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Foresight and hard work – not inevitability – shaped HM, CEO says
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
Conway says health care payment, quality reform to continue
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
Hidradenitis suppurativa diagnosis typically delayed in children
WASHINGTON – Children with hidradenitis suppurativa (HS) may suffer with symptoms for an average of 7 years before they are diagnosed, according to pediatric dermatologist Anna Yasmine Kirkorian, MD.
Data from a 2015 study showed that 73% of pediatric patients with HS were diagnosed more than 2 years after the onset of symptoms, said Dr. Kirkorian of the department of dermatology at Children’s National Health System and George Washington University, Washington. (Br J Dermatol. 2015 Dec;173[6]:1546-9).
Genetics can play a role in HS, likely via mutations in the gamma-secretase protein that leads to epidermal differentiation and immune regulation, Dr. Kirkorian said. Most of her patients with HS are black, and a recent study described a gamma-secretase mutation in a black family of a proband and four family members, she noted (JAMA Dermatol. 2015 Jun;151[6]:668-70). Gamma-secretase mutations also have been identified in Han Chinese populations, she said.
HS also is associated with precocious puberty. However, defining the age of onset of puberty can be difficulty because pubertal onset may vary between different ethnicities, noted Dr. Kirkorian. “Prepubertal children presenting with HS warrant an endocrinologic evaluation,” she said.
Dr. Kirkorian added that more research is needed to pinpoint the possible genetic component of HS and to identify genetic susceptibility that could lead to targeted treatment strategies.
The optimal treatment plan for pediatric HS is multimodal and addresses the comorbidities common with the condition, she said, and she predicted that specialized clinic or treatment centers that bring together areas, including psychiatry, wound care, pain management, surgery, endocrinology, and genetics, will evolve to serve these patients. To support these collaborative efforts, Dr. Kirkorian is a member of the Pediatric Dermatology Research Alliance (PeDRA), an organization formed to accelerate research on skin diseases in children.
The symposium was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose. She is on the editorial board of Dermatology News.
WASHINGTON – Children with hidradenitis suppurativa (HS) may suffer with symptoms for an average of 7 years before they are diagnosed, according to pediatric dermatologist Anna Yasmine Kirkorian, MD.
Data from a 2015 study showed that 73% of pediatric patients with HS were diagnosed more than 2 years after the onset of symptoms, said Dr. Kirkorian of the department of dermatology at Children’s National Health System and George Washington University, Washington. (Br J Dermatol. 2015 Dec;173[6]:1546-9).
Genetics can play a role in HS, likely via mutations in the gamma-secretase protein that leads to epidermal differentiation and immune regulation, Dr. Kirkorian said. Most of her patients with HS are black, and a recent study described a gamma-secretase mutation in a black family of a proband and four family members, she noted (JAMA Dermatol. 2015 Jun;151[6]:668-70). Gamma-secretase mutations also have been identified in Han Chinese populations, she said.
HS also is associated with precocious puberty. However, defining the age of onset of puberty can be difficulty because pubertal onset may vary between different ethnicities, noted Dr. Kirkorian. “Prepubertal children presenting with HS warrant an endocrinologic evaluation,” she said.
Dr. Kirkorian added that more research is needed to pinpoint the possible genetic component of HS and to identify genetic susceptibility that could lead to targeted treatment strategies.
The optimal treatment plan for pediatric HS is multimodal and addresses the comorbidities common with the condition, she said, and she predicted that specialized clinic or treatment centers that bring together areas, including psychiatry, wound care, pain management, surgery, endocrinology, and genetics, will evolve to serve these patients. To support these collaborative efforts, Dr. Kirkorian is a member of the Pediatric Dermatology Research Alliance (PeDRA), an organization formed to accelerate research on skin diseases in children.
The symposium was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose. She is on the editorial board of Dermatology News.
WASHINGTON – Children with hidradenitis suppurativa (HS) may suffer with symptoms for an average of 7 years before they are diagnosed, according to pediatric dermatologist Anna Yasmine Kirkorian, MD.
Data from a 2015 study showed that 73% of pediatric patients with HS were diagnosed more than 2 years after the onset of symptoms, said Dr. Kirkorian of the department of dermatology at Children’s National Health System and George Washington University, Washington. (Br J Dermatol. 2015 Dec;173[6]:1546-9).
Genetics can play a role in HS, likely via mutations in the gamma-secretase protein that leads to epidermal differentiation and immune regulation, Dr. Kirkorian said. Most of her patients with HS are black, and a recent study described a gamma-secretase mutation in a black family of a proband and four family members, she noted (JAMA Dermatol. 2015 Jun;151[6]:668-70). Gamma-secretase mutations also have been identified in Han Chinese populations, she said.
HS also is associated with precocious puberty. However, defining the age of onset of puberty can be difficulty because pubertal onset may vary between different ethnicities, noted Dr. Kirkorian. “Prepubertal children presenting with HS warrant an endocrinologic evaluation,” she said.
Dr. Kirkorian added that more research is needed to pinpoint the possible genetic component of HS and to identify genetic susceptibility that could lead to targeted treatment strategies.
The optimal treatment plan for pediatric HS is multimodal and addresses the comorbidities common with the condition, she said, and she predicted that specialized clinic or treatment centers that bring together areas, including psychiatry, wound care, pain management, surgery, endocrinology, and genetics, will evolve to serve these patients. To support these collaborative efforts, Dr. Kirkorian is a member of the Pediatric Dermatology Research Alliance (PeDRA), an organization formed to accelerate research on skin diseases in children.
The symposium was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose. She is on the editorial board of Dermatology News.
From idea to abstract, RIV posters highlight novel thinking
Masih Shinwa, MD, stood beside a half-circle of judges Tuesday night at SHM’s annual Research, Innovations and Clinical Vignettes (RIV) poster competition and argued why his entry, already a finalist, should win. And to think, his poster, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was born simply of a group of medical students who incredulously said they were amazed patients would be woken in the middle of the night for laboratory tests.
Eighteen months later, the poster drew hundreds of questions from passersby on how a team approach could help generate fewer labs and chemistry testing. Now, the work could serve as a potential guide for other hospitals seeking to reduce unnecessary tests, a focal point of SHM and the ABIM Foundation’s Choosing Wisely campaign.
“This is a way to make it national,” he said. “You may have affected the lives of the patients in your hospital, but unless you attend these types of national meetings, it’s hard to get that perspective across [the country].”
