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From the Washington Office: Reporting global codes data in 2017
On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.
Which states are impacted by the requirement to report global codes data?
What data must be reported?
Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.
Is claims-based data reporting mandatory? Is there a penalty for failure to report?
Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.
Why is CMS requiring the reporting of global codes data?
For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.
Which states are impacted by the requirement to report global codes data?
What data must be reported?
Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.
Is claims-based data reporting mandatory? Is there a penalty for failure to report?
Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.
Why is CMS requiring the reporting of global codes data?
For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.
Which states are impacted by the requirement to report global codes data?
What data must be reported?
Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.
Is claims-based data reporting mandatory? Is there a penalty for failure to report?
Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.
Why is CMS requiring the reporting of global codes data?
For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
ACS Board of Regents approves new Foundation officers teaser
The American College of Surgeons (ACS) Board of Regents approved new officers of the ACS Foundation Board of Directors at the Regents’ February meeting in Chicago, IL. The new officers, who began their two-year terms in February, are Chair Mary H. McGrath, MD, MPH, FACS, professor of surgery, University of California, San Francisco (UCSF); Vice-Chair Charles E. Lucas, MD, FACS, professor of surgery, Wayne State University, Detroit, MI; and Secretary Ruth L. Bush, MD, JD, MPH, FACS, deputy director, the Center for Innovations in Quality, Effectiveness and Safety, a partnership between the Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX.
Mary H. McGrath, MD, MPH, FACS
Dr. McGrath is a graduate of St. Louis University School of Medicine, MO, and completed her general surgery residency at the University of Colorado Medical Center, Denver. She then trained in plastic surgery at Yale University School of Medicine, New Haven, CT, and has made outstanding clinical and academic contributions to the field of plastic surgery, especially in the areas of breast and hand surgery, wound healing, introduction of new technology, and workforce issues. 
Dr. McGrath’s career as an academic surgeon started at Yale in 1978 with a position as assistant professor of surgery in the school of medicine’s division of plastic and reconstructive surgery. In 1980, she attained the position of assistant professor of surgery, division of plastic and reconstructive surgery, Columbia University College of Physicians and Surgeons, New York, NY. In 1984, she moved to the George Washington University Medical Center, Washington, DC, where she began as chief, division of plastic and reconstructive surgery, and director, residency training program, ultimately ascending to professor of surgery. She has held her present position at UCSF since 2003. She has served in many national positions in plastic surgery and is the present president of the American Association of Plastic Surgeons.
A Fellow of the College since 1983, Dr. McGrath has provided exceptional service to the ACS and has served for 25 years in leadership roles, including First Vice-President (2007–2008); Vice-Chair, Board of Regents (2005–2006); member, Executive Committee, Board of Regents (2002–2006); Regent (1997– 2006); and Chair, Committee on Ethics (2003–2006). She served on the Board of Governors (B/G) Executive Committee and as a Governor-at-Large representing the District of Columbia.
In 2009, the ACS appointed her to serve on the Board of Commissioners of The Joint Commission. She is currently serving her third term in this capacity.
For this remarkable record of service, Dr. McGrath received the College’s highest honor, the Distinguished Service Award, in 2011. She received the ACS Foundation’s Distinguished Philanthropist Award in 2016 for her generous contributions to the College and service to the larger philanthropic community.
Charles E. Lucas, MD, FACS
A native of Detroit, Dr. Lucas has dedicated his surgical career to his hometown. He earned his undergraduate degree from the University of Detroit and his doctor of medicine degree from Wayne State University (WSU). After completing his residency at WSU, he accepted a position on the WSU surgical faculty, specializing in trauma and surgical critical care.
Dr. Lucas conducted his clinical and academic activities at Detroit General Hospital until its closure in 1980. He then moved to the Detroit Medical Center (DMC), practicing at the new Detroit Receiving Hospital (DRH), the Harper University Hospital (HUH), the Hutzel Hospital, and the Karmanos Cancer Hospital. A renowned trauma surgeon, Dr. Lucas was instrumental in securing DRH as the first ACS-verified Level I trauma center in the U.S. He has trained hundreds of medical students and residents, and his research efforts have resulted in the publication of more than 400 peer-reviewed articles, books, and book chapters.
An ACS Fellow since 1970, Dr. Lucas has served in several ACS volunteer roles for more than 35 years, including member, B/G (1984–1990, 1998–2004); President, ACS Michigan Chapter, (1981–1983); and member, Committee on Trauma (1993–2003). He has also been active in a number of surgical organizations, including the American Association for the Surgery of Trauma, American Surgical Association, Central Surgical Association, Midwest Surgical Association, Society of University Surgeons, and Western Surgical Association.
Ruth L. Bush, MD, JD, MPH, FACS
Dr. Bush received her doctor of medicine degree from the University of North Carolina School of Medicine, Chapel Hill, in 1992. She completed her general surgery residency at the University of California, Davis, Medical Center, where she also spent two additional years as a vascular research fellow. She then finished her vascular surgery fellowship at Emory University Hospital, Atlanta, GA. Serving in several academic positions over her career, Dr. Bush was most recently vice-dean and professor of surgery at Texas A&M College of Medicine, Bryan, TX.
Dr. Bush has received several research support funding awards to conduct studies on vascular disease and improved treatment and has published broadly on an array of topics. In addition to service on the ACS Foundation Board, Dr. Bush has been a member of the ACS B/G (2007–2010). She is active in several surgical associations including American Venous Forum, Association of Women Surgeons, and the Society for Vascular Surgery. She has been honored with a number of awards, including Distinguished Fellow (2007) and Presidential Citation (2014), Society of Vascular Surgery; Distinguished Fellow (2015), American Venous Forum; and Outstanding Faculty Teaching Awards, Texas A&M College of Medicine in 2014 and 2015. She continues to practice vascular surgery at the Michael E. DeBakey VA Medical Center.
For more information on the ACS Foundation, contact Shane Hollett, ACS Foundation Executive Director, at 312-202-5506 or [email protected], and visit facs.org/acsfoundation.
Ms. Klein is Director, Donor Relations and Communications, ACS Foundation, Chicago, IL.
The American College of Surgeons (ACS) Board of Regents approved new officers of the ACS Foundation Board of Directors at the Regents’ February meeting in Chicago, IL. The new officers, who began their two-year terms in February, are Chair Mary H. McGrath, MD, MPH, FACS, professor of surgery, University of California, San Francisco (UCSF); Vice-Chair Charles E. Lucas, MD, FACS, professor of surgery, Wayne State University, Detroit, MI; and Secretary Ruth L. Bush, MD, JD, MPH, FACS, deputy director, the Center for Innovations in Quality, Effectiveness and Safety, a partnership between the Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX.
Mary H. McGrath, MD, MPH, FACS
Dr. McGrath is a graduate of St. Louis University School of Medicine, MO, and completed her general surgery residency at the University of Colorado Medical Center, Denver. She then trained in plastic surgery at Yale University School of Medicine, New Haven, CT, and has made outstanding clinical and academic contributions to the field of plastic surgery, especially in the areas of breast and hand surgery, wound healing, introduction of new technology, and workforce issues.
Dr. McGrath’s career as an academic surgeon started at Yale in 1978 with a position as assistant professor of surgery in the school of medicine’s division of plastic and reconstructive surgery. In 1980, she attained the position of assistant professor of surgery, division of plastic and reconstructive surgery, Columbia University College of Physicians and Surgeons, New York, NY. In 1984, she moved to the George Washington University Medical Center, Washington, DC, where she began as chief, division of plastic and reconstructive surgery, and director, residency training program, ultimately ascending to professor of surgery. She has held her present position at UCSF since 2003. She has served in many national positions in plastic surgery and is the present president of the American Association of Plastic Surgeons.
A Fellow of the College since 1983, Dr. McGrath has provided exceptional service to the ACS and has served for 25 years in leadership roles, including First Vice-President (2007–2008); Vice-Chair, Board of Regents (2005–2006); member, Executive Committee, Board of Regents (2002–2006); Regent (1997– 2006); and Chair, Committee on Ethics (2003–2006). She served on the Board of Governors (B/G) Executive Committee and as a Governor-at-Large representing the District of Columbia.
