Three years ago, SHM launched Hospital Medicine Exchange (HMX), an online collaborative forum designed to foster thoughtful discussions related to the hospital medicine movement, facilitate networking among SHM members, and house shared resources and best practices in the field.

In celebration of this milestone, SHM has unveiled a new native mobile app for HMX, ensuring that SHM members have access to insight and answers from thousands of other members, wherever they are.

The redesigned app features a new user interface, including easy access to your communities as well as SHM’s website, social media, and The Hospital Leader blog. Not only is the new app easy to use, but, once you are online, you can be a part of the vibrant conversations taking place among thousands of hospitalists across the country.

After you download the new app from the iTunes or Google Play stores, log in using your SHM username and password on your tablet or smartphone to:

• Quickly scan through and engage in discussions in your favorite communities, including HMX Open Forum;
• Connect and network with fellow SHM members across the country by clicking on “People”;
• Check your private messages with Inbox; and
• Access resources relevant to your everyday practice in the Libraries.

“It is a great app, and I love the shortcuts on the home screen.” —Masoumeh Ghaffari, MD, hospitalist, Piedmont Healthcare, Acworth, Ga., in a posting to the HMX Open Forum

Members already are responding to the new and improved HMX mobile app. Hospitalist Masoumeh Ghaffari, MD of Piedmont Healthcare in Acworth, Ga., posted in HMX Open Forum, “It is a great app, and I love the shortcuts on the home screen.”

The new HMX mobile app is one of many recent HMX enhancements. HMX is constantly growing and launching new communities for members. For example, the Patient Experience community and the Women in Hospital Medicine community were most recently launched. Join these and other communities to share your thoughts on topics ranging from admissions to pediatrics and everything in between.

Get involved now by downloading the new app.

Brett Radler is SHM’s communications coordinator.

Three years ago, SHM launched Hospital Medicine Exchange (HMX), an online collaborative forum designed to foster thoughtful discussions related to the hospital medicine movement, facilitate networking among SHM members, and house shared resources and best practices in the field.

In celebration of this milestone, SHM has unveiled a new native mobile app for HMX, ensuring that SHM members have access to insight and answers from thousands of other members, wherever they are.

The redesigned app features a new user interface, including easy access to your communities as well as SHM’s website, social media, and The Hospital Leader blog. Not only is the new app easy to use, but, once you are online, you can be a part of the vibrant conversations taking place among thousands of hospitalists across the country.

After you download the new app from the iTunes or Google Play stores, log in using your SHM username and password on your tablet or smartphone to:

• Quickly scan through and engage in discussions in your favorite communities, including HMX Open Forum;
• Connect and network with fellow SHM members across the country by clicking on “People”;
• Check your private messages with Inbox; and
• Access resources relevant to your everyday practice in the Libraries.

“It is a great app, and I love the shortcuts on the home screen.” —Masoumeh Ghaffari, MD, hospitalist, Piedmont Healthcare, Acworth, Ga., in a posting to the HMX Open Forum

Members already are responding to the new and improved HMX mobile app. Hospitalist Masoumeh Ghaffari, MD of Piedmont Healthcare in Acworth, Ga., posted in HMX Open Forum, “It is a great app, and I love the shortcuts on the home screen.”

The new HMX mobile app is one of many recent HMX enhancements. HMX is constantly growing and launching new communities for members. For example, the Patient Experience community and the Women in Hospital Medicine community were most recently launched. Join these and other communities to share your thoughts on topics ranging from admissions to pediatrics and everything in between.

Get involved now by downloading the new app.

Brett Radler is SHM’s communications coordinator.

Three years ago, SHM launched Hospital Medicine Exchange (HMX), an online collaborative forum designed to foster thoughtful discussions related to the hospital medicine movement, facilitate networking among SHM members, and house shared resources and best practices in the field.

In celebration of this milestone, SHM has unveiled a new native mobile app for HMX, ensuring that SHM members have access to insight and answers from thousands of other members, wherever they are.

The redesigned app features a new user interface, including easy access to your communities as well as SHM’s website, social media, and The Hospital Leader blog. Not only is the new app easy to use, but, once you are online, you can be a part of the vibrant conversations taking place among thousands of hospitalists across the country.

After you download the new app from the iTunes or Google Play stores, log in using your SHM username and password on your tablet or smartphone to:

• Quickly scan through and engage in discussions in your favorite communities, including HMX Open Forum;
• Connect and network with fellow SHM members across the country by clicking on “People”;
• Check your private messages with Inbox; and
• Access resources relevant to your everyday practice in the Libraries.

“It is a great app, and I love the shortcuts on the home screen.” —Masoumeh Ghaffari, MD, hospitalist, Piedmont Healthcare, Acworth, Ga., in a posting to the HMX Open Forum

Members already are responding to the new and improved HMX mobile app. Hospitalist Masoumeh Ghaffari, MD of Piedmont Healthcare in Acworth, Ga., posted in HMX Open Forum, “It is a great app, and I love the shortcuts on the home screen.”

The new HMX mobile app is one of many recent HMX enhancements. HMX is constantly growing and launching new communities for members. For example, the Patient Experience community and the Women in Hospital Medicine community were most recently launched. Join these and other communities to share your thoughts on topics ranging from admissions to pediatrics and everything in between.

Get involved now by downloading the new app.

Brett Radler is SHM’s communications coordinator.

In a study with implications for the development of new influenza vaccine strategies, researchers discovered that – among patients who received the 2009 H1N1 influenza vaccine – individuals with low levels of H1N1-specific antibodies prior to vaccination produced a more broadly protective immune response against the influenza virus than patients with high levels of H1N1-specific antibodies prior to vaccination.

A research team led by Patrick C. Wilson, Ph.D., of the Knapp Center for Lupus and Immunology Research at the University of Chicago, studied the B cell response in patients who received the pandemic 2009 H1N1 vaccine 2 years in a row and had varied histories of influenza exposure. All patients were 18 years or older, healthy, and had not received the yearly influenza vaccine prior to participating in the study. The researchers compared the patients’ “vaccine-induced plasmablast response upon first vaccination with the pandemic H1N1 strain in 2009-2010” with the patients’ plasmablast response upon revaccination with this same strain in 2010-2011 or 2011-2012. Each of the 21 study participants provided the researchers with at least four H1N1-specific plasmablasts.

CDC/Cynthia Goldsmith

The researchers “analyzed the immunoglobulin regions, strain specificity, and functional properties of the antibodies produced by this plasmablast population at the single-cell level across multiple years,” which allowed them to directly evaluate the effect of immune memory on the specificity of the current response to the virus.