That level of personal and professional collaboration is the purpose of the RIV, one of the best-attended events of SHM’s annual meeting. The event has become so popular that submissions this year tallied 1,712, nearly triple the number of submissions at the 2010 event.
“One of the amazing things is everyone has their own poster. They are doing their work,” said Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, the formal name for the poster contest. “But then they start up conversations with the people next to them. ... seeing the organic networking and the discussions that arise from that is really exciting. RIV really serves as a way of connecting people together who might not have known the other person was doing that kind of work.”
Dr. Shinwa said that the specialty’s focus on research is important. He said it positions the field to be leaders, not just for patient care, but for hospitals and institutions.
“We are physicians. Our role is taking care of patients,” he said. “[But] knowing that there are people who are not just focusing on taking care of specific patients, but are actually there to improve the entire system and the process, that is really gratifying.”
Masih Shinwa, MD, stood beside a half-circle of judges Tuesday night at SHM’s annual Research, Innovations and Clinical Vignettes (RIV) poster competition and argued why his entry, already a finalist, should win. And to think, his poster, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was born simply of a group of medical students who incredulously said they were amazed patients would be woken in the middle of the night for laboratory tests.
Eighteen months later, the poster drew hundreds of questions from passersby on how a team approach could help generate fewer labs and chemistry testing. Now, the work could serve as a potential guide for other hospitals seeking to reduce unnecessary tests, a focal point of SHM and the ABIM Foundation’s Choosing Wisely campaign.
“This is a way to make it national,” he said. “You may have affected the lives of the patients in your hospital, but unless you attend these types of national meetings, it’s hard to get that perspective across [the country].”
That level of personal and professional collaboration is the purpose of the RIV, one of the best-attended events of SHM’s annual meeting. The event has become so popular that submissions this year tallied 1,712, nearly triple the number of submissions at the 2010 event.
“One of the amazing things is everyone has their own poster. They are doing their work,” said Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, the formal name for the poster contest. “But then they start up conversations with the people next to them. ... seeing the organic networking and the discussions that arise from that is really exciting. RIV really serves as a way of connecting people together who might not have known the other person was doing that kind of work.”
Dr. Shinwa said that the specialty’s focus on research is important. He said it positions the field to be leaders, not just for patient care, but for hospitals and institutions.
“We are physicians. Our role is taking care of patients,” he said. “[But] knowing that there are people who are not just focusing on taking care of specific patients, but are actually there to improve the entire system and the process, that is really gratifying.”
Masih Shinwa, MD, stood beside a half-circle of judges Tuesday night at SHM’s annual Research, Innovations and Clinical Vignettes (RIV) poster competition and argued why his entry, already a finalist, should win. And to think, his poster, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was born simply of a group of medical students who incredulously said they were amazed patients would be woken in the middle of the night for laboratory tests.
Eighteen months later, the poster drew hundreds of questions from passersby on how a team approach could help generate fewer labs and chemistry testing. Now, the work could serve as a potential guide for other hospitals seeking to reduce unnecessary tests, a focal point of SHM and the ABIM Foundation’s Choosing Wisely campaign.
“This is a way to make it national,” he said. “You may have affected the lives of the patients in your hospital, but unless you attend these types of national meetings, it’s hard to get that perspective across [the country].”
That level of personal and professional collaboration is the purpose of the RIV, one of the best-attended events of SHM’s annual meeting. The event has become so popular that submissions this year tallied 1,712, nearly triple the number of submissions at the 2010 event.
“One of the amazing things is everyone has their own poster. They are doing their work,” said Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, the formal name for the poster contest. “But then they start up conversations with the people next to them. ... seeing the organic networking and the discussions that arise from that is really exciting. RIV really serves as a way of connecting people together who might not have known the other person was doing that kind of work.”
Dr. Shinwa said that the specialty’s focus on research is important. He said it positions the field to be leaders, not just for patient care, but for hospitals and institutions.
“We are physicians. Our role is taking care of patients,” he said. “[But] knowing that there are people who are not just focusing on taking care of specific patients, but are actually there to improve the entire system and the process, that is really gratifying.”
No increase in hand osteoarthritis seen in Sjögren’s syndrome
LAS VEGAS – Patients with Sjögren’s syndrome do not have an increased prevalence of hand osteoarthritis, but they are strongly predisposed to have a history of hypothyroidism, Jeremie Sellam, MD, reported at the World Congress on Osteoarthritis.
Both of these findings in his small case-control study were unexpected, he added at the congress sponsored by the Osteoarthritis Research Society International.
The study included 34 women with primary Sjögren’s syndrome according to the 2002 American-European Consensus Group criteria and 54 female controls with sicca syndrome but no autoantibodies and no Sjögren’s syndrome. All subjects were evaluated at a specialized tertiary Sjögren’s syndrome clinic. The controls were referred there to ascertain whether they had Sjögren’s syndrome.
Among the Sjögren’s syndrome patients, 41% had radiographic evidence of hand osteoarthritis, 12% had symptomatic hand osteoarthritis, and 9% had erosive hand osteoarthritis. In the sicca syndrome–only patients, the rates were similar at 52%, 28%, and 9%, respectively.
Looking for commonalities and differences between the Sjögren’s syndrome patients and controls, Dr. Sellam and his coinvestigators noted that the Sjögren’s syndrome patients were significantly older, with an average age of 64 years, compared with 48.5 years in the controls.
Impressively, two-thirds of the 15 Sjögren’s syndrome patients with hand osteoarthritis had a history of hypothyroidism, compared with just 15% of the 27 non-autoimmune sicca syndrome patients with hand osteoarthritis and one-quarter of the Sjögren’s syndrome patients without hand osteoarthritis. This suggests a possible interaction between Sjögren’s syndrome, hand osteoarthritis, and a history of hypothyroidism which merits further study, according to the rheumatologist.
Because of the relatively small patient numbers in the French study, Dr. Sellam and coworkers ran a crosscheck with data from the Framingham Osteoarthritis Study and found hand osteoarthritis prevalence rates comparable to their own findings. For example, the prevalences of radiographic and erosive hand osteoarthritis in the French Sjögren’s syndrome and non-autoimmune sicca syndrome groups were similar to the 44% and 10% figures, respectively, in the general population of age-matched Framingham women (Ann Rheum Dis. 2011 Sep;70[9]:1581-6).
He reported having no financial conflicts regarding his study, which was conducted free of commercial support.
