Patients started on less costly generic statin drugs have significantly better adherence than those started on brand name statins, as well as improved cardiovascular outcomes, according to results from a study that looked at records from more than 90,000 Medicare patients aged 65 and older (mean age 75.6, 61% female) over a 2-year period.

The study, led by Joshua J. Gagne, Pharm.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and published online Sept. 15 in Annals of Internal Medicine (doi:10.7326/M13-2942), found that the average portion of days covered under prescribed statin therapy was 77% for patients started on generic lovastatin, pravastatin, or simvastatin, and 71% for patients started on name brands of these medications (P < .001). Researchers pinpointed cost as the likeliest reason for the differences in adherence; mean copay in the study was $10 for generics and $48 for brand-name drugs.

©PhotoDisk

Dr. Gagne and colleagues also reported that patients on generics saw an 8% reduction in cardiovascular events (as measured by a composite outcome of hospitalization for an acute coronary syndrome, stroke, or all-cause mortality), compared with those on brand-name medications (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99).

Dr. Gagne and colleagues called the difference in cardiovascular outcomes “commensurate with the expected effect” based on differences in adherence, while noting that theirs was the first study to demonstrate differences in health outcomes related to the dispensing of generic or brand-name statins. Most patients in the study (n = 83,731) were started on generics. Generic drug recipients were more likely to be women (62% vs. 54%), and brand-name statin recipients were more likely to be white (66% vs. 48%).

“In the setting of tiered copayments in typical pharmacy benefit designs, initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the researchers concluded (Ann. Int. Med. 2014;161:400-7. [doi:10.7326/M13-2942]).

Dr. Gagne and colleagues noted among the limitations of their study its nonrandomized design, the use of only three statins, and the fact that they could not determine who decided whether patients initiated a generic or brand-name drug, noting that many states require pharmacists to dispense generics unless a prescriber or patient requests otherwise. The results may not apply to patients with types of insurance other than Medicare, they noted.

Teva pharmaceuticals, a manufacturer of generic medications, sponsored the study; Dr. Gagne and a coauthor, Niteesh K. Choudhry, M.D., Ph.D., disclosed grant support from Teva, while three coauthors disclosed being employees of CVS Caremark, a major pharmacy benefits administrator.

Patients started on less costly generic statin drugs have significantly better adherence than those started on brand name statins, as well as improved cardiovascular outcomes, according to results from a study that looked at records from more than 90,000 Medicare patients aged 65 and older (mean age 75.6, 61% female) over a 2-year period.

The study, led by Joshua J. Gagne, Pharm.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and published online Sept. 15 in Annals of Internal Medicine (doi:10.7326/M13-2942), found that the average portion of days covered under prescribed statin therapy was 77% for patients started on generic lovastatin, pravastatin, or simvastatin, and 71% for patients started on name brands of these medications (P < .001). Researchers pinpointed cost as the likeliest reason for the differences in adherence; mean copay in the study was $10 for generics and $48 for brand-name drugs.

©PhotoDisk

Dr. Gagne and colleagues also reported that patients on generics saw an 8% reduction in cardiovascular events (as measured by a composite outcome of hospitalization for an acute coronary syndrome, stroke, or all-cause mortality), compared with those on brand-name medications (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99).

Dr. Gagne and colleagues called the difference in cardiovascular outcomes “commensurate with the expected effect” based on differences in adherence, while noting that theirs was the first study to demonstrate differences in health outcomes related to the dispensing of generic or brand-name statins. Most patients in the study (n = 83,731) were started on generics. Generic drug recipients were more likely to be women (62% vs. 54%), and brand-name statin recipients were more likely to be white (66% vs. 48%).

“In the setting of tiered copayments in typical pharmacy benefit designs, initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the researchers concluded (Ann. Int. Med. 2014;161:400-7. [doi:10.7326/M13-2942]).

Dr. Gagne and colleagues noted among the limitations of their study its nonrandomized design, the use of only three statins, and the fact that they could not determine who decided whether patients initiated a generic or brand-name drug, noting that many states require pharmacists to dispense generics unless a prescriber or patient requests otherwise. The results may not apply to patients with types of insurance other than Medicare, they noted.

Teva pharmaceuticals, a manufacturer of generic medications, sponsored the study; Dr. Gagne and a coauthor, Niteesh K. Choudhry, M.D., Ph.D., disclosed grant support from Teva, while three coauthors disclosed being employees of CVS Caremark, a major pharmacy benefits administrator.

Patients started on less costly generic statin drugs have significantly better adherence than those started on brand name statins, as well as improved cardiovascular outcomes, according to results from a study that looked at records from more than 90,000 Medicare patients aged 65 and older (mean age 75.6, 61% female) over a 2-year period.

The study, led by Joshua J. Gagne, Pharm.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and published online Sept. 15 in Annals of Internal Medicine (doi:10.7326/M13-2942), found that the average portion of days covered under prescribed statin therapy was 77% for patients started on generic lovastatin, pravastatin, or simvastatin, and 71% for patients started on name brands of these medications (P < .001). Researchers pinpointed cost as the likeliest reason for the differences in adherence; mean copay in the study was $10 for generics and $48 for brand-name drugs.

©PhotoDisk

Dr. Gagne and colleagues also reported that patients on generics saw an 8% reduction in cardiovascular events (as measured by a composite outcome of hospitalization for an acute coronary syndrome, stroke, or all-cause mortality), compared with those on brand-name medications (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99).

Dr. Gagne and colleagues called the difference in cardiovascular outcomes “commensurate with the expected effect” based on differences in adherence, while noting that theirs was the first study to demonstrate differences in health outcomes related to the dispensing of generic or brand-name statins. Most patients in the study (n = 83,731) were started on generics. Generic drug recipients were more likely to be women (62% vs. 54%), and brand-name statin recipients were more likely to be white (66% vs. 48%).

“In the setting of tiered copayments in typical pharmacy benefit designs, initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the researchers concluded (Ann. Int. Med. 2014;161:400-7. [doi:10.7326/M13-2942]).

Dr. Gagne and colleagues noted among the limitations of their study its nonrandomized design, the use of only three statins, and the fact that they could not determine who decided whether patients initiated a generic or brand-name drug, noting that many states require pharmacists to dispense generics unless a prescriber or patient requests otherwise. The results may not apply to patients with types of insurance other than Medicare, they noted.

Teva pharmaceuticals, a manufacturer of generic medications, sponsored the study; Dr. Gagne and a coauthor, Niteesh K. Choudhry, M.D., Ph.D., disclosed grant support from Teva, while three coauthors disclosed being employees of CVS Caremark, a major pharmacy benefits administrator.

Over the last 20 years, litigation rates, malpractice coverage costs, and the number of cesarean deliveries have increased significantly. In fact, many ObGyns have dropped their obstetric practices because of the increased cost of malpractice insurance, say researchers from Johns Hopkins and Brown, and three states (New York, Florida, and Virginia) now have birth injury funds to help deflect the burden of malpractice insurance and litigation costs.¹

What is the existing state-level relationship between malpractice rates and the mode of delivery, including cesarean delivery (CD) and vaginal delivery (VD), as well as operative vaginal delivery (OVD)? And how do the state-run injury funds affect this relationship, asked Clark T. Johnson, MD, MPH, and Erika F. Werner, MD.

To answer their question, the investigators collected 8 years of data on mode of delivery (from the Centers for Disease Control and Prevention National Vital Statistics System) and malpractice rates for ObGyns in each US state (from the 2011 Medical Liability Monitor Rate Survey). The researchers used linear regression modeling to analyze their 2003−2010 data.¹

They found that states with higher malpractice rates had higher CD delivery rates and lower VD rates than states with lower malpractice rates, and that higher malpractice rates also correlated with lower rates of OVD, including the use of forceps and vacuum extraction. Overall, the change in malpractice rates between 2003 and 2010 did not correlate with the rates of OVD.¹

Those states with the highest average annual malpractice insurance rate (> $120,000) to cover claims with a cap of $1 million/$3 million in 2010, were Florida, New York, and Connecticut. Illinois, Pennsylvania, New Jersey, and Maryland had an average annual rate of $100,000 to $120,000.

Those states with the lowest average annual malpractice insurance rate (0$ to $40,000) were North Dakota, South Dakota, Nebraska, Minnesota, Iowa, and Wisconsin.

In the 1980s, medical malpractice insurance rates soared and insurance companies were faced with eliminating coverage to obstetricians. In 1987, the Virginia General Assembly developed the Virginia Birth-Related Neurological Injury Compensation Program. This no-fault system ensures lifetime care to eligible participants, and has successfully stabilized the malpractice environment in the state.² Birth-related neurologic injury funds were also created in Florida in 1988³ and in New York in 2011.⁴

The three states with birth injury funds showed a decrease in malpractice rates, a slower rate of CD-rate increase, and an OVD-rate decrease. However, the researchers note that while developing a state birth injury fund is seen as a trend that might reduce malpractice rates, there were not enough data to demonstrate significance.¹

Over the last 20 years, litigation rates, malpractice coverage costs, and the number of cesarean deliveries have increased significantly. In fact, many ObGyns have dropped their obstetric practices because of the increased cost of malpractice insurance, say researchers from Johns Hopkins and Brown, and three states (New York, Florida, and Virginia) now have birth injury funds to help deflect the burden of malpractice insurance and litigation costs.¹

What is the existing state-level relationship between malpractice rates and the mode of delivery, including cesarean delivery (CD) and vaginal delivery (VD), as well as operative vaginal delivery (OVD)? And how do the state-run injury funds affect this relationship, asked Clark T. Johnson, MD, MPH, and Erika F. Werner, MD.

To answer their question, the investigators collected 8 years of data on mode of delivery (from the Centers for Disease Control and Prevention National Vital Statistics System) and malpractice rates for ObGyns in each US state (from the 2011 Medical Liability Monitor Rate Survey). The researchers used linear regression modeling to analyze their 2003−2010 data.¹

They found that states with higher malpractice rates had higher CD delivery rates and lower VD rates than states with lower malpractice rates, and that higher malpractice rates also correlated with lower rates of OVD, including the use of forceps and vacuum extraction. Overall, the change in malpractice rates between 2003 and 2010 did not correlate with the rates of OVD.¹

Those states with the highest average annual malpractice insurance rate (> $120,000) to cover claims with a cap of $1 million/$3 million in 2010, were Florida, New York, and Connecticut. Illinois, Pennsylvania, New Jersey, and Maryland had an average annual rate of $100,000 to $120,000.

Those states with the lowest average annual malpractice insurance rate (0$ to $40,000) were North Dakota, South Dakota, Nebraska, Minnesota, Iowa, and Wisconsin.

