Bruce Jancin

AMSTERDAM – Does pushing for a PASI 90 response instead of settling for a PASI 75 matter to patients being treated for moderate-to-severe chronic plaque psoriasis?

You bet it does, Dr. Mark G. Lebwohl asserted at the annual congress of the European Academy of Dermatology and Venereology.

He presented a pooled analysis of data from two large pivotal phase III randomized trials of secukinumab for psoriasis. The primary endpoints in the analysis were how often and how soon patients who achieved a PASI 75 or PASI 90 response at 12 weeks reported obtaining a Dermatology Life Quality Index (DLQI) response, defined as a score of 0 or 1.

The answer: More patients who had a PASI 90 response (meaning almost clear at 12 weeks) had a DLQI response, and it occurred a full 4 weeks faster than in PASI 75 responders – at a median of 8 weeks, compared with 12 weeks, reported Dr. Lebwohl, professor and chairman of the department of dermatology at Mt. Sinai Medical Center in New York.

Scores on the DLQI can range from 0, meaning no psoriasis-related impairment of the patient’s quality of life, up to 30. The average baseline score in this study population was 13.5, so a DLQI response dropping the score down to 0 or 1 represents a dramatic improvement in this patient-reported outcome.

Study participants completed the DLQI questionnaire at weeks 4, 8, 12, 24, 36, and again at week 52. The subjects’ mean baseline PASI score was 23.2.

The two double-blind, randomized, placebo-controlled clinical trials that formed the basis for this analysis were the recently published 52-week ERASURE (Efficacy of Response and Safety of Two Fixed Secukinumab Regimens in Psoriasis) and FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis) studies (N. Engl. J. Med. 2014;371:326-38), in which patients were assigned to secukinumab at a dose of either 150 mg or 300 mg, placebo, or in the case of FIXTURE, to etanercept. The PASI 75 and 90 response rates at 12 weeks were markedly higher at both doses of secukinumab than with etanercept.

Dr. Lebwohl’s pooled analysis was restricted to the 1,470 study participants in the two studies who were randomized to active therapy. A total of 612 patients achieved a PASI 90 response by week 12. Another 365 had a PASI 75 response. Fully 89% of PASI 90 responders also had a DLQI response maintained out to week 52, as did 77% of PASI 75 responders.

The key finding: The median time to a DLQI response in the PASI 90 responders was 8 weeks, compared with 12 weeks in the PASI 75 responders. Thus, patients with a PASI 90 response obtained virtually total relief from what had previously been a debilitating disease a full month sooner than PASI 75 responders. And that, as reported by the patients themselves, constitutes a meaningful advantage, Dr. Lebwohl stated.

Secukinumab is a fully human monoclonal antibody directed against a novel target: interleukin-17A. Novartis has filed for marketing approval of the biologic agent with an indication for psoriasis both with the Food and Drug Administration and European regulators. Secukinumab is also being developed as a treatment for psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis.

Novartis funded the analysis. Dr. Lebwohl reported serving as a consultant to Novartis and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom.com

AMSTERDAM – Does pushing for a PASI 90 response instead of settling for a PASI 75 matter to patients being treated for moderate-to-severe chronic plaque psoriasis?

You bet it does, Dr. Mark G. Lebwohl asserted at the annual congress of the European Academy of Dermatology and Venereology.

He presented a pooled analysis of data from two large pivotal phase III randomized trials of secukinumab for psoriasis. The primary endpoints in the analysis were how often and how soon patients who achieved a PASI 75 or PASI 90 response at 12 weeks reported obtaining a Dermatology Life Quality Index (DLQI) response, defined as a score of 0 or 1.

The answer: More patients who had a PASI 90 response (meaning almost clear at 12 weeks) had a DLQI response, and it occurred a full 4 weeks faster than in PASI 75 responders – at a median of 8 weeks, compared with 12 weeks, reported Dr. Lebwohl, professor and chairman of the department of dermatology at Mt. Sinai Medical Center in New York.

Scores on the DLQI can range from 0, meaning no psoriasis-related impairment of the patient’s quality of life, up to 30. The average baseline score in this study population was 13.5, so a DLQI response dropping the score down to 0 or 1 represents a dramatic improvement in this patient-reported outcome.

