. The median time between index and surveillance exams was 4.9 years, and median age was 61 years, according to Joseph Anderson, MD, of Geisel School of Medicine at Dartmouth, Hanover, N.H., and his associates.
Overall, the risk for metachronous high-risk adenomas in the study group was 6.3% and the risk of large serrated polyps greater than or equal to 1 cm was 1.2%. After patient age, sex, smoking, body mass index, and time between the two exams were adjusted for, low-risk adenomas at the time of the index colonoscopy were associated with an increased metachronous risk of high-risk adenomas, Dr. Anderson and his colleagues noted.
Large serrated polyps and the presence of sessile serrated polyps or traditional serrated adenomas at index exam increased the risk of metachronous serrated polyps at the surveillance colonoscopy 10-fold and 14-fold, respectively, but did not increase the risk of high-risk adenomas. The presence of both low-risk adenomas and significant serrated polyps was not associated with an increased risk of high-risk adenomas over the presence of low-risk adenomas alone.
The study was not funded by industry grants, and no disclosures were reported.
The presence of serrated polyps on index colonoscopies without low-risk adenomas was not associated with metachronous high-risk adenomas on surveillance exams, according to a study presented at the World Congress of Gastroenterology at ACG 2017.
Data for the study were collected from 4,616 adults who had two colonoscopies on record with the New Hampshire Colonoscopy Registry. Patients with high-risk adenomas at the index colonoscopy were excluded from the study. The median time between index and surveillance exams was 4.9 years, and median age was 61 years, according to Joseph Anderson, MD, of Geisel School of Medicine at Dartmouth, Hanover, N.H., and his associates.
Overall, the risk for metachronous high-risk adenomas in the study group was 6.3% and the risk of large serrated polyps greater than or equal to 1 cm was 1.2%. After patient age, sex, smoking, body mass index, and time between the two exams were adjusted for, low-risk adenomas at the time of the index colonoscopy were associated with an increased metachronous risk of high-risk adenomas, Dr. Anderson and his colleagues noted.
Large serrated polyps and the presence of sessile serrated polyps or traditional serrated adenomas at index exam increased the risk of metachronous serrated polyps at the surveillance colonoscopy 10-fold and 14-fold, respectively, but did not increase the risk of high-risk adenomas. The presence of both low-risk adenomas and significant serrated polyps was not associated with an increased risk of high-risk adenomas over the presence of low-risk adenomas alone.
The study was not funded by industry grants, and no disclosures were reported.
FROM THE 13TH WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: After patient age, sex, smoking, body mass index, and time between index and surveillance exams were adjusted for, the presence of index serrated polyps without additional low-risk adenomas did not increase risk of high-risk adenomas at surveillance exams.
Data source: Data collected from 4,616 patients in the New Hampshire Colonoscopy Registry.
Disclosures: The study was not funded by industry grants, and no disclosures were reported.
MACRA Monday: Advance care plan
If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.
Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.
Consider this measure:
Measure #47: Care Plan
This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.
What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.
Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.
To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.
Certain clinicians are exempt from reporting and do not face a penalty under MIPS:
- Those who enrolled in Medicare for the first time during a performance period.
- Those who have Medicare Part B–allowed charges of $30,000 or less.
- Those who have 100 or fewer Medicare Part B patients.
- Those who are significantly participating in an Advanced Alternative Payment Model (APM).
If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.
Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.
Consider this measure:
Measure #47: Care Plan
This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.
What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.
Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.
To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.
Certain clinicians are exempt from reporting and do not face a penalty under MIPS:
- Those who enrolled in Medicare for the first time during a performance period.
- Those who have Medicare Part B–allowed charges of $30,000 or less.
- Those who have 100 or fewer Medicare Part B patients.
- Those who are significantly participating in an Advanced Alternative Payment Model (APM).
If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.
Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.
Consider this measure:
Measure #47: Care Plan
This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.
What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.
Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.