Among the study’s findings was that “only individuals with low preexisting serological levels of pandemic H1N1 specific antibodies generated a broadly neutralizing plasmablast response directed toward the [hemagglutinin] stalk,” which is part of the hemagglutinin protein located on the surface of the influenza virus.

“[W]e demonstrate that the immune subdominance of the [hemagglutinin] stalk is a function of both the poor accessibility to the broadly protective epitopes and the inherent polyreactivity of the antibodies that can bind. We conclude that immunological memory profoundly shapes the viral epitopes targeted upon exposure with divergent influenza strains and determines the likelihood of generating a broadly protective response,” said Dr. Wilson and his coauthors. The authors reported no conflicts of interest.

Read the full study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad0522).

[email protected]

In a study with implications for the development of new influenza vaccine strategies, researchers discovered that – among patients who received the 2009 H1N1 influenza vaccine – individuals with low levels of H1N1-specific antibodies prior to vaccination produced a more broadly protective immune response against the influenza virus than patients with high levels of H1N1-specific antibodies prior to vaccination.

A research team led by Patrick C. Wilson, Ph.D., of the Knapp Center for Lupus and Immunology Research at the University of Chicago, studied the B cell response in patients who received the pandemic 2009 H1N1 vaccine 2 years in a row and had varied histories of influenza exposure. All patients were 18 years or older, healthy, and had not received the yearly influenza vaccine prior to participating in the study. The researchers compared the patients’ “vaccine-induced plasmablast response upon first vaccination with the pandemic H1N1 strain in 2009-2010” with the patients’ plasmablast response upon revaccination with this same strain in 2010-2011 or 2011-2012. Each of the 21 study participants provided the researchers with at least four H1N1-specific plasmablasts.

CDC/Cynthia Goldsmith

The researchers “analyzed the immunoglobulin regions, strain specificity, and functional properties of the antibodies produced by this plasmablast population at the single-cell level across multiple years,” which allowed them to directly evaluate the effect of immune memory on the specificity of the current response to the virus.

Among the study’s findings was that “only individuals with low preexisting serological levels of pandemic H1N1 specific antibodies generated a broadly neutralizing plasmablast response directed toward the [hemagglutinin] stalk,” which is part of the hemagglutinin protein located on the surface of the influenza virus.

“[W]e demonstrate that the immune subdominance of the [hemagglutinin] stalk is a function of both the poor accessibility to the broadly protective epitopes and the inherent polyreactivity of the antibodies that can bind. We conclude that immunological memory profoundly shapes the viral epitopes targeted upon exposure with divergent influenza strains and determines the likelihood of generating a broadly protective response,” said Dr. Wilson and his coauthors. The authors reported no conflicts of interest.

Read the full study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad0522).

[email protected]

In a study with implications for the development of new influenza vaccine strategies, researchers discovered that – among patients who received the 2009 H1N1 influenza vaccine – individuals with low levels of H1N1-specific antibodies prior to vaccination produced a more broadly protective immune response against the influenza virus than patients with high levels of H1N1-specific antibodies prior to vaccination.

A research team led by Patrick C. Wilson, Ph.D., of the Knapp Center for Lupus and Immunology Research at the University of Chicago, studied the B cell response in patients who received the pandemic 2009 H1N1 vaccine 2 years in a row and had varied histories of influenza exposure. All patients were 18 years or older, healthy, and had not received the yearly influenza vaccine prior to participating in the study. The researchers compared the patients’ “vaccine-induced plasmablast response upon first vaccination with the pandemic H1N1 strain in 2009-2010” with the patients’ plasmablast response upon revaccination with this same strain in 2010-2011 or 2011-2012. Each of the 21 study participants provided the researchers with at least four H1N1-specific plasmablasts.

CDC/Cynthia Goldsmith

The researchers “analyzed the immunoglobulin regions, strain specificity, and functional properties of the antibodies produced by this plasmablast population at the single-cell level across multiple years,” which allowed them to directly evaluate the effect of immune memory on the specificity of the current response to the virus.

Among the study’s findings was that “only individuals with low preexisting serological levels of pandemic H1N1 specific antibodies generated a broadly neutralizing plasmablast response directed toward the [hemagglutinin] stalk,” which is part of the hemagglutinin protein located on the surface of the influenza virus.

“[W]e demonstrate that the immune subdominance of the [hemagglutinin] stalk is a function of both the poor accessibility to the broadly protective epitopes and the inherent polyreactivity of the antibodies that can bind. We conclude that immunological memory profoundly shapes the viral epitopes targeted upon exposure with divergent influenza strains and determines the likelihood of generating a broadly protective response,” said Dr. Wilson and his coauthors. The authors reported no conflicts of interest.

Read the full study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad0522).

[email protected]

Psoriatic arthritis may occur more frequently among people with psoriasis than previously reported, and risk factors include having severe psoriasis, nail pitting, low education levels, and uveitis, according to findings from a Canadian cohort study.

Beginning in 2006, Dr. Lihi Eder of the University of Toronto and coinvestigators recruited 464 patients (mean age 47, 56% male, 77% white) mainly from phototherapy and dermatology outpatient clinics in Toronto, and followed them 8 years. All had psoriasis of varying type and severity at baseline, but not inflammatory arthritis or spondylitis (Arthritis Rheumatol. 2015 Nov 10 doi: 10.1002/art.39494).

©eenevski/thinkstockphotos.com

During the 8-year follow-up, 51 patients developed rheumatologist-confirmed psoriatic arthritis (PsA). Dr. Eder and colleagues reported an annual incidence rate of 2.7 confirmed cases of psoriatic arthritis per 100 psoriasis patients per year, which is considerably higher than previous published estimates, the investigators noted. The independent predictors of confirmed psoriatic arthritis were severe psoriasis (relative risk, 5.4; P = .006), not finishing high school (vs. finishing college RR, 4.5, P = .005; and vs. finishing high school RR, 3.3; P = .049), and use of systemic retinoids (RR, 3.4; P = .02). Time-dependent predictive variables included psoriatic nail pitting (RR, 2.5; P = .002) and uveitis (RR, 31.5; P = .001). Disease severity and nail pitting have been found in previous studies to be associated with a higher risk of psoriatic arthritis.

This study confirmed this association and also identified low education levels and uveitis as predictors. Low education is a marker of socioeconomic status that has been associated with lifestyle habits and possibly occupations that may increase PsA risk, the study authors noted, but the link requires further investigation. The authors cautioned that only three uveitis cases occurred in the cohort and that confidence intervals were wide. They also noted as a limitation that most participants were recruited from dermatology clinics, leading to overrepresentation of moderate-severe psoriasis and possibly patients with longer disease duration. Nevertheless, it “is likely that the true incidence of PsA in patients with psoriasis, particularly those attending dermatology clinics, is higher than previously reported,” the investigators wrote. “This highlights the role of dermatologists as key players in identifying psoriasis patients who are at higher risk of developing PsA.”