LAS VEGAS – Patients with Sjögren’s syndrome do not have an increased prevalence of hand osteoarthritis, but they are strongly predisposed to have a history of hypothyroidism, Jeremie Sellam, MD, reported at the World Congress on Osteoarthritis.
Both of these findings in his small case-control study were unexpected, he added at the congress sponsored by the Osteoarthritis Research Society International.
The study included 34 women with primary Sjögren’s syndrome according to the 2002 American-European Consensus Group criteria and 54 female controls with sicca syndrome but no autoantibodies and no Sjögren’s syndrome. All subjects were evaluated at a specialized tertiary Sjögren’s syndrome clinic. The controls were referred there to ascertain whether they had Sjögren’s syndrome.
Among the Sjögren’s syndrome patients, 41% had radiographic evidence of hand osteoarthritis, 12% had symptomatic hand osteoarthritis, and 9% had erosive hand osteoarthritis. In the sicca syndrome–only patients, the rates were similar at 52%, 28%, and 9%, respectively.
Looking for commonalities and differences between the Sjögren’s syndrome patients and controls, Dr. Sellam and his coinvestigators noted that the Sjögren’s syndrome patients were significantly older, with an average age of 64 years, compared with 48.5 years in the controls.
Impressively, two-thirds of the 15 Sjögren’s syndrome patients with hand osteoarthritis had a history of hypothyroidism, compared with just 15% of the 27 non-autoimmune sicca syndrome patients with hand osteoarthritis and one-quarter of the Sjögren’s syndrome patients without hand osteoarthritis. This suggests a possible interaction between Sjögren’s syndrome, hand osteoarthritis, and a history of hypothyroidism which merits further study, according to the rheumatologist.
Because of the relatively small patient numbers in the French study, Dr. Sellam and coworkers ran a crosscheck with data from the Framingham Osteoarthritis Study and found hand osteoarthritis prevalence rates comparable to their own findings. For example, the prevalences of radiographic and erosive hand osteoarthritis in the French Sjögren’s syndrome and non-autoimmune sicca syndrome groups were similar to the 44% and 10% figures, respectively, in the general population of age-matched Framingham women (Ann Rheum Dis. 2011 Sep;70[9]:1581-6).
He reported having no financial conflicts regarding his study, which was conducted free of commercial support.
LAS VEGAS – Patients with Sjögren’s syndrome do not have an increased prevalence of hand osteoarthritis, but they are strongly predisposed to have a history of hypothyroidism, Jeremie Sellam, MD, reported at the World Congress on Osteoarthritis.
Both of these findings in his small case-control study were unexpected, he added at the congress sponsored by the Osteoarthritis Research Society International.
The study included 34 women with primary Sjögren’s syndrome according to the 2002 American-European Consensus Group criteria and 54 female controls with sicca syndrome but no autoantibodies and no Sjögren’s syndrome. All subjects were evaluated at a specialized tertiary Sjögren’s syndrome clinic. The controls were referred there to ascertain whether they had Sjögren’s syndrome.
Among the Sjögren’s syndrome patients, 41% had radiographic evidence of hand osteoarthritis, 12% had symptomatic hand osteoarthritis, and 9% had erosive hand osteoarthritis. In the sicca syndrome–only patients, the rates were similar at 52%, 28%, and 9%, respectively.
Looking for commonalities and differences between the Sjögren’s syndrome patients and controls, Dr. Sellam and his coinvestigators noted that the Sjögren’s syndrome patients were significantly older, with an average age of 64 years, compared with 48.5 years in the controls.
Impressively, two-thirds of the 15 Sjögren’s syndrome patients with hand osteoarthritis had a history of hypothyroidism, compared with just 15% of the 27 non-autoimmune sicca syndrome patients with hand osteoarthritis and one-quarter of the Sjögren’s syndrome patients without hand osteoarthritis. This suggests a possible interaction between Sjögren’s syndrome, hand osteoarthritis, and a history of hypothyroidism which merits further study, according to the rheumatologist.
Because of the relatively small patient numbers in the French study, Dr. Sellam and coworkers ran a crosscheck with data from the Framingham Osteoarthritis Study and found hand osteoarthritis prevalence rates comparable to their own findings. For example, the prevalences of radiographic and erosive hand osteoarthritis in the French Sjögren’s syndrome and non-autoimmune sicca syndrome groups were similar to the 44% and 10% figures, respectively, in the general population of age-matched Framingham women (Ann Rheum Dis. 2011 Sep;70[9]:1581-6).
He reported having no financial conflicts regarding his study, which was conducted free of commercial support.
AT OARSI 2017
Key clinical point:
Major finding: Nine percent of women with Sjögren’s syndrome had erosive hand osteoarthritis, a prevalence identical to that in a group with non-autoimmune sicca syndrome only.
Data source: This case-control study included 34 women with Sjögren’s syndrome and 54 women with non-autoimmune sicca syndrome.
Disclosures: The presenter reported having no financial conflicts regarding the study, which was conducted free of commercial support.
RF, IPL score highest for facial rejuvenation in review
SAN DIEGO – A review of existing research found that newer technologies are safer and more effective at skin rejuvenation than older ones, with two types – intense pulsed laser (IPL) and radiofrequency (RF) – at or near the head of the pack on both fronts.
In addition, 10 types of treatments, including multiple laser technologies, scored higher than facial peels on safety, although the peels beat almost all comers in terms of efficacy, the study’s lead author, Caerwyn Ash, PhD, said in an interview after presenting the results at the annual meeting of the American Society for Laser Medicine and Surgery.
The review is unique because it maps the various treatments on two axes – safety and efficacy – in a chart. Viewers gain an instant perspective on how the individual treatments fare when stacked up against each other. “The study gives credence to the new technologies,” said Dr. Ash, associate professor of medical devices at the University of Wales Trinity Saint David, Swansea. “We’re moving toward safer and more efficacious results.”
He and his colleagues analyzed more than 500 studies published since 1985, which evaluated 15 different types of technology used for facial rejuvenation. They reviewed at least 35 clinical studies per platform. They also reported on the safety and efficacy of facial peels.
The technologies examined included RF, light emitting diode (LED), pulsed dyed laser (PDL), frequency doubled 532-nm potassium-titanyl-phosphate neodymium:YAG laser (which had a low number of clinical studies), 980-nm diode laser, Q-switched Nd:YAG laser, 1320-nm Nd:YAG laser, 1540-nm Erbium:glass laser, 1450-nm diode laser, IPL, long pulsed Nd:YAG laser, plasma, and copper bromide laser.