In the 1980s, medical malpractice insurance rates soared and insurance companies were faced with eliminating coverage to obstetricians. In 1987, the Virginia General Assembly developed the Virginia Birth-Related Neurological Injury Compensation Program. This no-fault system ensures lifetime care to eligible participants, and has successfully stabilized the malpractice environment in the state.² Birth-related neurologic injury funds were also created in Florida in 1988³ and in New York in 2011.⁴

The three states with birth injury funds showed a decrease in malpractice rates, a slower rate of CD-rate increase, and an OVD-rate decrease. However, the researchers note that while developing a state birth injury fund is seen as a trend that might reduce malpractice rates, there were not enough data to demonstrate significance.¹

Over the last 20 years, litigation rates, malpractice coverage costs, and the number of cesarean deliveries have increased significantly. In fact, many ObGyns have dropped their obstetric practices because of the increased cost of malpractice insurance, say researchers from Johns Hopkins and Brown, and three states (New York, Florida, and Virginia) now have birth injury funds to help deflect the burden of malpractice insurance and litigation costs.¹

What is the existing state-level relationship between malpractice rates and the mode of delivery, including cesarean delivery (CD) and vaginal delivery (VD), as well as operative vaginal delivery (OVD)? And how do the state-run injury funds affect this relationship, asked Clark T. Johnson, MD, MPH, and Erika F. Werner, MD.

To answer their question, the investigators collected 8 years of data on mode of delivery (from the Centers for Disease Control and Prevention National Vital Statistics System) and malpractice rates for ObGyns in each US state (from the 2011 Medical Liability Monitor Rate Survey). The researchers used linear regression modeling to analyze their 2003−2010 data.¹

They found that states with higher malpractice rates had higher CD delivery rates and lower VD rates than states with lower malpractice rates, and that higher malpractice rates also correlated with lower rates of OVD, including the use of forceps and vacuum extraction. Overall, the change in malpractice rates between 2003 and 2010 did not correlate with the rates of OVD.¹

Those states with the highest average annual malpractice insurance rate (> $120,000) to cover claims with a cap of $1 million/$3 million in 2010, were Florida, New York, and Connecticut. Illinois, Pennsylvania, New Jersey, and Maryland had an average annual rate of $100,000 to $120,000.

Those states with the lowest average annual malpractice insurance rate (0$ to $40,000) were North Dakota, South Dakota, Nebraska, Minnesota, Iowa, and Wisconsin.

In the 1980s, medical malpractice insurance rates soared and insurance companies were faced with eliminating coverage to obstetricians. In 1987, the Virginia General Assembly developed the Virginia Birth-Related Neurological Injury Compensation Program. This no-fault system ensures lifetime care to eligible participants, and has successfully stabilized the malpractice environment in the state.² Birth-related neurologic injury funds were also created in Florida in 1988³ and in New York in 2011.⁴

The three states with birth injury funds showed a decrease in malpractice rates, a slower rate of CD-rate increase, and an OVD-rate decrease. However, the researchers note that while developing a state birth injury fund is seen as a trend that might reduce malpractice rates, there were not enough data to demonstrate significance.¹

The VA Learning Opportunity Residency (VALOR) program is a prelicensure experience with a nurse preceptor for rising senior students enrolled in a bachelor of science in nursing program. Students must have a minimum 3.0 grade-point average to apply. The program provides 800 hours of paid learning experiences in diverse didactic and hands-on clinical situations. The first 400 hours of the program (10 weeks) occur over the summer, and the second 400 hours take place during the fall and spring semesters of the student’s last year of school.¹ During the last 400 hours, students are placed in the areas they are interested in working as new graduate nurses.

The aim of the Salem VALOR program is to develop the next generation of VAMC nurses by recruiting new graduate nurses. The Salem VAMC structures the VALOR program to meet the needs of both the students and the facility. According to Glenda Fuller, the student programs manager for the VA, national VALOR retention rates from 2007 to 2011 have averaged 38%. However, more applicants apply for new graduate nurse positions than are available. Included in the VHA Directive 2011-039, facilities that hire a nurse with ≤ 1 year of experience must enroll them in a yearlong transition-to-practice program.² Therefore, facilities may limit the number of new graduate nurse positions.

On entry into the VALOR program, participants write a journal entry regarding their fears and concerns about becoming a new graduate nurse. In addition, each student turns in a written reflection about their experiences each week and participates in daily group discussions with the program coordinator. The last day of the summer portion of the program, students again write about their fears and concerns about becoming a new graduate nurse. After reviewing the VALOR journals, conducting focus groups, and taking notes during the daily meetings, the authors describe the following VALOR experience from the summer of 2013 at the Salem VAMC.

Preparing New Graduates

Hospitals are under pressure to provide high-quality nursing care despite hiring new graduate nurses who are unfamiliar and inexperienced in caring for patients’ complex health care needs. New graduate nurses currently make up more than 10% of hospital nursing staff, and that number is expected to grow as baby boomers retire.³ Boswell and colleagues suggest that those new graduate nurses are unprepared for the registered nurse role.⁴ Identifying strategies to facilitate the transition from student to the new graduate nurse role will likely decrease attrition rates and increase the effectiveness and the quality of patient care. Nursing programs, such as the VALOR, can ease the transition from the classroom to the working environment.⁵

This result is evident when observing how VALOR students enhance their nursing skills after the 10-week summer program. VALOR participant Andrea King published her summer experience at the Salem VAMC in The Torch, the Virginia Nursing Students’ Association newsletter.⁶ “I had so much practice and eventually confidence in my nursing skills,” she wrote, “that I had the autonomy and independence to feel like I was working as an actual nurse.”⁶

The VALOR Experience

During the summer months, senior nursing students have the opportunity to go on rounds with the chaplain, work with nurse practitioners, attend outings with mental health patients, participate in home health visits, interact with patients in groups, and rotate to different hospital units. Students attend FranklinCovey classes (which specialize in employee performance improvement), participate in an evidence-based practice (EBP) project (which helps them to learn about teamwork), and collaborate with interdisciplinary health care professionals. At the end of the summer, students present their team EBP project to the nurse executive committee. Presentation experience assists students in acquiring public speaking skills. Students are nervous about presenting to a room full of executives. However, they learn to depend on one another and to strengthen weaknesses and build on strengths.

When high-performing students come together as one cohort, this dynamic poses challenges for the VALOR participants. One student described her vulnerability in relation to her VALOR peers as “the hardest hit to my self-confidence has been working with such intelligent and accomplished cohorts.” Another student found that even though she was at the top of her class, working with the other VALORs “challenged her self-confidence” because all the program participants were high-performing students. She found it pushed her to perform better. One person reflected, “I feel the VALOR experience has really given all of us the opportunity to unleash our full potential. I have no doubt that these students will become future health care leaders.”

Building Skills

Learning new skills and interacting with physicians are stressful experiences for new graduate nurses.⁷ A study by Casey and colleagues suggests that new graduate nurses feel inadequate and lack self-confidence.⁸ VALOR participants share these concerns. The initial journal entries revealed fears of making a mistake, harming patients, fitting in to the work culture, working with doctors, feeling anxious about patient interactions, and performing clinical skills competently.

Initially, students focused on needing extensive practice with nursing skills as evidenced by one student’s comments, “I’m honestly concerned about some of the procedures; I’ve only put in 3 IVs during nursing school, I am not confident walking in to a room and performing a procedure on my own. I would be overwhelmed.” When considering RN-to-MD communication, one student commented, “I’m nervous, doctors can be very hard on new nurses, I’ve witnessed this over and over.”

During the first weeks, the participants discussed the fear of being “on their own” without the benefit of their instructor once they graduate. One person noted this feeling as “The seed of fear grows as graduation approaches.” This lack of self-confidence and feeling scared is a consistent issue with all the VALOR students the first day of the program.

During the program, VALOR students developed nursing skills and became certified in advanced cardiac life support (ACLS). One student suggested that the ACLS class was a great team builder and instilled confidence among the VALOR participants. Another student shared, “We all agreed that attaining this certification was a culmination of our overall VA experience.” A student who was working in an acute care area applied the newly learned ACLS skills the following week when a patient coded. The student’s journal reflected how preparation makes a difference and described his experience and knowing how to react as “powerful.”

The Reality of Nursing

The VALOR program helps connect the academic environment with the realities of the workplace. Wilson found bridging the theory-practice gap between school and workplace improves learning opportunities for students.⁹ Wilson also suggests that having peers to identify with helps to bridge the theory-practice gap.⁹ Journal entries reflected “the perfect hospital” of textbooks was different from working every day and “almost being a nurse.” During the VALOR program, students immerse themselves in the realistic nursing environment of staff shortages, equipment unavailability, disgruntled patients, and peer-to-peer communication that is not always civil. The 40-hour workweek provides a realistic hands-on view of nursing and introduces students to socializing as a nurse and the nursing work culture.

After the 2013 summer portion of the program, students were able to differentiate between the realities of the world of health care and the academic view of the health care environment. As students progressed over the summer, a noticeable transformation took place. The student who wrote about needing more skills practice on day 1 found that she was comfortable with injections, hanging IVs, and providing patient care at the end of week 3. Students grew more comfortable collaborating with doctors and other interdisciplinary professionals. They also became competent with basic nursing skills and had a realistic view of the nursing world.

In addition, students became aware of the emotional aspects of nursing. One student discussed making a difference in a veteran’s life after participating in a substance abuse group. “While I was on my way home I started thinking about those vets and their stories, and I started getting emotional. I just felt bad that after doing the great deed of fighting for our country that they became victims of substance abuse,” the student explained. “That afternoon, as I departed the vets, I left hopeful and realized I could make a difference in the life of a veteran.” Another student perceived that doctors were discussing a veteran’s terminal lung cancer “nonchalantly” and reflected, “though I do recognize that a certain degree of disconnection must take place, a certain measure of empathy must remain at all times to effect positive outcomes in the patient’s health.”

VALOR students noted that the program gave them exposure to different areas of nursing. This experience assisted them in deciding on an area of nursing interest. One student who always wanted to be an emergency department nurse found that after that rotation, she was not “cut out to be an emergency department nurse.” Some students came into the program thinking they knew precisely what they wanted to do following graduation, but found a new interest.

Daily Debriefings

Through daily debriefing discussions, students learn about best practices, patient advocacy, nursing leadership, and communication skills. Some have said that it has helped them “get through the day” knowing they had an outlet to review their experiences with VALOR peers. Discussions focus on both the positive and negative aspects of their day.