Krembil Foundation, the Canadian Institutes of Health Research, and The Arthritis Society supported the study.

Psoriatic arthritis may occur more frequently among people with psoriasis than previously reported, and risk factors include having severe psoriasis, nail pitting, low education levels, and uveitis, according to findings from a Canadian cohort study.

Beginning in 2006, Dr. Lihi Eder of the University of Toronto and coinvestigators recruited 464 patients (mean age 47, 56% male, 77% white) mainly from phototherapy and dermatology outpatient clinics in Toronto, and followed them 8 years. All had psoriasis of varying type and severity at baseline, but not inflammatory arthritis or spondylitis (Arthritis Rheumatol. 2015 Nov 10 doi: 10.1002/art.39494).

©eenevski/thinkstockphotos.com

During the 8-year follow-up, 51 patients developed rheumatologist-confirmed psoriatic arthritis (PsA). Dr. Eder and colleagues reported an annual incidence rate of 2.7 confirmed cases of psoriatic arthritis per 100 psoriasis patients per year, which is considerably higher than previous published estimates, the investigators noted. The independent predictors of confirmed psoriatic arthritis were severe psoriasis (relative risk, 5.4; P = .006), not finishing high school (vs. finishing college RR, 4.5, P = .005; and vs. finishing high school RR, 3.3; P = .049), and use of systemic retinoids (RR, 3.4; P = .02). Time-dependent predictive variables included psoriatic nail pitting (RR, 2.5; P = .002) and uveitis (RR, 31.5; P = .001). Disease severity and nail pitting have been found in previous studies to be associated with a higher risk of psoriatic arthritis.

This study confirmed this association and also identified low education levels and uveitis as predictors. Low education is a marker of socioeconomic status that has been associated with lifestyle habits and possibly occupations that may increase PsA risk, the study authors noted, but the link requires further investigation. The authors cautioned that only three uveitis cases occurred in the cohort and that confidence intervals were wide. They also noted as a limitation that most participants were recruited from dermatology clinics, leading to overrepresentation of moderate-severe psoriasis and possibly patients with longer disease duration. Nevertheless, it “is likely that the true incidence of PsA in patients with psoriasis, particularly those attending dermatology clinics, is higher than previously reported,” the investigators wrote. “This highlights the role of dermatologists as key players in identifying psoriasis patients who are at higher risk of developing PsA.”

Krembil Foundation, the Canadian Institutes of Health Research, and The Arthritis Society supported the study.

Psoriatic arthritis may occur more frequently among people with psoriasis than previously reported, and risk factors include having severe psoriasis, nail pitting, low education levels, and uveitis, according to findings from a Canadian cohort study.

Beginning in 2006, Dr. Lihi Eder of the University of Toronto and coinvestigators recruited 464 patients (mean age 47, 56% male, 77% white) mainly from phototherapy and dermatology outpatient clinics in Toronto, and followed them 8 years. All had psoriasis of varying type and severity at baseline, but not inflammatory arthritis or spondylitis (Arthritis Rheumatol. 2015 Nov 10 doi: 10.1002/art.39494).

©eenevski/thinkstockphotos.com

During the 8-year follow-up, 51 patients developed rheumatologist-confirmed psoriatic arthritis (PsA). Dr. Eder and colleagues reported an annual incidence rate of 2.7 confirmed cases of psoriatic arthritis per 100 psoriasis patients per year, which is considerably higher than previous published estimates, the investigators noted. The independent predictors of confirmed psoriatic arthritis were severe psoriasis (relative risk, 5.4; P = .006), not finishing high school (vs. finishing college RR, 4.5, P = .005; and vs. finishing high school RR, 3.3; P = .049), and use of systemic retinoids (RR, 3.4; P = .02). Time-dependent predictive variables included psoriatic nail pitting (RR, 2.5; P = .002) and uveitis (RR, 31.5; P = .001). Disease severity and nail pitting have been found in previous studies to be associated with a higher risk of psoriatic arthritis.

This study confirmed this association and also identified low education levels and uveitis as predictors. Low education is a marker of socioeconomic status that has been associated with lifestyle habits and possibly occupations that may increase PsA risk, the study authors noted, but the link requires further investigation. The authors cautioned that only three uveitis cases occurred in the cohort and that confidence intervals were wide. They also noted as a limitation that most participants were recruited from dermatology clinics, leading to overrepresentation of moderate-severe psoriasis and possibly patients with longer disease duration. Nevertheless, it “is likely that the true incidence of PsA in patients with psoriasis, particularly those attending dermatology clinics, is higher than previously reported,” the investigators wrote. “This highlights the role of dermatologists as key players in identifying psoriasis patients who are at higher risk of developing PsA.”

Krembil Foundation, the Canadian Institutes of Health Research, and The Arthritis Society supported the study.

SAN DIEGO – Raising levels of vitamin D, deficient in many patients with chronic kidney disease, improved vascular function and reduced inflammation and vessel wall stiffness after 16 weeks, according to results of a study in a small group of early kidney disease patients in India.

“This tells us that vitamin D has the potential, at least over the short- to intermediate term, to improve vascular function,” with a promise of reducing or preventing cardiovascular outcomes in a larger study, said Dr. Vivekanand Jha, of the George Institute for Global Health in New Delhi.

©iStock/thinkstock.com

“Patients with very early kidney disease are at very high risk of developing cardiovascular complications such as heart attacks, strokes, and peripheral vascular disease – and that’s what kills them before they get to the point where they need dialysis,” Dr. Jha said. “So, many die before they need dialysis. But we don’t know the factors that cause these cardiovascular complications.”

His group hypothesized that because vitamin D has biological action on blood vessels, “if we supplemented patients with vitamin D, their vascular function would improve.”

Participants were randomized to receive directly observed oral doses of 300,000 IU of cholecalciferol at baseline and at 8 weeks, or directly observed doses of a placebo in a matched control arm.

“We measured several parameters to look at vascular function after 16 weeks and found that patients who received vitamin D showed normalized vitamin D and decreases in levels of parathyroid hormone,” Dr. Jha said at the meeting sponsored by the American Society of Nephrology.

“But most importantly, we found that vitamin D recipients showed improvement in their vascular function on two or three tests; in flow-mediated dilation, which suggests improved endothelial function; and improved augmentation index, which looks at the stiffness of blood vessels,” he explained.