In 2009, the ACS appointed her to serve on the Board of Commissioners of The Joint Commission. She is currently serving her third term in this capacity.
For this remarkable record of service, Dr. McGrath received the College’s highest honor, the Distinguished Service Award, in 2011. She received the ACS Foundation’s Distinguished Philanthropist Award in 2016 for her generous contributions to the College and service to the larger philanthropic community.
Charles E. Lucas, MD, FACS
A native of Detroit, Dr. Lucas has dedicated his surgical career to his hometown. He earned his undergraduate degree from the University of Detroit and his doctor of medicine degree from Wayne State University (WSU). After completing his residency at WSU, he accepted a position on the WSU surgical faculty, specializing in trauma and surgical critical care.
Dr. Lucas conducted his clinical and academic activities at Detroit General Hospital until its closure in 1980. He then moved to the Detroit Medical Center (DMC), practicing at the new Detroit Receiving Hospital (DRH), the Harper University Hospital (HUH), the Hutzel Hospital, and the Karmanos Cancer Hospital. A renowned trauma surgeon, Dr. Lucas was instrumental in securing DRH as the first ACS-verified Level I trauma center in the U.S. He has trained hundreds of medical students and residents, and his research efforts have resulted in the publication of more than 400 peer-reviewed articles, books, and book chapters.
An ACS Fellow since 1970, Dr. Lucas has served in several ACS volunteer roles for more than 35 years, including member, B/G (1984–1990, 1998–2004); President, ACS Michigan Chapter, (1981–1983); and member, Committee on Trauma (1993–2003). He has also been active in a number of surgical organizations, including the American Association for the Surgery of Trauma, American Surgical Association, Central Surgical Association, Midwest Surgical Association, Society of University Surgeons, and Western Surgical Association.
Ruth L. Bush, MD, JD, MPH, FACS
Dr. Bush received her doctor of medicine degree from the University of North Carolina School of Medicine, Chapel Hill, in 1992. She completed her general surgery residency at the University of California, Davis, Medical Center, where she also spent two additional years as a vascular research fellow. She then finished her vascular surgery fellowship at Emory University Hospital, Atlanta, GA. Serving in several academic positions over her career, Dr. Bush was most recently vice-dean and professor of surgery at Texas A&M College of Medicine, Bryan, TX.
Dr. Bush has received several research support funding awards to conduct studies on vascular disease and improved treatment and has published broadly on an array of topics. In addition to service on the ACS Foundation Board, Dr. Bush has been a member of the ACS B/G (2007–2010). She is active in several surgical associations including American Venous Forum, Association of Women Surgeons, and the Society for Vascular Surgery. She has been honored with a number of awards, including Distinguished Fellow (2007) and Presidential Citation (2014), Society of Vascular Surgery; Distinguished Fellow (2015), American Venous Forum; and Outstanding Faculty Teaching Awards, Texas A&M College of Medicine in 2014 and 2015. She continues to practice vascular surgery at the Michael E. DeBakey VA Medical Center.
For more information on the ACS Foundation, contact Shane Hollett, ACS Foundation Executive Director, at 312-202-5506 or [email protected], and visit facs.org/acsfoundation.
Ms. Klein is Director, Donor Relations and Communications, ACS Foundation, Chicago, IL.
The American College of Surgeons (ACS) Board of Regents approved new officers of the ACS Foundation Board of Directors at the Regents’ February meeting in Chicago, IL. The new officers, who began their two-year terms in February, are Chair Mary H. McGrath, MD, MPH, FACS, professor of surgery, University of California, San Francisco (UCSF); Vice-Chair Charles E. Lucas, MD, FACS, professor of surgery, Wayne State University, Detroit, MI; and Secretary Ruth L. Bush, MD, JD, MPH, FACS, deputy director, the Center for Innovations in Quality, Effectiveness and Safety, a partnership between the Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX.
Mary H. McGrath, MD, MPH, FACS
Dr. McGrath is a graduate of St. Louis University School of Medicine, MO, and completed her general surgery residency at the University of Colorado Medical Center, Denver. She then trained in plastic surgery at Yale University School of Medicine, New Haven, CT, and has made outstanding clinical and academic contributions to the field of plastic surgery, especially in the areas of breast and hand surgery, wound healing, introduction of new technology, and workforce issues.
Dr. McGrath’s career as an academic surgeon started at Yale in 1978 with a position as assistant professor of surgery in the school of medicine’s division of plastic and reconstructive surgery. In 1980, she attained the position of assistant professor of surgery, division of plastic and reconstructive surgery, Columbia University College of Physicians and Surgeons, New York, NY. In 1984, she moved to the George Washington University Medical Center, Washington, DC, where she began as chief, division of plastic and reconstructive surgery, and director, residency training program, ultimately ascending to professor of surgery. She has held her present position at UCSF since 2003. She has served in many national positions in plastic surgery and is the present president of the American Association of Plastic Surgeons.
A Fellow of the College since 1983, Dr. McGrath has provided exceptional service to the ACS and has served for 25 years in leadership roles, including First Vice-President (2007–2008); Vice-Chair, Board of Regents (2005–2006); member, Executive Committee, Board of Regents (2002–2006); Regent (1997– 2006); and Chair, Committee on Ethics (2003–2006). She served on the Board of Governors (B/G) Executive Committee and as a Governor-at-Large representing the District of Columbia.
In 2009, the ACS appointed her to serve on the Board of Commissioners of The Joint Commission. She is currently serving her third term in this capacity.
For this remarkable record of service, Dr. McGrath received the College’s highest honor, the Distinguished Service Award, in 2011. She received the ACS Foundation’s Distinguished Philanthropist Award in 2016 for her generous contributions to the College and service to the larger philanthropic community.
Charles E. Lucas, MD, FACS
A native of Detroit, Dr. Lucas has dedicated his surgical career to his hometown. He earned his undergraduate degree from the University of Detroit and his doctor of medicine degree from Wayne State University (WSU). After completing his residency at WSU, he accepted a position on the WSU surgical faculty, specializing in trauma and surgical critical care.
Dr. Lucas conducted his clinical and academic activities at Detroit General Hospital until its closure in 1980. He then moved to the Detroit Medical Center (DMC), practicing at the new Detroit Receiving Hospital (DRH), the Harper University Hospital (HUH), the Hutzel Hospital, and the Karmanos Cancer Hospital. A renowned trauma surgeon, Dr. Lucas was instrumental in securing DRH as the first ACS-verified Level I trauma center in the U.S. He has trained hundreds of medical students and residents, and his research efforts have resulted in the publication of more than 400 peer-reviewed articles, books, and book chapters.
An ACS Fellow since 1970, Dr. Lucas has served in several ACS volunteer roles for more than 35 years, including member, B/G (1984–1990, 1998–2004); President, ACS Michigan Chapter, (1981–1983); and member, Committee on Trauma (1993–2003). He has also been active in a number of surgical organizations, including the American Association for the Surgery of Trauma, American Surgical Association, Central Surgical Association, Midwest Surgical Association, Society of University Surgeons, and Western Surgical Association.
Ruth L. Bush, MD, JD, MPH, FACS
Dr. Bush received her doctor of medicine degree from the University of North Carolina School of Medicine, Chapel Hill, in 1992. She completed her general surgery residency at the University of California, Davis, Medical Center, where she also spent two additional years as a vascular research fellow. She then finished her vascular surgery fellowship at Emory University Hospital, Atlanta, GA. Serving in several academic positions over her career, Dr. Bush was most recently vice-dean and professor of surgery at Texas A&M College of Medicine, Bryan, TX.
Dr. Bush has received several research support funding awards to conduct studies on vascular disease and improved treatment and has published broadly on an array of topics. In addition to service on the ACS Foundation Board, Dr. Bush has been a member of the ACS B/G (2007–2010). She is active in several surgical associations including American Venous Forum, Association of Women Surgeons, and the Society for Vascular Surgery. She has been honored with a number of awards, including Distinguished Fellow (2007) and Presidential Citation (2014), Society of Vascular Surgery; Distinguished Fellow (2015), American Venous Forum; and Outstanding Faculty Teaching Awards, Texas A&M College of Medicine in 2014 and 2015. She continues to practice vascular surgery at the Michael E. DeBakey VA Medical Center.
