As Oliver Wendell Holmes stated “The great thing in this world is not so much where we stand, as in what direction we are moving.” Where is AGA moving? AGA represents the highest values in the field of gastroenterology and hepatology, and a focus on the care of patients. We need to demonstrate value, maintain certification, discover new treatments, and improve patient care.

The era of reimbursement based on value, quality care is here: AGA is the leading GI society helping you provide quality care and demonstrating to payors that you’re doing so. Medicare is in the midst of shifting to a value and quality-driven physician reimbursement system. AGA is here to help you successfully make the transition. You must learn about the new system and start preparations – decisions made this year will impact your payment in the future.

AGA Institute

An important milestone in the transition to the new system was the recent release of proposed rules related to MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which replaces the flawed Sustainable Growth Rate formula. CHIP is the Children’s Health Insurance Program. Under MACRA, physicians will have a choice – to be paid via the Merit-Based Incentive Payment System (MIPS) or Alternate Payment Models. Most GIs will participate in MIPS. The most important thing you can do now is report on quality. AGA has quality measures and our Digestive Health Recognition Program is a qualified clinical data registry.

AGA must lead our profession to increase the value of the care we provide. High-value, cost-conscious care refers to care that aims to assess the benefits, harms, and costs of interventions and, consequently, to provide care that adds value. Guidance to enhance value of care based on cognitive skills and appropriate use of biomarkers and imaging, and Clinical Practice Updates are complementary to AGA Guidelines.

Gastroenterologists must maintain certification in a system we don’t support. Maintenance of certification is a major issue in medicine. AGA is pushing for change, favoring continuous professional development for gastroenterologists who self-categorize their practice expertise, and participate in assessments having a built‐in remediation experience with access to resources during the testing. Having developed consensus principles authored by AGA, AASLD, ACG, ASGE, ANMS, and NASPGHAN, we have achieved a stop to the 10-year high stakes exam. We have developed an alliance with other internal medicine societies to attempt to co-create MOC of the future.

One area that is a constant in medicine is the need for research. AGA is committed to research and supporting young investigators so that the future is bright for our patients. Every year our foundation gives $2.5 million in research grants and we continue to advocate for increased NIH funding.

Patients need us to better understand digestive disease and discover new treatments. We have extensive patient education tools on the AGA website. AGA supports device and drug makers working to bring new treatments to patients, with dedicated centers: Center for GI Technology, Center for Diagnostics and Therapeutics, and the Center for the Microbiome, which recently received a prestigious grant from the NIH to support microbiome research.

Patients also want evidence-based care and want to participate in choices. We are developing new patient education materials for use AT THE POINT OF CARE, and for inclusion in EHRs to provide automated qualified clinical data registry (QCDR) reporting by gastroenterologists. At present, there are still challenges of interoperability in the electronic environment.

Obesity is a chronic disease concomitant with many GI diseases and reflects an opportunity for obesity management by gastroenterologists through a forthcoming white paper, entitled Practice Guide on Obesity and Weight Management Education, and Resources.

Finally, we recognized Martin Brotman, MD, AGAF, for innumerable contributions over almost 3 decades as a leader of the AGA, and Richard Boland, MD, AGAF, as the Julius Friedenwald Medal awardee.

Dr. Camilleri is the Atherton and Winifred W. Bean Professor and professor of medicine, pharmacology, and physiology, Mayo Clinic College of Medicine Consultant, division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

As Oliver Wendell Holmes stated “The great thing in this world is not so much where we stand, as in what direction we are moving.” Where is AGA moving? AGA represents the highest values in the field of gastroenterology and hepatology, and a focus on the care of patients. We need to demonstrate value, maintain certification, discover new treatments, and improve patient care.

The era of reimbursement based on value, quality care is here: AGA is the leading GI society helping you provide quality care and demonstrating to payors that you’re doing so. Medicare is in the midst of shifting to a value and quality-driven physician reimbursement system. AGA is here to help you successfully make the transition. You must learn about the new system and start preparations – decisions made this year will impact your payment in the future.

AGA Institute

An important milestone in the transition to the new system was the recent release of proposed rules related to MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which replaces the flawed Sustainable Growth Rate formula. CHIP is the Children’s Health Insurance Program. Under MACRA, physicians will have a choice – to be paid via the Merit-Based Incentive Payment System (MIPS) or Alternate Payment Models. Most GIs will participate in MIPS. The most important thing you can do now is report on quality. AGA has quality measures and our Digestive Health Recognition Program is a qualified clinical data registry.