To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.
Certain clinicians are exempt from reporting and do not face a penalty under MIPS:
- Those who enrolled in Medicare for the first time during a performance period.
- Those who have Medicare Part B–allowed charges of $30,000 or less.
- Those who have 100 or fewer Medicare Part B patients.
- Those who are significantly participating in an Advanced Alternative Payment Model (APM).
CBT for insomnia and hot flashes lifts mood in midlife
PHILADELPHIA – Cognitive-behavioral therapy tailored to perimenopausal and postmenopausal women who were experiencing both insomnia and vasomotor symptoms effectively improved both sleep and mood, according to a small controlled study.
When 40 women were randomized to receive either cognitive-behavioral therapy for menopausal insomnia (CBTMI) or education about menopause and sleep, those who received CBTMI had significantly reduced scores on both objective and subjective scales of depression, and their sleep also improved.
The CBTMI intervention was effective even for women with high scores on the depression scales at baseline, Sara Nowakowski, PhD, said at a top abstracts session at the annual meeting of the North American Menopause Society.
Over the 8 weeks of the study intervention, women in the CBTMI arm received four 50-minute individual sessions with either a social worker or a psychologist in a gynecology clinic outpatient setting. Counseling during the sessions focused both on hot flashes and insomnia, using evidence-based CBT techniques to address both. These included sleep restriction, changing behaviors to strengthen the association of the bed with sleep, cognitive therapy to address maladaptive beliefs about both sleep and host flashes, general sleep hygiene, hot flash coping mechanisms, and relaxation training.
Those in the menopause education control arm had a 1-hour educational session about menopausal symptoms and sleep hygiene, received written material, and were told they could make any changes desired.
Participants, whose mean age was 55 years, were included if they reported at least one nocturnal hot flash per night and met criteria for the sleep disorder of insomnia. Although patients who met criteria for major depression were not excluded, women with surgical menopause or cancer treatment–related menopause were excluded, as were those with substance use disorder, significant other psychiatric comorbidities, and those with obstructive sleep apnea or periodic limb movements/restless leg syndrome.
Dr. Nowakowski, a clinical psychologist in the department of obstetrics and gynecology, University of Texas, Galveston, and her colleagues administered the Insomnia Severity Index (ISI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Hamilton Depression Rating Scale (HDRS) both before and after the 8-week intervention.
The investigators used a mixed-models statistical analysis, finding a significant improvement over time during the study period in both patient-reported (P = .001) and clinician-assessed (P = .001) ratings of depression for the CBTMI group.
When the effect of the treatment arm was analyzed, CBTMI also offered significantly greater improvement in patient-reported (P = .009) and clinician-assessed (P = .022) depression ratings.
Patients were divided into high and low depression severity, with a score over 8 on the CES-D and 16 on the HDRS putting the participant into the high-severity category. Both groups had significant improvement on the ISI from baseline. “Treatment response for insomnia severity did not differ based on baseline depression severity,” Dr. Nowakowski said.
The efficacy of the relatively brief intervention has clinical relevance to those caring for the 39%-60% of women in midlife who have symptoms of insomnia and the 8%-40% of midlife women who report elevated depression symptoms. “Comprehensive interventions that simultaneously improve sleep and mood in midlife women are greatly needed,” she said.
The National Institutes of Health and the Hogg Foundation for Mental Health funded the study. Dr. Nowakowski reported no conflicts of interest.
[email protected]
On Twitter @karioakes
PHILADELPHIA – Cognitive-behavioral therapy tailored to perimenopausal and postmenopausal women who were experiencing both insomnia and vasomotor symptoms effectively improved both sleep and mood, according to a small controlled study.
When 40 women were randomized to receive either cognitive-behavioral therapy for menopausal insomnia (CBTMI) or education about menopause and sleep, those who received CBTMI had significantly reduced scores on both objective and subjective scales of depression, and their sleep also improved.
