Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.

• Infectious Disease: Bugs, Drugs, and You: ID Boot Camp for Hospitalists
• Perioperative Medicine: Essential Elements and Latest Advances
• ABIM Maintenance of Certification and Board Review
• Practice Management Success Strategies: Building a Practice That People Want to Be Part Of
• Bedside Procedures for the Hospitalist
• Point-of-Care Ultrasound for the Hospitalist

New to SHM? Receive a FREE membership with your meeting registration. Visit www.hospitalmedicine2017.org to learn more.

• Infectious Disease: Bugs, Drugs, and You: ID Boot Camp for Hospitalists
• Perioperative Medicine: Essential Elements and Latest Advances
• ABIM Maintenance of Certification and Board Review
• Practice Management Success Strategies: Building a Practice That People Want to Be Part Of
• Bedside Procedures for the Hospitalist
• Point-of-Care Ultrasound for the Hospitalist

New to SHM? Receive a FREE membership with your meeting registration. Visit www.hospitalmedicine2017.org to learn more.

• Infectious Disease: Bugs, Drugs, and You: ID Boot Camp for Hospitalists
• Perioperative Medicine: Essential Elements and Latest Advances
• ABIM Maintenance of Certification and Board Review
• Practice Management Success Strategies: Building a Practice That People Want to Be Part Of
• Bedside Procedures for the Hospitalist
• Point-of-Care Ultrasound for the Hospitalist

New to SHM? Receive a FREE membership with your meeting registration. Visit www.hospitalmedicine2017.org to learn more.