AGA must lead our profession to increase the value of the care we provide. High-value, cost-conscious care refers to care that aims to assess the benefits, harms, and costs of interventions and, consequently, to provide care that adds value. Guidance to enhance value of care based on cognitive skills and appropriate use of biomarkers and imaging, and Clinical Practice Updates are complementary to AGA Guidelines.

Gastroenterologists must maintain certification in a system we don’t support. Maintenance of certification is a major issue in medicine. AGA is pushing for change, favoring continuous professional development for gastroenterologists who self-categorize their practice expertise, and participate in assessments having a built‐in remediation experience with access to resources during the testing. Having developed consensus principles authored by AGA, AASLD, ACG, ASGE, ANMS, and NASPGHAN, we have achieved a stop to the 10-year high stakes exam. We have developed an alliance with other internal medicine societies to attempt to co-create MOC of the future.

One area that is a constant in medicine is the need for research. AGA is committed to research and supporting young investigators so that the future is bright for our patients. Every year our foundation gives $2.5 million in research grants and we continue to advocate for increased NIH funding.

Patients need us to better understand digestive disease and discover new treatments. We have extensive patient education tools on the AGA website. AGA supports device and drug makers working to bring new treatments to patients, with dedicated centers: Center for GI Technology, Center for Diagnostics and Therapeutics, and the Center for the Microbiome, which recently received a prestigious grant from the NIH to support microbiome research.

Patients also want evidence-based care and want to participate in choices. We are developing new patient education materials for use AT THE POINT OF CARE, and for inclusion in EHRs to provide automated qualified clinical data registry (QCDR) reporting by gastroenterologists. At present, there are still challenges of interoperability in the electronic environment.

Obesity is a chronic disease concomitant with many GI diseases and reflects an opportunity for obesity management by gastroenterologists through a forthcoming white paper, entitled Practice Guide on Obesity and Weight Management Education, and Resources.

Finally, we recognized Martin Brotman, MD, AGAF, for innumerable contributions over almost 3 decades as a leader of the AGA, and Richard Boland, MD, AGAF, as the Julius Friedenwald Medal awardee.

Dr. Camilleri is the Atherton and Winifred W. Bean Professor and professor of medicine, pharmacology, and physiology, Mayo Clinic College of Medicine Consultant, division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

As Oliver Wendell Holmes stated “The great thing in this world is not so much where we stand, as in what direction we are moving.” Where is AGA moving? AGA represents the highest values in the field of gastroenterology and hepatology, and a focus on the care of patients. We need to demonstrate value, maintain certification, discover new treatments, and improve patient care.

The era of reimbursement based on value, quality care is here: AGA is the leading GI society helping you provide quality care and demonstrating to payors that you’re doing so. Medicare is in the midst of shifting to a value and quality-driven physician reimbursement system. AGA is here to help you successfully make the transition. You must learn about the new system and start preparations – decisions made this year will impact your payment in the future.

AGA Institute

An important milestone in the transition to the new system was the recent release of proposed rules related to MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which replaces the flawed Sustainable Growth Rate formula. CHIP is the Children’s Health Insurance Program. Under MACRA, physicians will have a choice – to be paid via the Merit-Based Incentive Payment System (MIPS) or Alternate Payment Models. Most GIs will participate in MIPS. The most important thing you can do now is report on quality. AGA has quality measures and our Digestive Health Recognition Program is a qualified clinical data registry.

AGA must lead our profession to increase the value of the care we provide. High-value, cost-conscious care refers to care that aims to assess the benefits, harms, and costs of interventions and, consequently, to provide care that adds value. Guidance to enhance value of care based on cognitive skills and appropriate use of biomarkers and imaging, and Clinical Practice Updates are complementary to AGA Guidelines.

Gastroenterologists must maintain certification in a system we don’t support. Maintenance of certification is a major issue in medicine. AGA is pushing for change, favoring continuous professional development for gastroenterologists who self-categorize their practice expertise, and participate in assessments having a built‐in remediation experience with access to resources during the testing. Having developed consensus principles authored by AGA, AASLD, ACG, ASGE, ANMS, and NASPGHAN, we have achieved a stop to the 10-year high stakes exam. We have developed an alliance with other internal medicine societies to attempt to co-create MOC of the future.

One area that is a constant in medicine is the need for research. AGA is committed to research and supporting young investigators so that the future is bright for our patients. Every year our foundation gives $2.5 million in research grants and we continue to advocate for increased NIH funding.

Patients need us to better understand digestive disease and discover new treatments. We have extensive patient education tools on the AGA website. AGA supports device and drug makers working to bring new treatments to patients, with dedicated centers: Center for GI Technology, Center for Diagnostics and Therapeutics, and the Center for the Microbiome, which recently received a prestigious grant from the NIH to support microbiome research.