Another technology reviewed was fractional selective photothermolysis, but studies of this modality were difficult to compare, according to the authors. Also included was the carbon dioxide laser, which the authors described as being hampered by long healing times and discomfort that requires anesthesia.
The review notes that comparisons between studies of the different treatments in the review were limited by such factors as varied beam and tip sizes (even within individual studies), various pulse durations, and different treatment times and intervals.
The researchers mapped the treatments in a single chart on two axes, safety and efficacy.
Three treatments scored the best in terms of efficacy: RF, IPL and chemical peels. However, while RF and IPL scored near the top of all treatments on the safety scale, chemical peels pulled up the rear.
The treatment strategies on the safety scale, ranked from most safe to least safe, were LED, IPL, diode laser, RF, argon laser, PDL and carbon dioxide laser, Nd:YAG, ablative Erbium, plasma, and chemical peel.
Radiofrequency topped the efficacy scale, followed closely by chemical peel and IPL. Following them, from most efficacious to least efficacious, were carbon dioxide laser, ablative Erbium, plasma treatments, and PDL, Nd:YAG and argon laser, diode laser, and LED.
The study was funded by the University of Wales Trinity Saint David. The authors had no disclosures.
SAN DIEGO – A review of existing research found that newer technologies are safer and more effective at skin rejuvenation than older ones, with two types – intense pulsed laser (IPL) and radiofrequency (RF) – at or near the head of the pack on both fronts.
In addition, 10 types of treatments, including multiple laser technologies, scored higher than facial peels on safety, although the peels beat almost all comers in terms of efficacy, the study’s lead author, Caerwyn Ash, PhD, said in an interview after presenting the results at the annual meeting of the American Society for Laser Medicine and Surgery.
The review is unique because it maps the various treatments on two axes – safety and efficacy – in a chart. Viewers gain an instant perspective on how the individual treatments fare when stacked up against each other. “The study gives credence to the new technologies,” said Dr. Ash, associate professor of medical devices at the University of Wales Trinity Saint David, Swansea. “We’re moving toward safer and more efficacious results.”
He and his colleagues analyzed more than 500 studies published since 1985, which evaluated 15 different types of technology used for facial rejuvenation. They reviewed at least 35 clinical studies per platform. They also reported on the safety and efficacy of facial peels.
The technologies examined included RF, light emitting diode (LED), pulsed dyed laser (PDL), frequency doubled 532-nm potassium-titanyl-phosphate neodymium:YAG laser (which had a low number of clinical studies), 980-nm diode laser, Q-switched Nd:YAG laser, 1320-nm Nd:YAG laser, 1540-nm Erbium:glass laser, 1450-nm diode laser, IPL, long pulsed Nd:YAG laser, plasma, and copper bromide laser.
Another technology reviewed was fractional selective photothermolysis, but studies of this modality were difficult to compare, according to the authors. Also included was the carbon dioxide laser, which the authors described as being hampered by long healing times and discomfort that requires anesthesia.
The review notes that comparisons between studies of the different treatments in the review were limited by such factors as varied beam and tip sizes (even within individual studies), various pulse durations, and different treatment times and intervals.
The researchers mapped the treatments in a single chart on two axes, safety and efficacy.
Three treatments scored the best in terms of efficacy: RF, IPL and chemical peels. However, while RF and IPL scored near the top of all treatments on the safety scale, chemical peels pulled up the rear.
The treatment strategies on the safety scale, ranked from most safe to least safe, were LED, IPL, diode laser, RF, argon laser, PDL and carbon dioxide laser, Nd:YAG, ablative Erbium, plasma, and chemical peel.
Radiofrequency topped the efficacy scale, followed closely by chemical peel and IPL. Following them, from most efficacious to least efficacious, were carbon dioxide laser, ablative Erbium, plasma treatments, and PDL, Nd:YAG and argon laser, diode laser, and LED.
The study was funded by the University of Wales Trinity Saint David. The authors had no disclosures.
SAN DIEGO – A review of existing research found that newer technologies are safer and more effective at skin rejuvenation than older ones, with two types – intense pulsed laser (IPL) and radiofrequency (RF) – at or near the head of the pack on both fronts.
In addition, 10 types of treatments, including multiple laser technologies, scored higher than facial peels on safety, although the peels beat almost all comers in terms of efficacy, the study’s lead author, Caerwyn Ash, PhD, said in an interview after presenting the results at the annual meeting of the American Society for Laser Medicine and Surgery.
The review is unique because it maps the various treatments on two axes – safety and efficacy – in a chart. Viewers gain an instant perspective on how the individual treatments fare when stacked up against each other. “The study gives credence to the new technologies,” said Dr. Ash, associate professor of medical devices at the University of Wales Trinity Saint David, Swansea. “We’re moving toward safer and more efficacious results.”
He and his colleagues analyzed more than 500 studies published since 1985, which evaluated 15 different types of technology used for facial rejuvenation. They reviewed at least 35 clinical studies per platform. They also reported on the safety and efficacy of facial peels.
The technologies examined included RF, light emitting diode (LED), pulsed dyed laser (PDL), frequency doubled 532-nm potassium-titanyl-phosphate neodymium:YAG laser (which had a low number of clinical studies), 980-nm diode laser, Q-switched Nd:YAG laser, 1320-nm Nd:YAG laser, 1540-nm Erbium:glass laser, 1450-nm diode laser, IPL, long pulsed Nd:YAG laser, plasma, and copper bromide laser.
Another technology reviewed was fractional selective photothermolysis, but studies of this modality were difficult to compare, according to the authors. Also included was the carbon dioxide laser, which the authors described as being hampered by long healing times and discomfort that requires anesthesia.
The review notes that comparisons between studies of the different treatments in the review were limited by such factors as varied beam and tip sizes (even within individual studies), various pulse durations, and different treatment times and intervals.
The researchers mapped the treatments in a single chart on two axes, safety and efficacy.
Three treatments scored the best in terms of efficacy: RF, IPL and chemical peels. However, while RF and IPL scored near the top of all treatments on the safety scale, chemical peels pulled up the rear.
The treatment strategies on the safety scale, ranked from most safe to least safe, were LED, IPL, diode laser, RF, argon laser, PDL and carbon dioxide laser, Nd:YAG, ablative Erbium, plasma, and chemical peel.