The next step is a much larger study designed to show that vitamin D supplements in this population can prevent cardiovascular events. “But that’s going to be a long-term study,” Dr. Jha noted.

“I don’t want to get ahead of myself and say that this is going to cure cardiovascular problems,” Dr. Jha cautioned. “But now we know we need to do a definitive study to look at these events, and prove whether supplementation with vitamin D does or does not significantly improve those endpoints.”

SAN DIEGO – Raising levels of vitamin D, deficient in many patients with chronic kidney disease, improved vascular function and reduced inflammation and vessel wall stiffness after 16 weeks, according to results of a study in a small group of early kidney disease patients in India.

“This tells us that vitamin D has the potential, at least over the short- to intermediate term, to improve vascular function,” with a promise of reducing or preventing cardiovascular outcomes in a larger study, said Dr. Vivekanand Jha, of the George Institute for Global Health in New Delhi.

©iStock/thinkstock.com

“Patients with very early kidney disease are at very high risk of developing cardiovascular complications such as heart attacks, strokes, and peripheral vascular disease – and that’s what kills them before they get to the point where they need dialysis,” Dr. Jha said. “So, many die before they need dialysis. But we don’t know the factors that cause these cardiovascular complications.”

His group hypothesized that because vitamin D has biological action on blood vessels, “if we supplemented patients with vitamin D, their vascular function would improve.”

Participants were randomized to receive directly observed oral doses of 300,000 IU of cholecalciferol at baseline and at 8 weeks, or directly observed doses of a placebo in a matched control arm.

“We measured several parameters to look at vascular function after 16 weeks and found that patients who received vitamin D showed normalized vitamin D and decreases in levels of parathyroid hormone,” Dr. Jha said at the meeting sponsored by the American Society of Nephrology.

“But most importantly, we found that vitamin D recipients showed improvement in their vascular function on two or three tests; in flow-mediated dilation, which suggests improved endothelial function; and improved augmentation index, which looks at the stiffness of blood vessels,” he explained.

The next step is a much larger study designed to show that vitamin D supplements in this population can prevent cardiovascular events. “But that’s going to be a long-term study,” Dr. Jha noted.

“I don’t want to get ahead of myself and say that this is going to cure cardiovascular problems,” Dr. Jha cautioned. “But now we know we need to do a definitive study to look at these events, and prove whether supplementation with vitamin D does or does not significantly improve those endpoints.”

SAN DIEGO – Raising levels of vitamin D, deficient in many patients with chronic kidney disease, improved vascular function and reduced inflammation and vessel wall stiffness after 16 weeks, according to results of a study in a small group of early kidney disease patients in India.

“This tells us that vitamin D has the potential, at least over the short- to intermediate term, to improve vascular function,” with a promise of reducing or preventing cardiovascular outcomes in a larger study, said Dr. Vivekanand Jha, of the George Institute for Global Health in New Delhi.

©iStock/thinkstock.com

“Patients with very early kidney disease are at very high risk of developing cardiovascular complications such as heart attacks, strokes, and peripheral vascular disease – and that’s what kills them before they get to the point where they need dialysis,” Dr. Jha said. “So, many die before they need dialysis. But we don’t know the factors that cause these cardiovascular complications.”

His group hypothesized that because vitamin D has biological action on blood vessels, “if we supplemented patients with vitamin D, their vascular function would improve.”

Participants were randomized to receive directly observed oral doses of 300,000 IU of cholecalciferol at baseline and at 8 weeks, or directly observed doses of a placebo in a matched control arm.

“We measured several parameters to look at vascular function after 16 weeks and found that patients who received vitamin D showed normalized vitamin D and decreases in levels of parathyroid hormone,” Dr. Jha said at the meeting sponsored by the American Society of Nephrology.

“But most importantly, we found that vitamin D recipients showed improvement in their vascular function on two or three tests; in flow-mediated dilation, which suggests improved endothelial function; and improved augmentation index, which looks at the stiffness of blood vessels,” he explained.

The next step is a much larger study designed to show that vitamin D supplements in this population can prevent cardiovascular events. “But that’s going to be a long-term study,” Dr. Jha noted.

“I don’t want to get ahead of myself and say that this is going to cure cardiovascular problems,” Dr. Jha cautioned. “But now we know we need to do a definitive study to look at these events, and prove whether supplementation with vitamin D does or does not significantly improve those endpoints.”

Patient-centered care increasingly means focusing on quality of life. For the past 26 years, Betty Ferrell, PhD, MA, FAAN, FPCN, director and professor, nursing research and education at City of Hope has focused on quality of life research.

Dr. Ferrell recently sat down Federal Practitioner to discuss the components of quality cancer care, the role of family caregivers, and the importance of patient communication.

According to Dr. Ferrell, quality cancer care starts a comprehensive assessment so that care providers understand not only comorbidities, but also family help and psychosocial concerns. Interdisciplinary collaboration is also an essential element of quality care, bringing together an entire team to focus on the patient. Finally, Dr. Ferrell noted, care must include patient and family education.

0:15 Quality of life research
1:35 Quality of life interventions
2:52 Family care givers
3:30 Three components of quality cancer care
4:38 Communication
5:20 VA cancer care

Patient-centered care increasingly means focusing on quality of life. For the past 26 years, Betty Ferrell, PhD, MA, FAAN, FPCN, director and professor, nursing research and education at City of Hope has focused on quality of life research.

Dr. Ferrell recently sat down Federal Practitioner to discuss the components of quality cancer care, the role of family caregivers, and the importance of patient communication.

According to Dr. Ferrell, quality cancer care starts a comprehensive assessment so that care providers understand not only comorbidities, but also family help and psychosocial concerns. Interdisciplinary collaboration is also an essential element of quality care, bringing together an entire team to focus on the patient. Finally, Dr. Ferrell noted, care must include patient and family education.

0:15 Quality of life research
1:35 Quality of life interventions
2:52 Family care givers
3:30 Three components of quality cancer care
4:38 Communication
5:20 VA cancer care

Patient-centered care increasingly means focusing on quality of life. For the past 26 years, Betty Ferrell, PhD, MA, FAAN, FPCN, director and professor, nursing research and education at City of Hope has focused on quality of life research.

Dr. Ferrell recently sat down Federal Practitioner to discuss the components of quality cancer care, the role of family caregivers, and the importance of patient communication.

According to Dr. Ferrell, quality cancer care starts a comprehensive assessment so that care providers understand not only comorbidities, but also family help and psychosocial concerns. Interdisciplinary collaboration is also an essential element of quality care, bringing together an entire team to focus on the patient. Finally, Dr. Ferrell noted, care must include patient and family education.