Students found that group discussions bonded them as a team and allowed them to share their feelings openly. One student found, “What really impacted me was just the amount of learning I received from my VALOR friends.” The group discussions and projects allow students who may typically work in isolation to come together as a team, providing a safe outlet for reflection and self-expression. Meeting daily with peers to share personal experiences increases team cohesion. Research suggests that students learn from their peers.^10,11 Working closely with these students, the benefit of peer-to-peer learning was obvious. Students support and teach one another in a nonthreatening environment, which enhances their learning process.

End of the Summer Journey

For the students’ final journal entry, they are asked to identify their greatest fear from week 1 and describe how that has changed by week 10. Journal entries indicated that the students were no longer afraid of being a new nurse, and doctors were “not so scary anymore.” Students already know that nursing is not “going to be peachy,” but participating in the VALOR program allayed their worst fears. One student wrote, “When I had the experiences of doctors, dieticians, and physical therapists asking me questions about my patient and taking what I said seriously, it really boosted my confidence.”

Students seemed less nervous taking on the new graduate nurse role, because they practiced skills and experienced the real life of a nurse. The student who was worried about starting IVs stated, “It is second nature now.” The student who was worried about talking to doctors is now paging and communicating with them in teams. “I feel that I’m more likely to converse with other members of the health care team because of this experience,” one student reported. Another student experienced being afraid of practicing clinical skills because of her lack of experience. “I had put in only 3 IVs previously. I had never seen a cardiac catheterization,” she related.  “I had never run an electrocardiography (EKG), and I had never had an opportunity to see many of the things I have seen. I was afraid of taking a full patient load, and I was apprehensive about simple things such as hanging IV medications. I was unsure of myself, and desperately needed practice. I lacked confidence, and needed to gain experience. Now, looking back, those things seem silly.”

Coming out of this program, one student suggested, “I have found that my expectations were blown away.” The 2013 cohort walked away from the summer portion of the program with ACLS training, EKG classes, interdisciplinary team experiences, FranklinCovey personal development seminars, and most of all, hands-on experience that provided these future nurses with confidence in their abilities. Participants felt that after this summer they would be “a step ahead” of their peers when they returned to school in the fall. One student related, after returning to school, “My professor asked me to help teach an EKG class since I was ACLS certified.”

Conclusion

The goal of sharing the VALOR program and students’ experiences at the Salem VAMC is to highlight how students grow clinically and professionally. The program is not a single-person endeavor. The chief nurse executive, managers, interdisciplinary health care professionals, and nursing preceptors support the program. Gaining stakeholder buy-in for the program results in positive experiences for both students and veterans.

Taking top-performing students and grouping them as a cohort creates a learning experience for students and benefits the facility. Students develop essential nursing skills, which assist their transition to the new graduate nurse role. In the words of one student, “As this experience comes to a close, I find myself increasingly apprehensive of finishing. The VALOR position has been like a dream come true for me. I have developed as a person and a future nurse.” As the new generation of nurses, the VALORs provide the institution with fresh eyes and new ideas on how to improve the system and to care for our nation’s veterans.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

The VA Learning Opportunity Residency (VALOR) program is a prelicensure experience with a nurse preceptor for rising senior students enrolled in a bachelor of science in nursing program. Students must have a minimum 3.0 grade-point average to apply. The program provides 800 hours of paid learning experiences in diverse didactic and hands-on clinical situations. The first 400 hours of the program (10 weeks) occur over the summer, and the second 400 hours take place during the fall and spring semesters of the student’s last year of school.¹ During the last 400 hours, students are placed in the areas they are interested in working as new graduate nurses.

The aim of the Salem VALOR program is to develop the next generation of VAMC nurses by recruiting new graduate nurses. The Salem VAMC structures the VALOR program to meet the needs of both the students and the facility. According to Glenda Fuller, the student programs manager for the VA, national VALOR retention rates from 2007 to 2011 have averaged 38%. However, more applicants apply for new graduate nurse positions than are available. Included in the VHA Directive 2011-039, facilities that hire a nurse with ≤ 1 year of experience must enroll them in a yearlong transition-to-practice program.² Therefore, facilities may limit the number of new graduate nurse positions.

On entry into the VALOR program, participants write a journal entry regarding their fears and concerns about becoming a new graduate nurse. In addition, each student turns in a written reflection about their experiences each week and participates in daily group discussions with the program coordinator. The last day of the summer portion of the program, students again write about their fears and concerns about becoming a new graduate nurse. After reviewing the VALOR journals, conducting focus groups, and taking notes during the daily meetings, the authors describe the following VALOR experience from the summer of 2013 at the Salem VAMC.

Preparing New Graduates

Hospitals are under pressure to provide high-quality nursing care despite hiring new graduate nurses who are unfamiliar and inexperienced in caring for patients’ complex health care needs. New graduate nurses currently make up more than 10% of hospital nursing staff, and that number is expected to grow as baby boomers retire.³ Boswell and colleagues suggest that those new graduate nurses are unprepared for the registered nurse role.⁴ Identifying strategies to facilitate the transition from student to the new graduate nurse role will likely decrease attrition rates and increase the effectiveness and the quality of patient care. Nursing programs, such as the VALOR, can ease the transition from the classroom to the working environment.⁵

This result is evident when observing how VALOR students enhance their nursing skills after the 10-week summer program. VALOR participant Andrea King published her summer experience at the Salem VAMC in The Torch, the Virginia Nursing Students’ Association newsletter.⁶ “I had so much practice and eventually confidence in my nursing skills,” she wrote, “that I had the autonomy and independence to feel like I was working as an actual nurse.”⁶

The VALOR Experience

During the summer months, senior nursing students have the opportunity to go on rounds with the chaplain, work with nurse practitioners, attend outings with mental health patients, participate in home health visits, interact with patients in groups, and rotate to different hospital units. Students attend FranklinCovey classes (which specialize in employee performance improvement), participate in an evidence-based practice (EBP) project (which helps them to learn about teamwork), and collaborate with interdisciplinary health care professionals. At the end of the summer, students present their team EBP project to the nurse executive committee. Presentation experience assists students in acquiring public speaking skills. Students are nervous about presenting to a room full of executives. However, they learn to depend on one another and to strengthen weaknesses and build on strengths.

When high-performing students come together as one cohort, this dynamic poses challenges for the VALOR participants. One student described her vulnerability in relation to her VALOR peers as “the hardest hit to my self-confidence has been working with such intelligent and accomplished cohorts.” Another student found that even though she was at the top of her class, working with the other VALORs “challenged her self-confidence” because all the program participants were high-performing students. She found it pushed her to perform better. One person reflected, “I feel the VALOR experience has really given all of us the opportunity to unleash our full potential. I have no doubt that these students will become future health care leaders.”

Building Skills

Learning new skills and interacting with physicians are stressful experiences for new graduate nurses.⁷ A study by Casey and colleagues suggests that new graduate nurses feel inadequate and lack self-confidence.⁸ VALOR participants share these concerns. The initial journal entries revealed fears of making a mistake, harming patients, fitting in to the work culture, working with doctors, feeling anxious about patient interactions, and performing clinical skills competently.

Initially, students focused on needing extensive practice with nursing skills as evidenced by one student’s comments, “I’m honestly concerned about some of the procedures; I’ve only put in 3 IVs during nursing school, I am not confident walking in to a room and performing a procedure on my own. I would be overwhelmed.” When considering RN-to-MD communication, one student commented, “I’m nervous, doctors can be very hard on new nurses, I’ve witnessed this over and over.”

During the first weeks, the participants discussed the fear of being “on their own” without the benefit of their instructor once they graduate. One person noted this feeling as “The seed of fear grows as graduation approaches.” This lack of self-confidence and feeling scared is a consistent issue with all the VALOR students the first day of the program.

During the program, VALOR students developed nursing skills and became certified in advanced cardiac life support (ACLS). One student suggested that the ACLS class was a great team builder and instilled confidence among the VALOR participants. Another student shared, “We all agreed that attaining this certification was a culmination of our overall VA experience.” A student who was working in an acute care area applied the newly learned ACLS skills the following week when a patient coded. The student’s journal reflected how preparation makes a difference and described his experience and knowing how to react as “powerful.”

The Reality of Nursing

The VALOR program helps connect the academic environment with the realities of the workplace. Wilson found bridging the theory-practice gap between school and workplace improves learning opportunities for students.⁹ Wilson also suggests that having peers to identify with helps to bridge the theory-practice gap.⁹ Journal entries reflected “the perfect hospital” of textbooks was different from working every day and “almost being a nurse.” During the VALOR program, students immerse themselves in the realistic nursing environment of staff shortages, equipment unavailability, disgruntled patients, and peer-to-peer communication that is not always civil. The 40-hour workweek provides a realistic hands-on view of nursing and introduces students to socializing as a nurse and the nursing work culture.

After the 2013 summer portion of the program, students were able to differentiate between the realities of the world of health care and the academic view of the health care environment. As students progressed over the summer, a noticeable transformation took place. The student who wrote about needing more skills practice on day 1 found that she was comfortable with injections, hanging IVs, and providing patient care at the end of week 3. Students grew more comfortable collaborating with doctors and other interdisciplinary professionals. They also became competent with basic nursing skills and had a realistic view of the nursing world.

In addition, students became aware of the emotional aspects of nursing. One student discussed making a difference in a veteran’s life after participating in a substance abuse group. “While I was on my way home I started thinking about those vets and their stories, and I started getting emotional. I just felt bad that after doing the great deed of fighting for our country that they became victims of substance abuse,” the student explained. “That afternoon, as I departed the vets, I left hopeful and realized I could make a difference in the life of a veteran.” Another student perceived that doctors were discussing a veteran’s terminal lung cancer “nonchalantly” and reflected, “though I do recognize that a certain degree of disconnection must take place, a certain measure of empathy must remain at all times to effect positive outcomes in the patient’s health.”

VALOR students noted that the program gave them exposure to different areas of nursing. This experience assisted them in deciding on an area of nursing interest. One student who always wanted to be an emergency department nurse found that after that rotation, she was not “cut out to be an emergency department nurse.” Some students came into the program thinking they knew precisely what they wanted to do following graduation, but found a new interest.

Daily Debriefings

Through daily debriefing discussions, students learn about best practices, patient advocacy, nursing leadership, and communication skills. Some have said that it has helped them “get through the day” knowing they had an outlet to review their experiences with VALOR peers. Discussions focus on both the positive and negative aspects of their day.