Patients also want evidence-based care and want to participate in choices. We are developing new patient education materials for use AT THE POINT OF CARE, and for inclusion in EHRs to provide automated qualified clinical data registry (QCDR) reporting by gastroenterologists. At present, there are still challenges of interoperability in the electronic environment.

Obesity is a chronic disease concomitant with many GI diseases and reflects an opportunity for obesity management by gastroenterologists through a forthcoming white paper, entitled Practice Guide on Obesity and Weight Management Education, and Resources.

Finally, we recognized Martin Brotman, MD, AGAF, for innumerable contributions over almost 3 decades as a leader of the AGA, and Richard Boland, MD, AGAF, as the Julius Friedenwald Medal awardee.

Dr. Camilleri is the Atherton and Winifred W. Bean Professor and professor of medicine, pharmacology, and physiology, Mayo Clinic College of Medicine Consultant, division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson

As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.

Perhaps the questions we should be asking ourselves, our trainees and our families are:

• Instead of “What’s the matter?” ask “What matters?”
• Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”

Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.

A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.

One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.

This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.

When asking for the Pediatric Value Meal, this is one where I will not Super size it!

Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.

As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.

Perhaps the questions we should be asking ourselves, our trainees and our families are:

• Instead of “What’s the matter?” ask “What matters?”
• Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”

Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.

A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.

One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.

This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.

When asking for the Pediatric Value Meal, this is one where I will not Super size it!

Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.

As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.

Perhaps the questions we should be asking ourselves, our trainees and our families are:

• Instead of “What’s the matter?” ask “What matters?”
• Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”

Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.

A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.

One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.

This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.

When asking for the Pediatric Value Meal, this is one where I will not Super size it!

Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

[email protected]

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

[email protected]

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

[email protected]

SAN DIEGO—New or worse headaches may persist five years after traumatic brain injury (TBI), according to results of a prospective study presented at the 58th Annual Scientific Meeting of the American Headache Society. “Results suggest that ongoing assessment and treatment of headache after TBI is needed as headache remains a potential problem even five years post injury,” the researchers said.

Headache is one of the most common symptoms in patients with TBI, but the characteristics of headache after brain injury are not well defined, and prior estimates of the prevalence of headache after TBI have been based on retrospective studies.

To assess the natural history and features of headache after TBI, Sylvia Lucas, MD, PhD, Clinical Professor of Neurology and Neurological Surgery at the University of Washington in Seattle, and colleagues conducted a prospective study in civilian patients with TBI. Participants were enrolled during inpatient rehabilitation hospitalizations at seven centers. Researchers conducted follow-up phone interviews with participants at three, six, 12, and 60 months. One-year follow-up data were published in the Journal of Neurotrauma in 2011.

Sylvia Lucas, MD, PhD

The investigators obtained five-year follow-up data for 316 participants. Participants had an average age of 42. Seventy-two percent were male, 73% were white, and 74% had completed high school. Most injuries involved motor vehicle crashes, and patients mostly had moderate to severe TBI. Patients may have sustained other injuries in addition to TBI. Only 17% had pre-injury headaches.

High Prevalence

Compared with pre-injury, the prevalence of new or worse headache was high and remained so over time: 38% at baseline, 37% at three months, 33% at six months, 34% at one year, and 35% at five years. Average headache pain on a 0-to-10 scale remained high over time, ranging from 5.5 at baseline to 5.7 at five years. Headache Impact Test scores showed a substantial impact of headache on quality of life, with mean scores of 57.1 at three months and 56.5 at five years. The proportion of patients with headaches occurring several times per week or daily was 50% at three months and 36% at five years.

Patients may have had subsequent concussions or new-onset primary headache disorders during the study, but the researchers believe that most of the headaches are related to the initial injury.

Dr. Lucas and colleagues determined whether patients’ headache characteristics matched those of primary headache disorders described in the International Classification of Headache Disorders, second edition (ICHD-2). They found that migraine was the most common headache type (approximately 59%), followed by tension-type headache (approximately 14%). About a quarter of the headaches were not classifiable using ICHD-2 criteria.

Effective Interventions?

Neurologists should educate primary care physicians about the persistent nature of headache after TBI. “Be prepared never to cut those strings to your patients because they may be back really needing help to deal with their headaches,” Dr. Lucas said.

Future studies should assess the effectiveness of interventions. “The next step is treatment studies to look at whether the frequency, severity, and the impact of headache after TBI can be decreased with effective pharmacologic or nonpharmacologic methods,” Dr. Lucas concluded.