Radiofrequency topped the efficacy scale, followed closely by chemical peel and IPL. Following them, from most efficacious to least efficacious, were carbon dioxide laser, ablative Erbium, plasma treatments, and PDL, Nd:YAG and argon laser, diode laser, and LED.
The study was funded by the University of Wales Trinity Saint David. The authors had no disclosures.
AT LASER 2017
Key clinical point:
Major finding: IPL and RF were among the modalities that were safer and more effective at skin rejuvenation than were older ones.
Data source: An analysis of more than 500 studies published since 1985 evaluating of 15 different types of technology used for facial rejuvenation, reviewing at least 35 clinical studies per platform.
Disclosures: The study was funded by the University of Wales Trinity Saint David. The authors had no disclosures.
VIDEO: Attaining the tools to start your own quality improvement project
Quality improvement at the program level is a major concern for most hospitalists. That’s exactly why Venkata Dontaraju, MD, MRCP, FHM, attended a Tuesday afternoon HM17 workshop entitled “Adding to Your Toolbox: QI Methodologies.”
Dr. Dontaraju, a hospitalist for 7 years with Rockford Health Physicians in Loves Park, Ill., wants to begin QI projects of his own. He planned to attend a number of QI-focused sessions at the annual meeting, with the toolbox session laying the foundation for such work.
“There is a lot of emphasis on cutting down the waste in health care, and also improving the processes,” he said. “That is where the role of QI comes into place. I want to do QI projects at my own hospital, but I first want to get the tools necessary for a successful project.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Quality improvement at the program level is a major concern for most hospitalists. That’s exactly why Venkata Dontaraju, MD, MRCP, FHM, attended a Tuesday afternoon HM17 workshop entitled “Adding to Your Toolbox: QI Methodologies.”
Dr. Dontaraju, a hospitalist for 7 years with Rockford Health Physicians in Loves Park, Ill., wants to begin QI projects of his own. He planned to attend a number of QI-focused sessions at the annual meeting, with the toolbox session laying the foundation for such work.
“There is a lot of emphasis on cutting down the waste in health care, and also improving the processes,” he said. “That is where the role of QI comes into place. I want to do QI projects at my own hospital, but I first want to get the tools necessary for a successful project.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Quality improvement at the program level is a major concern for most hospitalists. That’s exactly why Venkata Dontaraju, MD, MRCP, FHM, attended a Tuesday afternoon HM17 workshop entitled “Adding to Your Toolbox: QI Methodologies.”
Dr. Dontaraju, a hospitalist for 7 years with Rockford Health Physicians in Loves Park, Ill., wants to begin QI projects of his own. He planned to attend a number of QI-focused sessions at the annual meeting, with the toolbox session laying the foundation for such work.
“There is a lot of emphasis on cutting down the waste in health care, and also improving the processes,” he said. “That is where the role of QI comes into place. I want to do QI projects at my own hospital, but I first want to get the tools necessary for a successful project.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Forum focuses on forging Q.I. connections
Scrounging for information that could help her with quality improvement (Q.I.) projects, Charmaine Lewis, MD, MPH, the quality director with New Hanover Hospitalists in Wilmington, N.C., said she finds herself reviewing posters at the Annual Meeting and squinting at the images to see whether the electronic health records involved match the system she uses back home.
There’s got to be a better way.
Mangla Gulati, MD, SFHM, associate professor of medicine and chief quality officer at the University of Maryland, and Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement, led what grew into a lively, thoughtful discussion about ways for hospitalists to exchange information and to get support with Q.I. efforts at their centers.
The hospitalists who attended brought their experiences and their questions from a diverse range of centers, from Anchorage, Alaska, to southern California to Poughkeepsie, New York. They emphasized the need for easier access to initiatives that mirror what they are trying to do at their own centers, for more mentoring opportunities, and for more SHM chapters outside major metropolitan areas to help with networking. And they offered lessons on what they have already learned.
Remus Popa, MD, FHM, associate professor of medicine at the University of California, Riverside, who has led Q.I. projects on the use of telemetry, said a successful project will likely be more than an idea that blooms inside the head of a hospitalist.
“We have to find something that the institution really needs,” Dr. Popa said. “You have to design a better fit with them. Otherwise, it’s going to be a tough conversation about resources, right?”
Esther Lee, MD, a hospitalist in Anchorage, Alaska, asked whether it might be possible for SHM to host a “mini-conference” specifically on quality improvement. At the Annual Meeting, she said, she often finds herself torn between attending Q.I. sessions and sessions on clinical topics.
SHM’s Goldstein said it was a possibility.
“It is something that we have talked about and will continue to talk about,” she said.
David Lucier, MD, MBA, MPH, Director of Quality and Safety for Hospital Medicine at Massachusetts General Hospital, said that emphasizing the safety aspect of a project can often help push it along.
“I find these [types of projects] to be quite compelling, at least in reordering the priority list,” he said.
Ms. Goldstein said the suggestions were helpful in SHM’s goal of creating a “culture of ‘quality enthusiasts.’”
“We want to be the home for quality for hospitalists,” she said. “So this input is really helpful for all of us in here.”
Scrounging for information that could help her with quality improvement (Q.I.) projects, Charmaine Lewis, MD, MPH, the quality director with New Hanover Hospitalists in Wilmington, N.C., said she finds herself reviewing posters at the Annual Meeting and squinting at the images to see whether the electronic health records involved match the system she uses back home.
There’s got to be a better way.
Mangla Gulati, MD, SFHM, associate professor of medicine and chief quality officer at the University of Maryland, and Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement, led what grew into a lively, thoughtful discussion about ways for hospitalists to exchange information and to get support with Q.I. efforts at their centers.
The hospitalists who attended brought their experiences and their questions from a diverse range of centers, from Anchorage, Alaska, to southern California to Poughkeepsie, New York. They emphasized the need for easier access to initiatives that mirror what they are trying to do at their own centers, for more mentoring opportunities, and for more SHM chapters outside major metropolitan areas to help with networking. And they offered lessons on what they have already learned.
Remus Popa, MD, FHM, associate professor of medicine at the University of California, Riverside, who has led Q.I. projects on the use of telemetry, said a successful project will likely be more than an idea that blooms inside the head of a hospitalist.