For more information on the ACS Foundation, contact Shane Hollett, ACS Foundation Executive Director, at 312-202-5506 or [email protected], and visit facs.org/acsfoundation.
Ms. Klein is Director, Donor Relations and Communications, ACS Foundation, Chicago, IL.
CQGS releases preliminary standards for quality surgical care of older adults
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the ACS and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults.
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the American College of Surgeons (ACS) and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults. The standards have been published on the Annals of Surgery website ahead of print publication in a report titled “Hospital Standards to Promote Optimal Surgical Care of the Older Adult.” (See the article at bit.ly/2p1TmNC.)
These preliminary standards reflect the shift toward interdisciplinary care of surgical patients, while taking into account the unique physiologic changes related to aging and chronic diseases that can leave older patients at risk for postoperative complications. The standards build upon existing quality indicators, National Quality Forum-endorsed quality measures, and previous work by the ACS, American Geriatrics Society, and John A. Hartford Foundation, which have previously collaborated to develop and release two sets of perioperative guidelines. Standards, however, differ from guidelines, as Julia Berian, MD, lead author and ACS Clinical Scholar, notes. “Standards, as they exist in ACS Quality Programs, are more than recommendations—they are elevated to the level of care practices that are expected to be completed,” Dr. Berian said.
The standards are divided into four categories—continuum of care, clinical care, program management, and patient outcomes and follow-up. CQGS stakeholders rated 308 proposed standards of care for whether they are validated means of improving quality of geriatric surgery and can feasibly be implemented. The reviewers rated 306 of the standards as valid and 304 as feasible.
The preliminary standards are undergoing a two-phase pilot process. The alpha phase, which involved engaging 15 end-user hospitals to gain their insight on the possibility of implementing these standards, is nearing completion. The beta phase, which involves actual implementation of the standards in six hospitals, will occur later this year.
Read the full ACS press release at facs.org/media/press-releases/2017/olderadults040617.
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the ACS and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults.
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the American College of Surgeons (ACS) and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults. The standards have been published on the Annals of Surgery website ahead of print publication in a report titled “Hospital Standards to Promote Optimal Surgical Care of the Older Adult.” (See the article at bit.ly/2p1TmNC.)
These preliminary standards reflect the shift toward interdisciplinary care of surgical patients, while taking into account the unique physiologic changes related to aging and chronic diseases that can leave older patients at risk for postoperative complications. The standards build upon existing quality indicators, National Quality Forum-endorsed quality measures, and previous work by the ACS, American Geriatrics Society, and John A. Hartford Foundation, which have previously collaborated to develop and release two sets of perioperative guidelines. Standards, however, differ from guidelines, as Julia Berian, MD, lead author and ACS Clinical Scholar, notes. “Standards, as they exist in ACS Quality Programs, are more than recommendations—they are elevated to the level of care practices that are expected to be completed,” Dr. Berian said.
The standards are divided into four categories—continuum of care, clinical care, program management, and patient outcomes and follow-up. CQGS stakeholders rated 308 proposed standards of care for whether they are validated means of improving quality of geriatric surgery and can feasibly be implemented. The reviewers rated 306 of the standards as valid and 304 as feasible.
The preliminary standards are undergoing a two-phase pilot process. The alpha phase, which involved engaging 15 end-user hospitals to gain their insight on the possibility of implementing these standards, is nearing completion. The beta phase, which involves actual implementation of the standards in six hospitals, will occur later this year.
Read the full ACS press release at facs.org/media/press-releases/2017/olderadults040617.
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the ACS and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults.
The Coalition for Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the American College of Surgeons (ACS) and 58 other stakeholder organizations, has released the first comprehensive set of hospital-level surgical care standards for older adults. The standards have been published on the Annals of Surgery website ahead of print publication in a report titled “Hospital Standards to Promote Optimal Surgical Care of the Older Adult.” (See the article at bit.ly/2p1TmNC.)
These preliminary standards reflect the shift toward interdisciplinary care of surgical patients, while taking into account the unique physiologic changes related to aging and chronic diseases that can leave older patients at risk for postoperative complications. The standards build upon existing quality indicators, National Quality Forum-endorsed quality measures, and previous work by the ACS, American Geriatrics Society, and John A. Hartford Foundation, which have previously collaborated to develop and release two sets of perioperative guidelines. Standards, however, differ from guidelines, as Julia Berian, MD, lead author and ACS Clinical Scholar, notes. “Standards, as they exist in ACS Quality Programs, are more than recommendations—they are elevated to the level of care practices that are expected to be completed,” Dr. Berian said.
The standards are divided into four categories—continuum of care, clinical care, program management, and patient outcomes and follow-up. CQGS stakeholders rated 308 proposed standards of care for whether they are validated means of improving quality of geriatric surgery and can feasibly be implemented. The reviewers rated 306 of the standards as valid and 304 as feasible.
The preliminary standards are undergoing a two-phase pilot process. The alpha phase, which involved engaging 15 end-user hospitals to gain their insight on the possibility of implementing these standards, is nearing completion. The beta phase, which involves actual implementation of the standards in six hospitals, will occur later this year.
Read the full ACS press release at facs.org/media/press-releases/2017/olderadults040617.
Consider applying for two ACS scholarships
The American College of Surgeons (ACS) International Relations Committee has announced the availability of the following scholarships for 2018.
Community Surgeon Travel Awards
The International Relations Committee of the ACS has announced the availability of Community Surgeon Travel Awards. This new program provides a stipend of $4,000 to enable international surgeons ages 30–50 in regional or community hospitals/clinics or financially challenged surgical departments to attend the ACS Clinical Congress 2018.
The complete requirements and the online application form are posted on the College website at facs.org/member-services/scholarships/international/communitytravel. Applications and all related documents are due July 3. For more information, contact [email protected].
International Guest Scholarships
The International Relations Committee of the ACS has announced the availability of International Guest Scholarships for 2018 to young surgeons from countries other than the U.S. or Canada. The scholarships, in the amount of $10,000 each, provide the scholars with an opportunity to visit clinical, teaching, and research activities in the U.S. or Canada, and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress.
The complete requirements and the link to the direct online application form appear online on the College’s website at facs.org/member-services/scholarships/international/igs. Applications and all related documents are due July 3. For more information, contact [email protected].
The American College of Surgeons (ACS) International Relations Committee has announced the availability of the following scholarships for 2018.
Community Surgeon Travel Awards
The International Relations Committee of the ACS has announced the availability of Community Surgeon Travel Awards. This new program provides a stipend of $4,000 to enable international surgeons ages 30–50 in regional or community hospitals/clinics or financially challenged surgical departments to attend the ACS Clinical Congress 2018.
The complete requirements and the online application form are posted on the College website at facs.org/member-services/scholarships/international/communitytravel. Applications and all related documents are due July 3. For more information, contact [email protected].
International Guest Scholarships
The International Relations Committee of the ACS has announced the availability of International Guest Scholarships for 2018 to young surgeons from countries other than the U.S. or Canada. The scholarships, in the amount of $10,000 each, provide the scholars with an opportunity to visit clinical, teaching, and research activities in the U.S. or Canada, and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress.
The complete requirements and the link to the direct online application form appear online on the College’s website at facs.org/member-services/scholarships/international/igs. Applications and all related documents are due July 3. For more information, contact [email protected].
The American College of Surgeons (ACS) International Relations Committee has announced the availability of the following scholarships for 2018.
Community Surgeon Travel Awards
The International Relations Committee of the ACS has announced the availability of Community Surgeon Travel Awards. This new program provides a stipend of $4,000 to enable international surgeons ages 30–50 in regional or community hospitals/clinics or financially challenged surgical departments to attend the ACS Clinical Congress 2018.
The complete requirements and the online application form are posted on the College website at facs.org/member-services/scholarships/international/communitytravel. Applications and all related documents are due July 3. For more information, contact [email protected].