Students found that group discussions bonded them as a team and allowed them to share their feelings openly. One student found, “What really impacted me was just the amount of learning I received from my VALOR friends.” The group discussions and projects allow students who may typically work in isolation to come together as a team, providing a safe outlet for reflection and self-expression. Meeting daily with peers to share personal experiences increases team cohesion. Research suggests that students learn from their peers.^10,11 Working closely with these students, the benefit of peer-to-peer learning was obvious. Students support and teach one another in a nonthreatening environment, which enhances their learning process.

End of the Summer Journey

For the students’ final journal entry, they are asked to identify their greatest fear from week 1 and describe how that has changed by week 10. Journal entries indicated that the students were no longer afraid of being a new nurse, and doctors were “not so scary anymore.” Students already know that nursing is not “going to be peachy,” but participating in the VALOR program allayed their worst fears. One student wrote, “When I had the experiences of doctors, dieticians, and physical therapists asking me questions about my patient and taking what I said seriously, it really boosted my confidence.”

Students seemed less nervous taking on the new graduate nurse role, because they practiced skills and experienced the real life of a nurse. The student who was worried about starting IVs stated, “It is second nature now.” The student who was worried about talking to doctors is now paging and communicating with them in teams. “I feel that I’m more likely to converse with other members of the health care team because of this experience,” one student reported. Another student experienced being afraid of practicing clinical skills because of her lack of experience. “I had put in only 3 IVs previously. I had never seen a cardiac catheterization,” she related.  “I had never run an electrocardiography (EKG), and I had never had an opportunity to see many of the things I have seen. I was afraid of taking a full patient load, and I was apprehensive about simple things such as hanging IV medications. I was unsure of myself, and desperately needed practice. I lacked confidence, and needed to gain experience. Now, looking back, those things seem silly.”

Coming out of this program, one student suggested, “I have found that my expectations were blown away.” The 2013 cohort walked away from the summer portion of the program with ACLS training, EKG classes, interdisciplinary team experiences, FranklinCovey personal development seminars, and most of all, hands-on experience that provided these future nurses with confidence in their abilities. Participants felt that after this summer they would be “a step ahead” of their peers when they returned to school in the fall. One student related, after returning to school, “My professor asked me to help teach an EKG class since I was ACLS certified.”

Conclusion

The goal of sharing the VALOR program and students’ experiences at the Salem VAMC is to highlight how students grow clinically and professionally. The program is not a single-person endeavor. The chief nurse executive, managers, interdisciplinary health care professionals, and nursing preceptors support the program. Gaining stakeholder buy-in for the program results in positive experiences for both students and veterans.

Taking top-performing students and grouping them as a cohort creates a learning experience for students and benefits the facility. Students develop essential nursing skills, which assist their transition to the new graduate nurse role. In the words of one student, “As this experience comes to a close, I find myself increasingly apprehensive of finishing. The VALOR position has been like a dream come true for me. I have developed as a person and a future nurse.” As the new generation of nurses, the VALORs provide the institution with fresh eyes and new ideas on how to improve the system and to care for our nation’s veterans.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

The VA Learning Opportunity Residency (VALOR) program is a prelicensure experience with a nurse preceptor for rising senior students enrolled in a bachelor of science in nursing program. Students must have a minimum 3.0 grade-point average to apply. The program provides 800 hours of paid learning experiences in diverse didactic and hands-on clinical situations. The first 400 hours of the program (10 weeks) occur over the summer, and the second 400 hours take place during the fall and spring semesters of the student’s last year of school.¹ During the last 400 hours, students are placed in the areas they are interested in working as new graduate nurses.

The aim of the Salem VALOR program is to develop the next generation of VAMC nurses by recruiting new graduate nurses. The Salem VAMC structures the VALOR program to meet the needs of both the students and the facility. According to Glenda Fuller, the student programs manager for the VA, national VALOR retention rates from 2007 to 2011 have averaged 38%. However, more applicants apply for new graduate nurse positions than are available. Included in the VHA Directive 2011-039, facilities that hire a nurse with ≤ 1 year of experience must enroll them in a yearlong transition-to-practice program.² Therefore, facilities may limit the number of new graduate nurse positions.

On entry into the VALOR program, participants write a journal entry regarding their fears and concerns about becoming a new graduate nurse. In addition, each student turns in a written reflection about their experiences each week and participates in daily group discussions with the program coordinator. The last day of the summer portion of the program, students again write about their fears and concerns about becoming a new graduate nurse. After reviewing the VALOR journals, conducting focus groups, and taking notes during the daily meetings, the authors describe the following VALOR experience from the summer of 2013 at the Salem VAMC.

Preparing New Graduates

Hospitals are under pressure to provide high-quality nursing care despite hiring new graduate nurses who are unfamiliar and inexperienced in caring for patients’ complex health care needs. New graduate nurses currently make up more than 10% of hospital nursing staff, and that number is expected to grow as baby boomers retire.³ Boswell and colleagues suggest that those new graduate nurses are unprepared for the registered nurse role.⁴ Identifying strategies to facilitate the transition from student to the new graduate nurse role will likely decrease attrition rates and increase the effectiveness and the quality of patient care. Nursing programs, such as the VALOR, can ease the transition from the classroom to the working environment.⁵

This result is evident when observing how VALOR students enhance their nursing skills after the 10-week summer program. VALOR participant Andrea King published her summer experience at the Salem VAMC in The Torch, the Virginia Nursing Students’ Association newsletter.⁶ “I had so much practice and eventually confidence in my nursing skills,” she wrote, “that I had the autonomy and independence to feel like I was working as an actual nurse.”⁶

The VALOR Experience

During the summer months, senior nursing students have the opportunity to go on rounds with the chaplain, work with nurse practitioners, attend outings with mental health patients, participate in home health visits, interact with patients in groups, and rotate to different hospital units. Students attend FranklinCovey classes (which specialize in employee performance improvement), participate in an evidence-based practice (EBP) project (which helps them to learn about teamwork), and collaborate with interdisciplinary health care professionals. At the end of the summer, students present their team EBP project to the nurse executive committee. Presentation experience assists students in acquiring public speaking skills. Students are nervous about presenting to a room full of executives. However, they learn to depend on one another and to strengthen weaknesses and build on strengths.

When high-performing students come together as one cohort, this dynamic poses challenges for the VALOR participants. One student described her vulnerability in relation to her VALOR peers as “the hardest hit to my self-confidence has been working with such intelligent and accomplished cohorts.” Another student found that even though she was at the top of her class, working with the other VALORs “challenged her self-confidence” because all the program participants were high-performing students. She found it pushed her to perform better. One person reflected, “I feel the VALOR experience has really given all of us the opportunity to unleash our full potential. I have no doubt that these students will become future health care leaders.”

Building Skills

Learning new skills and interacting with physicians are stressful experiences for new graduate nurses.⁷ A study by Casey and colleagues suggests that new graduate nurses feel inadequate and lack self-confidence.⁸ VALOR participants share these concerns. The initial journal entries revealed fears of making a mistake, harming patients, fitting in to the work culture, working with doctors, feeling anxious about patient interactions, and performing clinical skills competently.

Initially, students focused on needing extensive practice with nursing skills as evidenced by one student’s comments, “I’m honestly concerned about some of the procedures; I’ve only put in 3 IVs during nursing school, I am not confident walking in to a room and performing a procedure on my own. I would be overwhelmed.” When considering RN-to-MD communication, one student commented, “I’m nervous, doctors can be very hard on new nurses, I’ve witnessed this over and over.”

During the first weeks, the participants discussed the fear of being “on their own” without the benefit of their instructor once they graduate. One person noted this feeling as “The seed of fear grows as graduation approaches.” This lack of self-confidence and feeling scared is a consistent issue with all the VALOR students the first day of the program.

During the program, VALOR students developed nursing skills and became certified in advanced cardiac life support (ACLS). One student suggested that the ACLS class was a great team builder and instilled confidence among the VALOR participants. Another student shared, “We all agreed that attaining this certification was a culmination of our overall VA experience.” A student who was working in an acute care area applied the newly learned ACLS skills the following week when a patient coded. The student’s journal reflected how preparation makes a difference and described his experience and knowing how to react as “powerful.”

The Reality of Nursing

The VALOR program helps connect the academic environment with the realities of the workplace. Wilson found bridging the theory-practice gap between school and workplace improves learning opportunities for students.⁹ Wilson also suggests that having peers to identify with helps to bridge the theory-practice gap.⁹ Journal entries reflected “the perfect hospital” of textbooks was different from working every day and “almost being a nurse.” During the VALOR program, students immerse themselves in the realistic nursing environment of staff shortages, equipment unavailability, disgruntled patients, and peer-to-peer communication that is not always civil. The 40-hour workweek provides a realistic hands-on view of nursing and introduces students to socializing as a nurse and the nursing work culture.

After the 2013 summer portion of the program, students were able to differentiate between the realities of the world of health care and the academic view of the health care environment. As students progressed over the summer, a noticeable transformation took place. The student who wrote about needing more skills practice on day 1 found that she was comfortable with injections, hanging IVs, and providing patient care at the end of week 3. Students grew more comfortable collaborating with doctors and other interdisciplinary professionals. They also became competent with basic nursing skills and had a realistic view of the nursing world.

In addition, students became aware of the emotional aspects of nursing. One student discussed making a difference in a veteran’s life after participating in a substance abuse group. “While I was on my way home I started thinking about those vets and their stories, and I started getting emotional. I just felt bad that after doing the great deed of fighting for our country that they became victims of substance abuse,” the student explained. “That afternoon, as I departed the vets, I left hopeful and realized I could make a difference in the life of a veteran.” Another student perceived that doctors were discussing a veteran’s terminal lung cancer “nonchalantly” and reflected, “though I do recognize that a certain degree of disconnection must take place, a certain measure of empathy must remain at all times to effect positive outcomes in the patient’s health.”

VALOR students noted that the program gave them exposure to different areas of nursing. This experience assisted them in deciding on an area of nursing interest. One student who always wanted to be an emergency department nurse found that after that rotation, she was not “cut out to be an emergency department nurse.” Some students came into the program thinking they knew precisely what they wanted to do following graduation, but found a new interest.

Daily Debriefings

Through daily debriefing discussions, students learn about best practices, patient advocacy, nursing leadership, and communication skills. Some have said that it has helped them “get through the day” knowing they had an outlet to review their experiences with VALOR peers. Discussions focus on both the positive and negative aspects of their day.

Students found that group discussions bonded them as a team and allowed them to share their feelings openly. One student found, “What really impacted me was just the amount of learning I received from my VALOR friends.” The group discussions and projects allow students who may typically work in isolation to come together as a team, providing a safe outlet for reflection and self-expression. Meeting daily with peers to share personal experiences increases team cohesion. Research suggests that students learn from their peers.^10,11 Working closely with these students, the benefit of peer-to-peer learning was obvious. Students support and teach one another in a nonthreatening environment, which enhances their learning process.