The CBTMI intervention was effective even for women with high scores on the depression scales at baseline, Sara Nowakowski, PhD, said at a top abstracts session at the annual meeting of the North American Menopause Society.
Over the 8 weeks of the study intervention, women in the CBTMI arm received four 50-minute individual sessions with either a social worker or a psychologist in a gynecology clinic outpatient setting. Counseling during the sessions focused both on hot flashes and insomnia, using evidence-based CBT techniques to address both. These included sleep restriction, changing behaviors to strengthen the association of the bed with sleep, cognitive therapy to address maladaptive beliefs about both sleep and host flashes, general sleep hygiene, hot flash coping mechanisms, and relaxation training.
Those in the menopause education control arm had a 1-hour educational session about menopausal symptoms and sleep hygiene, received written material, and were told they could make any changes desired.
Participants, whose mean age was 55 years, were included if they reported at least one nocturnal hot flash per night and met criteria for the sleep disorder of insomnia. Although patients who met criteria for major depression were not excluded, women with surgical menopause or cancer treatment–related menopause were excluded, as were those with substance use disorder, significant other psychiatric comorbidities, and those with obstructive sleep apnea or periodic limb movements/restless leg syndrome.
Dr. Nowakowski, a clinical psychologist in the department of obstetrics and gynecology, University of Texas, Galveston, and her colleagues administered the Insomnia Severity Index (ISI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Hamilton Depression Rating Scale (HDRS) both before and after the 8-week intervention.
The investigators used a mixed-models statistical analysis, finding a significant improvement over time during the study period in both patient-reported (P = .001) and clinician-assessed (P = .001) ratings of depression for the CBTMI group.
When the effect of the treatment arm was analyzed, CBTMI also offered significantly greater improvement in patient-reported (P = .009) and clinician-assessed (P = .022) depression ratings.
Patients were divided into high and low depression severity, with a score over 8 on the CES-D and 16 on the HDRS putting the participant into the high-severity category. Both groups had significant improvement on the ISI from baseline. “Treatment response for insomnia severity did not differ based on baseline depression severity,” Dr. Nowakowski said.
The efficacy of the relatively brief intervention has clinical relevance to those caring for the 39%-60% of women in midlife who have symptoms of insomnia and the 8%-40% of midlife women who report elevated depression symptoms. “Comprehensive interventions that simultaneously improve sleep and mood in midlife women are greatly needed,” she said.
The National Institutes of Health and the Hogg Foundation for Mental Health funded the study. Dr. Nowakowski reported no conflicts of interest.
[email protected]
On Twitter @karioakes
PHILADELPHIA – Cognitive-behavioral therapy tailored to perimenopausal and postmenopausal women who were experiencing both insomnia and vasomotor symptoms effectively improved both sleep and mood, according to a small controlled study.
When 40 women were randomized to receive either cognitive-behavioral therapy for menopausal insomnia (CBTMI) or education about menopause and sleep, those who received CBTMI had significantly reduced scores on both objective and subjective scales of depression, and their sleep also improved.
The CBTMI intervention was effective even for women with high scores on the depression scales at baseline, Sara Nowakowski, PhD, said at a top abstracts session at the annual meeting of the North American Menopause Society.
Over the 8 weeks of the study intervention, women in the CBTMI arm received four 50-minute individual sessions with either a social worker or a psychologist in a gynecology clinic outpatient setting. Counseling during the sessions focused both on hot flashes and insomnia, using evidence-based CBT techniques to address both. These included sleep restriction, changing behaviors to strengthen the association of the bed with sleep, cognitive therapy to address maladaptive beliefs about both sleep and host flashes, general sleep hygiene, hot flash coping mechanisms, and relaxation training.
Those in the menopause education control arm had a 1-hour educational session about menopausal symptoms and sleep hygiene, received written material, and were told they could make any changes desired.