International Guest Scholarships
The International Relations Committee of the ACS has announced the availability of International Guest Scholarships for 2018 to young surgeons from countries other than the U.S. or Canada. The scholarships, in the amount of $10,000 each, provide the scholars with an opportunity to visit clinical, teaching, and research activities in the U.S. or Canada, and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress.
The complete requirements and the link to the direct online application form appear online on the College’s website at facs.org/member-services/scholarships/international/igs. Applications and all related documents are due July 3. For more information, contact [email protected].
Apply by July 10 for ACS Residents Leading Quality Course
Surgical residents and fellows should plan to attend the American College of Surgeons (ACS) Residents Leading Quality course, a two-day program in quality improvement (QI). The course will take place 12:00 noon–5:00 pm, July 20, and 8:00 am–12:00 noon, July 21, immediately preceding the official start of the inaugural ACS Quality and Safety Conference 2017 in New York, NY.
Course participants will be introduced to the basics of QI, including the identification of a problem, data review, QI models and techniques, and patient and provider engagement strategies. National experts will discuss overcoming barriers and provide advice on careers in QI. The course will use practical case-based scenarios for initiating QI in a surgical practice or hospital.
The course information will prepare participants to return to their institutions ready to engage in quality and safety practices, share ideas with faculty and co-trainees, and disseminate new tools and strategies in compliance with modern recommendations from the Accreditation Council for Graduate Medical Education, the Residency Review Committee, and the American Board of Surgery.
Seating is limited. To be considered for enrollment, e-mail course staff at [email protected] by July 10 with your full name, credentials, institution, and surgical specialty. Describe in 75 words or less any relevant QI experience or aspirations. The course fee is $175 for Resident Members and $250 for non-member residents. (Apply to become a Resident Member of the College at facs.org/member-services/join/resident).
Attendees will be expected to review pre-course materials, and attendee feedback will be used for subsequent course development. A certificate of attendance will be issued upon completion of the program.
Surgical residents and fellows should plan to attend the American College of Surgeons (ACS) Residents Leading Quality course, a two-day program in quality improvement (QI). The course will take place 12:00 noon–5:00 pm, July 20, and 8:00 am–12:00 noon, July 21, immediately preceding the official start of the inaugural ACS Quality and Safety Conference 2017 in New York, NY.
Course participants will be introduced to the basics of QI, including the identification of a problem, data review, QI models and techniques, and patient and provider engagement strategies. National experts will discuss overcoming barriers and provide advice on careers in QI. The course will use practical case-based scenarios for initiating QI in a surgical practice or hospital.
The course information will prepare participants to return to their institutions ready to engage in quality and safety practices, share ideas with faculty and co-trainees, and disseminate new tools and strategies in compliance with modern recommendations from the Accreditation Council for Graduate Medical Education, the Residency Review Committee, and the American Board of Surgery.
Seating is limited. To be considered for enrollment, e-mail course staff at [email protected] by July 10 with your full name, credentials, institution, and surgical specialty. Describe in 75 words or less any relevant QI experience or aspirations. The course fee is $175 for Resident Members and $250 for non-member residents. (Apply to become a Resident Member of the College at facs.org/member-services/join/resident).
Attendees will be expected to review pre-course materials, and attendee feedback will be used for subsequent course development. A certificate of attendance will be issued upon completion of the program.
Surgical residents and fellows should plan to attend the American College of Surgeons (ACS) Residents Leading Quality course, a two-day program in quality improvement (QI). The course will take place 12:00 noon–5:00 pm, July 20, and 8:00 am–12:00 noon, July 21, immediately preceding the official start of the inaugural ACS Quality and Safety Conference 2017 in New York, NY.
Course participants will be introduced to the basics of QI, including the identification of a problem, data review, QI models and techniques, and patient and provider engagement strategies. National experts will discuss overcoming barriers and provide advice on careers in QI. The course will use practical case-based scenarios for initiating QI in a surgical practice or hospital.
The course information will prepare participants to return to their institutions ready to engage in quality and safety practices, share ideas with faculty and co-trainees, and disseminate new tools and strategies in compliance with modern recommendations from the Accreditation Council for Graduate Medical Education, the Residency Review Committee, and the American Board of Surgery.
Seating is limited. To be considered for enrollment, e-mail course staff at [email protected] by July 10 with your full name, credentials, institution, and surgical specialty. Describe in 75 words or less any relevant QI experience or aspirations. The course fee is $175 for Resident Members and $250 for non-member residents. (Apply to become a Resident Member of the College at facs.org/member-services/join/resident).
Attendees will be expected to review pre-course materials, and attendee feedback will be used for subsequent course development. A certificate of attendance will be issued upon completion of the program.
Expanded policy restricts health aid to countries that promote abortion
The U.S. State Department is moving forward with an expanded policy that restricts recipients of U.S. global health assistance from performing or promoting abortions.
In January, President Trump reinstated the “Mexico City Policy,” a policy that requires foreign nongovernmental organizations (NGOs) to certify they will not perform or actively promote abortion as a method of family planning using funds from any source as a condition for receiving U.S. global family planning assistance. The policy has been revoked and reinstated by presidential administrations along party lines for the last 32 years. However, President Trump’s order expands the definition of “global health assistance” to include funding for international health programs, such as HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health care.
“All foreign NGOs will have the opportunity to receive global health assistance awards if they indicate their agreement to abide by the terms of Protecting Life in Global Health Assistance by accepting the provisions in their award,” the department stated. “Given the expansive nature of the new policy, the department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next 6 months, which could include identifying implementation issues, and any other new information affecting implementation going forward.”
Nancy Northup, president and CEO for the Center for Reproductive Rights, called President Trump’s expansion of the “global gag rule” a major assault on those who serve the world’s poorest and most vulnerable women. “This policy does not protect life,” Ms. Northup said in a statement. “It jeopardizes the lives of countless women by withholding critical information and access to the full range of reproductive health care.”
But Rep. Chris Smith (R-N.J.), a supporter of the expanded policy, said it ensures that U.S. taxpayers will no longer subsidize foreign nongovernmental organizations that perform or promote abortion on demand. “This humane policy seeks to respect and protect the precious lives of unborn girls and boys from the violence of abortion,” Rep. Smith said in a statement. “The new policy doesn’t cut global health assistance by so much as a penny.”
[email protected]
On Twitter @legal_med
The U.S. State Department is moving forward with an expanded policy that restricts recipients of U.S. global health assistance from performing or promoting abortions.
In January, President Trump reinstated the “Mexico City Policy,” a policy that requires foreign nongovernmental organizations (NGOs) to certify they will not perform or actively promote abortion as a method of family planning using funds from any source as a condition for receiving U.S. global family planning assistance. The policy has been revoked and reinstated by presidential administrations along party lines for the last 32 years. However, President Trump’s order expands the definition of “global health assistance” to include funding for international health programs, such as HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health care.
“All foreign NGOs will have the opportunity to receive global health assistance awards if they indicate their agreement to abide by the terms of Protecting Life in Global Health Assistance by accepting the provisions in their award,” the department stated. “Given the expansive nature of the new policy, the department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next 6 months, which could include identifying implementation issues, and any other new information affecting implementation going forward.”
Nancy Northup, president and CEO for the Center for Reproductive Rights, called President Trump’s expansion of the “global gag rule” a major assault on those who serve the world’s poorest and most vulnerable women. “This policy does not protect life,” Ms. Northup said in a statement. “It jeopardizes the lives of countless women by withholding critical information and access to the full range of reproductive health care.”
But Rep. Chris Smith (R-N.J.), a supporter of the expanded policy, said it ensures that U.S. taxpayers will no longer subsidize foreign nongovernmental organizations that perform or promote abortion on demand. “This humane policy seeks to respect and protect the precious lives of unborn girls and boys from the violence of abortion,” Rep. Smith said in a statement. “The new policy doesn’t cut global health assistance by so much as a penny.”
[email protected]
On Twitter @legal_med
The U.S. State Department is moving forward with an expanded policy that restricts recipients of U.S. global health assistance from performing or promoting abortions.