G. Alvernaz, Alabama

M. Schloss, Alabama

L. M. Benson, FNP, Arizona

P. Kiesner, Arizona

H. Breen, MD, Arkansas

E. Porter, ACNP, APRN-BC, Arkansas

P. Charugundla, DO, California

J. Leroux, California

R. Liang, DO, California

S. Ramirez, California

A. Sardi, California

K. Waloff, MD, FAAP, California

M. Alami, MD, Colorado

B. Paul, FACP, Colorado

J. Pierce, MD, Colorado

J. Ross, Colorado

C. Schoo, MD, Colorado

R. Ashkar, Connecticut

C. Lodato, Connecticut

R. Nardino, MD, Connecticut

D. No, Connecticut

E. R. H. Pana, MD, Connecticut

J. P. Patel, Connecticut

T. Banks, DO, Delaware

H. Divatia, DO, Delaware

I. Misra, MD, Delaware

D. Baker, ACNP, District of Columbia

G. Baldwin, ACMPE, MS, PA-C, Florida

J. Berquist, Florida

J. Geanes, Florida

J. Mellone, Florida

P. Brown, Georgia

K. Clearo, MD, Georgia

E. Evans, DO, Georgia

F. Fontem, Georgia

N. Gunter, Georgia

Q. L. Ta, FNP, Georgia

J. Kiaffas, BC, Hawaii

K. King, ARNP, Hawaii

Q. J. N. Leo, MBBS, Hawaii

I. Yepishin, DO, Hawaii

P. Costa, MD, Illinois

D. Gibson, MD, Illinois

L. Gimbel, Illinois

E. Lambers, PhD, Illinois

J. Lennon, Illinois

C. Pak, MD, Illinois

J. Yasin, MD, Illinois

F. Zahra, Illinois

T. Adugna, Indiana

N. Akula, FACP, Indiana

M. Aliniazee, MD, Indiana

L. Fick, MD, FACP, Indiana

R. Gotur, AHIP, Indiana

T. Mehta, Indiana

M. Batt, ANP, Iowa

R. Boppana, MD, Iowa

B. Funke, Iowa

C. Gumpert, Iowa

S. Litterer, Iowa

C. Strickler, ANP, Iowa

S. Akidiva, Kansas

T. Core, Kansas

A. Storrer, Kansas

S. Bale, MD, Kentucky

S. Haider, MBBS, Kentucky

A. Hickman, ACNP, Kentucky

A. Depta, Louisiana

M. D. Lindley, MD, MPH, Louisiana

L. Pham, MD, Louisiana

E. Stone, Louisiana

A. Stuart, Louisiana

S. Eleoff Van Durme, MD, MPH, Maryland

P. Guenter, PhD, RN, Maryland

A. Patterson, Maryland

I. Allen, MD, MPH, Massachusetts

R. Berger, MD, Massachusetts

M. Gibbons, MD, Massachusetts

A. C. Kataya, MD, Massachusetts

D. Moran, MD, Massachusetts

J. Sanchez, MD, Massachusetts

R. Hazin, MD, Michigan

L. Johnston, PA-C, Michigan

P. Patel, MD, Michigan

S. Patel, Michigan

J. Hunter, MD, Michigan

J. Coldwell, PA-C, Minnesota

W. Latham, PA-C, Minnesota

S. Tongen, MD, Minnesota

J. Wiederin, MD, Minnesota

V. A. Harrison, MD, FAAP, Mississippi

J. Henry, Mississippi

T. LaGarde, FAAFP, Mississippi

R. Edwards, MD, Missouri

W. El Aneed, MD, Missouri

S. Kolli, MD, Missouri

U. Muthyala, MD, Missouri

T. Thomas, DO, Missouri

C. Cole, PhD, DNP, Montana

K. Lien, MD, FACFM, Montana

N. Lewman, DO, Nevada

M. Makatam-Abrams, MD, New Hampshire

J. Cruz, PharmD, New Jersey

S. Kadiyam, MD, New Jersey

G. Acety, MD, New York

M. Desta, MD, New York

D. Konsky, DO, New York

F. Kumar, MD, New York

S. Ramamoorthy, ANP, New York

R. Ravindran, MD, New York

C. Tauro, MD, New York

P. Vitale, BS, MS, New York

S. Khan, MD, North Carolina

S. Menon, MD, North Carolina

J. Asteriou, MD, Ohio

S. Bearelly, MD, Ohio

K. Clark, MD, Ohio

F. Darmoch, Ohio

L. McKnight, MD, Ohio

A. Pope, APRN-BC, Ohio

D. Abernethy, Oklahoma

I. Liao, MD, Oregon

L. Matlock, FNP, Oregon

M. Bhatta, MD, Pennsylvania

B. Da Silva, MD, Pennsylvania

H. Entero, MD, Pennsylvania

Z. Garbuz, MD, Pennsylvania

B. Goldner, Pennsylvania

J. Goodling, CRNP, Pennsylvania

J. Jablonowski, PA-C, Pennsylvania

S. Kalim, Pennsylvania

J. Kim, Pennsylvania

S. McKimm, DO, Pennsylvania

B. Mosch, Pennsylvania

R. Naik, MBBS, Pennsylvania

V. Patel, MD, Pennsylvania

C. Raffferty, Pennsylvania

S. Ramakrishnan, MD, Pennsylvania

M. Rehr, DO, Pennsylvania

R. Sathi, MD, Pennsylvania

S. Shrestha, MD, Pennsylvania

T. Wigoda, Pennsylvania

B. Yemenu, MD, Pennsylvania

A. Gebru, Rhode Island

J. Freelin, MD, South Carolina

R. Romano Martin, PA-C, South Carolina

D. Njingeh, MD, South Dakota

P. Frost, MD, Tennessee

C. Olechowski, MD, Tennessee

O. Zaka, MD, Tennessee

K. Dowell, MS, Texas

T. Mian, Texas

R. Nuila, Texas

S. Pardinek, Texas

C. Pywell, Texas

K. Sanders, Texas

M. Varwani, MD, Texas

K. Johnson, MD, MPH, Washington

J. A. Levin, MD, Washington

R. Brant, FAAP, West Virginia

E. Hjertstedt, MD, Wisconsin

V. Kumar, Wisconsin

C. A. Valino, MD, Wyoming

E. Nehme, MD, United Arab Emirates

G. Alvernaz, Alabama

M. Schloss, Alabama

L. M. Benson, FNP, Arizona

P. Kiesner, Arizona

H. Breen, MD, Arkansas

E. Porter, ACNP, APRN-BC, Arkansas

P. Charugundla, DO, California

J. Leroux, California

R. Liang, DO, California

S. Ramirez, California

A. Sardi, California

K. Waloff, MD, FAAP, California

M. Alami, MD, Colorado

B. Paul, FACP, Colorado

J. Pierce, MD, Colorado

J. Ross, Colorado

C. Schoo, MD, Colorado

R. Ashkar, Connecticut

C. Lodato, Connecticut

R. Nardino, MD, Connecticut

D. No, Connecticut

E. R. H. Pana, MD, Connecticut

J. P. Patel, Connecticut

T. Banks, DO, Delaware

H. Divatia, DO, Delaware

I. Misra, MD, Delaware

D. Baker, ACNP, District of Columbia