—Jake Remaly

SAN DIEGO—New or worse headaches may persist five years after traumatic brain injury (TBI), according to results of a prospective study presented at the 58th Annual Scientific Meeting of the American Headache Society. “Results suggest that ongoing assessment and treatment of headache after TBI is needed as headache remains a potential problem even five years post injury,” the researchers said.

Headache is one of the most common symptoms in patients with TBI, but the characteristics of headache after brain injury are not well defined, and prior estimates of the prevalence of headache after TBI have been based on retrospective studies.

To assess the natural history and features of headache after TBI, Sylvia Lucas, MD, PhD, Clinical Professor of Neurology and Neurological Surgery at the University of Washington in Seattle, and colleagues conducted a prospective study in civilian patients with TBI. Participants were enrolled during inpatient rehabilitation hospitalizations at seven centers. Researchers conducted follow-up phone interviews with participants at three, six, 12, and 60 months. One-year follow-up data were published in the Journal of Neurotrauma in 2011.

Sylvia Lucas, MD, PhD

The investigators obtained five-year follow-up data for 316 participants. Participants had an average age of 42. Seventy-two percent were male, 73% were white, and 74% had completed high school. Most injuries involved motor vehicle crashes, and patients mostly had moderate to severe TBI. Patients may have sustained other injuries in addition to TBI. Only 17% had pre-injury headaches.

High Prevalence

Compared with pre-injury, the prevalence of new or worse headache was high and remained so over time: 38% at baseline, 37% at three months, 33% at six months, 34% at one year, and 35% at five years. Average headache pain on a 0-to-10 scale remained high over time, ranging from 5.5 at baseline to 5.7 at five years. Headache Impact Test scores showed a substantial impact of headache on quality of life, with mean scores of 57.1 at three months and 56.5 at five years. The proportion of patients with headaches occurring several times per week or daily was 50% at three months and 36% at five years.

Patients may have had subsequent concussions or new-onset primary headache disorders during the study, but the researchers believe that most of the headaches are related to the initial injury.

Dr. Lucas and colleagues determined whether patients’ headache characteristics matched those of primary headache disorders described in the International Classification of Headache Disorders, second edition (ICHD-2). They found that migraine was the most common headache type (approximately 59%), followed by tension-type headache (approximately 14%). About a quarter of the headaches were not classifiable using ICHD-2 criteria.

Effective Interventions?

Neurologists should educate primary care physicians about the persistent nature of headache after TBI. “Be prepared never to cut those strings to your patients because they may be back really needing help to deal with their headaches,” Dr. Lucas said.

Future studies should assess the effectiveness of interventions. “The next step is treatment studies to look at whether the frequency, severity, and the impact of headache after TBI can be decreased with effective pharmacologic or nonpharmacologic methods,” Dr. Lucas concluded.

—Jake Remaly

SAN DIEGO—New or worse headaches may persist five years after traumatic brain injury (TBI), according to results of a prospective study presented at the 58th Annual Scientific Meeting of the American Headache Society. “Results suggest that ongoing assessment and treatment of headache after TBI is needed as headache remains a potential problem even five years post injury,” the researchers said.

Headache is one of the most common symptoms in patients with TBI, but the characteristics of headache after brain injury are not well defined, and prior estimates of the prevalence of headache after TBI have been based on retrospective studies.

To assess the natural history and features of headache after TBI, Sylvia Lucas, MD, PhD, Clinical Professor of Neurology and Neurological Surgery at the University of Washington in Seattle, and colleagues conducted a prospective study in civilian patients with TBI. Participants were enrolled during inpatient rehabilitation hospitalizations at seven centers. Researchers conducted follow-up phone interviews with participants at three, six, 12, and 60 months. One-year follow-up data were published in the Journal of Neurotrauma in 2011.

Sylvia Lucas, MD, PhD

The investigators obtained five-year follow-up data for 316 participants. Participants had an average age of 42. Seventy-two percent were male, 73% were white, and 74% had completed high school. Most injuries involved motor vehicle crashes, and patients mostly had moderate to severe TBI. Patients may have sustained other injuries in addition to TBI. Only 17% had pre-injury headaches.

High Prevalence

Compared with pre-injury, the prevalence of new or worse headache was high and remained so over time: 38% at baseline, 37% at three months, 33% at six months, 34% at one year, and 35% at five years. Average headache pain on a 0-to-10 scale remained high over time, ranging from 5.5 at baseline to 5.7 at five years. Headache Impact Test scores showed a substantial impact of headache on quality of life, with mean scores of 57.1 at three months and 56.5 at five years. The proportion of patients with headaches occurring several times per week or daily was 50% at three months and 36% at five years.