In January, President Trump reinstated the “Mexico City Policy,” a policy that requires foreign nongovernmental organizations (NGOs) to certify they will not perform or actively promote abortion as a method of family planning using funds from any source as a condition for receiving U.S. global family planning assistance. The policy has been revoked and reinstated by presidential administrations along party lines for the last 32 years. However, President Trump’s order expands the definition of “global health assistance” to include funding for international health programs, such as HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health care.
“All foreign NGOs will have the opportunity to receive global health assistance awards if they indicate their agreement to abide by the terms of Protecting Life in Global Health Assistance by accepting the provisions in their award,” the department stated. “Given the expansive nature of the new policy, the department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next 6 months, which could include identifying implementation issues, and any other new information affecting implementation going forward.”
Nancy Northup, president and CEO for the Center for Reproductive Rights, called President Trump’s expansion of the “global gag rule” a major assault on those who serve the world’s poorest and most vulnerable women. “This policy does not protect life,” Ms. Northup said in a statement. “It jeopardizes the lives of countless women by withholding critical information and access to the full range of reproductive health care.”
But Rep. Chris Smith (R-N.J.), a supporter of the expanded policy, said it ensures that U.S. taxpayers will no longer subsidize foreign nongovernmental organizations that perform or promote abortion on demand. “This humane policy seeks to respect and protect the precious lives of unborn girls and boys from the violence of abortion,” Rep. Smith said in a statement. “The new policy doesn’t cut global health assistance by so much as a penny.”
[email protected]
On Twitter @legal_med
Combo antifungal/corticosteroid creams contraindicated in children
Don’t use combination antifungal/corticosteroid medications in children or for treating diaper dermatitis, warned Chikoti M. Wheat, MD, of Johns Hopkins University, Baltimore, and her associates.
Lotrisone is a combination product with a high-potency topical corticosteroid, betamethasone dipropionate 0.05% cream, and a topical antifungal agent, clotrimazole 1% cream. The Food and Drug Administration does not recommend it for the population and indication mentioned above, yet it is often used so off-label, Dr. Wheat and her associates said. Mycolog-II, a combination antifungal/corticosteroid with nystatin, an antiyeast agent, and triamcinolone, a medium-potency topical steroid, was taken off the market in 2015, but patients may still have some that they are inclined to use (J Pediatr. 2017. doi: 0.1016/j.jpeds.2017.03.031).
In a study of 9,797 patients aged 0-14 years who were prescribed either Lotrisone or Mycolog-II creams from 2007 to 2014, pediatricians were most likely to prescribe the combination creams (mean, 810 patients), followed by family physicians (mean, 309 patients), and dermatologists (mean, 49 patients). No pediatric dermatologists prescribed either cream.
Why are these combination creams being used?
Sometimes a fungal infection induces an inflammatory dermatitis. In these cases the use of both an antifungal and a corticosteroid with careful monitoring can benefit the patient, the researchers said. “Research, however, has shown that when combination antifungal/corticosteroid agents are used for fungal infections, they not only result in high rates of recurrence of fungal infections but also have greater side effect profiles.”
Also, in 1984, Lotrisone was approved by the FDA for treating tinea corporis, tinea pedis, and tinea cruris in patients older than 12 years. However, lack of efficacy and severe adverse effects including hypothalamic-pituitary-adrenal axis suppression, Cushing syndrome, hyperglycemia, hirsutism, delayed growth, and skin atrophy led the FDA to recommend that Lotrisone not be prescribed for patients younger than 17 years and not be prescribed to treat diaper dermatitis.
So what should you do?
Dr. Wheat and her associates recommend a single-agent topical antifungal to treat superficial fungal infection. If there is intense itching due to infection-induced dermatitis, add a low- or medium-potency topical corticosteroid for just 7-10 days.
For diaper dermatitis with a confirmed secondary fungal infection, they recommend a topical antifungal agent in combination with a barrier cream. “If intense inflammatory changes are present, a low- to medium-potency topical corticosteroid can be used up to twice daily and tapered over 1-2 weeks with careful monitoring,” they said.
Dr. Wheat and her associates declared they had no conflicts of interest.
[email protected]
Don’t use combination antifungal/corticosteroid medications in children or for treating diaper dermatitis, warned Chikoti M. Wheat, MD, of Johns Hopkins University, Baltimore, and her associates.
Lotrisone is a combination product with a high-potency topical corticosteroid, betamethasone dipropionate 0.05% cream, and a topical antifungal agent, clotrimazole 1% cream. The Food and Drug Administration does not recommend it for the population and indication mentioned above, yet it is often used so off-label, Dr. Wheat and her associates said. Mycolog-II, a combination antifungal/corticosteroid with nystatin, an antiyeast agent, and triamcinolone, a medium-potency topical steroid, was taken off the market in 2015, but patients may still have some that they are inclined to use (J Pediatr. 2017. doi: 0.1016/j.jpeds.2017.03.031).
In a study of 9,797 patients aged 0-14 years who were prescribed either Lotrisone or Mycolog-II creams from 2007 to 2014, pediatricians were most likely to prescribe the combination creams (mean, 810 patients), followed by family physicians (mean, 309 patients), and dermatologists (mean, 49 patients). No pediatric dermatologists prescribed either cream.
Why are these combination creams being used?
Sometimes a fungal infection induces an inflammatory dermatitis. In these cases the use of both an antifungal and a corticosteroid with careful monitoring can benefit the patient, the researchers said. “Research, however, has shown that when combination antifungal/corticosteroid agents are used for fungal infections, they not only result in high rates of recurrence of fungal infections but also have greater side effect profiles.”
Also, in 1984, Lotrisone was approved by the FDA for treating tinea corporis, tinea pedis, and tinea cruris in patients older than 12 years. However, lack of efficacy and severe adverse effects including hypothalamic-pituitary-adrenal axis suppression, Cushing syndrome, hyperglycemia, hirsutism, delayed growth, and skin atrophy led the FDA to recommend that Lotrisone not be prescribed for patients younger than 17 years and not be prescribed to treat diaper dermatitis.
So what should you do?
Dr. Wheat and her associates recommend a single-agent topical antifungal to treat superficial fungal infection. If there is intense itching due to infection-induced dermatitis, add a low- or medium-potency topical corticosteroid for just 7-10 days.
For diaper dermatitis with a confirmed secondary fungal infection, they recommend a topical antifungal agent in combination with a barrier cream. “If intense inflammatory changes are present, a low- to medium-potency topical corticosteroid can be used up to twice daily and tapered over 1-2 weeks with careful monitoring,” they said.
Dr. Wheat and her associates declared they had no conflicts of interest.
[email protected]
Don’t use combination antifungal/corticosteroid medications in children or for treating diaper dermatitis, warned Chikoti M. Wheat, MD, of Johns Hopkins University, Baltimore, and her associates.
Lotrisone is a combination product with a high-potency topical corticosteroid, betamethasone dipropionate 0.05% cream, and a topical antifungal agent, clotrimazole 1% cream. The Food and Drug Administration does not recommend it for the population and indication mentioned above, yet it is often used so off-label, Dr. Wheat and her associates said. Mycolog-II, a combination antifungal/corticosteroid with nystatin, an antiyeast agent, and triamcinolone, a medium-potency topical steroid, was taken off the market in 2015, but patients may still have some that they are inclined to use (J Pediatr. 2017. doi: 0.1016/j.jpeds.2017.03.031).
In a study of 9,797 patients aged 0-14 years who were prescribed either Lotrisone or Mycolog-II creams from 2007 to 2014, pediatricians were most likely to prescribe the combination creams (mean, 810 patients), followed by family physicians (mean, 309 patients), and dermatologists (mean, 49 patients). No pediatric dermatologists prescribed either cream.
Why are these combination creams being used?
Sometimes a fungal infection induces an inflammatory dermatitis. In these cases the use of both an antifungal and a corticosteroid with careful monitoring can benefit the patient, the researchers said. “Research, however, has shown that when combination antifungal/corticosteroid agents are used for fungal infections, they not only result in high rates of recurrence of fungal infections but also have greater side effect profiles.”