“We have to find something that the institution really needs,” Dr. Popa said. “You have to design a better fit with them. Otherwise, it’s going to be a tough conversation about resources, right?”
Esther Lee, MD, a hospitalist in Anchorage, Alaska, asked whether it might be possible for SHM to host a “mini-conference” specifically on quality improvement. At the Annual Meeting, she said, she often finds herself torn between attending Q.I. sessions and sessions on clinical topics.
SHM’s Goldstein said it was a possibility.
“It is something that we have talked about and will continue to talk about,” she said.
David Lucier, MD, MBA, MPH, Director of Quality and Safety for Hospital Medicine at Massachusetts General Hospital, said that emphasizing the safety aspect of a project can often help push it along.
“I find these [types of projects] to be quite compelling, at least in reordering the priority list,” he said.
Ms. Goldstein said the suggestions were helpful in SHM’s goal of creating a “culture of ‘quality enthusiasts.’”
“We want to be the home for quality for hospitalists,” she said. “So this input is really helpful for all of us in here.”
Scrounging for information that could help her with quality improvement (Q.I.) projects, Charmaine Lewis, MD, MPH, the quality director with New Hanover Hospitalists in Wilmington, N.C., said she finds herself reviewing posters at the Annual Meeting and squinting at the images to see whether the electronic health records involved match the system she uses back home.
There’s got to be a better way.
Mangla Gulati, MD, SFHM, associate professor of medicine and chief quality officer at the University of Maryland, and Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement, led what grew into a lively, thoughtful discussion about ways for hospitalists to exchange information and to get support with Q.I. efforts at their centers.
The hospitalists who attended brought their experiences and their questions from a diverse range of centers, from Anchorage, Alaska, to southern California to Poughkeepsie, New York. They emphasized the need for easier access to initiatives that mirror what they are trying to do at their own centers, for more mentoring opportunities, and for more SHM chapters outside major metropolitan areas to help with networking. And they offered lessons on what they have already learned.
Remus Popa, MD, FHM, associate professor of medicine at the University of California, Riverside, who has led Q.I. projects on the use of telemetry, said a successful project will likely be more than an idea that blooms inside the head of a hospitalist.
“We have to find something that the institution really needs,” Dr. Popa said. “You have to design a better fit with them. Otherwise, it’s going to be a tough conversation about resources, right?”
Esther Lee, MD, a hospitalist in Anchorage, Alaska, asked whether it might be possible for SHM to host a “mini-conference” specifically on quality improvement. At the Annual Meeting, she said, she often finds herself torn between attending Q.I. sessions and sessions on clinical topics.
SHM’s Goldstein said it was a possibility.
“It is something that we have talked about and will continue to talk about,” she said.
David Lucier, MD, MBA, MPH, Director of Quality and Safety for Hospital Medicine at Massachusetts General Hospital, said that emphasizing the safety aspect of a project can often help push it along.
“I find these [types of projects] to be quite compelling, at least in reordering the priority list,” he said.
Ms. Goldstein said the suggestions were helpful in SHM’s goal of creating a “culture of ‘quality enthusiasts.’”
“We want to be the home for quality for hospitalists,” she said. “So this input is really helpful for all of us in here.”
High CD86+pDC counts may predict CML relapses
Patients with chronic myeloid leukemia (CML) with high CD86+pDC counts had a higher risk of relapse after discontinuing tyrosine kinase inhibitor (TKI) therapy, according to new findings published in Leukemia.
Of patients who achieve a deep molecular remission, only a minority are able to sustain it and remain off therapy. Even when deep remission is achieved, TKI therapy fails to eradicate CML stem cells, which can perpetuate disease.
“This is clinically reflected by the long-term persistence of BCR-ABL messenger RNA (mRNA) in the majority of patients,” wrote C. Schütz, MD, of the University Hospital Marburg (Germany) and colleagues (Leukemia. 2017 Apr;31[4]:829-36). “Even with undetectable BCR-ABL mRNA levels, patients frequently relapse after TKI cessation.”
The researchers investigated whether the expression of the T-cell inhibitory receptor (CTLA-4)-ligand CD86 (B7.2) on plasmacytoid dendritic cells (pDC) could have an effect on the risk of relapse in CML patients who discontinue TKI therapy after achieving remission.
The frequency of CD86+pDC was analyzed in 14 CML patients who were in treatment-free remission, in 130 patients in molecular remission who were part of the CML-V study, and prospectively in 122 EURO-SKI patients right before they discontinued TKI therapy.
The authors found that CML patients in molecular remission had a significantly higher frequency of CD86+pDC expression, compared with normal donors (P less than .0024). In contrast, those who were in treatment-free remission had consistently low CD86+pDC.
These results suggest that low CD86+pDC could be predictive of treatment-free remission.
To test the hypothesis that low CD86+pDC frequencies during TKI-induced molecular remission were associated with a lower risk of molecular relapse after stopping TKI therapy, the study authors measured CD86+pDC levels in the 122 EURO-SKI patients before they stopped therapy, and then prospectively monitored them for relapse.
Findings showed that the 122 EURO-SKI patients had a significantly higher CD86+pDC frequency than did 8 healthy donors (median, 20.8% vs. 7.3%; P = .0024).
When matched with the treatment-free remission patients, the 73 patients in the EURO-SKI group who did not relapse within the first 12 months after stopping therapy had a significantly lower median frequency of CD86+pDC at baseline, compared with the 49 patients who did relapse (P = .014).
Patients who relapsed also demonstrated higher absolute CD86+pDC counts (CD86+pDC per 105 lymphocytes) at baseline (median, 86.1 vs. 50.6; P = .0147).
Based on the findings, the authors noted that they provided “for the first time evidence that relapse biology after TKI discontinuation depends on the quantity of activated pDC and a T-cell exhaustion phenotype, rather than TKI pretreatment duration per se.”
The Clinical Research Group of the German Research Foundation and the German José Carreras Leukaemia Foundation funded the study. Several of the authors report relationships with Ariad, Bristol-Myers Squibb, Novartis, and Pfizer.
Patients with chronic myeloid leukemia (CML) with high CD86+pDC counts had a higher risk of relapse after discontinuing tyrosine kinase inhibitor (TKI) therapy, according to new findings published in Leukemia.
Of patients who achieve a deep molecular remission, only a minority are able to sustain it and remain off therapy. Even when deep remission is achieved, TKI therapy fails to eradicate CML stem cells, which can perpetuate disease.