Study participants completed the DLQI questionnaire at weeks 4, 8, 12, 24, 36, and again at week 52. The subjects’ mean baseline PASI score was 23.2.

The two double-blind, randomized, placebo-controlled clinical trials that formed the basis for this analysis were the recently published 52-week ERASURE (Efficacy of Response and Safety of Two Fixed Secukinumab Regimens in Psoriasis) and FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis) studies (N. Engl. J. Med. 2014;371:326-38), in which patients were assigned to secukinumab at a dose of either 150 mg or 300 mg, placebo, or in the case of FIXTURE, to etanercept. The PASI 75 and 90 response rates at 12 weeks were markedly higher at both doses of secukinumab than with etanercept.

Dr. Lebwohl’s pooled analysis was restricted to the 1,470 study participants in the two studies who were randomized to active therapy. A total of 612 patients achieved a PASI 90 response by week 12. Another 365 had a PASI 75 response. Fully 89% of PASI 90 responders also had a DLQI response maintained out to week 52, as did 77% of PASI 75 responders.

The key finding: The median time to a DLQI response in the PASI 90 responders was 8 weeks, compared with 12 weeks in the PASI 75 responders. Thus, patients with a PASI 90 response obtained virtually total relief from what had previously been a debilitating disease a full month sooner than PASI 75 responders. And that, as reported by the patients themselves, constitutes a meaningful advantage, Dr. Lebwohl stated.

Secukinumab is a fully human monoclonal antibody directed against a novel target: interleukin-17A. Novartis has filed for marketing approval of the biologic agent with an indication for psoriasis both with the Food and Drug Administration and European regulators. Secukinumab is also being developed as a treatment for psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis.

Novartis funded the analysis. Dr. Lebwohl reported serving as a consultant to Novartis and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom.com

AMSTERDAM – Does pushing for a PASI 90 response instead of settling for a PASI 75 matter to patients being treated for moderate-to-severe chronic plaque psoriasis?

You bet it does, Dr. Mark G. Lebwohl asserted at the annual congress of the European Academy of Dermatology and Venereology.

He presented a pooled analysis of data from two large pivotal phase III randomized trials of secukinumab for psoriasis. The primary endpoints in the analysis were how often and how soon patients who achieved a PASI 75 or PASI 90 response at 12 weeks reported obtaining a Dermatology Life Quality Index (DLQI) response, defined as a score of 0 or 1.

The answer: More patients who had a PASI 90 response (meaning almost clear at 12 weeks) had a DLQI response, and it occurred a full 4 weeks faster than in PASI 75 responders – at a median of 8 weeks, compared with 12 weeks, reported Dr. Lebwohl, professor and chairman of the department of dermatology at Mt. Sinai Medical Center in New York.

Scores on the DLQI can range from 0, meaning no psoriasis-related impairment of the patient’s quality of life, up to 30. The average baseline score in this study population was 13.5, so a DLQI response dropping the score down to 0 or 1 represents a dramatic improvement in this patient-reported outcome.

Study participants completed the DLQI questionnaire at weeks 4, 8, 12, 24, 36, and again at week 52. The subjects’ mean baseline PASI score was 23.2.

The two double-blind, randomized, placebo-controlled clinical trials that formed the basis for this analysis were the recently published 52-week ERASURE (Efficacy of Response and Safety of Two Fixed Secukinumab Regimens in Psoriasis) and FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis) studies (N. Engl. J. Med. 2014;371:326-38), in which patients were assigned to secukinumab at a dose of either 150 mg or 300 mg, placebo, or in the case of FIXTURE, to etanercept. The PASI 75 and 90 response rates at 12 weeks were markedly higher at both doses of secukinumab than with etanercept.

Dr. Lebwohl’s pooled analysis was restricted to the 1,470 study participants in the two studies who were randomized to active therapy. A total of 612 patients achieved a PASI 90 response by week 12. Another 365 had a PASI 75 response. Fully 89% of PASI 90 responders also had a DLQI response maintained out to week 52, as did 77% of PASI 75 responders.