0:15 Quality of life research
1:35 Quality of life interventions
2:52 Family care givers
3:30 Three components of quality cancer care
4:38 Communication
5:20 VA cancer care

Malaria-transmitting mosquito

Photo by James Gathany

A larger portion of Africa is at high risk for malaria transmission than previously predicted, according to a mapping study published in Vector-Borne and Zoonotic Diseases.

The research also suggests that, under future climate regimes, the area where the disease can be transmitted most easily will shrink, but the total

malaria transmission zone in Africa will expand and move into new territory.

Researchers estimate that, by 2080, the year-round, highest-risk transmission zone will move from coastal West Africa, east to the Albertine Rift, between the Democratic Republic of Congo and Uganda.

The area suitable for seasonal, lower-risk transmission will shift north into coastal sub-Saharan Africa.

In addition, some parts of Africa will become too hot for malaria.

The overall expansion of malaria-vulnerable areas will challenge management of the deadly disease, said study author Sadie Ryan, PhD, of the University of Florida in Gainesville.

She noted that malaria will arrive in new areas, posing a risk to new populations, and the shift of endemic and epidemic areas will require public health management changes.

“Mapping a mathematical predictive model of a climate-driven infectious disease like malaria allows us to develop tools to understand both spatial and seasonal dynamics, and to anticipate the future changes to those dynamics,” Dr Ryan said.

She and her colleagues used a model that takes into account how mosquitoes and the malaria parasite respond to temperature. This model shows an optimal transmission temperature for malaria that, at 25 degrees Celsius, is 6 degrees lower than previous predictive models.

Dr Ryan said this work will play an important role in helping public health officials and non-governmental organizations plan for the efficient deployment of resources and interventions to control future outbreaks of malaria and their associated societal costs.

This study expands upon the team’s prior work at the National Center for Ecological Analysis and Synthesis at the University of California, Santa Barbara.

Malaria-transmitting mosquito

Photo by James Gathany

A larger portion of Africa is at high risk for malaria transmission than previously predicted, according to a mapping study published in Vector-Borne and Zoonotic Diseases.

The research also suggests that, under future climate regimes, the area where the disease can be transmitted most easily will shrink, but the total

malaria transmission zone in Africa will expand and move into new territory.

Researchers estimate that, by 2080, the year-round, highest-risk transmission zone will move from coastal West Africa, east to the Albertine Rift, between the Democratic Republic of Congo and Uganda.

The area suitable for seasonal, lower-risk transmission will shift north into coastal sub-Saharan Africa.

In addition, some parts of Africa will become too hot for malaria.

The overall expansion of malaria-vulnerable areas will challenge management of the deadly disease, said study author Sadie Ryan, PhD, of the University of Florida in Gainesville.

She noted that malaria will arrive in new areas, posing a risk to new populations, and the shift of endemic and epidemic areas will require public health management changes.

“Mapping a mathematical predictive model of a climate-driven infectious disease like malaria allows us to develop tools to understand both spatial and seasonal dynamics, and to anticipate the future changes to those dynamics,” Dr Ryan said.

She and her colleagues used a model that takes into account how mosquitoes and the malaria parasite respond to temperature. This model shows an optimal transmission temperature for malaria that, at 25 degrees Celsius, is 6 degrees lower than previous predictive models.

Dr Ryan said this work will play an important role in helping public health officials and non-governmental organizations plan for the efficient deployment of resources and interventions to control future outbreaks of malaria and their associated societal costs.

This study expands upon the team’s prior work at the National Center for Ecological Analysis and Synthesis at the University of California, Santa Barbara.

Malaria-transmitting mosquito

Photo by James Gathany

A larger portion of Africa is at high risk for malaria transmission than previously predicted, according to a mapping study published in Vector-Borne and Zoonotic Diseases.

The research also suggests that, under future climate regimes, the area where the disease can be transmitted most easily will shrink, but the total

malaria transmission zone in Africa will expand and move into new territory.

Researchers estimate that, by 2080, the year-round, highest-risk transmission zone will move from coastal West Africa, east to the Albertine Rift, between the Democratic Republic of Congo and Uganda.

The area suitable for seasonal, lower-risk transmission will shift north into coastal sub-Saharan Africa.

In addition, some parts of Africa will become too hot for malaria.

The overall expansion of malaria-vulnerable areas will challenge management of the deadly disease, said study author Sadie Ryan, PhD, of the University of Florida in Gainesville.

She noted that malaria will arrive in new areas, posing a risk to new populations, and the shift of endemic and epidemic areas will require public health management changes.

“Mapping a mathematical predictive model of a climate-driven infectious disease like malaria allows us to develop tools to understand both spatial and seasonal dynamics, and to anticipate the future changes to those dynamics,” Dr Ryan said.

She and her colleagues used a model that takes into account how mosquitoes and the malaria parasite respond to temperature. This model shows an optimal transmission temperature for malaria that, at 25 degrees Celsius, is 6 degrees lower than previous predictive models.

Dr Ryan said this work will play an important role in helping public health officials and non-governmental organizations plan for the efficient deployment of resources and interventions to control future outbreaks of malaria and their associated societal costs.

This study expands upon the team’s prior work at the National Center for Ecological Analysis and Synthesis at the University of California, Santa Barbara.

Breast implant

Photo courtesy of the FDA

The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.

The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.

BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.

An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.

“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”

Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.

The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.

“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”

Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.

In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.

“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.

“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”

The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.

Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.

Breast implant

Photo courtesy of the FDA

The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.

The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.

BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.

An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.

“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”

Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.

The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.

“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”

Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.

In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.

“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.

“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”

The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.

Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.

Breast implant

Photo courtesy of the FDA

The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.

The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.

BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.

An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.

“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”

Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.

The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.

“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”

Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.

In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.

“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.

“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”

The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.

Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.

Monica Guzman, PhD

Photo by Kristin Gladney

New research published in Cell Reports has revealed biomarkers that may help predict which acute myeloid leukemia (AML) patients will respond to treatment with PU-H71.

This drug targets a tumor-enriched form of the protein Hsp90 called teHSP90, which is critical to the growth of cancer cells.

However, previous preclinical experiments showed that PU-H71 only kills some AML cells.

“We observed that only a subset of leukemia patient samples were sensitive to the drug,” said study author Monica Guzman, PhD, of Weill Cornell Medical College in New York, New York.

“We wanted to be able to identify which patients with leukemia would respond to this drug.”

So Dr Guzman and her colleagues focused on groups of proteins that function within signaling networks in leukemia cells.

The researchers found that 2 of these networks, JAK-STAT and PI3K-AKT, were important for leukemia cells to function. These signaling pathways are critical for the survival of AML cells, and they, in turn, are dependent on teHsp90.