“This is clinically reflected by the long-term persistence of BCR-ABL messenger RNA (mRNA) in the majority of patients,” wrote C. Schütz, MD, of the University Hospital Marburg (Germany) and colleagues (Leukemia. 2017 Apr;31[4]:829-36). “Even with undetectable BCR-ABL mRNA levels, patients frequently relapse after TKI cessation.”
The researchers investigated whether the expression of the T-cell inhibitory receptor (CTLA-4)-ligand CD86 (B7.2) on plasmacytoid dendritic cells (pDC) could have an effect on the risk of relapse in CML patients who discontinue TKI therapy after achieving remission.
The frequency of CD86+pDC was analyzed in 14 CML patients who were in treatment-free remission, in 130 patients in molecular remission who were part of the CML-V study, and prospectively in 122 EURO-SKI patients right before they discontinued TKI therapy.
The authors found that CML patients in molecular remission had a significantly higher frequency of CD86+pDC expression, compared with normal donors (P less than .0024). In contrast, those who were in treatment-free remission had consistently low CD86+pDC.
These results suggest that low CD86+pDC could be predictive of treatment-free remission.
To test the hypothesis that low CD86+pDC frequencies during TKI-induced molecular remission were associated with a lower risk of molecular relapse after stopping TKI therapy, the study authors measured CD86+pDC levels in the 122 EURO-SKI patients before they stopped therapy, and then prospectively monitored them for relapse.
Findings showed that the 122 EURO-SKI patients had a significantly higher CD86+pDC frequency than did 8 healthy donors (median, 20.8% vs. 7.3%; P = .0024).
When matched with the treatment-free remission patients, the 73 patients in the EURO-SKI group who did not relapse within the first 12 months after stopping therapy had a significantly lower median frequency of CD86+pDC at baseline, compared with the 49 patients who did relapse (P = .014).
Patients who relapsed also demonstrated higher absolute CD86+pDC counts (CD86+pDC per 105 lymphocytes) at baseline (median, 86.1 vs. 50.6; P = .0147).
Based on the findings, the authors noted that they provided “for the first time evidence that relapse biology after TKI discontinuation depends on the quantity of activated pDC and a T-cell exhaustion phenotype, rather than TKI pretreatment duration per se.”
The Clinical Research Group of the German Research Foundation and the German José Carreras Leukaemia Foundation funded the study. Several of the authors report relationships with Ariad, Bristol-Myers Squibb, Novartis, and Pfizer.
Patients with chronic myeloid leukemia (CML) with high CD86+pDC counts had a higher risk of relapse after discontinuing tyrosine kinase inhibitor (TKI) therapy, according to new findings published in Leukemia.
Of patients who achieve a deep molecular remission, only a minority are able to sustain it and remain off therapy. Even when deep remission is achieved, TKI therapy fails to eradicate CML stem cells, which can perpetuate disease.
“This is clinically reflected by the long-term persistence of BCR-ABL messenger RNA (mRNA) in the majority of patients,” wrote C. Schütz, MD, of the University Hospital Marburg (Germany) and colleagues (Leukemia. 2017 Apr;31[4]:829-36). “Even with undetectable BCR-ABL mRNA levels, patients frequently relapse after TKI cessation.”
The researchers investigated whether the expression of the T-cell inhibitory receptor (CTLA-4)-ligand CD86 (B7.2) on plasmacytoid dendritic cells (pDC) could have an effect on the risk of relapse in CML patients who discontinue TKI therapy after achieving remission.
The frequency of CD86+pDC was analyzed in 14 CML patients who were in treatment-free remission, in 130 patients in molecular remission who were part of the CML-V study, and prospectively in 122 EURO-SKI patients right before they discontinued TKI therapy.
The authors found that CML patients in molecular remission had a significantly higher frequency of CD86+pDC expression, compared with normal donors (P less than .0024). In contrast, those who were in treatment-free remission had consistently low CD86+pDC.
These results suggest that low CD86+pDC could be predictive of treatment-free remission.
To test the hypothesis that low CD86+pDC frequencies during TKI-induced molecular remission were associated with a lower risk of molecular relapse after stopping TKI therapy, the study authors measured CD86+pDC levels in the 122 EURO-SKI patients before they stopped therapy, and then prospectively monitored them for relapse.
Findings showed that the 122 EURO-SKI patients had a significantly higher CD86+pDC frequency than did 8 healthy donors (median, 20.8% vs. 7.3%; P = .0024).
When matched with the treatment-free remission patients, the 73 patients in the EURO-SKI group who did not relapse within the first 12 months after stopping therapy had a significantly lower median frequency of CD86+pDC at baseline, compared with the 49 patients who did relapse (P = .014).
Patients who relapsed also demonstrated higher absolute CD86+pDC counts (CD86+pDC per 105 lymphocytes) at baseline (median, 86.1 vs. 50.6; P = .0147).
Based on the findings, the authors noted that they provided “for the first time evidence that relapse biology after TKI discontinuation depends on the quantity of activated pDC and a T-cell exhaustion phenotype, rather than TKI pretreatment duration per se.”
The Clinical Research Group of the German Research Foundation and the German José Carreras Leukaemia Foundation funded the study. Several of the authors report relationships with Ariad, Bristol-Myers Squibb, Novartis, and Pfizer.
FROM LEUKEMIA
Key clinical point: High CD86+pDC counts predicted relapses in CML patients who stopped TKI therapy.
Major finding: CML patients in molecular remission had significantly higher CD86+pDC frequencies, while patients in treatment-free remission had consistently low CD86+pDC.
Data source: A study that used patient cohorts (n = 14, n = 130, n = 122) at different stages of TKI discontinuation and remission.
Disclosures: The Clinical Research Group of the German Research Foundation and the German José Carreras Leukaemia Foundation funded the study. Several of the authors report relationships with Ariad, Bristol-Myers Squibb, Novartis, and Pfizer.
Proper UTI diagnosis, treatment relies on cautious approach
LAS VEGAS – Prudent use of catheters, cultures, and antibiotics are three keys to proper urinary tract diagnosis and management, according to a speaker at this year’s annual meeting of the Society of Hospital Medicine.
“We have not done very well with decreasing catheter-associated urinary tract infections,” said Jennifer Hanrahan, DO, an assistant professor of infectious disease medicine at Case Western Reserve University in Cleveland, Ohio, and an infectious disease physician at MetroHealth Medical Center, where she is the medical director for infection prevention. “The main reason is people don’t really think of i
The main way to reduce catheter-associated urinary tract infections is to avoid catheters, she said, noting “that’s obvious, but unnecessary catheters get put in all the time.”