G. Baldwin, ACMPE, MS, PA-C, Florida

J. Berquist, Florida

J. Geanes, Florida

J. Mellone, Florida

P. Brown, Georgia

K. Clearo, MD, Georgia

E. Evans, DO, Georgia

F. Fontem, Georgia

N. Gunter, Georgia

Q. L. Ta, FNP, Georgia

J. Kiaffas, BC, Hawaii

K. King, ARNP, Hawaii

Q. J. N. Leo, MBBS, Hawaii

I. Yepishin, DO, Hawaii

P. Costa, MD, Illinois

D. Gibson, MD, Illinois

L. Gimbel, Illinois

E. Lambers, PhD, Illinois

J. Lennon, Illinois

C. Pak, MD, Illinois

J. Yasin, MD, Illinois

F. Zahra, Illinois

T. Adugna, Indiana

N. Akula, FACP, Indiana

M. Aliniazee, MD, Indiana

L. Fick, MD, FACP, Indiana

R. Gotur, AHIP, Indiana

T. Mehta, Indiana

M. Batt, ANP, Iowa

R. Boppana, MD, Iowa

B. Funke, Iowa

C. Gumpert, Iowa

S. Litterer, Iowa

C. Strickler, ANP, Iowa

S. Akidiva, Kansas

T. Core, Kansas

A. Storrer, Kansas

S. Bale, MD, Kentucky

S. Haider, MBBS, Kentucky

A. Hickman, ACNP, Kentucky

A. Depta, Louisiana

M. D. Lindley, MD, MPH, Louisiana

L. Pham, MD, Louisiana

E. Stone, Louisiana

A. Stuart, Louisiana

S. Eleoff Van Durme, MD, MPH, Maryland

P. Guenter, PhD, RN, Maryland

A. Patterson, Maryland

I. Allen, MD, MPH, Massachusetts

R. Berger, MD, Massachusetts

M. Gibbons, MD, Massachusetts

A. C. Kataya, MD, Massachusetts

D. Moran, MD, Massachusetts

J. Sanchez, MD, Massachusetts

R. Hazin, MD, Michigan

L. Johnston, PA-C, Michigan

P. Patel, MD, Michigan

S. Patel, Michigan

J. Hunter, MD, Michigan

J. Coldwell, PA-C, Minnesota

W. Latham, PA-C, Minnesota

S. Tongen, MD, Minnesota

J. Wiederin, MD, Minnesota

V. A. Harrison, MD, FAAP, Mississippi

J. Henry, Mississippi

T. LaGarde, FAAFP, Mississippi

R. Edwards, MD, Missouri

W. El Aneed, MD, Missouri

S. Kolli, MD, Missouri

U. Muthyala, MD, Missouri

T. Thomas, DO, Missouri

C. Cole, PhD, DNP, Montana

K. Lien, MD, FACFM, Montana

N. Lewman, DO, Nevada

M. Makatam-Abrams, MD, New Hampshire

J. Cruz, PharmD, New Jersey

S. Kadiyam, MD, New Jersey

G. Acety, MD, New York

M. Desta, MD, New York

D. Konsky, DO, New York

F. Kumar, MD, New York

S. Ramamoorthy, ANP, New York

R. Ravindran, MD, New York

C. Tauro, MD, New York

P. Vitale, BS, MS, New York

S. Khan, MD, North Carolina

S. Menon, MD, North Carolina

J. Asteriou, MD, Ohio

S. Bearelly, MD, Ohio

K. Clark, MD, Ohio

F. Darmoch, Ohio

L. McKnight, MD, Ohio

A. Pope, APRN-BC, Ohio

D. Abernethy, Oklahoma

I. Liao, MD, Oregon

L. Matlock, FNP, Oregon

M. Bhatta, MD, Pennsylvania

B. Da Silva, MD, Pennsylvania

H. Entero, MD, Pennsylvania

Z. Garbuz, MD, Pennsylvania

B. Goldner, Pennsylvania

J. Goodling, CRNP, Pennsylvania

J. Jablonowski, PA-C, Pennsylvania

S. Kalim, Pennsylvania

J. Kim, Pennsylvania

S. McKimm, DO, Pennsylvania

B. Mosch, Pennsylvania

R. Naik, MBBS, Pennsylvania

V. Patel, MD, Pennsylvania

C. Raffferty, Pennsylvania

S. Ramakrishnan, MD, Pennsylvania

M. Rehr, DO, Pennsylvania

R. Sathi, MD, Pennsylvania

S. Shrestha, MD, Pennsylvania

T. Wigoda, Pennsylvania

B. Yemenu, MD, Pennsylvania

A. Gebru, Rhode Island

J. Freelin, MD, South Carolina

R. Romano Martin, PA-C, South Carolina

D. Njingeh, MD, South Dakota

P. Frost, MD, Tennessee

C. Olechowski, MD, Tennessee

O. Zaka, MD, Tennessee

K. Dowell, MS, Texas

T. Mian, Texas

R. Nuila, Texas

S. Pardinek, Texas

C. Pywell, Texas

K. Sanders, Texas

M. Varwani, MD, Texas

K. Johnson, MD, MPH, Washington

J. A. Levin, MD, Washington

R. Brant, FAAP, West Virginia

E. Hjertstedt, MD, Wisconsin

V. Kumar, Wisconsin

C. A. Valino, MD, Wyoming

E. Nehme, MD, United Arab Emirates

G. Alvernaz, Alabama

M. Schloss, Alabama

L. M. Benson, FNP, Arizona

P. Kiesner, Arizona

H. Breen, MD, Arkansas

E. Porter, ACNP, APRN-BC, Arkansas

P. Charugundla, DO, California

J. Leroux, California

R. Liang, DO, California

S. Ramirez, California

A. Sardi, California

K. Waloff, MD, FAAP, California

M. Alami, MD, Colorado

B. Paul, FACP, Colorado

J. Pierce, MD, Colorado

J. Ross, Colorado

C. Schoo, MD, Colorado

R. Ashkar, Connecticut

C. Lodato, Connecticut

R. Nardino, MD, Connecticut

D. No, Connecticut

E. R. H. Pana, MD, Connecticut

J. P. Patel, Connecticut

T. Banks, DO, Delaware

H. Divatia, DO, Delaware

I. Misra, MD, Delaware

D. Baker, ACNP, District of Columbia

G. Baldwin, ACMPE, MS, PA-C, Florida

J. Berquist, Florida

J. Geanes, Florida

J. Mellone, Florida

P. Brown, Georgia

K. Clearo, MD, Georgia

E. Evans, DO, Georgia

F. Fontem, Georgia

N. Gunter, Georgia

Q. L. Ta, FNP, Georgia

J. Kiaffas, BC, Hawaii

K. King, ARNP, Hawaii

Q. J. N. Leo, MBBS, Hawaii

I. Yepishin, DO, Hawaii

P. Costa, MD, Illinois

D. Gibson, MD, Illinois

L. Gimbel, Illinois

E. Lambers, PhD, Illinois

J. Lennon, Illinois

C. Pak, MD, Illinois

J. Yasin, MD, Illinois

F. Zahra, Illinois

T. Adugna, Indiana

N. Akula, FACP, Indiana

M. Aliniazee, MD, Indiana

L. Fick, MD, FACP, Indiana

R. Gotur, AHIP, Indiana

T. Mehta, Indiana

M. Batt, ANP, Iowa