Also, in 1984, Lotrisone was approved by the FDA for treating tinea corporis, tinea pedis, and tinea cruris in patients older than 12 years. However, lack of efficacy and severe adverse effects including hypothalamic-pituitary-adrenal axis suppression, Cushing syndrome, hyperglycemia, hirsutism, delayed growth, and skin atrophy led the FDA to recommend that Lotrisone not be prescribed for patients younger than 17 years and not be prescribed to treat diaper dermatitis.
So what should you do?
Dr. Wheat and her associates recommend a single-agent topical antifungal to treat superficial fungal infection. If there is intense itching due to infection-induced dermatitis, add a low- or medium-potency topical corticosteroid for just 7-10 days.
For diaper dermatitis with a confirmed secondary fungal infection, they recommend a topical antifungal agent in combination with a barrier cream. “If intense inflammatory changes are present, a low- to medium-potency topical corticosteroid can be used up to twice daily and tapered over 1-2 weeks with careful monitoring,” they said.
Dr. Wheat and her associates declared they had no conflicts of interest.
[email protected]
FROM THE JOURNAL OF PEDIATRICS
Key clinical point:
Major finding: Pediatricians were most likely to prescribe the combination creams (mean, 810 patients), followed by family physicians (mean, 309 patients), dermatologists (mean, 49 patients), and pediatric dermatologists (none).
Data source: A study of 9,797 patients aged 0-14 years who were prescribed either Lotrisone or Mycolog-II creams from 2007 to 2014.
Disclosures: Dr. Wheat and her associates declared they had no conflicts of interest.
Intraoperative radiation looks good for DCIS
LAS VEGAS – Intraoperative radiation therapy (IORT) is effective in patients with ductal carcinoma in situ (DCIS), and bilateral digital mammography and breast MRI effectively predicted which patients would be most suited for the procedure, according to a nonrandomized study.
The TARGIT-A trial showed that IORT was noninferior to external beam radiation therapy in women with early-stage breast cancer (Lancet. 2014 Feb 15;383:603-13), but the technique hasn’t been tested in DCIS patients.
The researchers conducted a prospective, nonrandomized study of DCIS in women who underwent core biopsy between February 2012 and July 2016 at Virginia Mason Medical Center. Those who elected breast conserving therapy were assessed for IORT using bilateral digital mammography and contrast enhanced MRI.
For criteria, the researchers selected patients over age 44 years with unifocal DCIS and a lesion size of up to 3.0 cm. Physicians recommended additional therapy when the pathology report revealed DCIS larger than 3 cm and/or margins of up to 2 mm.
Of the 57 patients initially enrolled, 7 were found to have invasive disease and were excluded. Another eight patients were excluded because of margins, tumor size, or multifocal disease, and were recommended for additional treatment.
The remaining 42 patients with DCIS were treated with IORT. At a mean follow-up time of 32 months, the researchers observed no local recurrences, and no Radiation Therapy Oncology Group grade 3 or 4 complications were reported.
Hyperpigmentation occurred more often in the IORT group, at 40% (17 of 42 patients), than in the additional treatment group, at 13% (1 of 8), a nonsignificant difference. The hyperpigmentation tended to be minimal and focused on the surgical scar. There were no differences between the groups with respect to superficial wound separation, infection, seroma, fat necrosis, transient radiation dermatitis, or rib fracture.
“Our conclusions are that are selection criteria with mammography and MRI are effective in identifying patients who are appropriate for IORT, and importantly, at 32 months follow-up, no patients had recurrences, so we’re not negatively impacting oncological outcome,” said Dr. Carlson.
The fact that eight patients were recommended for additional treatment based on margins, a disease span greater than 3 cm, or multifocal disease “is actually quite heartening because it implies that the mammogram and the MRI are quite effective at identifying patients that met our criteria,” said Dr. Carlson.
The study is small and had no control group, but Dr. Carlson is confident of the results. “We didn’t do a randomized trial because we believed strongly that IORT will be effective in these patients with good cosmesis. When you compare it to local recurrence rates in the TARGIT-A trial, we’re still doing quite well, so to some extent that can be used as a baseline benchmark,” she said.
LAS VEGAS – Intraoperative radiation therapy (IORT) is effective in patients with ductal carcinoma in situ (DCIS), and bilateral digital mammography and breast MRI effectively predicted which patients would be most suited for the procedure, according to a nonrandomized study.
The TARGIT-A trial showed that IORT was noninferior to external beam radiation therapy in women with early-stage breast cancer (Lancet. 2014 Feb 15;383:603-13), but the technique hasn’t been tested in DCIS patients.
The researchers conducted a prospective, nonrandomized study of DCIS in women who underwent core biopsy between February 2012 and July 2016 at Virginia Mason Medical Center. Those who elected breast conserving therapy were assessed for IORT using bilateral digital mammography and contrast enhanced MRI.
For criteria, the researchers selected patients over age 44 years with unifocal DCIS and a lesion size of up to 3.0 cm. Physicians recommended additional therapy when the pathology report revealed DCIS larger than 3 cm and/or margins of up to 2 mm.
Of the 57 patients initially enrolled, 7 were found to have invasive disease and were excluded. Another eight patients were excluded because of margins, tumor size, or multifocal disease, and were recommended for additional treatment.
The remaining 42 patients with DCIS were treated with IORT. At a mean follow-up time of 32 months, the researchers observed no local recurrences, and no Radiation Therapy Oncology Group grade 3 or 4 complications were reported.
Hyperpigmentation occurred more often in the IORT group, at 40% (17 of 42 patients), than in the additional treatment group, at 13% (1 of 8), a nonsignificant difference. The hyperpigmentation tended to be minimal and focused on the surgical scar. There were no differences between the groups with respect to superficial wound separation, infection, seroma, fat necrosis, transient radiation dermatitis, or rib fracture.
“Our conclusions are that are selection criteria with mammography and MRI are effective in identifying patients who are appropriate for IORT, and importantly, at 32 months follow-up, no patients had recurrences, so we’re not negatively impacting oncological outcome,” said Dr. Carlson.
The fact that eight patients were recommended for additional treatment based on margins, a disease span greater than 3 cm, or multifocal disease “is actually quite heartening because it implies that the mammogram and the MRI are quite effective at identifying patients that met our criteria,” said Dr. Carlson.
The study is small and had no control group, but Dr. Carlson is confident of the results. “We didn’t do a randomized trial because we believed strongly that IORT will be effective in these patients with good cosmesis. When you compare it to local recurrence rates in the TARGIT-A trial, we’re still doing quite well, so to some extent that can be used as a baseline benchmark,” she said.
LAS VEGAS – Intraoperative radiation therapy (IORT) is effective in patients with ductal carcinoma in situ (DCIS), and bilateral digital mammography and breast MRI effectively predicted which patients would be most suited for the procedure, according to a nonrandomized study.
The TARGIT-A trial showed that IORT was noninferior to external beam radiation therapy in women with early-stage breast cancer (Lancet. 2014 Feb 15;383:603-13), but the technique hasn’t been tested in DCIS patients.
The researchers conducted a prospective, nonrandomized study of DCIS in women who underwent core biopsy between February 2012 and July 2016 at Virginia Mason Medical Center. Those who elected breast conserving therapy were assessed for IORT using bilateral digital mammography and contrast enhanced MRI.
For criteria, the researchers selected patients over age 44 years with unifocal DCIS and a lesion size of up to 3.0 cm. Physicians recommended additional therapy when the pathology report revealed DCIS larger than 3 cm and/or margins of up to 2 mm.
Of the 57 patients initially enrolled, 7 were found to have invasive disease and were excluded. Another eight patients were excluded because of margins, tumor size, or multifocal disease, and were recommended for additional treatment.
The remaining 42 patients with DCIS were treated with IORT. At a mean follow-up time of 32 months, the researchers observed no local recurrences, and no Radiation Therapy Oncology Group grade 3 or 4 complications were reported.
Hyperpigmentation occurred more often in the IORT group, at 40% (17 of 42 patients), than in the additional treatment group, at 13% (1 of 8), a nonsignificant difference. The hyperpigmentation tended to be minimal and focused on the surgical scar. There were no differences between the groups with respect to superficial wound separation, infection, seroma, fat necrosis, transient radiation dermatitis, or rib fracture.