Dr. Hanrahan recommended only putting them in when absolutely necessary, doing so in a sterile manner, and then continually monitoring whether the patient still needs the catheter.
Knowing when to obtain a urine culture is key to ensuring proper diagnosing and treatment for UTIs. A person who is asymptomatic does not need a culture, Dr. Hanrahan said during the well-attended, rapid-fire session. Those who do need a culture include septic patients with no apparent cause for their symptomatic presentation, despite a careful history taking and physical exam. Also, patients with pelvic pain, or flank tenderness for whom no cause can otherwise be determined should be cultured. It is also appropriate to screen for asymptomatic bacteriuria for pregnant patients, since it can be a sign of premature labor, and for patients about to undergo any invasive urologic procedure, Dr Hanrahan said.
“An awful lot of people have asymptomatic bacteriuria all the time,” she added, “and it doesn’t mean anything.”
Reasons to not culture include urine that smells “off” or that is cloudy or has sediment. “Anyone who has eaten asparagus knows that, after you eat it, your urine smells weird. It doesn’t mean you have a UTI,” she said.
She recommended against “pan culturing” in sepsis, and culturing “just because” when there is a clearly identifiable cause for the fever.
Once a diagnosis is made, Dr. Hanrahan urged physicians to avoid the overuse of antibiotics, suggesting that, whenever possible, the shortest possible course should be used. In order to help preserve antibiotic resistance, she also recommended using antibiotics that are not as prevalent, in order to help preserve antibiotic resistance. These could include nitrofurantoin and fosfomycin.
Dr. Hanrahan had no relevant financial disclosures.
[email protected]
On Twitter @whitneymcknight
LAS VEGAS – Prudent use of catheters, cultures, and antibiotics are three keys to proper urinary tract diagnosis and management, according to a speaker at this year’s annual meeting of the Society of Hospital Medicine.
“We have not done very well with decreasing catheter-associated urinary tract infections,” said Jennifer Hanrahan, DO, an assistant professor of infectious disease medicine at Case Western Reserve University in Cleveland, Ohio, and an infectious disease physician at MetroHealth Medical Center, where she is the medical director for infection prevention. “The main reason is people don’t really think of i
The main way to reduce catheter-associated urinary tract infections is to avoid catheters, she said, noting “that’s obvious, but unnecessary catheters get put in all the time.”
Dr. Hanrahan recommended only putting them in when absolutely necessary, doing so in a sterile manner, and then continually monitoring whether the patient still needs the catheter.
Knowing when to obtain a urine culture is key to ensuring proper diagnosing and treatment for UTIs. A person who is asymptomatic does not need a culture, Dr. Hanrahan said during the well-attended, rapid-fire session. Those who do need a culture include septic patients with no apparent cause for their symptomatic presentation, despite a careful history taking and physical exam. Also, patients with pelvic pain, or flank tenderness for whom no cause can otherwise be determined should be cultured. It is also appropriate to screen for asymptomatic bacteriuria for pregnant patients, since it can be a sign of premature labor, and for patients about to undergo any invasive urologic procedure, Dr Hanrahan said.
“An awful lot of people have asymptomatic bacteriuria all the time,” she added, “and it doesn’t mean anything.”
Reasons to not culture include urine that smells “off” or that is cloudy or has sediment. “Anyone who has eaten asparagus knows that, after you eat it, your urine smells weird. It doesn’t mean you have a UTI,” she said.
She recommended against “pan culturing” in sepsis, and culturing “just because” when there is a clearly identifiable cause for the fever.
Once a diagnosis is made, Dr. Hanrahan urged physicians to avoid the overuse of antibiotics, suggesting that, whenever possible, the shortest possible course should be used. In order to help preserve antibiotic resistance, she also recommended using antibiotics that are not as prevalent, in order to help preserve antibiotic resistance. These could include nitrofurantoin and fosfomycin.
Dr. Hanrahan had no relevant financial disclosures.
[email protected]
On Twitter @whitneymcknight
LAS VEGAS – Prudent use of catheters, cultures, and antibiotics are three keys to proper urinary tract diagnosis and management, according to a speaker at this year’s annual meeting of the Society of Hospital Medicine.
“We have not done very well with decreasing catheter-associated urinary tract infections,” said Jennifer Hanrahan, DO, an assistant professor of infectious disease medicine at Case Western Reserve University in Cleveland, Ohio, and an infectious disease physician at MetroHealth Medical Center, where she is the medical director for infection prevention. “The main reason is people don’t really think of i
The main way to reduce catheter-associated urinary tract infections is to avoid catheters, she said, noting “that’s obvious, but unnecessary catheters get put in all the time.”
Dr. Hanrahan recommended only putting them in when absolutely necessary, doing so in a sterile manner, and then continually monitoring whether the patient still needs the catheter.
Knowing when to obtain a urine culture is key to ensuring proper diagnosing and treatment for UTIs. A person who is asymptomatic does not need a culture, Dr. Hanrahan said during the well-attended, rapid-fire session. Those who do need a culture include septic patients with no apparent cause for their symptomatic presentation, despite a careful history taking and physical exam. Also, patients with pelvic pain, or flank tenderness for whom no cause can otherwise be determined should be cultured. It is also appropriate to screen for asymptomatic bacteriuria for pregnant patients, since it can be a sign of premature labor, and for patients about to undergo any invasive urologic procedure, Dr Hanrahan said.
“An awful lot of people have asymptomatic bacteriuria all the time,” she added, “and it doesn’t mean anything.”
Reasons to not culture include urine that smells “off” or that is cloudy or has sediment. “Anyone who has eaten asparagus knows that, after you eat it, your urine smells weird. It doesn’t mean you have a UTI,” she said.
She recommended against “pan culturing” in sepsis, and culturing “just because” when there is a clearly identifiable cause for the fever.
Once a diagnosis is made, Dr. Hanrahan urged physicians to avoid the overuse of antibiotics, suggesting that, whenever possible, the shortest possible course should be used. In order to help preserve antibiotic resistance, she also recommended using antibiotics that are not as prevalent, in order to help preserve antibiotic resistance. These could include nitrofurantoin and fosfomycin.
Dr. Hanrahan had no relevant financial disclosures.
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