R. Boppana, MD, Iowa

B. Funke, Iowa

C. Gumpert, Iowa

S. Litterer, Iowa

C. Strickler, ANP, Iowa

S. Akidiva, Kansas

T. Core, Kansas

A. Storrer, Kansas

S. Bale, MD, Kentucky

S. Haider, MBBS, Kentucky

A. Hickman, ACNP, Kentucky

A. Depta, Louisiana

M. D. Lindley, MD, MPH, Louisiana

L. Pham, MD, Louisiana

E. Stone, Louisiana

A. Stuart, Louisiana

S. Eleoff Van Durme, MD, MPH, Maryland

P. Guenter, PhD, RN, Maryland

A. Patterson, Maryland

I. Allen, MD, MPH, Massachusetts

R. Berger, MD, Massachusetts

M. Gibbons, MD, Massachusetts

A. C. Kataya, MD, Massachusetts

D. Moran, MD, Massachusetts

J. Sanchez, MD, Massachusetts

R. Hazin, MD, Michigan

L. Johnston, PA-C, Michigan

P. Patel, MD, Michigan

S. Patel, Michigan

J. Hunter, MD, Michigan

J. Coldwell, PA-C, Minnesota

W. Latham, PA-C, Minnesota

S. Tongen, MD, Minnesota

J. Wiederin, MD, Minnesota

V. A. Harrison, MD, FAAP, Mississippi

J. Henry, Mississippi

T. LaGarde, FAAFP, Mississippi

R. Edwards, MD, Missouri

W. El Aneed, MD, Missouri

S. Kolli, MD, Missouri

U. Muthyala, MD, Missouri

T. Thomas, DO, Missouri

C. Cole, PhD, DNP, Montana

K. Lien, MD, FACFM, Montana

N. Lewman, DO, Nevada

M. Makatam-Abrams, MD, New Hampshire

J. Cruz, PharmD, New Jersey

S. Kadiyam, MD, New Jersey

G. Acety, MD, New York

M. Desta, MD, New York

D. Konsky, DO, New York

F. Kumar, MD, New York

S. Ramamoorthy, ANP, New York

R. Ravindran, MD, New York

C. Tauro, MD, New York

P. Vitale, BS, MS, New York

S. Khan, MD, North Carolina

S. Menon, MD, North Carolina

J. Asteriou, MD, Ohio

S. Bearelly, MD, Ohio

K. Clark, MD, Ohio

F. Darmoch, Ohio

L. McKnight, MD, Ohio

A. Pope, APRN-BC, Ohio

D. Abernethy, Oklahoma

I. Liao, MD, Oregon

L. Matlock, FNP, Oregon

M. Bhatta, MD, Pennsylvania

B. Da Silva, MD, Pennsylvania

H. Entero, MD, Pennsylvania

Z. Garbuz, MD, Pennsylvania

B. Goldner, Pennsylvania

J. Goodling, CRNP, Pennsylvania

J. Jablonowski, PA-C, Pennsylvania

S. Kalim, Pennsylvania

J. Kim, Pennsylvania

S. McKimm, DO, Pennsylvania

B. Mosch, Pennsylvania

R. Naik, MBBS, Pennsylvania

V. Patel, MD, Pennsylvania

C. Raffferty, Pennsylvania

S. Ramakrishnan, MD, Pennsylvania

M. Rehr, DO, Pennsylvania

R. Sathi, MD, Pennsylvania

S. Shrestha, MD, Pennsylvania

T. Wigoda, Pennsylvania

B. Yemenu, MD, Pennsylvania

A. Gebru, Rhode Island

J. Freelin, MD, South Carolina

R. Romano Martin, PA-C, South Carolina

D. Njingeh, MD, South Dakota

P. Frost, MD, Tennessee

C. Olechowski, MD, Tennessee

O. Zaka, MD, Tennessee

K. Dowell, MS, Texas

T. Mian, Texas

R. Nuila, Texas

S. Pardinek, Texas

C. Pywell, Texas

K. Sanders, Texas

M. Varwani, MD, Texas

K. Johnson, MD, MPH, Washington

J. A. Levin, MD, Washington

R. Brant, FAAP, West Virginia

E. Hjertstedt, MD, Wisconsin

V. Kumar, Wisconsin

C. A. Valino, MD, Wyoming

E. Nehme, MD, United Arab Emirates

In fiscal year (FY) 2015, VA conducted 2.14 million telehealth visits, reaching more than 677,000 veterans. Telehealth “remains a critical strategy in ensuring veterans can access health care when and where they need it,” Kevin Galpin, MD, acting executive director for telehealth at the VHA told the House Committee on Veterans Affairs earlier this month. “With the support of Congress, we have an opportunity to shape the future and ensure that VA is leveraging cutting-edge technology to provide convenient, accessible, high-quality care to all veterans.”

Related: Madhulika Agarwal on Telehealth at the VHA

Telemental health, in particular, also has seen significant growth. From 2002 through July 2, 2016, Galpin reported, more than 2 million telemental health visits have been provided to more than 389,400 unique veterans. And use of telehealth in the Greater Los Angeles Health Care System alone increased by 61,500, including more than 20,000 telehealth visits, which reached more than 6,000 veterans in southern California.

“For the past 10 years, I have studied many telehealth models and have been most impressed by the VA model as both exemplary and successful,” Herb Rogove, DO, FCCM, FACP, president and chief executive officer, C30 Telemedicine and former board member of the American Telemedicine Association, reported in a statement to the committee.

Related: Telejustice: Reaching Incarcerated Veterans via Telehealth

The VA is testing a new system that will allow veterans to access telehealth from their personal mobile device, smartphone, tablet, or computer. The VA Video Connect (VVC) is currently undergoing field testing for real-time access to VA care and will be fully encrypted to protect patient information. It will complement the VA’s current offerings of home telehealth, using VA-provided devices and store-and-forward telehealth, which allows users to asynchronously acquire and store clinical information (such as data, images, sound, and video) that then can be examined by a provider at another location for clinical evaluation.