End of the Summer Journey

For the students’ final journal entry, they are asked to identify their greatest fear from week 1 and describe how that has changed by week 10. Journal entries indicated that the students were no longer afraid of being a new nurse, and doctors were “not so scary anymore.” Students already know that nursing is not “going to be peachy,” but participating in the VALOR program allayed their worst fears. One student wrote, “When I had the experiences of doctors, dieticians, and physical therapists asking me questions about my patient and taking what I said seriously, it really boosted my confidence.”

Students seemed less nervous taking on the new graduate nurse role, because they practiced skills and experienced the real life of a nurse. The student who was worried about starting IVs stated, “It is second nature now.” The student who was worried about talking to doctors is now paging and communicating with them in teams. “I feel that I’m more likely to converse with other members of the health care team because of this experience,” one student reported. Another student experienced being afraid of practicing clinical skills because of her lack of experience. “I had put in only 3 IVs previously. I had never seen a cardiac catheterization,” she related.  “I had never run an electrocardiography (EKG), and I had never had an opportunity to see many of the things I have seen. I was afraid of taking a full patient load, and I was apprehensive about simple things such as hanging IV medications. I was unsure of myself, and desperately needed practice. I lacked confidence, and needed to gain experience. Now, looking back, those things seem silly.”

Coming out of this program, one student suggested, “I have found that my expectations were blown away.” The 2013 cohort walked away from the summer portion of the program with ACLS training, EKG classes, interdisciplinary team experiences, FranklinCovey personal development seminars, and most of all, hands-on experience that provided these future nurses with confidence in their abilities. Participants felt that after this summer they would be “a step ahead” of their peers when they returned to school in the fall. One student related, after returning to school, “My professor asked me to help teach an EKG class since I was ACLS certified.”

Conclusion

The goal of sharing the VALOR program and students’ experiences at the Salem VAMC is to highlight how students grow clinically and professionally. The program is not a single-person endeavor. The chief nurse executive, managers, interdisciplinary health care professionals, and nursing preceptors support the program. Gaining stakeholder buy-in for the program results in positive experiences for both students and veterans.

Taking top-performing students and grouping them as a cohort creates a learning experience for students and benefits the facility. Students develop essential nursing skills, which assist their transition to the new graduate nurse role. In the words of one student, “As this experience comes to a close, I find myself increasingly apprehensive of finishing. The VALOR position has been like a dream come true for me. I have developed as a person and a future nurse.” As the new generation of nurses, the VALORs provide the institution with fresh eyes and new ideas on how to improve the system and to care for our nation’s veterans.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Team performing surgery

Credit: Piotr Bodzek

HOUSTON—A family of hemostatic products can decrease the need for blood transfusions, reduce hospital stays, and cut the cost of care for certain surgical patients, a retrospective study suggests.

Researchers compared the SURGICEL family of topical, absorbable hemostats—which are based on oxidized regenerated cellulose—to other adjunctive hemostats—flowables, gelatin, and thrombin—in patients undergoing a range of surgical procedures.

The team presented their findings in a poster at the Society for the Advancement of Blood Management Annual Meeting. The study was sponsored by Ethicon, makers of the SURGICEL products.

The goal of this research was to compare the healthcare resource utilization, costs, and outcomes associated with SURGICEL products—SURGICEL® ORIGINAL, SURGICEL® NU-KNIT®, SURGICEL® FIBRILLAR™, and SURGICEL® SNOW™—to those associated with other adjunctive hemostats.

The researchers analyzed data from adult patients (18 years and older) from the Premier Research Database who were discharged from the hospital between January 1, 2011, and December 31, 2012.

Patients had undergone cholecystectomy (n=3045), cardiovascular surgery (n=11,359), hysterectomy (n=4674), or carotid endarterectomy (5445).

The researchers found that fewer units of hemostat were used per discharge among patients who received SURGICEL products than among those who received other hemostats, regardless of the type of surgery.

Hemostat use was 18% lower for cholecystectomy patients (P<0.0001), 28% lower for cardiovascular patients (P<0.0001), 16% lower for hysterectomy patients (P<0.05), and 41% for carotid endarterectomy patients (P<0.0001).

SURGICEL products were also associated with a reduction in blood transfusions for some patients. Transfusions were reduced by 5% among hysterectomy patients (not significant), 18% in cholecystectomy patients (P<0.05), and 32% for carotid endarterectomy patients (P<0.0001).

The mean length of hospital stay and the mean length of stay in the intensive care unit (ICU) were both lower for certain patients who received SURGICEL products.

Hospital stays were 12% lower in cholecystectomy patients (P<0.05) and 8% lower in carotid endarterectomy patients (P<0.0001). And ICU stays were 3% lower in cholecystectomy patients (not significant) and 8% lower in carotid endarterectomy patients (P<0.05).

ICU costs were not significantly lower for patients who received SURGICEL products. However, the costs of hemostats and all-cause costs were lower with SURGICEL products than with other hemostats.

The cost of hemostats was 59% lower for in cholecystectomy patients (P<0.0001), 33% lower in cardiovascular patients (P<0.0001), 57% lower in hysterectomy patients (P<0.0001), and 49% lower in carotid endarterectomy patients (P<0.0001).

The all-cause costs per discharge were 1% lower for hysterectomy patients (P<0.05), 6% lower for carotid endarterectomy patients (P<0.0001), and 14% lower for cholecystectomy patients (P<0.0001).

Cost savings ranged from $71 to $155 per procedure.

“This study adds to the growing body of evidence that suggests the SURGICEL family of topical, absorbable hemostats has the potential to reduce burdens associated with bleeding and bleeding-related complications, which translates into cost and resource-use savings for healthcare providers,” said study investigator Jerome Riebman, MD, director of medical affairs at Ethicon.

Dr Riebman and his colleagues did note that this study was subject to limitations. For example, not all of the factors influencing the physicians’ choice of treatment were available in the dataset.

Furthermore, it’s not clear whether the hospitals studied are representative of all US hospitals. And coding errors or omitted procedure/product codes could have led to patient misclassification and potential bias in the results.

Team performing surgery

Credit: Piotr Bodzek

HOUSTON—A family of hemostatic products can decrease the need for blood transfusions, reduce hospital stays, and cut the cost of care for certain surgical patients, a retrospective study suggests.

Researchers compared the SURGICEL family of topical, absorbable hemostats—which are based on oxidized regenerated cellulose—to other adjunctive hemostats—flowables, gelatin, and thrombin—in patients undergoing a range of surgical procedures.

The team presented their findings in a poster at the Society for the Advancement of Blood Management Annual Meeting. The study was sponsored by Ethicon, makers of the SURGICEL products.

The goal of this research was to compare the healthcare resource utilization, costs, and outcomes associated with SURGICEL products—SURGICEL® ORIGINAL, SURGICEL® NU-KNIT®, SURGICEL® FIBRILLAR™, and SURGICEL® SNOW™—to those associated with other adjunctive hemostats.

The researchers analyzed data from adult patients (18 years and older) from the Premier Research Database who were discharged from the hospital between January 1, 2011, and December 31, 2012.

Patients had undergone cholecystectomy (n=3045), cardiovascular surgery (n=11,359), hysterectomy (n=4674), or carotid endarterectomy (5445).

The researchers found that fewer units of hemostat were used per discharge among patients who received SURGICEL products than among those who received other hemostats, regardless of the type of surgery.

Hemostat use was 18% lower for cholecystectomy patients (P<0.0001), 28% lower for cardiovascular patients (P<0.0001), 16% lower for hysterectomy patients (P<0.05), and 41% for carotid endarterectomy patients (P<0.0001).

SURGICEL products were also associated with a reduction in blood transfusions for some patients. Transfusions were reduced by 5% among hysterectomy patients (not significant), 18% in cholecystectomy patients (P<0.05), and 32% for carotid endarterectomy patients (P<0.0001).

The mean length of hospital stay and the mean length of stay in the intensive care unit (ICU) were both lower for certain patients who received SURGICEL products.

Hospital stays were 12% lower in cholecystectomy patients (P<0.05) and 8% lower in carotid endarterectomy patients (P<0.0001). And ICU stays were 3% lower in cholecystectomy patients (not significant) and 8% lower in carotid endarterectomy patients (P<0.05).

ICU costs were not significantly lower for patients who received SURGICEL products. However, the costs of hemostats and all-cause costs were lower with SURGICEL products than with other hemostats.

The cost of hemostats was 59% lower for in cholecystectomy patients (P<0.0001), 33% lower in cardiovascular patients (P<0.0001), 57% lower in hysterectomy patients (P<0.0001), and 49% lower in carotid endarterectomy patients (P<0.0001).

The all-cause costs per discharge were 1% lower for hysterectomy patients (P<0.05), 6% lower for carotid endarterectomy patients (P<0.0001), and 14% lower for cholecystectomy patients (P<0.0001).

Cost savings ranged from $71 to $155 per procedure.

“This study adds to the growing body of evidence that suggests the SURGICEL family of topical, absorbable hemostats has the potential to reduce burdens associated with bleeding and bleeding-related complications, which translates into cost and resource-use savings for healthcare providers,” said study investigator Jerome Riebman, MD, director of medical affairs at Ethicon.

Dr Riebman and his colleagues did note that this study was subject to limitations. For example, not all of the factors influencing the physicians’ choice of treatment were available in the dataset.

Furthermore, it’s not clear whether the hospitals studied are representative of all US hospitals. And coding errors or omitted procedure/product codes could have led to patient misclassification and potential bias in the results.

Team performing surgery

Credit: Piotr Bodzek

HOUSTON—A family of hemostatic products can decrease the need for blood transfusions, reduce hospital stays, and cut the cost of care for certain surgical patients, a retrospective study suggests.

Researchers compared the SURGICEL family of topical, absorbable hemostats—which are based on oxidized regenerated cellulose—to other adjunctive hemostats—flowables, gelatin, and thrombin—in patients undergoing a range of surgical procedures.

The team presented their findings in a poster at the Society for the Advancement of Blood Management Annual Meeting. The study was sponsored by Ethicon, makers of the SURGICEL products.

The goal of this research was to compare the healthcare resource utilization, costs, and outcomes associated with SURGICEL products—SURGICEL® ORIGINAL, SURGICEL® NU-KNIT®, SURGICEL® FIBRILLAR™, and SURGICEL® SNOW™—to those associated with other adjunctive hemostats.