Patients may have had subsequent concussions or new-onset primary headache disorders during the study, but the researchers believe that most of the headaches are related to the initial injury.

Dr. Lucas and colleagues determined whether patients’ headache characteristics matched those of primary headache disorders described in the International Classification of Headache Disorders, second edition (ICHD-2). They found that migraine was the most common headache type (approximately 59%), followed by tension-type headache (approximately 14%). About a quarter of the headaches were not classifiable using ICHD-2 criteria.

Effective Interventions?

Neurologists should educate primary care physicians about the persistent nature of headache after TBI. “Be prepared never to cut those strings to your patients because they may be back really needing help to deal with their headaches,” Dr. Lucas said.

Future studies should assess the effectiveness of interventions. “The next step is treatment studies to look at whether the frequency, severity, and the impact of headache after TBI can be decreased with effective pharmacologic or nonpharmacologic methods,” Dr. Lucas concluded.

—Jake Remaly

In elderly patients with chronic lymphocytic leukemia, complex karyotype abnormalities, certain KRAS and POT1 mutations, and newly discovered mutations in genes involved in the DNA damage response were found to predict a poor response to chlorambucil-based chemotherapy or chemoimmunotherapy and poor survival, according to a report in Blood.

These findings are from what the investigators described as the first comprehensive prospective analysis of chromosomal aberrations (including complex karyotype abnormalities), gene mutations, and clinical and biological features in elderly CLL patients who had multiple comorbidities. This patient population is generally considered ineligible for aggressive first-line agents such as fludarabine and cyclophosphamide, said Carmen Diana Herling, MD, of the Laboratory of Functional Genomics in Lymphoid Malignancies, University of Cologne (Germany), and her associates.

For their analysis, investigators studied 161 such patients enrolled in a clinical trial in which all were treated with chlorambucil alone, chlorambucil plus obinutuzumab, or chlorambucil plus rituximab. The median patient age was 75 years. Comprehensive genetic analyses were performed using peripheral blood drawn before the patients underwent treatment.

Karyotyping detected chromosomal aberrations in 68.68% of patients, while 31.2% carried translocations and 19.5% showed complex karyotypes. Gene sequencing detected 198 missense/nonsense mutations and other abnormalities in 76.4% of patients.

Dr. Herling and her associates found that complex karyotype abnormalities independently predicted poor response to chlorambucil and poor survival. “Thus, global karyotyping (i.e., by chromosome banding analysis) seems to substantially contribute to the identification of CLL patients with most adverse prognoses and should be considered a standard assessment in future CLL trials,” they said (Blood. 2016;128:395-404).

In addition, KRAS mutations correlated with a poor treatment response, particularly to rituximab. Targeting such patients for MEK, BRAF, or ERK inhibitors “might offer personalized treatment strategies to be investigated in such cases.”

Mutations in the POT1 gene also correlated with shorter survival after chlorambucil treatment. And finally, poor treatment response also correlated with previously unknown mutations in genes involved with the response to DNA damage. This “might contribute to the accumulation of genomic alterations and clonal evolution of CLL,” Dr. Herling and her associates said.

In elderly patients with chronic lymphocytic leukemia, complex karyotype abnormalities, certain KRAS and POT1 mutations, and newly discovered mutations in genes involved in the DNA damage response were found to predict a poor response to chlorambucil-based chemotherapy or chemoimmunotherapy and poor survival, according to a report in Blood.

These findings are from what the investigators described as the first comprehensive prospective analysis of chromosomal aberrations (including complex karyotype abnormalities), gene mutations, and clinical and biological features in elderly CLL patients who had multiple comorbidities. This patient population is generally considered ineligible for aggressive first-line agents such as fludarabine and cyclophosphamide, said Carmen Diana Herling, MD, of the Laboratory of Functional Genomics in Lymphoid Malignancies, University of Cologne (Germany), and her associates.

For their analysis, investigators studied 161 such patients enrolled in a clinical trial in which all were treated with chlorambucil alone, chlorambucil plus obinutuzumab, or chlorambucil plus rituximab. The median patient age was 75 years. Comprehensive genetic analyses were performed using peripheral blood drawn before the patients underwent treatment.

Karyotyping detected chromosomal aberrations in 68.68% of patients, while 31.2% carried translocations and 19.5% showed complex karyotypes. Gene sequencing detected 198 missense/nonsense mutations and other abnormalities in 76.4% of patients.