Related: Patients Benefit From ICU Telemedicine

Other important telehealth developments include:

• In FY 2015, more than 57,000 rehabilitation encounters for more than 33,000 unique veterans occurred using home telehealth.
• Store-and-forward telehealth has been particularly successful for dermatologic and retinal diagnosis and triage.
• The National Telemental Health Centers have provided access and consults to more than 4,600 veterans at more than 120 sites. 
• The Tele-Intensive Care program links VA intensive care units to a central monitoring hub.
• Telesurgical consultation is being used to “enhance the diagnosis, the coordination of care, and the triage of surgical patients.”

In fiscal year (FY) 2015, VA conducted 2.14 million telehealth visits, reaching more than 677,000 veterans. Telehealth “remains a critical strategy in ensuring veterans can access health care when and where they need it,” Kevin Galpin, MD, acting executive director for telehealth at the VHA told the House Committee on Veterans Affairs earlier this month. “With the support of Congress, we have an opportunity to shape the future and ensure that VA is leveraging cutting-edge technology to provide convenient, accessible, high-quality care to all veterans.”

Related: Madhulika Agarwal on Telehealth at the VHA

Telemental health, in particular, also has seen significant growth. From 2002 through July 2, 2016, Galpin reported, more than 2 million telemental health visits have been provided to more than 389,400 unique veterans. And use of telehealth in the Greater Los Angeles Health Care System alone increased by 61,500, including more than 20,000 telehealth visits, which reached more than 6,000 veterans in southern California.

“For the past 10 years, I have studied many telehealth models and have been most impressed by the VA model as both exemplary and successful,” Herb Rogove, DO, FCCM, FACP, president and chief executive officer, C30 Telemedicine and former board member of the American Telemedicine Association, reported in a statement to the committee.

Related: Telejustice: Reaching Incarcerated Veterans via Telehealth

The VA is testing a new system that will allow veterans to access telehealth from their personal mobile device, smartphone, tablet, or computer. The VA Video Connect (VVC) is currently undergoing field testing for real-time access to VA care and will be fully encrypted to protect patient information. It will complement the VA’s current offerings of home telehealth, using VA-provided devices and store-and-forward telehealth, which allows users to asynchronously acquire and store clinical information (such as data, images, sound, and video) that then can be examined by a provider at another location for clinical evaluation.

Related: Patients Benefit From ICU Telemedicine

Other important telehealth developments include:

• In FY 2015, more than 57,000 rehabilitation encounters for more than 33,000 unique veterans occurred using home telehealth.
• Store-and-forward telehealth has been particularly successful for dermatologic and retinal diagnosis and triage.
• The National Telemental Health Centers have provided access and consults to more than 4,600 veterans at more than 120 sites. 
• The Tele-Intensive Care program links VA intensive care units to a central monitoring hub.
• Telesurgical consultation is being used to “enhance the diagnosis, the coordination of care, and the triage of surgical patients.”

In fiscal year (FY) 2015, VA conducted 2.14 million telehealth visits, reaching more than 677,000 veterans. Telehealth “remains a critical strategy in ensuring veterans can access health care when and where they need it,” Kevin Galpin, MD, acting executive director for telehealth at the VHA told the House Committee on Veterans Affairs earlier this month. “With the support of Congress, we have an opportunity to shape the future and ensure that VA is leveraging cutting-edge technology to provide convenient, accessible, high-quality care to all veterans.”

Related: Madhulika Agarwal on Telehealth at the VHA

Telemental health, in particular, also has seen significant growth. From 2002 through July 2, 2016, Galpin reported, more than 2 million telemental health visits have been provided to more than 389,400 unique veterans. And use of telehealth in the Greater Los Angeles Health Care System alone increased by 61,500, including more than 20,000 telehealth visits, which reached more than 6,000 veterans in southern California.

“For the past 10 years, I have studied many telehealth models and have been most impressed by the VA model as both exemplary and successful,” Herb Rogove, DO, FCCM, FACP, president and chief executive officer, C30 Telemedicine and former board member of the American Telemedicine Association, reported in a statement to the committee.

Related: Telejustice: Reaching Incarcerated Veterans via Telehealth

The VA is testing a new system that will allow veterans to access telehealth from their personal mobile device, smartphone, tablet, or computer. The VA Video Connect (VVC) is currently undergoing field testing for real-time access to VA care and will be fully encrypted to protect patient information. It will complement the VA’s current offerings of home telehealth, using VA-provided devices and store-and-forward telehealth, which allows users to asynchronously acquire and store clinical information (such as data, images, sound, and video) that then can be examined by a provider at another location for clinical evaluation.

Related: Patients Benefit From ICU Telemedicine

Other important telehealth developments include:

• In FY 2015, more than 57,000 rehabilitation encounters for more than 33,000 unique veterans occurred using home telehealth.
• Store-and-forward telehealth has been particularly successful for dermatologic and retinal diagnosis and triage.
• The National Telemental Health Centers have provided access and consults to more than 4,600 veterans at more than 120 sites. 
• The Tele-Intensive Care program links VA intensive care units to a central monitoring hub.
• Telesurgical consultation is being used to “enhance the diagnosis, the coordination of care, and the triage of surgical patients.”

All young physicians are adept at using electronic medical records. Do you agree? If so, you’d be wrong. It’s true that young, so-called “digital-native” physicians have more training and experience using EMRs, compared with those who trained in the days of paper charts. But young physicians are also inexperienced at caring for patients, and using a keyboard adds complexity to an already difficult task. Some struggle with the sheer volume of work that EMRs create, while others wrestle with the intrusive computer in the exam room. The former is a complex problem, and solving it involves improving both system and individual work flows. The latter is one I’ve had great success with when coaching inexperienced doctors.