The researchers analyzed data from adult patients (18 years and older) from the Premier Research Database who were discharged from the hospital between January 1, 2011, and December 31, 2012.

Patients had undergone cholecystectomy (n=3045), cardiovascular surgery (n=11,359), hysterectomy (n=4674), or carotid endarterectomy (5445).

The researchers found that fewer units of hemostat were used per discharge among patients who received SURGICEL products than among those who received other hemostats, regardless of the type of surgery.

Hemostat use was 18% lower for cholecystectomy patients (P<0.0001), 28% lower for cardiovascular patients (P<0.0001), 16% lower for hysterectomy patients (P<0.05), and 41% for carotid endarterectomy patients (P<0.0001).

SURGICEL products were also associated with a reduction in blood transfusions for some patients. Transfusions were reduced by 5% among hysterectomy patients (not significant), 18% in cholecystectomy patients (P<0.05), and 32% for carotid endarterectomy patients (P<0.0001).

The mean length of hospital stay and the mean length of stay in the intensive care unit (ICU) were both lower for certain patients who received SURGICEL products.

Hospital stays were 12% lower in cholecystectomy patients (P<0.05) and 8% lower in carotid endarterectomy patients (P<0.0001). And ICU stays were 3% lower in cholecystectomy patients (not significant) and 8% lower in carotid endarterectomy patients (P<0.05).

ICU costs were not significantly lower for patients who received SURGICEL products. However, the costs of hemostats and all-cause costs were lower with SURGICEL products than with other hemostats.

The cost of hemostats was 59% lower for in cholecystectomy patients (P<0.0001), 33% lower in cardiovascular patients (P<0.0001), 57% lower in hysterectomy patients (P<0.0001), and 49% lower in carotid endarterectomy patients (P<0.0001).

The all-cause costs per discharge were 1% lower for hysterectomy patients (P<0.05), 6% lower for carotid endarterectomy patients (P<0.0001), and 14% lower for cholecystectomy patients (P<0.0001).

Cost savings ranged from $71 to $155 per procedure.

“This study adds to the growing body of evidence that suggests the SURGICEL family of topical, absorbable hemostats has the potential to reduce burdens associated with bleeding and bleeding-related complications, which translates into cost and resource-use savings for healthcare providers,” said study investigator Jerome Riebman, MD, director of medical affairs at Ethicon.

Dr Riebman and his colleagues did note that this study was subject to limitations. For example, not all of the factors influencing the physicians’ choice of treatment were available in the dataset.

Furthermore, it’s not clear whether the hospitals studied are representative of all US hospitals. And coding errors or omitted procedure/product codes could have led to patient misclassification and potential bias in the results.

Lab mice

Credit: Aaron Logan

A compound that has demonstrated efficacy in older adults with acute myeloid leukemia (AML) may be a viable option for childhood acute lymphoblastic

leukemia (ALL) as well.

The drug, CPX-351, is a fixed-ratio combination of cytarabine and daunorubicin inside a lipid vesicle.

It previously showed promise in a phase 2 trial of AML patients ages 60 to 75 years. Now, preclinical results suggest CPX-351 can work against aggressive

pediatric ALL too.

The research appears in Pediatric Blood & Cancer. It was supported by the National Cancer Institute.

“Cytarabine and anthracyclines such as daunorubicin are commonly used to treat ALL in pediatric patients, and while these drug are very effective in front-line, multidrug, combination chemotherapy regimens, there remains room for improvement, especially in pediatric patients who relapse within 36 months of diagnosis,” said study author Richard Lock, PhD, of Children’s Cancer Institute in Sydney, Australia.

“We are very encouraged by these preclinical results, indicating that the proprietary CPX-351 formulation of cytarabine and daunorubicin may be an important tool to maximize efficacy outcomes in relapsed ALL, and we believe these data substantiate the need for additional, clinical study in pediatric patients.”

Dr Lock and his colleagues studied CPX-351 in mice inoculated with leukemia cells from 5 children who had died from ALL. Three of the children, 2 with B-precursor ALL and 1 with T-cell ALL, had relapsed disease at the time of biopsy.

The researchers inoculated up to 18 mice for each of the 5 leukemia types and then randomized the mice to treatment or control.

The maximum-tolerated dose of CPX-351 was 5 units/kg (corresponding to 5 mg/kg cytarabine and 2.2 mg/kg daunorubicin). This dose provided clinically relevant plasma drug exposure and correlated to the pharmacokinetic properties observed in patients with AML.

The researchers found that all 5 models of ALL were “highly responsive” to CPX-351. In the 4 models of B-precursor ALL, the median group response was a complete response. In the mice inoculated with T-cell ALL, the median group response was a partial response.

Among treated mice, event-free survival ranged from 32.8 days to 41.9 days. And among controls, event-free survival ranged from 2.4 days to 10.8 days.

Dr Lock and his colleagues believe these results suggest CPX-351 may be a promising treatment for ALL and support its testing in pediatric leukemia patients.

CPX-351 is currently under investigation in a phase 3 trial in older patients with high-risk (secondary) AML.

Lab mice

Credit: Aaron Logan

A compound that has demonstrated efficacy in older adults with acute myeloid leukemia (AML) may be a viable option for childhood acute lymphoblastic

leukemia (ALL) as well.

The drug, CPX-351, is a fixed-ratio combination of cytarabine and daunorubicin inside a lipid vesicle.

It previously showed promise in a phase 2 trial of AML patients ages 60 to 75 years. Now, preclinical results suggest CPX-351 can work against aggressive

pediatric ALL too.

The research appears in Pediatric Blood & Cancer. It was supported by the National Cancer Institute.

“Cytarabine and anthracyclines such as daunorubicin are commonly used to treat ALL in pediatric patients, and while these drug are very effective in front-line, multidrug, combination chemotherapy regimens, there remains room for improvement, especially in pediatric patients who relapse within 36 months of diagnosis,” said study author Richard Lock, PhD, of Children’s Cancer Institute in Sydney, Australia.

“We are very encouraged by these preclinical results, indicating that the proprietary CPX-351 formulation of cytarabine and daunorubicin may be an important tool to maximize efficacy outcomes in relapsed ALL, and we believe these data substantiate the need for additional, clinical study in pediatric patients.”

Dr Lock and his colleagues studied CPX-351 in mice inoculated with leukemia cells from 5 children who had died from ALL. Three of the children, 2 with B-precursor ALL and 1 with T-cell ALL, had relapsed disease at the time of biopsy.

The researchers inoculated up to 18 mice for each of the 5 leukemia types and then randomized the mice to treatment or control.

The maximum-tolerated dose of CPX-351 was 5 units/kg (corresponding to 5 mg/kg cytarabine and 2.2 mg/kg daunorubicin). This dose provided clinically relevant plasma drug exposure and correlated to the pharmacokinetic properties observed in patients with AML.

The researchers found that all 5 models of ALL were “highly responsive” to CPX-351. In the 4 models of B-precursor ALL, the median group response was a complete response. In the mice inoculated with T-cell ALL, the median group response was a partial response.

Among treated mice, event-free survival ranged from 32.8 days to 41.9 days. And among controls, event-free survival ranged from 2.4 days to 10.8 days.

Dr Lock and his colleagues believe these results suggest CPX-351 may be a promising treatment for ALL and support its testing in pediatric leukemia patients.

CPX-351 is currently under investigation in a phase 3 trial in older patients with high-risk (secondary) AML.

Lab mice

Credit: Aaron Logan

A compound that has demonstrated efficacy in older adults with acute myeloid leukemia (AML) may be a viable option for childhood acute lymphoblastic

leukemia (ALL) as well.

The drug, CPX-351, is a fixed-ratio combination of cytarabine and daunorubicin inside a lipid vesicle.

It previously showed promise in a phase 2 trial of AML patients ages 60 to 75 years. Now, preclinical results suggest CPX-351 can work against aggressive

pediatric ALL too.

The research appears in Pediatric Blood & Cancer. It was supported by the National Cancer Institute.

“Cytarabine and anthracyclines such as daunorubicin are commonly used to treat ALL in pediatric patients, and while these drug are very effective in front-line, multidrug, combination chemotherapy regimens, there remains room for improvement, especially in pediatric patients who relapse within 36 months of diagnosis,” said study author Richard Lock, PhD, of Children’s Cancer Institute in Sydney, Australia.

“We are very encouraged by these preclinical results, indicating that the proprietary CPX-351 formulation of cytarabine and daunorubicin may be an important tool to maximize efficacy outcomes in relapsed ALL, and we believe these data substantiate the need for additional, clinical study in pediatric patients.”

Dr Lock and his colleagues studied CPX-351 in mice inoculated with leukemia cells from 5 children who had died from ALL. Three of the children, 2 with B-precursor ALL and 1 with T-cell ALL, had relapsed disease at the time of biopsy.

The researchers inoculated up to 18 mice for each of the 5 leukemia types and then randomized the mice to treatment or control.

The maximum-tolerated dose of CPX-351 was 5 units/kg (corresponding to 5 mg/kg cytarabine and 2.2 mg/kg daunorubicin). This dose provided clinically relevant plasma drug exposure and correlated to the pharmacokinetic properties observed in patients with AML.

The researchers found that all 5 models of ALL were “highly responsive” to CPX-351. In the 4 models of B-precursor ALL, the median group response was a complete response. In the mice inoculated with T-cell ALL, the median group response was a partial response.

Among treated mice, event-free survival ranged from 32.8 days to 41.9 days. And among controls, event-free survival ranged from 2.4 days to 10.8 days.

Dr Lock and his colleagues believe these results suggest CPX-351 may be a promising treatment for ALL and support its testing in pediatric leukemia patients.

CPX-351 is currently under investigation in a phase 3 trial in older patients with high-risk (secondary) AML.

Preparing for radiation

Credit: Rhoda Baer

SAN FRANCISCO—Results of a large study suggest that consolidation radiation therapy (RT) can improve survival in patients with stage I and II Hodgkin lymphoma (HL), but the use of RT in these patients may be on the decline.

In this study of more than 40,000 patients, the 10-year survival rate was 84% among those who received RT and 76% among those who did not.

Despite this benefit, the use of RT declined during the period studied, from 56% in 1998 to 41% in 2011.

These data were presented at the American Society for Radiation Oncology’s 56th Annual Meeting (abstract 1042).

“Multiple prospective, randomized trials have shown a significant improvement in disease control with the addition of RT,” said lead study author Rahul R. Parikh, MD, of the Mount Sinai Health System in New York.

“However, previous trials were limited by low patient numbers and limited follow-up and, thus, were unable to demonstrate an overall survival benefit. This is the largest dataset in this patient population to demonstrate a survival benefit with the addition of RT.”