Dr. Herling and her associates found that complex karyotype abnormalities independently predicted poor response to chlorambucil and poor survival. “Thus, global karyotyping (i.e., by chromosome banding analysis) seems to substantially contribute to the identification of CLL patients with most adverse prognoses and should be considered a standard assessment in future CLL trials,” they said (Blood. 2016;128:395-404).

In addition, KRAS mutations correlated with a poor treatment response, particularly to rituximab. Targeting such patients for MEK, BRAF, or ERK inhibitors “might offer personalized treatment strategies to be investigated in such cases.”

Mutations in the POT1 gene also correlated with shorter survival after chlorambucil treatment. And finally, poor treatment response also correlated with previously unknown mutations in genes involved with the response to DNA damage. This “might contribute to the accumulation of genomic alterations and clonal evolution of CLL,” Dr. Herling and her associates said.

In elderly patients with chronic lymphocytic leukemia, complex karyotype abnormalities, certain KRAS and POT1 mutations, and newly discovered mutations in genes involved in the DNA damage response were found to predict a poor response to chlorambucil-based chemotherapy or chemoimmunotherapy and poor survival, according to a report in Blood.

These findings are from what the investigators described as the first comprehensive prospective analysis of chromosomal aberrations (including complex karyotype abnormalities), gene mutations, and clinical and biological features in elderly CLL patients who had multiple comorbidities. This patient population is generally considered ineligible for aggressive first-line agents such as fludarabine and cyclophosphamide, said Carmen Diana Herling, MD, of the Laboratory of Functional Genomics in Lymphoid Malignancies, University of Cologne (Germany), and her associates.

For their analysis, investigators studied 161 such patients enrolled in a clinical trial in which all were treated with chlorambucil alone, chlorambucil plus obinutuzumab, or chlorambucil plus rituximab. The median patient age was 75 years. Comprehensive genetic analyses were performed using peripheral blood drawn before the patients underwent treatment.

Karyotyping detected chromosomal aberrations in 68.68% of patients, while 31.2% carried translocations and 19.5% showed complex karyotypes. Gene sequencing detected 198 missense/nonsense mutations and other abnormalities in 76.4% of patients.

Dr. Herling and her associates found that complex karyotype abnormalities independently predicted poor response to chlorambucil and poor survival. “Thus, global karyotyping (i.e., by chromosome banding analysis) seems to substantially contribute to the identification of CLL patients with most adverse prognoses and should be considered a standard assessment in future CLL trials,” they said (Blood. 2016;128:395-404).

In addition, KRAS mutations correlated with a poor treatment response, particularly to rituximab. Targeting such patients for MEK, BRAF, or ERK inhibitors “might offer personalized treatment strategies to be investigated in such cases.”

Mutations in the POT1 gene also correlated with shorter survival after chlorambucil treatment. And finally, poor treatment response also correlated with previously unknown mutations in genes involved with the response to DNA damage. This “might contribute to the accumulation of genomic alterations and clonal evolution of CLL,” Dr. Herling and her associates said.

I. Hate. ATVs.

The modern world is full of potentially dangerous things that we regulate – sometimes by the knowledge of the person giving it (medication) or by age (tobacco, alcohol, cars). Or sometimes we simply ban something altogether (illicit drugs).

After years of neurology practice, I’ve learned to hate ATVs. Outside of firearms, I don’t think I’ve seen any gadget that has such a devastating effect on young lives.

My first medical encounter with one was 20-some years ago during my neurosurgery rotation. It was a man in his mid-20s. He was young, muscular, and clearly in excellent condition. And here he was, flaccid below the neck, and permanently on a ventilator.

I sat at the nurses station for a long time, looking at him and thinking about how a young life can go so horribly wrong so quickly. He hadn’t been drunk at the time. He’d simply had a wreck, the cause of which I never found out. After a few days, he was shipped off to a long-term ventilator facility, and I never saw him again.

Cars are dangerous, too, but are bigger and have gadgets to try to improve safety. ATVs are exposed, with only minimal, if any, protection for their riders. Their use is most typically by the young, meaning a disproportionate number of serious injuries will affect those at the beginning of adulthood.

Sadly, banning ATVs won’t stop injuries. There will always be people who do risky things in the name of being daring and having fun.

What’s changed is that 100 years ago they’d likely have died of their injuries soon afterward. Today they’ll probably survive, debilitated long term because of medical advancements.

These are the situations where I feel helpless. There are all kinds of horrible diseases we handle that have no known cause or cure. That’s one kind of helpless. But the ones with easily avoidable risk factors (ATVs, illegal drugs, tobacco) that occur are just plain frustrating for us and tragic for the patients and families.