One of my roles at Kaiser Permanente, San Diego, is to coach new physicians to help them perform at their best. In particular, we provide one-on-one help for physicians to optimize the quality of service they provide. More often than not, young physicians benefit from optimizing their work flow as much as from modifying their bedside manner.

Here are five common tips I share with them to improve their service while using EMRs:

• Preview coming attractions. High-quality interactions require that prep work be done before the visit begins. Before seeing your patient, review his or her record to learn about the medical history, particularly any recent important health issues. This is true even if the problem is not related to your specialty. This sends a strong signal to your patient that you know and care about him or her as a person.

• Connect with your patient first, then turn to HealthConnect (our version of the EPIC electronic record). For every patient, every visit, spend the first few minutes giving your undivided attention to them while in the room. Conversely, entering the room and logging on the computer immediately diminishes the quality of the experience for patients.

• Ask permission, not forgiveness. When you must use the EMR to review or to chart, ask permission first. Try something like, “This is important. Do you mind if I start typing some of this to be sure it is captured in your record?” I’ve never seen a patient object if you start typing. If they did, then the time isn’t right for you to go to the EMR, and it would best for you to address their concern first.

• Share the screen. Many patients love to see their chart. It’s like giving them a backstage pass. It’s also a great way to keep them engaged while you talk about their issues. Point things out to them and use it to engage in discussion. The better informed your patients are, the more likely they will evaluate you favorably, and the more likely they are to adhere to your advice.

• Complete diagnoses and write any prescriptions while in the room. This is a wonderful opportunity to engage with your patients on the risks and benefits of what you recommend, to review your specific instructions, and to allow them to see their diagnoses written out. Close with a printed copy of what just transpired. The act of giving something tangible makes the encounter feel complete, while also increasing patients’ retention of key information and their likelihood of following up as directed.

As more young physicians join us in the workforce, we know that it doesn’t matter much if you grew up with Facebook and Snapchat; using EMRs effectively is a learned skill that all of us can improve upon.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

All young physicians are adept at using electronic medical records. Do you agree? If so, you’d be wrong. It’s true that young, so-called “digital-native” physicians have more training and experience using EMRs, compared with those who trained in the days of paper charts. But young physicians are also inexperienced at caring for patients, and using a keyboard adds complexity to an already difficult task. Some struggle with the sheer volume of work that EMRs create, while others wrestle with the intrusive computer in the exam room. The former is a complex problem, and solving it involves improving both system and individual work flows. The latter is one I’ve had great success with when coaching inexperienced doctors.

One of my roles at Kaiser Permanente, San Diego, is to coach new physicians to help them perform at their best. In particular, we provide one-on-one help for physicians to optimize the quality of service they provide. More often than not, young physicians benefit from optimizing their work flow as much as from modifying their bedside manner.

Here are five common tips I share with them to improve their service while using EMRs:

• Preview coming attractions. High-quality interactions require that prep work be done before the visit begins. Before seeing your patient, review his or her record to learn about the medical history, particularly any recent important health issues. This is true even if the problem is not related to your specialty. This sends a strong signal to your patient that you know and care about him or her as a person.

• Connect with your patient first, then turn to HealthConnect (our version of the EPIC electronic record). For every patient, every visit, spend the first few minutes giving your undivided attention to them while in the room. Conversely, entering the room and logging on the computer immediately diminishes the quality of the experience for patients.

• Ask permission, not forgiveness. When you must use the EMR to review or to chart, ask permission first. Try something like, “This is important. Do you mind if I start typing some of this to be sure it is captured in your record?” I’ve never seen a patient object if you start typing. If they did, then the time isn’t right for you to go to the EMR, and it would best for you to address their concern first.

• Share the screen. Many patients love to see their chart. It’s like giving them a backstage pass. It’s also a great way to keep them engaged while you talk about their issues. Point things out to them and use it to engage in discussion. The better informed your patients are, the more likely they will evaluate you favorably, and the more likely they are to adhere to your advice.

• Complete diagnoses and write any prescriptions while in the room. This is a wonderful opportunity to engage with your patients on the risks and benefits of what you recommend, to review your specific instructions, and to allow them to see their diagnoses written out. Close with a printed copy of what just transpired. The act of giving something tangible makes the encounter feel complete, while also increasing patients’ retention of key information and their likelihood of following up as directed.

As more young physicians join us in the workforce, we know that it doesn’t matter much if you grew up with Facebook and Snapchat; using EMRs effectively is a learned skill that all of us can improve upon.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

All young physicians are adept at using electronic medical records. Do you agree? If so, you’d be wrong. It’s true that young, so-called “digital-native” physicians have more training and experience using EMRs, compared with those who trained in the days of paper charts. But young physicians are also inexperienced at caring for patients, and using a keyboard adds complexity to an already difficult task. Some struggle with the sheer volume of work that EMRs create, while others wrestle with the intrusive computer in the exam room. The former is a complex problem, and solving it involves improving both system and individual work flows. The latter is one I’ve had great success with when coaching inexperienced doctors.

One of my roles at Kaiser Permanente, San Diego, is to coach new physicians to help them perform at their best. In particular, we provide one-on-one help for physicians to optimize the quality of service they provide. More often than not, young physicians benefit from optimizing their work flow as much as from modifying their bedside manner.

Here are five common tips I share with them to improve their service while using EMRs:

• Preview coming attractions. High-quality interactions require that prep work be done before the visit begins. Before seeing your patient, review his or her record to learn about the medical history, particularly any recent important health issues. This is true even if the problem is not related to your specialty. This sends a strong signal to your patient that you know and care about him or her as a person.