Dr Parikh and his colleagues studied 41,502 patients who were diagnosed with stage I and II HL from 1998 to 2011. They were included in the National Cancer Data Base, which consists of cases from 1500 sites and represents more than 75% of all cancers diagnosed in the US.

The average patient age was 37 years (range, 18 to 90). The median follow-up was 7.5 years. Ninety-six percent of patients (n=39,842) received multi-agent chemotherapy, and 49% (n=20,441) received a median RT dose of 30.6 Gy.

The 10-year overall survival of the entire group was 80.8%. Patients receiving RT had significantly better overall survival than those who did not (84.4% vs 76.4%; P<0.00001).

When adjusting for age, stage, comorbidity, transplant, chemotherapy use, and socioeconomic status, RT use was still associated with significantly improved overall survival (hazard ratio=0.51; P<0.00001).

The study also showed that omitting RT was related to higher rates of salvage transplant procedures, a surrogate for persistent/relapsed disease (P=0.04).

Nevertheless, RT use decreased at the study sites from 56% to 41% between 1998 and 2011.

In 88.4% of patients who did not receive RT, the physician-reported reason was that RT was not part of the planned initial treatment strategy.

The research also indicated that RT use was more likely among younger patients (40 years or younger), those in a higher socioeconomic status, those who had access to health insurance, and those who received treatment at comprehensive cancer centers (all P<0.0001).

“[W]e have highlighted ongoing disparities in Hodgkin’s disease treatment, and it is important that we recognize these findings as potential barriers to care,” Dr Parikh said.

“Given the survival benefit demonstrated in this study, radiotherapy should be included in the combined modality approach of multi-agent chemotherapy followed by consolidation RT in order to maintain high overall survival rates for this curable disease.”

Preparing for radiation

Credit: Rhoda Baer

SAN FRANCISCO—Results of a large study suggest that consolidation radiation therapy (RT) can improve survival in patients with stage I and II Hodgkin lymphoma (HL), but the use of RT in these patients may be on the decline.

In this study of more than 40,000 patients, the 10-year survival rate was 84% among those who received RT and 76% among those who did not.

Despite this benefit, the use of RT declined during the period studied, from 56% in 1998 to 41% in 2011.

These data were presented at the American Society for Radiation Oncology’s 56th Annual Meeting (abstract 1042).

“Multiple prospective, randomized trials have shown a significant improvement in disease control with the addition of RT,” said lead study author Rahul R. Parikh, MD, of the Mount Sinai Health System in New York.

“However, previous trials were limited by low patient numbers and limited follow-up and, thus, were unable to demonstrate an overall survival benefit. This is the largest dataset in this patient population to demonstrate a survival benefit with the addition of RT.”

Dr Parikh and his colleagues studied 41,502 patients who were diagnosed with stage I and II HL from 1998 to 2011. They were included in the National Cancer Data Base, which consists of cases from 1500 sites and represents more than 75% of all cancers diagnosed in the US.

The average patient age was 37 years (range, 18 to 90). The median follow-up was 7.5 years. Ninety-six percent of patients (n=39,842) received multi-agent chemotherapy, and 49% (n=20,441) received a median RT dose of 30.6 Gy.

The 10-year overall survival of the entire group was 80.8%. Patients receiving RT had significantly better overall survival than those who did not (84.4% vs 76.4%; P<0.00001).

When adjusting for age, stage, comorbidity, transplant, chemotherapy use, and socioeconomic status, RT use was still associated with significantly improved overall survival (hazard ratio=0.51; P<0.00001).

The study also showed that omitting RT was related to higher rates of salvage transplant procedures, a surrogate for persistent/relapsed disease (P=0.04).

Nevertheless, RT use decreased at the study sites from 56% to 41% between 1998 and 2011.

In 88.4% of patients who did not receive RT, the physician-reported reason was that RT was not part of the planned initial treatment strategy.

The research also indicated that RT use was more likely among younger patients (40 years or younger), those in a higher socioeconomic status, those who had access to health insurance, and those who received treatment at comprehensive cancer centers (all P<0.0001).

“[W]e have highlighted ongoing disparities in Hodgkin’s disease treatment, and it is important that we recognize these findings as potential barriers to care,” Dr Parikh said.

“Given the survival benefit demonstrated in this study, radiotherapy should be included in the combined modality approach of multi-agent chemotherapy followed by consolidation RT in order to maintain high overall survival rates for this curable disease.”

Preparing for radiation

Credit: Rhoda Baer

SAN FRANCISCO—Results of a large study suggest that consolidation radiation therapy (RT) can improve survival in patients with stage I and II Hodgkin lymphoma (HL), but the use of RT in these patients may be on the decline.

In this study of more than 40,000 patients, the 10-year survival rate was 84% among those who received RT and 76% among those who did not.

Despite this benefit, the use of RT declined during the period studied, from 56% in 1998 to 41% in 2011.

These data were presented at the American Society for Radiation Oncology’s 56th Annual Meeting (abstract 1042).

“Multiple prospective, randomized trials have shown a significant improvement in disease control with the addition of RT,” said lead study author Rahul R. Parikh, MD, of the Mount Sinai Health System in New York.

“However, previous trials were limited by low patient numbers and limited follow-up and, thus, were unable to demonstrate an overall survival benefit. This is the largest dataset in this patient population to demonstrate a survival benefit with the addition of RT.”

Dr Parikh and his colleagues studied 41,502 patients who were diagnosed with stage I and II HL from 1998 to 2011. They were included in the National Cancer Data Base, which consists of cases from 1500 sites and represents more than 75% of all cancers diagnosed in the US.

The average patient age was 37 years (range, 18 to 90). The median follow-up was 7.5 years. Ninety-six percent of patients (n=39,842) received multi-agent chemotherapy, and 49% (n=20,441) received a median RT dose of 30.6 Gy.

The 10-year overall survival of the entire group was 80.8%. Patients receiving RT had significantly better overall survival than those who did not (84.4% vs 76.4%; P<0.00001).

When adjusting for age, stage, comorbidity, transplant, chemotherapy use, and socioeconomic status, RT use was still associated with significantly improved overall survival (hazard ratio=0.51; P<0.00001).

The study also showed that omitting RT was related to higher rates of salvage transplant procedures, a surrogate for persistent/relapsed disease (P=0.04).

Nevertheless, RT use decreased at the study sites from 56% to 41% between 1998 and 2011.

In 88.4% of patients who did not receive RT, the physician-reported reason was that RT was not part of the planned initial treatment strategy.

The research also indicated that RT use was more likely among younger patients (40 years or younger), those in a higher socioeconomic status, those who had access to health insurance, and those who received treatment at comprehensive cancer centers (all P<0.0001).

“[W]e have highlighted ongoing disparities in Hodgkin’s disease treatment, and it is important that we recognize these findings as potential barriers to care,” Dr Parikh said.

“Given the survival benefit demonstrated in this study, radiotherapy should be included in the combined modality approach of multi-agent chemotherapy followed by consolidation RT in order to maintain high overall survival rates for this curable disease.”

Blood samples

Credit: Graham Colm

Individuals with type AB blood may be more likely than those with other blood types to develop memory loss in later years, according to a study published in Neurology.

Investigators found that people with AB blood were 82% more likely to develop cognitive impairment, which can lead to dementia.

Previous studies have shown that individuals with type O blood have a lower risk of heart disease and stroke, factors that can increase the risk of memory loss and dementia.

The new research was part of a larger study—the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study—of more than 30,000 subjects who were followed for an average of 3.4 years.

“Our study looks at blood type and risk of cognitive impairment, but several studies have shown that factors such as high blood pressure, high cholesterol, and diabetes increase the risk of cognitive impairment and dementia,” said Mary Cushman, MD, of the University of Vermont College of Medicine in Burlington.

“Blood type is also related to other vascular conditions like stroke, so the findings highlight the connections between vascular issues and brain health. More research is needed to confirm these results.”

Dr Cushman and her colleagues had set out to assess the relationship between ABO group, factor VIII (FVIII), and incident cognitive impairment in a large, prospective cohort of black and white adults in the US.

The team used cognitive domain tests to assess cognitive impairment. They identified 495 subjects who had no cognitive impairment at baseline but became impaired during follow-up. The investigators then compared these cases with 587 control subjects.

It turned out that subjects with AB blood made up 6% of the group that developed cognitive impairment, which is higher than the 4% of AB individuals found in the general population.

Multivariate analysis—adjusted for age, race, region, and sex—suggested that subjects with AB blood and those with higher FVIII had an increased risk of cognitive impairment. The odds ratios were 1.82 and 1.24, respectively.

Subjects with AB blood had a higher average level of FVIII than subjects with other blood types. The mean level of FVIII was 142 IU/dL among AB subjects and 104 IU/dL among subjects with type O blood.

However, the investigators also found that FVIII mediated only 18% of the association between AB blood type and cognitive impairment.

Blood samples

Credit: Graham Colm

Individuals with type AB blood may be more likely than those with other blood types to develop memory loss in later years, according to a study published in Neurology.

Investigators found that people with AB blood were 82% more likely to develop cognitive impairment, which can lead to dementia.

Previous studies have shown that individuals with type O blood have a lower risk of heart disease and stroke, factors that can increase the risk of memory loss and dementia.

The new research was part of a larger study—the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study—of more than 30,000 subjects who were followed for an average of 3.4 years.

“Our study looks at blood type and risk of cognitive impairment, but several studies have shown that factors such as high blood pressure, high cholesterol, and diabetes increase the risk of cognitive impairment and dementia,” said Mary Cushman, MD, of the University of Vermont College of Medicine in Burlington.

“Blood type is also related to other vascular conditions like stroke, so the findings highlight the connections between vascular issues and brain health. More research is needed to confirm these results.”

Dr Cushman and her colleagues had set out to assess the relationship between ABO group, factor VIII (FVIII), and incident cognitive impairment in a large, prospective cohort of black and white adults in the US.

The team used cognitive domain tests to assess cognitive impairment. They identified 495 subjects who had no cognitive impairment at baseline but became impaired during follow-up. The investigators then compared these cases with 587 control subjects.

It turned out that subjects with AB blood made up 6% of the group that developed cognitive impairment, which is higher than the 4% of AB individuals found in the general population.

Multivariate analysis—adjusted for age, race, region, and sex—suggested that subjects with AB blood and those with higher FVIII had an increased risk of cognitive impairment. The odds ratios were 1.82 and 1.24, respectively.

Subjects with AB blood had a higher average level of FVIII than subjects with other blood types. The mean level of FVIII was 142 IU/dL among AB subjects and 104 IU/dL among subjects with type O blood.