Participants, whose mean age was 55 years, were included if they reported at least one nocturnal hot flash per night and met criteria for the sleep disorder of insomnia. Although patients who met criteria for major depression were not excluded, women with surgical menopause or cancer treatment–related menopause were excluded, as were those with substance use disorder, significant other psychiatric comorbidities, and those with obstructive sleep apnea or periodic limb movements/restless leg syndrome.
Dr. Nowakowski, a clinical psychologist in the department of obstetrics and gynecology, University of Texas, Galveston, and her colleagues administered the Insomnia Severity Index (ISI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Hamilton Depression Rating Scale (HDRS) both before and after the 8-week intervention.
The investigators used a mixed-models statistical analysis, finding a significant improvement over time during the study period in both patient-reported (P = .001) and clinician-assessed (P = .001) ratings of depression for the CBTMI group.
When the effect of the treatment arm was analyzed, CBTMI also offered significantly greater improvement in patient-reported (P = .009) and clinician-assessed (P = .022) depression ratings.
Patients were divided into high and low depression severity, with a score over 8 on the CES-D and 16 on the HDRS putting the participant into the high-severity category. Both groups had significant improvement on the ISI from baseline. “Treatment response for insomnia severity did not differ based on baseline depression severity,” Dr. Nowakowski said.
The efficacy of the relatively brief intervention has clinical relevance to those caring for the 39%-60% of women in midlife who have symptoms of insomnia and the 8%-40% of midlife women who report elevated depression symptoms. “Comprehensive interventions that simultaneously improve sleep and mood in midlife women are greatly needed,” she said.
The National Institutes of Health and the Hogg Foundation for Mental Health funded the study. Dr. Nowakowski reported no conflicts of interest.
[email protected]
On Twitter @karioakes
AT NAMS 2017
Key clinical point:
Major finding: Patient-reported and clinician-assessed depression scores dropped after the intervention (P = .001 for both).
Data source: Randomized controlled trial of 40 midlife women with insomnia and hot flashes.
Disclosures: The National Institutes of Health and the Hogg Foundation for Mental Health funded the study. Dr. Nowakowski reported no conflicts of interest.
Good for something, or an American tragedy
The headline in the Oct. 13, 2017, Portland (Maine) Press Herald hinted that I was about to read a sad story: “New Hampshire doctor, 85, may lose practice because she doesn’t use computer.” Anna Konopka, MD, who has a 300-patient practice in New London, doesn’t use a computer in her office, and as a consequence can’t participate in her state’s mandated prescription drug monitoring program. She has appealed to the governor, but if her appeal is denied she will be forced to close her office.
The closure will present a hardship for the residents of this small New Hampshire town, who will have to replace their obviously committed physician who has served them for more than 30 years. And I am sure that Dr. Konopka would have preferred to end her professional career on her own terms. It isn’t going to be easy to give up that positive feedback from her patients that every primary care physician enjoys even on her worst day.
I wouldn’t be surprised to learn that Dr. Konopka has listened to other physicians in her community complain about the cost and time-gobbling inefficiencies of their EHRs. She may have been put off by her own experiences as a patient whose physician spends too much time looking at his computer screen and fails to engage with her. Or she may have simply done the math and come up with the obvious answer that a computer system would be a bad investment for her small practice.
I suspect that there are days that you wish you had followed this wise older physician’s lead and never plugged into that “good-for-nothing piece of junk” sitting on the desk in your exam room. The sadness in this story is that the computer and the Internet are (or at least could be) good for some things, including the statewide prescription drug monitoring program that Dr. Konopka can’t participate in. Immunization data banks, prescribing programs that minimize physician error, and systems for storing and plotting your patient’s lab work and metrics are just a few of the things that a good computer system is good for. And, of course, there is the real-time access to the vast store of medical and research knowledge that has made textbooks obsolete.