• Connect with your patient first, then turn to HealthConnect (our version of the EPIC electronic record). For every patient, every visit, spend the first few minutes giving your undivided attention to them while in the room. Conversely, entering the room and logging on the computer immediately diminishes the quality of the experience for patients.

• Ask permission, not forgiveness. When you must use the EMR to review or to chart, ask permission first. Try something like, “This is important. Do you mind if I start typing some of this to be sure it is captured in your record?” I’ve never seen a patient object if you start typing. If they did, then the time isn’t right for you to go to the EMR, and it would best for you to address their concern first.

• Share the screen. Many patients love to see their chart. It’s like giving them a backstage pass. It’s also a great way to keep them engaged while you talk about their issues. Point things out to them and use it to engage in discussion. The better informed your patients are, the more likely they will evaluate you favorably, and the more likely they are to adhere to your advice.

• Complete diagnoses and write any prescriptions while in the room. This is a wonderful opportunity to engage with your patients on the risks and benefits of what you recommend, to review your specific instructions, and to allow them to see their diagnoses written out. Close with a printed copy of what just transpired. The act of giving something tangible makes the encounter feel complete, while also increasing patients’ retention of key information and their likelihood of following up as directed.

As more young physicians join us in the workforce, we know that it doesn’t matter much if you grew up with Facebook and Snapchat; using EMRs effectively is a learned skill that all of us can improve upon.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

The majority of patients who have undergone laparoscopic totally extraperitoneal groin hernia repair report mild or no symptoms 2 years after the operation, results of a large prospective study indicate.

Researchers assessed 293 patients – 93% of whom were male – who underwent laparoscopic totally extraperitoneal (TEP) groin hernia repair, both before and 3 weeks, 6 months, 1 year, and 2 years after their operation, using the 36-Item Short Form Survey (v2), Surgical Outcomes Measurement System, and Carolinas Comfort Scale.

Courtesy Wikimedia Commons/Samuel Bendet/Creative Commons License

The study, published in the July issue of the Journal of the American College of Surgeons, found that 98% of individuals reported no or nonbothersome symptoms of sensation of mesh, 95% reported the same for pain, and 97% reported the same for movement limitations when assessed using the Carolinas Comfort Scale 2 years after surgery.

Pain scores, as measured by the Surgical Outcomes Measurement System, also improved significantly from baseline to 2 years after surgery (10 vs. 7.5; P = .025), and at all postoperative points, patients said they were highly satisfied with their quality of life.

“This study found that laparoscopic TEP groin hernia repair improves patient quality of life significantly, as evidenced by two generic and one procedure-specific quality of life instruments,” wrote Matthew E. Gitelis and his colleagues at the department of surgery at NorthShore University HealthSystem, Evanston, Ill. “Additionally, the procedure can be performed safely with minimal morbidity and low recurrence rates.”

According to the 36-Item Short Form Survey, patients showed significant improvements in physical functioning at 2 years after surgery, but not at 3 weeks, 6 months, or 1 year postoperatively. Pain scores initially increased at 3 weeks after surgery, compared with baseline, decreased to baseline levels at 6 months, then improved significantly at 1 and 2 years after surgery.

While surgery did not appear to affect energy/fatigue scores or emotional well-being, patients did report significant improvements in social functioning and role limitations (J Am Coll Surg. 2016 Jul;223:153-161). On average, patients used narcotic pain medication for 2.5 days after surgery, and returned to work and daily activities after 5.4 days.

The study also examined the technical outcomes of the operations, which were all performed by four surgeons specializing in minimally invasive and bariatric surgery at three sites across an academic-affiliated hospital system.

The authors said the decision was made to study the outcomes from more experienced surgeons because of the steep learning curves and specialized skill set required for laparoscopic techniques.

“Looking at the technical outcomes of our cohort as they relate to recurrence rates and complications, we continue to show the importance of reporting the experience of high-volume centers,” they wrote. “Our goal is to better understand the details and duration of quality of life outcomes so that we can better address patient expectations and provide important information used in the decision-making process for patients undergoing an elective procedure.”

There were 66 complications overall, most of which were from seroma (25 patients), hematoma (13 patients), and urinary retention (21 patients), with 7 cases of wound infection reported. Eight patients (2.2%) experienced a hernia recurrence.

“It is worth noting that, in the middle of our study, in an effort to decrease long-term postoperative pain, we switched to lighter-weight mesh (Physiomesh) from the polyester mesh (Parietex anatomical) used previously,” the authors reported. “Carolinas Comfort Scale scores at 1 year did confirm decreased pain scores; however, we also saw significantly higher rates of recurrence during that period.”

No conflicts of interest were declared.

The majority of patients who have undergone laparoscopic totally extraperitoneal groin hernia repair report mild or no symptoms 2 years after the operation, results of a large prospective study indicate.

Researchers assessed 293 patients – 93% of whom were male – who underwent laparoscopic totally extraperitoneal (TEP) groin hernia repair, both before and 3 weeks, 6 months, 1 year, and 2 years after their operation, using the 36-Item Short Form Survey (v2), Surgical Outcomes Measurement System, and Carolinas Comfort Scale.

Courtesy Wikimedia Commons/Samuel Bendet/Creative Commons License

The study, published in the July issue of the Journal of the American College of Surgeons, found that 98% of individuals reported no or nonbothersome symptoms of sensation of mesh, 95% reported the same for pain, and 97% reported the same for movement limitations when assessed using the Carolinas Comfort Scale 2 years after surgery.