In the land of the free, freedom to endanger your own life and health are pretty deeply entrenched. The best we can do is present people with the facts and let them make informed decisions about risky behaviors (sadly, the young often believe they’re immortal). If we ban ATVs, we still won’t stop people from making bad decisions on motorcycles or in cars, or with firearms or illegal drugs.

Like so much in medicine, there are no easy answers, and there likely never will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I. Hate. ATVs.

The modern world is full of potentially dangerous things that we regulate – sometimes by the knowledge of the person giving it (medication) or by age (tobacco, alcohol, cars). Or sometimes we simply ban something altogether (illicit drugs).

After years of neurology practice, I’ve learned to hate ATVs. Outside of firearms, I don’t think I’ve seen any gadget that has such a devastating effect on young lives.

My first medical encounter with one was 20-some years ago during my neurosurgery rotation. It was a man in his mid-20s. He was young, muscular, and clearly in excellent condition. And here he was, flaccid below the neck, and permanently on a ventilator.

I sat at the nurses station for a long time, looking at him and thinking about how a young life can go so horribly wrong so quickly. He hadn’t been drunk at the time. He’d simply had a wreck, the cause of which I never found out. After a few days, he was shipped off to a long-term ventilator facility, and I never saw him again.

Cars are dangerous, too, but are bigger and have gadgets to try to improve safety. ATVs are exposed, with only minimal, if any, protection for their riders. Their use is most typically by the young, meaning a disproportionate number of serious injuries will affect those at the beginning of adulthood.

Sadly, banning ATVs won’t stop injuries. There will always be people who do risky things in the name of being daring and having fun.

What’s changed is that 100 years ago they’d likely have died of their injuries soon afterward. Today they’ll probably survive, debilitated long term because of medical advancements.

These are the situations where I feel helpless. There are all kinds of horrible diseases we handle that have no known cause or cure. That’s one kind of helpless. But the ones with easily avoidable risk factors (ATVs, illegal drugs, tobacco) that occur are just plain frustrating for us and tragic for the patients and families.

In the land of the free, freedom to endanger your own life and health are pretty deeply entrenched. The best we can do is present people with the facts and let them make informed decisions about risky behaviors (sadly, the young often believe they’re immortal). If we ban ATVs, we still won’t stop people from making bad decisions on motorcycles or in cars, or with firearms or illegal drugs.

Like so much in medicine, there are no easy answers, and there likely never will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I. Hate. ATVs.

The modern world is full of potentially dangerous things that we regulate – sometimes by the knowledge of the person giving it (medication) or by age (tobacco, alcohol, cars). Or sometimes we simply ban something altogether (illicit drugs).

After years of neurology practice, I’ve learned to hate ATVs. Outside of firearms, I don’t think I’ve seen any gadget that has such a devastating effect on young lives.

My first medical encounter with one was 20-some years ago during my neurosurgery rotation. It was a man in his mid-20s. He was young, muscular, and clearly in excellent condition. And here he was, flaccid below the neck, and permanently on a ventilator.

I sat at the nurses station for a long time, looking at him and thinking about how a young life can go so horribly wrong so quickly. He hadn’t been drunk at the time. He’d simply had a wreck, the cause of which I never found out. After a few days, he was shipped off to a long-term ventilator facility, and I never saw him again.

Cars are dangerous, too, but are bigger and have gadgets to try to improve safety. ATVs are exposed, with only minimal, if any, protection for their riders. Their use is most typically by the young, meaning a disproportionate number of serious injuries will affect those at the beginning of adulthood.

Sadly, banning ATVs won’t stop injuries. There will always be people who do risky things in the name of being daring and having fun.

What’s changed is that 100 years ago they’d likely have died of their injuries soon afterward. Today they’ll probably survive, debilitated long term because of medical advancements.

These are the situations where I feel helpless. There are all kinds of horrible diseases we handle that have no known cause or cure. That’s one kind of helpless. But the ones with easily avoidable risk factors (ATVs, illegal drugs, tobacco) that occur are just plain frustrating for us and tragic for the patients and families.

In the land of the free, freedom to endanger your own life and health are pretty deeply entrenched. The best we can do is present people with the facts and let them make informed decisions about risky behaviors (sadly, the young often believe they’re immortal). If we ban ATVs, we still won’t stop people from making bad decisions on motorcycles or in cars, or with firearms or illegal drugs.