However, the investigators also found that FVIII mediated only 18% of the association between AB blood type and cognitive impairment.

Blood samples

Credit: Graham Colm

Individuals with type AB blood may be more likely than those with other blood types to develop memory loss in later years, according to a study published in Neurology.

Investigators found that people with AB blood were 82% more likely to develop cognitive impairment, which can lead to dementia.

Previous studies have shown that individuals with type O blood have a lower risk of heart disease and stroke, factors that can increase the risk of memory loss and dementia.

The new research was part of a larger study—the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study—of more than 30,000 subjects who were followed for an average of 3.4 years.

“Our study looks at blood type and risk of cognitive impairment, but several studies have shown that factors such as high blood pressure, high cholesterol, and diabetes increase the risk of cognitive impairment and dementia,” said Mary Cushman, MD, of the University of Vermont College of Medicine in Burlington.

“Blood type is also related to other vascular conditions like stroke, so the findings highlight the connections between vascular issues and brain health. More research is needed to confirm these results.”

Dr Cushman and her colleagues had set out to assess the relationship between ABO group, factor VIII (FVIII), and incident cognitive impairment in a large, prospective cohort of black and white adults in the US.

The team used cognitive domain tests to assess cognitive impairment. They identified 495 subjects who had no cognitive impairment at baseline but became impaired during follow-up. The investigators then compared these cases with 587 control subjects.

It turned out that subjects with AB blood made up 6% of the group that developed cognitive impairment, which is higher than the 4% of AB individuals found in the general population.

Multivariate analysis—adjusted for age, race, region, and sex—suggested that subjects with AB blood and those with higher FVIII had an increased risk of cognitive impairment. The odds ratios were 1.82 and 1.24, respectively.

Subjects with AB blood had a higher average level of FVIII than subjects with other blood types. The mean level of FVIII was 142 IU/dL among AB subjects and 104 IU/dL among subjects with type O blood.

However, the investigators also found that FVIII mediated only 18% of the association between AB blood type and cognitive impairment.

Biospleen device

Credit: Wyss Institute

A device inspired by the human spleen could change the way we treat sepsis, researchers say.

This “biospleen” was able to cleanse human blood in lab tests and increase survival in animals with infected blood.

Experiments showed that, in a matter of hours, the biospleen can filter live and dead pathogens from the blood, as well as dangerous toxins released from the pathogens.

The researchers detailed these experiments in Nature Medicine.

“Sepsis is a major medical threat, which is increasing because of antibiotic resistance,” said study author Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering in Boston, Massachusetts.

“We’re excited by the biospleen because it potentially provides a way to treat patients quickly without having to wait days to identify the source of infection, and it works equally well with antibiotic-resistant organisms. We hope to move this toward human testing [by] advancing to large animal studies as quickly as possible.”

The biospleen is a microfluidic device that works outside the body like a dialysis machine and removes living and dead microbes of all varieties, as well as toxins.

It consists of 2 adjacent, hollow channels that are connected to each other by a series of slits. One channel contains flowing blood, and the other has a saline solution that collects and removes the pathogens that travel through the slits.

Key to the success of the device are nanometer-sized magnetic beads coated with a genetically engineered version of the protein mannose binding lectin (MBL).

In its innate state, MBL has a branch-like “head” and a stick-like “tail.” The head binds to specific sugars on the surfaces of all sorts of bacteria, fungi, viruses, protozoa, and toxins, and the tail cues the immune system to destroy them.

However, other immune system proteins sometimes bind to the MBL tail and activate clotting and organ damage. So Dr Ingber and his colleagues used genetic engineering tools to lop off the tail and graft on a similar one from an antibody protein that does not cause these problems.

The team then attached the hybrid proteins to magnetic beads measuring 128 nanometers in diameter. These novel beads could be added to infected blood to bind to the pathogens and toxins without having to first identify the type of infectious agent.

The biospleen has a magnet that pulls the pathogen-coated magnetic beads through the channels to cleanse the blood flowing through the device, which can then be returned to the patient.

The researchers first tested the biospleen using human blood spiked with pathogens. They were able to filter blood faster than ever before, and the magnets efficiently pulled the beads—coated with pathogens—out of the blood.

More than 90% of key sepsis pathogens were bound and removed when the blood flowed through a single device at a rate of about 0.5 L to 1 L per hour. Many devices can be linked together to obtain levels required for human blood cleansing at dialysis-like rates.

Next, the researchers tested the device using rats infected with E coli, S aureus, and toxins—mimicking many of the bloodstream infections human sepsis patients experience. After 5 hours of filtering, about 90% of the bacteria and toxins were removed from the rats’ bloodstreams.

“We didn’t have to kill the pathogens,” said Michael Super, PhD, also of the Wyss Institute. “We just captured and removed them.”

What’s more, 90% of the treated animals survived, compared to 14% of the controls. And the modified MBL prevented the activation of complement factors and coagulation.

Biospleen device

Credit: Wyss Institute

A device inspired by the human spleen could change the way we treat sepsis, researchers say.

This “biospleen” was able to cleanse human blood in lab tests and increase survival in animals with infected blood.

Experiments showed that, in a matter of hours, the biospleen can filter live and dead pathogens from the blood, as well as dangerous toxins released from the pathogens.

The researchers detailed these experiments in Nature Medicine.

“Sepsis is a major medical threat, which is increasing because of antibiotic resistance,” said study author Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering in Boston, Massachusetts.

“We’re excited by the biospleen because it potentially provides a way to treat patients quickly without having to wait days to identify the source of infection, and it works equally well with antibiotic-resistant organisms. We hope to move this toward human testing [by] advancing to large animal studies as quickly as possible.”

The biospleen is a microfluidic device that works outside the body like a dialysis machine and removes living and dead microbes of all varieties, as well as toxins.

It consists of 2 adjacent, hollow channels that are connected to each other by a series of slits. One channel contains flowing blood, and the other has a saline solution that collects and removes the pathogens that travel through the slits.

Key to the success of the device are nanometer-sized magnetic beads coated with a genetically engineered version of the protein mannose binding lectin (MBL).

In its innate state, MBL has a branch-like “head” and a stick-like “tail.” The head binds to specific sugars on the surfaces of all sorts of bacteria, fungi, viruses, protozoa, and toxins, and the tail cues the immune system to destroy them.

However, other immune system proteins sometimes bind to the MBL tail and activate clotting and organ damage. So Dr Ingber and his colleagues used genetic engineering tools to lop off the tail and graft on a similar one from an antibody protein that does not cause these problems.

The team then attached the hybrid proteins to magnetic beads measuring 128 nanometers in diameter. These novel beads could be added to infected blood to bind to the pathogens and toxins without having to first identify the type of infectious agent.

The biospleen has a magnet that pulls the pathogen-coated magnetic beads through the channels to cleanse the blood flowing through the device, which can then be returned to the patient.

The researchers first tested the biospleen using human blood spiked with pathogens. They were able to filter blood faster than ever before, and the magnets efficiently pulled the beads—coated with pathogens—out of the blood.

More than 90% of key sepsis pathogens were bound and removed when the blood flowed through a single device at a rate of about 0.5 L to 1 L per hour. Many devices can be linked together to obtain levels required for human blood cleansing at dialysis-like rates.

Next, the researchers tested the device using rats infected with E coli, S aureus, and toxins—mimicking many of the bloodstream infections human sepsis patients experience. After 5 hours of filtering, about 90% of the bacteria and toxins were removed from the rats’ bloodstreams.

“We didn’t have to kill the pathogens,” said Michael Super, PhD, also of the Wyss Institute. “We just captured and removed them.”

What’s more, 90% of the treated animals survived, compared to 14% of the controls. And the modified MBL prevented the activation of complement factors and coagulation.

Biospleen device

Credit: Wyss Institute

A device inspired by the human spleen could change the way we treat sepsis, researchers say.

This “biospleen” was able to cleanse human blood in lab tests and increase survival in animals with infected blood.

Experiments showed that, in a matter of hours, the biospleen can filter live and dead pathogens from the blood, as well as dangerous toxins released from the pathogens.

The researchers detailed these experiments in Nature Medicine.

“Sepsis is a major medical threat, which is increasing because of antibiotic resistance,” said study author Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering in Boston, Massachusetts.

“We’re excited by the biospleen because it potentially provides a way to treat patients quickly without having to wait days to identify the source of infection, and it works equally well with antibiotic-resistant organisms. We hope to move this toward human testing [by] advancing to large animal studies as quickly as possible.”

The biospleen is a microfluidic device that works outside the body like a dialysis machine and removes living and dead microbes of all varieties, as well as toxins.

It consists of 2 adjacent, hollow channels that are connected to each other by a series of slits. One channel contains flowing blood, and the other has a saline solution that collects and removes the pathogens that travel through the slits.

Key to the success of the device are nanometer-sized magnetic beads coated with a genetically engineered version of the protein mannose binding lectin (MBL).

In its innate state, MBL has a branch-like “head” and a stick-like “tail.” The head binds to specific sugars on the surfaces of all sorts of bacteria, fungi, viruses, protozoa, and toxins, and the tail cues the immune system to destroy them.

However, other immune system proteins sometimes bind to the MBL tail and activate clotting and organ damage. So Dr Ingber and his colleagues used genetic engineering tools to lop off the tail and graft on a similar one from an antibody protein that does not cause these problems.

The team then attached the hybrid proteins to magnetic beads measuring 128 nanometers in diameter. These novel beads could be added to infected blood to bind to the pathogens and toxins without having to first identify the type of infectious agent.

The biospleen has a magnet that pulls the pathogen-coated magnetic beads through the channels to cleanse the blood flowing through the device, which can then be returned to the patient.

The researchers first tested the biospleen using human blood spiked with pathogens. They were able to filter blood faster than ever before, and the magnets efficiently pulled the beads—coated with pathogens—out of the blood.

More than 90% of key sepsis pathogens were bound and removed when the blood flowed through a single device at a rate of about 0.5 L to 1 L per hour. Many devices can be linked together to obtain levels required for human blood cleansing at dialysis-like rates.

Next, the researchers tested the device using rats infected with E coli, S aureus, and toxins—mimicking many of the bloodstream infections human sepsis patients experience. After 5 hours of filtering, about 90% of the bacteria and toxins were removed from the rats’ bloodstreams.

“We didn’t have to kill the pathogens,” said Michael Super, PhD, also of the Wyss Institute. “We just captured and removed them.”

What’s more, 90% of the treated animals survived, compared to 14% of the controls. And the modified MBL prevented the activation of complement factors and coagulation.