Pain scores, as measured by the Surgical Outcomes Measurement System, also improved significantly from baseline to 2 years after surgery (10 vs. 7.5; P = .025), and at all postoperative points, patients said they were highly satisfied with their quality of life.

“This study found that laparoscopic TEP groin hernia repair improves patient quality of life significantly, as evidenced by two generic and one procedure-specific quality of life instruments,” wrote Matthew E. Gitelis and his colleagues at the department of surgery at NorthShore University HealthSystem, Evanston, Ill. “Additionally, the procedure can be performed safely with minimal morbidity and low recurrence rates.”

According to the 36-Item Short Form Survey, patients showed significant improvements in physical functioning at 2 years after surgery, but not at 3 weeks, 6 months, or 1 year postoperatively. Pain scores initially increased at 3 weeks after surgery, compared with baseline, decreased to baseline levels at 6 months, then improved significantly at 1 and 2 years after surgery.

While surgery did not appear to affect energy/fatigue scores or emotional well-being, patients did report significant improvements in social functioning and role limitations (J Am Coll Surg. 2016 Jul;223:153-161). On average, patients used narcotic pain medication for 2.5 days after surgery, and returned to work and daily activities after 5.4 days.

The study also examined the technical outcomes of the operations, which were all performed by four surgeons specializing in minimally invasive and bariatric surgery at three sites across an academic-affiliated hospital system.

The authors said the decision was made to study the outcomes from more experienced surgeons because of the steep learning curves and specialized skill set required for laparoscopic techniques.

“Looking at the technical outcomes of our cohort as they relate to recurrence rates and complications, we continue to show the importance of reporting the experience of high-volume centers,” they wrote. “Our goal is to better understand the details and duration of quality of life outcomes so that we can better address patient expectations and provide important information used in the decision-making process for patients undergoing an elective procedure.”

There were 66 complications overall, most of which were from seroma (25 patients), hematoma (13 patients), and urinary retention (21 patients), with 7 cases of wound infection reported. Eight patients (2.2%) experienced a hernia recurrence.

“It is worth noting that, in the middle of our study, in an effort to decrease long-term postoperative pain, we switched to lighter-weight mesh (Physiomesh) from the polyester mesh (Parietex anatomical) used previously,” the authors reported. “Carolinas Comfort Scale scores at 1 year did confirm decreased pain scores; however, we also saw significantly higher rates of recurrence during that period.”

No conflicts of interest were declared.

The majority of patients who have undergone laparoscopic totally extraperitoneal groin hernia repair report mild or no symptoms 2 years after the operation, results of a large prospective study indicate.

Researchers assessed 293 patients – 93% of whom were male – who underwent laparoscopic totally extraperitoneal (TEP) groin hernia repair, both before and 3 weeks, 6 months, 1 year, and 2 years after their operation, using the 36-Item Short Form Survey (v2), Surgical Outcomes Measurement System, and Carolinas Comfort Scale.

Courtesy Wikimedia Commons/Samuel Bendet/Creative Commons License

The study, published in the July issue of the Journal of the American College of Surgeons, found that 98% of individuals reported no or nonbothersome symptoms of sensation of mesh, 95% reported the same for pain, and 97% reported the same for movement limitations when assessed using the Carolinas Comfort Scale 2 years after surgery.

Pain scores, as measured by the Surgical Outcomes Measurement System, also improved significantly from baseline to 2 years after surgery (10 vs. 7.5; P = .025), and at all postoperative points, patients said they were highly satisfied with their quality of life.

“This study found that laparoscopic TEP groin hernia repair improves patient quality of life significantly, as evidenced by two generic and one procedure-specific quality of life instruments,” wrote Matthew E. Gitelis and his colleagues at the department of surgery at NorthShore University HealthSystem, Evanston, Ill. “Additionally, the procedure can be performed safely with minimal morbidity and low recurrence rates.”

According to the 36-Item Short Form Survey, patients showed significant improvements in physical functioning at 2 years after surgery, but not at 3 weeks, 6 months, or 1 year postoperatively. Pain scores initially increased at 3 weeks after surgery, compared with baseline, decreased to baseline levels at 6 months, then improved significantly at 1 and 2 years after surgery.

While surgery did not appear to affect energy/fatigue scores or emotional well-being, patients did report significant improvements in social functioning and role limitations (J Am Coll Surg. 2016 Jul;223:153-161). On average, patients used narcotic pain medication for 2.5 days after surgery, and returned to work and daily activities after 5.4 days.

The study also examined the technical outcomes of the operations, which were all performed by four surgeons specializing in minimally invasive and bariatric surgery at three sites across an academic-affiliated hospital system.

The authors said the decision was made to study the outcomes from more experienced surgeons because of the steep learning curves and specialized skill set required for laparoscopic techniques.

“Looking at the technical outcomes of our cohort as they relate to recurrence rates and complications, we continue to show the importance of reporting the experience of high-volume centers,” they wrote. “Our goal is to better understand the details and duration of quality of life outcomes so that we can better address patient expectations and provide important information used in the decision-making process for patients undergoing an elective procedure.”

There were 66 complications overall, most of which were from seroma (25 patients), hematoma (13 patients), and urinary retention (21 patients), with 7 cases of wound infection reported. Eight patients (2.2%) experienced a hernia recurrence.

“It is worth noting that, in the middle of our study, in an effort to decrease long-term postoperative pain, we switched to lighter-weight mesh (Physiomesh) from the polyester mesh (Parietex anatomical) used previously,” the authors reported. “Carolinas Comfort Scale scores at 1 year did confirm decreased pain scores; however, we also saw significantly higher rates of recurrence during that period.”

No conflicts of interest were declared.