Like so much in medicine, there are no easy answers, and there likely never will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Patients with postoperative delirium have significantly worse preoperative short-term cognitive performance and significantly greater long-term cognitive decline, compared with patients without delirium, according to Sharon K. Inouye, MD, and her associates.

In a prospective cohort study of 560 patients aged 70 years and older, 134 patients were selected for the delirium group and 426 for the nondelirium group. The delirium group had a significantly greater decline (–1.03 points) at 1 month, compared with those without delirium (P = .003). After cognitive function had recovered at 2 months, there were no significant differences between groups (P = 0.99). After 2 months, both groups decline on average; however, the delirium group declined significantly more (–1.07) in adjusted mean scores at 36 months (P =.02).

©Wavebreakmedia Ltd/thinkstockphotos.com

From baseline to 36 months, there was a significant change for the delirium group (–1.30, P less than .01) and no significant change for the group without delirium (–0.23, P = .30). Researchers noted that the effect of delirium remains undiminished after consecutive rehospitalizations, intercurrent illnesses, and major postoperative complications were controlled for.

The patients underwent major noncardiac surgery, such as total hip or knee replacement, open abdominal aortic aneurysm repair, colectomy, and lower-extremity arterial bypass.

“This study provides a novel presentation of the biphasic relationship of delirium and cognitive trajectory, both its well-recognized acute effects but also long-term effects,” the researchers wrote. “Our results suggest that after a period of initial recovery, patients with delirium experience a substantially accelerated trajectory of cognitive aging.”

Read the full study in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association (doi:10.1016/j.jalz.2016.03.005).

[email protected]

Patients with postoperative delirium have significantly worse preoperative short-term cognitive performance and significantly greater long-term cognitive decline, compared with patients without delirium, according to Sharon K. Inouye, MD, and her associates.

In a prospective cohort study of 560 patients aged 70 years and older, 134 patients were selected for the delirium group and 426 for the nondelirium group. The delirium group had a significantly greater decline (–1.03 points) at 1 month, compared with those without delirium (P = .003). After cognitive function had recovered at 2 months, there were no significant differences between groups (P = 0.99). After 2 months, both groups decline on average; however, the delirium group declined significantly more (–1.07) in adjusted mean scores at 36 months (P =.02).

©Wavebreakmedia Ltd/thinkstockphotos.com

From baseline to 36 months, there was a significant change for the delirium group (–1.30, P less than .01) and no significant change for the group without delirium (–0.23, P = .30). Researchers noted that the effect of delirium remains undiminished after consecutive rehospitalizations, intercurrent illnesses, and major postoperative complications were controlled for.

The patients underwent major noncardiac surgery, such as total hip or knee replacement, open abdominal aortic aneurysm repair, colectomy, and lower-extremity arterial bypass.

“This study provides a novel presentation of the biphasic relationship of delirium and cognitive trajectory, both its well-recognized acute effects but also long-term effects,” the researchers wrote. “Our results suggest that after a period of initial recovery, patients with delirium experience a substantially accelerated trajectory of cognitive aging.”

Read the full study in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association (doi:10.1016/j.jalz.2016.03.005).

[email protected]

Patients with postoperative delirium have significantly worse preoperative short-term cognitive performance and significantly greater long-term cognitive decline, compared with patients without delirium, according to Sharon K. Inouye, MD, and her associates.

In a prospective cohort study of 560 patients aged 70 years and older, 134 patients were selected for the delirium group and 426 for the nondelirium group. The delirium group had a significantly greater decline (–1.03 points) at 1 month, compared with those without delirium (P = .003). After cognitive function had recovered at 2 months, there were no significant differences between groups (P = 0.99). After 2 months, both groups decline on average; however, the delirium group declined significantly more (–1.07) in adjusted mean scores at 36 months (P =.02).

©Wavebreakmedia Ltd/thinkstockphotos.com

From baseline to 36 months, there was a significant change for the delirium group (–1.30, P less than .01) and no significant change for the group without delirium (–0.23, P = .30). Researchers noted that the effect of delirium remains undiminished after consecutive rehospitalizations, intercurrent illnesses, and major postoperative complications were controlled for.

The patients underwent major noncardiac surgery, such as total hip or knee replacement, open abdominal aortic aneurysm repair, colectomy, and lower-extremity arterial bypass.

“This study provides a novel presentation of the biphasic relationship of delirium and cognitive trajectory, both its well-recognized acute effects but also long-term effects,” the researchers wrote. “Our results suggest that after a period of initial recovery, patients with delirium experience a substantially accelerated trajectory of cognitive aging.”

Read the full study in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association (doi:10.1016/j.jalz.2016.03.005).

[email protected]