The team treated AML cells with PU-H71 and found that cells with greater JAK-STAT and PI3K-AKT activity were killed by the drug. Cells with less active signaling networks did not respond to PU-H71.

“Higher activation of these networks makes the leukemia cells more dependent on Hsp90,” Dr Guzman said. “Since PU-H71 targets teHsp90, leukemia samples with these features are good targets for treatment with the drug.”

The next step for Dr Guzman’s team is to test their findings in patients. Ideally, the JAK-STAT and PI3K-AKT signaling pathways will serve as biomarkers for identifying patients whose leukemias will be sensitive to PU-H71.

“We are working on a tool that will quickly and easily identify patients whose cancers will respond to PU-H71,” Dr Guzman said. “We are really looking forward to seeing this in leukemic patients and being able to offer them a new treatment.”

Monica Guzman, PhD

Photo by Kristin Gladney

New research published in Cell Reports has revealed biomarkers that may help predict which acute myeloid leukemia (AML) patients will respond to treatment with PU-H71.

This drug targets a tumor-enriched form of the protein Hsp90 called teHSP90, which is critical to the growth of cancer cells.

However, previous preclinical experiments showed that PU-H71 only kills some AML cells.

“We observed that only a subset of leukemia patient samples were sensitive to the drug,” said study author Monica Guzman, PhD, of Weill Cornell Medical College in New York, New York.

“We wanted to be able to identify which patients with leukemia would respond to this drug.”

So Dr Guzman and her colleagues focused on groups of proteins that function within signaling networks in leukemia cells.

The researchers found that 2 of these networks, JAK-STAT and PI3K-AKT, were important for leukemia cells to function. These signaling pathways are critical for the survival of AML cells, and they, in turn, are dependent on teHsp90.

The team treated AML cells with PU-H71 and found that cells with greater JAK-STAT and PI3K-AKT activity were killed by the drug. Cells with less active signaling networks did not respond to PU-H71.

“Higher activation of these networks makes the leukemia cells more dependent on Hsp90,” Dr Guzman said. “Since PU-H71 targets teHsp90, leukemia samples with these features are good targets for treatment with the drug.”

The next step for Dr Guzman’s team is to test their findings in patients. Ideally, the JAK-STAT and PI3K-AKT signaling pathways will serve as biomarkers for identifying patients whose leukemias will be sensitive to PU-H71.

“We are working on a tool that will quickly and easily identify patients whose cancers will respond to PU-H71,” Dr Guzman said. “We are really looking forward to seeing this in leukemic patients and being able to offer them a new treatment.”

Monica Guzman, PhD

Photo by Kristin Gladney

New research published in Cell Reports has revealed biomarkers that may help predict which acute myeloid leukemia (AML) patients will respond to treatment with PU-H71.

This drug targets a tumor-enriched form of the protein Hsp90 called teHSP90, which is critical to the growth of cancer cells.

However, previous preclinical experiments showed that PU-H71 only kills some AML cells.

“We observed that only a subset of leukemia patient samples were sensitive to the drug,” said study author Monica Guzman, PhD, of Weill Cornell Medical College in New York, New York.

“We wanted to be able to identify which patients with leukemia would respond to this drug.”

So Dr Guzman and her colleagues focused on groups of proteins that function within signaling networks in leukemia cells.

The researchers found that 2 of these networks, JAK-STAT and PI3K-AKT, were important for leukemia cells to function. These signaling pathways are critical for the survival of AML cells, and they, in turn, are dependent on teHsp90.

The team treated AML cells with PU-H71 and found that cells with greater JAK-STAT and PI3K-AKT activity were killed by the drug. Cells with less active signaling networks did not respond to PU-H71.

“Higher activation of these networks makes the leukemia cells more dependent on Hsp90,” Dr Guzman said. “Since PU-H71 targets teHsp90, leukemia samples with these features are good targets for treatment with the drug.”

The next step for Dr Guzman’s team is to test their findings in patients. Ideally, the JAK-STAT and PI3K-AKT signaling pathways will serve as biomarkers for identifying patients whose leukemias will be sensitive to PU-H71.

“We are working on a tool that will quickly and easily identify patients whose cancers will respond to PU-H71,” Dr Guzman said. “We are really looking forward to seeing this in leukemic patients and being able to offer them a new treatment.”

AngioJet ZelanteDVT

thrombectomy catheter

Image courtesy of

Boston Scientific

The AngioJet ZelanteDVT thrombectomy catheter has been approved for commercialization in the US and Europe.

The device received the CE mark and approval from the US Food and Drug Administration to treat deep vein thrombosis (DVT) in large-diameter

upper and lower limb peripheral veins.

The ZelanteDVT catheter was designed to remove large venous clot burdens and facilitate rapid restoration of blood flow, potentially decreasing procedural time, relieving symptoms, and reducing late complications.

The ZelanteDVT Thrombectomy Set is intended for use with the AngioJet Ultra Console to break apart and remove thrombi, including DVT, from iliofemoral and lower extremity veins greater than or equal to 6.0 mm in diameter and upper extremity peripheral veins greater than or equal to 6.0 mm in diameter.

The set is also intended for use with the AngioJet Power Pulse technique for the controlled and selective infusion of physician-specified fluids, including thrombolytic agents, into the peripheral vascular system.

The ZelanteDVT catheter is a product of Boston Scientific. For more information on the device, visit the company’s website.

AngioJet ZelanteDVT

thrombectomy catheter

Image courtesy of

Boston Scientific

The AngioJet ZelanteDVT thrombectomy catheter has been approved for commercialization in the US and Europe.

The device received the CE mark and approval from the US Food and Drug Administration to treat deep vein thrombosis (DVT) in large-diameter

upper and lower limb peripheral veins.

The ZelanteDVT catheter was designed to remove large venous clot burdens and facilitate rapid restoration of blood flow, potentially decreasing procedural time, relieving symptoms, and reducing late complications.

The ZelanteDVT Thrombectomy Set is intended for use with the AngioJet Ultra Console to break apart and remove thrombi, including DVT, from iliofemoral and lower extremity veins greater than or equal to 6.0 mm in diameter and upper extremity peripheral veins greater than or equal to 6.0 mm in diameter.

The set is also intended for use with the AngioJet Power Pulse technique for the controlled and selective infusion of physician-specified fluids, including thrombolytic agents, into the peripheral vascular system.

The ZelanteDVT catheter is a product of Boston Scientific. For more information on the device, visit the company’s website.

AngioJet ZelanteDVT

thrombectomy catheter

Image courtesy of

Boston Scientific

The AngioJet ZelanteDVT thrombectomy catheter has been approved for commercialization in the US and Europe.