“Our conclusions are that are selection criteria with mammography and MRI are effective in identifying patients who are appropriate for IORT, and importantly, at 32 months follow-up, no patients had recurrences, so we’re not negatively impacting oncological outcome,” said Dr. Carlson.
The fact that eight patients were recommended for additional treatment based on margins, a disease span greater than 3 cm, or multifocal disease “is actually quite heartening because it implies that the mammogram and the MRI are quite effective at identifying patients that met our criteria,” said Dr. Carlson.
The study is small and had no control group, but Dr. Carlson is confident of the results. “We didn’t do a randomized trial because we believed strongly that IORT will be effective in these patients with good cosmesis. When you compare it to local recurrence rates in the TARGIT-A trial, we’re still doing quite well, so to some extent that can be used as a baseline benchmark,” she said.
AT ASBS 2017
Key clinical point: Intraoperative radiation appears safe and effective, and is more convenient than postoperative radiation.
Major finding: There were no ductal carcinoma in situ recurrences at a median 32 months’ follow-up.
Data source: Uncontrolled, prospective study of 42 patients.
Disclosures: The study was funded by the National Institutes of Health. Dr. Carlson reported having no financial disclosures.
Sexual dysfunction, depression common in endometriosis patients
VANCOUVER – Endometriosis is associated with an increased risk of a range of sexual dysfunctions, and depression and anxiety are also common, according to a study conducted in Brazilian women.
Depression and anxiety were so common that the study itself had to be altered. Almost a third of participants were excluded from the study due to depressive symptoms. So many, in fact, that the researchers decided to include patients with mild to moderate depression and anxiety, and ultimately exclude only those with severe symptoms.
The final sample included 254 women with endometriosis and 329 control subjects between 18 and 45 years old. They all had an active sex life in the previous 6 months, and were heterosexual.
Forty-three percent of women in the endometriosis group had sexual dysfunction, compared with 18% in the control group (P less than .001), as measured by the Female Sexual Quotient. They also had higher rates of individual types of sexual dysfunction, including sexual desire dysfunction (25% vs. 16%; P = .007); sexual arousal dysfunction (16% vs. 4%; P less than .001); pain during intercourse/sex dysfunction (46% vs. 16%; P less than .001); and orgasm and/or sexual satisfaction dysfunction (30% vs. 13%; P less than .001).
The researchers also examined the relationship between sexual dysfunction and psychological factors, and found statistically significant positive associations with anxiety and depression.
The underlying psychological issues are of particular concern to Dr. Fairbanks. “It’s the main step to begin anything with them. We have to know if they have anxiety and depression or not,” she said.
Her team now asks patients with endometriosis about their sex life in order to establish a baseline that can be referred to. “After 1 year, 2 years, 5 years, we reapply the questionnaire to show them that their sexual life was not so good in the beginning.”
The study was eye-opening to Lori Brotto, PhD, professor of gynecology at the University of British Columbia, Vancouver, who was a discussant at the session. “The call to action is for doctors to really pay attention to sexual dysfunction, even though that might not be the primary issue that brings the patient to them,” Dr. Brotto said.
The high rates of depression and anxiety also suggest a need for a more rounded approach to endometriosis treatment. “A physician may think, ‘we’ll treat the endometriosis, and all other parts of her should improve as well.’ This study suggests that primarily physical interventions may not be sufficient for addressing something like sexual health, which is really mind and body together,” said Dr. Brotto.
The study was not funded. Dr. Fairbanks and Dr. Brotto reported having no relevant financial disclosures.
VANCOUVER – Endometriosis is associated with an increased risk of a range of sexual dysfunctions, and depression and anxiety are also common, according to a study conducted in Brazilian women.
Depression and anxiety were so common that the study itself had to be altered. Almost a third of participants were excluded from the study due to depressive symptoms. So many, in fact, that the researchers decided to include patients with mild to moderate depression and anxiety, and ultimately exclude only those with severe symptoms.
The final sample included 254 women with endometriosis and 329 control subjects between 18 and 45 years old. They all had an active sex life in the previous 6 months, and were heterosexual.
Forty-three percent of women in the endometriosis group had sexual dysfunction, compared with 18% in the control group (P less than .001), as measured by the Female Sexual Quotient. They also had higher rates of individual types of sexual dysfunction, including sexual desire dysfunction (25% vs. 16%; P = .007); sexual arousal dysfunction (16% vs. 4%; P less than .001); pain during intercourse/sex dysfunction (46% vs. 16%; P less than .001); and orgasm and/or sexual satisfaction dysfunction (30% vs. 13%; P less than .001).
The researchers also examined the relationship between sexual dysfunction and psychological factors, and found statistically significant positive associations with anxiety and depression.
The underlying psychological issues are of particular concern to Dr. Fairbanks. “It’s the main step to begin anything with them. We have to know if they have anxiety and depression or not,” she said.
Her team now asks patients with endometriosis about their sex life in order to establish a baseline that can be referred to. “After 1 year, 2 years, 5 years, we reapply the questionnaire to show them that their sexual life was not so good in the beginning.”
The study was eye-opening to Lori Brotto, PhD, professor of gynecology at the University of British Columbia, Vancouver, who was a discussant at the session. “The call to action is for doctors to really pay attention to sexual dysfunction, even though that might not be the primary issue that brings the patient to them,” Dr. Brotto said.
The high rates of depression and anxiety also suggest a need for a more rounded approach to endometriosis treatment. “A physician may think, ‘we’ll treat the endometriosis, and all other parts of her should improve as well.’ This study suggests that primarily physical interventions may not be sufficient for addressing something like sexual health, which is really mind and body together,” said Dr. Brotto.
The study was not funded. Dr. Fairbanks and Dr. Brotto reported having no relevant financial disclosures.
VANCOUVER – Endometriosis is associated with an increased risk of a range of sexual dysfunctions, and depression and anxiety are also common, according to a study conducted in Brazilian women.
Depression and anxiety were so common that the study itself had to be altered. Almost a third of participants were excluded from the study due to depressive symptoms. So many, in fact, that the researchers decided to include patients with mild to moderate depression and anxiety, and ultimately exclude only those with severe symptoms.
The final sample included 254 women with endometriosis and 329 control subjects between 18 and 45 years old. They all had an active sex life in the previous 6 months, and were heterosexual.
Forty-three percent of women in the endometriosis group had sexual dysfunction, compared with 18% in the control group (P less than .001), as measured by the Female Sexual Quotient. They also had higher rates of individual types of sexual dysfunction, including sexual desire dysfunction (25% vs. 16%; P = .007); sexual arousal dysfunction (16% vs. 4%; P less than .001); pain during intercourse/sex dysfunction (46% vs. 16%; P less than .001); and orgasm and/or sexual satisfaction dysfunction (30% vs. 13%; P less than .001).
The researchers also examined the relationship between sexual dysfunction and psychological factors, and found statistically significant positive associations with anxiety and depression.
The underlying psychological issues are of particular concern to Dr. Fairbanks. “It’s the main step to begin anything with them. We have to know if they have anxiety and depression or not,” she said.
Her team now asks patients with endometriosis about their sex life in order to establish a baseline that can be referred to. “After 1 year, 2 years, 5 years, we reapply the questionnaire to show them that their sexual life was not so good in the beginning.”
The study was eye-opening to Lori Brotto, PhD, professor of gynecology at the University of British Columbia, Vancouver, who was a discussant at the session. “The call to action is for doctors to really pay attention to sexual dysfunction, even though that might not be the primary issue that brings the patient to them,” Dr. Brotto said.
The high rates of depression and anxiety also suggest a need for a more rounded approach to endometriosis treatment. “A physician may think, ‘we’ll treat the endometriosis, and all other parts of her should improve as well.’ This study suggests that primarily physical interventions may not be sufficient for addressing something like sexual health, which is really mind and body together,” said Dr. Brotto.
The study was not funded. Dr. Fairbanks and Dr. Brotto reported having no relevant financial disclosures.
AT WCE 2017
Key clinical point: Sexual dysfunction is common but not always addressed by clinicians.
Major finding: Women with endometriosis had more than doubled risk of sexual dysfunction.