I’m not sure where we can go from here without throwing out the baby with the bathwater and starting from scratch. We have computer scientists and physicians who I am sure could create a patient- and physician-friendly system that could cover the whole country. The trick will be keeping the politicians out of the room.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
The headline in the Oct. 13, 2017, Portland (Maine) Press Herald hinted that I was about to read a sad story: “New Hampshire doctor, 85, may lose practice because she doesn’t use computer.” Anna Konopka, MD, who has a 300-patient practice in New London, doesn’t use a computer in her office, and as a consequence can’t participate in her state’s mandated prescription drug monitoring program. She has appealed to the governor, but if her appeal is denied she will be forced to close her office.
The closure will present a hardship for the residents of this small New Hampshire town, who will have to replace their obviously committed physician who has served them for more than 30 years. And I am sure that Dr. Konopka would have preferred to end her professional career on her own terms. It isn’t going to be easy to give up that positive feedback from her patients that every primary care physician enjoys even on her worst day.
I wouldn’t be surprised to learn that Dr. Konopka has listened to other physicians in her community complain about the cost and time-gobbling inefficiencies of their EHRs. She may have been put off by her own experiences as a patient whose physician spends too much time looking at his computer screen and fails to engage with her. Or she may have simply done the math and come up with the obvious answer that a computer system would be a bad investment for her small practice.
I suspect that there are days that you wish you had followed this wise older physician’s lead and never plugged into that “good-for-nothing piece of junk” sitting on the desk in your exam room. The sadness in this story is that the computer and the Internet are (or at least could be) good for some things, including the statewide prescription drug monitoring program that Dr. Konopka can’t participate in. Immunization data banks, prescribing programs that minimize physician error, and systems for storing and plotting your patient’s lab work and metrics are just a few of the things that a good computer system is good for. And, of course, there is the real-time access to the vast store of medical and research knowledge that has made textbooks obsolete.
I’m not sure where we can go from here without throwing out the baby with the bathwater and starting from scratch. We have computer scientists and physicians who I am sure could create a patient- and physician-friendly system that could cover the whole country. The trick will be keeping the politicians out of the room.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
The headline in the Oct. 13, 2017, Portland (Maine) Press Herald hinted that I was about to read a sad story: “New Hampshire doctor, 85, may lose practice because she doesn’t use computer.” Anna Konopka, MD, who has a 300-patient practice in New London, doesn’t use a computer in her office, and as a consequence can’t participate in her state’s mandated prescription drug monitoring program. She has appealed to the governor, but if her appeal is denied she will be forced to close her office.
The closure will present a hardship for the residents of this small New Hampshire town, who will have to replace their obviously committed physician who has served them for more than 30 years. And I am sure that Dr. Konopka would have preferred to end her professional career on her own terms. It isn’t going to be easy to give up that positive feedback from her patients that every primary care physician enjoys even on her worst day.
I wouldn’t be surprised to learn that Dr. Konopka has listened to other physicians in her community complain about the cost and time-gobbling inefficiencies of their EHRs. She may have been put off by her own experiences as a patient whose physician spends too much time looking at his computer screen and fails to engage with her. Or she may have simply done the math and come up with the obvious answer that a computer system would be a bad investment for her small practice.
I suspect that there are days that you wish you had followed this wise older physician’s lead and never plugged into that “good-for-nothing piece of junk” sitting on the desk in your exam room. The sadness in this story is that the computer and the Internet are (or at least could be) good for some things, including the statewide prescription drug monitoring program that Dr. Konopka can’t participate in. Immunization data banks, prescribing programs that minimize physician error, and systems for storing and plotting your patient’s lab work and metrics are just a few of the things that a good computer system is good for. And, of course, there is the real-time access to the vast store of medical and research knowledge that has made textbooks obsolete.
I’m not sure where we can go from here without throwing out the baby with the bathwater and starting from scratch. We have computer scientists and physicians who I am sure could create a patient- and physician-friendly system that could cover the whole country. The trick will be keeping the politicians out of the room.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].