The device received the CE mark and approval from the US Food and Drug Administration to treat deep vein thrombosis (DVT) in large-diameter

upper and lower limb peripheral veins.

The ZelanteDVT catheter was designed to remove large venous clot burdens and facilitate rapid restoration of blood flow, potentially decreasing procedural time, relieving symptoms, and reducing late complications.

The ZelanteDVT Thrombectomy Set is intended for use with the AngioJet Ultra Console to break apart and remove thrombi, including DVT, from iliofemoral and lower extremity veins greater than or equal to 6.0 mm in diameter and upper extremity peripheral veins greater than or equal to 6.0 mm in diameter.

The set is also intended for use with the AngioJet Power Pulse technique for the controlled and selective infusion of physician-specified fluids, including thrombolytic agents, into the peripheral vascular system.

The ZelanteDVT catheter is a product of Boston Scientific. For more information on the device, visit the company’s website.

ORLANDO – Peripheral artery disease constitutes “a health crisis that is largely unnoticed” by the public and all too often by physicians as well – but that’s all about to change, Dr. Mark A. Creager said in his presidential address at the American Heart Association scientific sessions.

In the coming months, look for rollout of major AHA initiatives on peripheral vascular disease. These programs grew out of a summit meeting of thought leaders in the field of vascular disease convened recently by the AHA in order to find ways to boost public awareness and improve the quality of care for patients with peripheral artery disease (PAD), venous thromboembolism, and aortic aneurysm.

Bruce Jancin/Frontline Medical news

PAD is all too often thought of as a disease of the legs, when in fact it is a clinical manifestation of systemic atherosclerosis, Dr. Creager noted. PAD affects on estimated 200 million people worldwide. In the United States alone, it accounts for $20 billion per year in health care costs. The mortality risk in affected patients is two- to fourfold greater than in individuals without PAD. Moreover, the risk of acute MI, stroke, or cardiovascular death among patients with PAD exceeds that of patients with established cerebrovascular disease.

“Clearly the unrecognized epidemic of vascular disease requires our attention,” observed Dr. Creager, professor of medicine and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Indeed, he made it clear that improved diagnosis and treatment of PAD will be a major AHA priority during his term as president. Noting that the annual rate of deaths due to cardiovascular disease and stroke has already dropped by 13.7% in the 5 years since the AHA set the ambitious goal of a 20% reduction by the year 2020, he emphasized that a critical element in getting the rest of the way there involves addressing peripheral vascular diseases more effectively.

Improved public awareness about PAD has to be a priority. One survey found that 75% of the public is unaware of PAD. It’s a condition which Dr. Creager and others have shown has its highest prevalence in Americans in the lowest income and educational strata, largely independent of traditional cardiovascular risk factors.

“Even physicians often fail to consider PAD, chalking up leg pain to age or arthritis. In one study, physicians missed the diagnosis of PAD half the time. And even when physicians diagnose PAD, they often don’t treat it adequately,” according to Dr. Creager.

The use of statins and antiplatelet therapy in patients with PAD each reduces the risk of MI, stroke, or cardiovascular death by about 25%. Yet when Dr. Creager and coworkers analyzed National Health and Nutrition Examination Survey data, they found only 19% of patients with PAD who didn’t have previously established coronary or cerebrovascular disease were on a statin, just 21% were on an ACE inhibitor or angiotensin receptor blocker, and 27% were on antiplatelet therapy (Circulation. 2011 Jul 5;124[1]:17-23).

Among patients with symptomatic PAD, studies have shown that supervised exercise training can double walking distance. That’s a major quality of life benefit, yet one that goes unconsidered if the diagnosis is missed. “It’s rarely instituted even with the diagnosis, largely because of the lack of reimbursement,” according to Dr. Creager.

He painted a picture of PAD as a field ripe with opportunities for improved outcomes.

“Our ability to diagnose and treat vascular diseases has never been greater. The field of vascular biology has virtually exploded in recent years,” he said. “I’d like to focus not only on the extent of this crisis, but also on the importance of using what we know to treat it and prevent it, and on the urgency of intensifying our research efforts to better understand it.”

In the diagnostic arena, optical coherence tomography, intravascular ultrasound, PET-CT, and contrast-enhanced MRI provide an unprecedented ability to image plaques and assess their vulnerability to rupture.

On the interventional front, innovative bioengineering has led to the development of drug-coated balloons and bioabsorbable vascular scaffolds with the potential to curb restenosis and preserve patency following endovascular treatment of critical lesions.

In terms of medical management, the novel, super-potent LDL cholesterol–lowering inhibitors of PCSK9 (proprotein convertase subtilisin-kexin type 9) will need to be studied in order to see if they have a special role in the treatment and/or prevention of PAD.

Roughly 2 decades ago, Dr. Creager and coinvestigators showed that endothelial function typically drops by 30% in our twenties and then in our thirties, and by 50% once we’re in our forties. A high research priority in PAD will be to learn how to more effectively prolong endothelial health and prevent vascular stiffness, he said.

He reported having no financial conflicts regarding his presentation.

[email protected]

ORLANDO – Peripheral artery disease constitutes “a health crisis that is largely unnoticed” by the public and all too often by physicians as well – but that’s all about to change, Dr. Mark A. Creager said in his presidential address at the American Heart Association scientific sessions.

In the coming months, look for rollout of major AHA initiatives on peripheral vascular disease. These programs grew out of a summit meeting of thought leaders in the field of vascular disease convened recently by the AHA in order to find ways to boost public awareness and improve the quality of care for patients with peripheral artery disease (PAD), venous thromboembolism, and aortic aneurysm.

Bruce Jancin/Frontline Medical news

PAD is all too often thought of as a disease of the legs, when in fact it is a clinical manifestation of systemic atherosclerosis, Dr. Creager noted. PAD affects on estimated 200 million people worldwide. In the United States alone, it accounts for $20 billion per year in health care costs. The mortality risk in affected patients is two- to fourfold greater than in individuals without PAD. Moreover, the risk of acute MI, stroke, or cardiovascular death among patients with PAD exceeds that of patients with established cerebrovascular disease.

“Clearly the unrecognized epidemic of vascular disease requires our attention,” observed Dr. Creager, professor of medicine and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Indeed, he made it clear that improved diagnosis and treatment of PAD will be a major AHA priority during his term as president. Noting that the annual rate of deaths due to cardiovascular disease and stroke has already dropped by 13.7% in the 5 years since the AHA set the ambitious goal of a 20% reduction by the year 2020, he emphasized that a critical element in getting the rest of the way there involves addressing peripheral vascular diseases more effectively.