Data source: Forty-three percent of the endometriosis group had dysfunction, compared with 17.6% of controls.
Disclosures: The study was not funded. Dr. Fairbanks and Dr. Brotto reported having no relevant financial disclosures.
Meconium-stained amniotic fluid linked to postcesarean SSI
SAN DIEGO – Meconium-stained amniotic fluid may increased risk of surgical site infections following a cesarean delivery, results from a large analysis showed.
Surgical site infection (SSI) occurs in 3%-9% of patients who have a cesarean delivery, and many require hospitalization or further surgery, lead study author Andrea Snyder, MD, PhD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. Risk factors for SSI included chorioamnionitis, obesity, preeclampsia, preterm premature rupture of membranes, nulliparity, or emergency cesarean. Current management for avoiding SSIs includes prophylactic antibiotics, antiseptic skin, and vaginal prep.
In an effort to test the hypothesis that meconium-stained fluid is an independent risk factor associated with an increased risk of postcesarean SSI, she and her associates evaluated a subset of 25,220 women from the Maternal-Fetal Medicine Units Network cesarean registry who were treated at 19 different institutions. Their mean age was 27 years, they were all attempting labor or induction of labor, were all singleton pregnancies, and all had cesarean deliveries.
Of the 25,220 patients studied, 5,883 (23%) had MSAF. The researchers found that the incidence of SSI was 11.9% among patients who had MSAF, compared with an incidence of 8.9% among patients who did not, a difference that reached statistical significance (P less than .001). After using a multivariable logistic regression model to control for confounders including chorioamnionitis, diabetes, intrauterine pressure catheter placement, tobacco use, length of labor, length of rupture, preeclampsia, and obesity, the association between MSAF and SSI persisted (odds ratio, 1.25; confidence interval, 1.12-1.39; P less than .001).
Advantages of the study, she said, include the fact that it was a large population of patients treated at multiple institutions, “so it should be very generalizable to most practices. We also controlled for many known factors associated with SSI.” Dr. Snyder acknowledged certain limitations of the study, including the fact that the data do not show causation and that there is no further information about the SSIs. “Were those associated with meconium less or more severe SSIs?” she asked. “Does the increase in risk confer an increased risk of severe infectious morbidity? Where do we go from here and what do we do with this information? At this point we don’t have any way of preventing meconium.”
A 2014 Cochrane review found that, while prophylactic antibiotics for patients with MSAF did not decrease the risk of postpartum endometriosis, it did decrease the risk of chorioamnionitis. “But would it help decrease the risk of SSIs? We have no idea,” Dr. Snyder asked. “Would continuing antibiotics after delivery help reduce wound infections? We don’t do that routinely in a C-section, but maybe that would make sense for patients that are higher risk.” She reported having no financial disclosures.
[email protected]
SAN DIEGO – Meconium-stained amniotic fluid may increased risk of surgical site infections following a cesarean delivery, results from a large analysis showed.
Surgical site infection (SSI) occurs in 3%-9% of patients who have a cesarean delivery, and many require hospitalization or further surgery, lead study author Andrea Snyder, MD, PhD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. Risk factors for SSI included chorioamnionitis, obesity, preeclampsia, preterm premature rupture of membranes, nulliparity, or emergency cesarean. Current management for avoiding SSIs includes prophylactic antibiotics, antiseptic skin, and vaginal prep.
In an effort to test the hypothesis that meconium-stained fluid is an independent risk factor associated with an increased risk of postcesarean SSI, she and her associates evaluated a subset of 25,220 women from the Maternal-Fetal Medicine Units Network cesarean registry who were treated at 19 different institutions. Their mean age was 27 years, they were all attempting labor or induction of labor, were all singleton pregnancies, and all had cesarean deliveries.
Of the 25,220 patients studied, 5,883 (23%) had MSAF. The researchers found that the incidence of SSI was 11.9% among patients who had MSAF, compared with an incidence of 8.9% among patients who did not, a difference that reached statistical significance (P less than .001). After using a multivariable logistic regression model to control for confounders including chorioamnionitis, diabetes, intrauterine pressure catheter placement, tobacco use, length of labor, length of rupture, preeclampsia, and obesity, the association between MSAF and SSI persisted (odds ratio, 1.25; confidence interval, 1.12-1.39; P less than .001).
Advantages of the study, she said, include the fact that it was a large population of patients treated at multiple institutions, “so it should be very generalizable to most practices. We also controlled for many known factors associated with SSI.” Dr. Snyder acknowledged certain limitations of the study, including the fact that the data do not show causation and that there is no further information about the SSIs. “Were those associated with meconium less or more severe SSIs?” she asked. “Does the increase in risk confer an increased risk of severe infectious morbidity? Where do we go from here and what do we do with this information? At this point we don’t have any way of preventing meconium.”
A 2014 Cochrane review found that, while prophylactic antibiotics for patients with MSAF did not decrease the risk of postpartum endometriosis, it did decrease the risk of chorioamnionitis. “But would it help decrease the risk of SSIs? We have no idea,” Dr. Snyder asked. “Would continuing antibiotics after delivery help reduce wound infections? We don’t do that routinely in a C-section, but maybe that would make sense for patients that are higher risk.” She reported having no financial disclosures.
[email protected]
SAN DIEGO – Meconium-stained amniotic fluid may increased risk of surgical site infections following a cesarean delivery, results from a large analysis showed.
Surgical site infection (SSI) occurs in 3%-9% of patients who have a cesarean delivery, and many require hospitalization or further surgery, lead study author Andrea Snyder, MD, PhD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. Risk factors for SSI included chorioamnionitis, obesity, preeclampsia, preterm premature rupture of membranes, nulliparity, or emergency cesarean. Current management for avoiding SSIs includes prophylactic antibiotics, antiseptic skin, and vaginal prep.
In an effort to test the hypothesis that meconium-stained fluid is an independent risk factor associated with an increased risk of postcesarean SSI, she and her associates evaluated a subset of 25,220 women from the Maternal-Fetal Medicine Units Network cesarean registry who were treated at 19 different institutions. Their mean age was 27 years, they were all attempting labor or induction of labor, were all singleton pregnancies, and all had cesarean deliveries.
Of the 25,220 patients studied, 5,883 (23%) had MSAF. The researchers found that the incidence of SSI was 11.9% among patients who had MSAF, compared with an incidence of 8.9% among patients who did not, a difference that reached statistical significance (P less than .001). After using a multivariable logistic regression model to control for confounders including chorioamnionitis, diabetes, intrauterine pressure catheter placement, tobacco use, length of labor, length of rupture, preeclampsia, and obesity, the association between MSAF and SSI persisted (odds ratio, 1.25; confidence interval, 1.12-1.39; P less than .001).
Advantages of the study, she said, include the fact that it was a large population of patients treated at multiple institutions, “so it should be very generalizable to most practices. We also controlled for many known factors associated with SSI.” Dr. Snyder acknowledged certain limitations of the study, including the fact that the data do not show causation and that there is no further information about the SSIs. “Were those associated with meconium less or more severe SSIs?” she asked. “Does the increase in risk confer an increased risk of severe infectious morbidity? Where do we go from here and what do we do with this information? At this point we don’t have any way of preventing meconium.”
A 2014 Cochrane review found that, while prophylactic antibiotics for patients with MSAF did not decrease the risk of postpartum endometriosis, it did decrease the risk of chorioamnionitis. “But would it help decrease the risk of SSIs? We have no idea,” Dr. Snyder asked. “Would continuing antibiotics after delivery help reduce wound infections? We don’t do that routinely in a C-section, but maybe that would make sense for patients that are higher risk.” She reported having no financial disclosures.
[email protected]
AT ACOG 2017
Key clinical point:
Major finding: The incidence of SSI was 11.9% in patients who had meconium-stained amniotic fluid, compared with an incidence of 8.9% in patients who did not, a difference that reached statistical significance (P less than .001).
Data source: A subset analysis of 25,220 women from the Maternal-Fetal Medicine Networks Cesarean Registry who were treated at 19 different institutions.
Disclosures: Dr. Snyder reported having no financial disclosures.