Improved public awareness about PAD has to be a priority. One survey found that 75% of the public is unaware of PAD. It’s a condition which Dr. Creager and others have shown has its highest prevalence in Americans in the lowest income and educational strata, largely independent of traditional cardiovascular risk factors.

“Even physicians often fail to consider PAD, chalking up leg pain to age or arthritis. In one study, physicians missed the diagnosis of PAD half the time. And even when physicians diagnose PAD, they often don’t treat it adequately,” according to Dr. Creager.

The use of statins and antiplatelet therapy in patients with PAD each reduces the risk of MI, stroke, or cardiovascular death by about 25%. Yet when Dr. Creager and coworkers analyzed National Health and Nutrition Examination Survey data, they found only 19% of patients with PAD who didn’t have previously established coronary or cerebrovascular disease were on a statin, just 21% were on an ACE inhibitor or angiotensin receptor blocker, and 27% were on antiplatelet therapy (Circulation. 2011 Jul 5;124[1]:17-23).

Among patients with symptomatic PAD, studies have shown that supervised exercise training can double walking distance. That’s a major quality of life benefit, yet one that goes unconsidered if the diagnosis is missed. “It’s rarely instituted even with the diagnosis, largely because of the lack of reimbursement,” according to Dr. Creager.

He painted a picture of PAD as a field ripe with opportunities for improved outcomes.

“Our ability to diagnose and treat vascular diseases has never been greater. The field of vascular biology has virtually exploded in recent years,” he said. “I’d like to focus not only on the extent of this crisis, but also on the importance of using what we know to treat it and prevent it, and on the urgency of intensifying our research efforts to better understand it.”

In the diagnostic arena, optical coherence tomography, intravascular ultrasound, PET-CT, and contrast-enhanced MRI provide an unprecedented ability to image plaques and assess their vulnerability to rupture.

On the interventional front, innovative bioengineering has led to the development of drug-coated balloons and bioabsorbable vascular scaffolds with the potential to curb restenosis and preserve patency following endovascular treatment of critical lesions.

In terms of medical management, the novel, super-potent LDL cholesterol–lowering inhibitors of PCSK9 (proprotein convertase subtilisin-kexin type 9) will need to be studied in order to see if they have a special role in the treatment and/or prevention of PAD.

Roughly 2 decades ago, Dr. Creager and coinvestigators showed that endothelial function typically drops by 30% in our twenties and then in our thirties, and by 50% once we’re in our forties. A high research priority in PAD will be to learn how to more effectively prolong endothelial health and prevent vascular stiffness, he said.

He reported having no financial conflicts regarding his presentation.

[email protected]

ORLANDO – Peripheral artery disease constitutes “a health crisis that is largely unnoticed” by the public and all too often by physicians as well – but that’s all about to change, Dr. Mark A. Creager said in his presidential address at the American Heart Association scientific sessions.

In the coming months, look for rollout of major AHA initiatives on peripheral vascular disease. These programs grew out of a summit meeting of thought leaders in the field of vascular disease convened recently by the AHA in order to find ways to boost public awareness and improve the quality of care for patients with peripheral artery disease (PAD), venous thromboembolism, and aortic aneurysm.

Bruce Jancin/Frontline Medical news

PAD is all too often thought of as a disease of the legs, when in fact it is a clinical manifestation of systemic atherosclerosis, Dr. Creager noted. PAD affects on estimated 200 million people worldwide. In the United States alone, it accounts for $20 billion per year in health care costs. The mortality risk in affected patients is two- to fourfold greater than in individuals without PAD. Moreover, the risk of acute MI, stroke, or cardiovascular death among patients with PAD exceeds that of patients with established cerebrovascular disease.

“Clearly the unrecognized epidemic of vascular disease requires our attention,” observed Dr. Creager, professor of medicine and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Indeed, he made it clear that improved diagnosis and treatment of PAD will be a major AHA priority during his term as president. Noting that the annual rate of deaths due to cardiovascular disease and stroke has already dropped by 13.7% in the 5 years since the AHA set the ambitious goal of a 20% reduction by the year 2020, he emphasized that a critical element in getting the rest of the way there involves addressing peripheral vascular diseases more effectively.

Improved public awareness about PAD has to be a priority. One survey found that 75% of the public is unaware of PAD. It’s a condition which Dr. Creager and others have shown has its highest prevalence in Americans in the lowest income and educational strata, largely independent of traditional cardiovascular risk factors.

“Even physicians often fail to consider PAD, chalking up leg pain to age or arthritis. In one study, physicians missed the diagnosis of PAD half the time. And even when physicians diagnose PAD, they often don’t treat it adequately,” according to Dr. Creager.

The use of statins and antiplatelet therapy in patients with PAD each reduces the risk of MI, stroke, or cardiovascular death by about 25%. Yet when Dr. Creager and coworkers analyzed National Health and Nutrition Examination Survey data, they found only 19% of patients with PAD who didn’t have previously established coronary or cerebrovascular disease were on a statin, just 21% were on an ACE inhibitor or angiotensin receptor blocker, and 27% were on antiplatelet therapy (Circulation. 2011 Jul 5;124[1]:17-23).

Among patients with symptomatic PAD, studies have shown that supervised exercise training can double walking distance. That’s a major quality of life benefit, yet one that goes unconsidered if the diagnosis is missed. “It’s rarely instituted even with the diagnosis, largely because of the lack of reimbursement,” according to Dr. Creager.

He painted a picture of PAD as a field ripe with opportunities for improved outcomes.

“Our ability to diagnose and treat vascular diseases has never been greater. The field of vascular biology has virtually exploded in recent years,” he said. “I’d like to focus not only on the extent of this crisis, but also on the importance of using what we know to treat it and prevent it, and on the urgency of intensifying our research efforts to better understand it.”

In the diagnostic arena, optical coherence tomography, intravascular ultrasound, PET-CT, and contrast-enhanced MRI provide an unprecedented ability to image plaques and assess their vulnerability to rupture.

On the interventional front, innovative bioengineering has led to the development of drug-coated balloons and bioabsorbable vascular scaffolds with the potential to curb restenosis and preserve patency following endovascular treatment of critical lesions.

In terms of medical management, the novel, super-potent LDL cholesterol–lowering inhibitors of PCSK9 (proprotein convertase subtilisin-kexin type 9) will need to be studied in order to see if they have a special role in the treatment and/or prevention of PAD.

Roughly 2 decades ago, Dr. Creager and coinvestigators showed that endothelial function typically drops by 30% in our twenties and then in our thirties, and by 50% once we’re in our forties. A high research priority in PAD will be to learn how to more effectively prolong endothelial health and prevent vascular stiffness, he said.

He reported having no financial conflicts regarding his presentation.

[email protected]