The key finding: The median time to a DLQI response in the PASI 90 responders was 8 weeks, compared with 12 weeks in the PASI 75 responders. Thus, patients with a PASI 90 response obtained virtually total relief from what had previously been a debilitating disease a full month sooner than PASI 75 responders. And that, as reported by the patients themselves, constitutes a meaningful advantage, Dr. Lebwohl stated.

Secukinumab is a fully human monoclonal antibody directed against a novel target: interleukin-17A. Novartis has filed for marketing approval of the biologic agent with an indication for psoriasis both with the Food and Drug Administration and European regulators. Secukinumab is also being developed as a treatment for psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis.

Novartis funded the analysis. Dr. Lebwohl reported serving as a consultant to Novartis and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom.com

AMSTERDAM – Living in a locale with hard water – defined as a calcium carbonate concentration of 258 mg/L or more in the domestic water supply – was associated with significantly increased risk of eczema at 3 months of age in a large study conducted across England and Wales.

The study findings have potentially far-reaching implications for the prevention of childhood eczema, as well as halting what is often called the “atopic march” from eczema to food allergies to asthma. A national follow-up study is now being prepared in which families will be given an effective water softener machine when a child is born, with randomization to the machine being switched on or off.

“We want to see whether we might be able to prevent eczema by removing calcium carbonate from domestic water,” Dr. Carsten Flohr explained at a meeting of the European Task Force on Atopic Dermatitis held in conjunction with the annual congress of the European Academy of Dermatology and Venereology.

He reported on 1,303 infants who at 3 months of age underwent a structured skin examination with SCORAD (SCORing Atopic Dermatitis) measurement. Twenty-four percent were diagnosed as having eczema, which was typically mild.

Calcium carbonate concentrations in the local water supply vary enormously across England and Wales because rich limestone beds are found in some areas, notably the south and east, Dr. Flohr noted.

Babies living in areas with a calcium carbonate water concentration above the median level had a 45% increase in eczema risk. This risk was mediated by filaggrin loss-of-function (FLG) mutations. All study participants underwent testing for the six most common such mutations. In children without an FLG mutation, water hardness made little difference in eczema risk.

But FLG carriers living in the third quartile for water hardness – defined as a calcium carbonate concentration of 258-285 mg/L – had a 4.9-fold greater risk of eczema than did the general study population. Those in the highest quartile were at 2.67-fold increased risk, which just missed achieving statistical significance.

Looking at calcium carbonate concentration as a continuous variable, FLG carriers had an impressive 1% increase in the risk of eczema for each 1 mg/L rise in domestic water hardness, added Dr. Flohr, a pediatric dermatologist at St. Thomas’ Hospital, London.

The investigators also measured transepidermal water loss (TEWL) as an indicator of skin barrier function. FLG carriers without eczema living in hard-water areas had a high rate of excessive TEWL, defined as at least 15 g/m² per hour. Those in the third quartile for calcium carbonate were at a 4.63-fold greater risk of abnormal TEWL, compared with FLG carriers living in areas in the two lowest quartiles of water hardness. The risk of excessive TEWL among FLG carriers without eczema rose by 1% for every 1 mg/L increase in calcium carbonate concentration.

“This suggests that the interaction between filaggrin mutation, water hardness, and eczema is related to a direct skin barrier effect,” Dr. Flohr said.

©jarih/thinkstockphotos.com

He and his coinvestigators have found supporting evidence in an adult population for their findings of a link between water hardness and infant eczema and TEWL. In a large national United Kingdom cohort of individuals born in 1958, who are part of an ongoing epidemiologic study, data show that those living in areas of high water hardness have increased rates of atopic disease.

As to the possible mechanism involved, Dr. Flohr said it’s known that as calcium carbonate concentration increases, it alters the skin surface pH. This could potentially have a detrimental effect on skin barrier function, although such an effect remains speculative. The attenuated risks of eczema and TEWL seen in FLG-carrying infants in the fourth water hardness quartile as compared to the third water hardness quartile warrants further study, but it might be the result of a calcium-scavenging effect, perhaps because of magnesium in the water, he added.

“I really think that the skin pH is involved in this,” Dr. Flohr emphasized.

Session cochair Dr. Ulf Darsow of Technical University, Munich, noted that Dr. Flohr’s countrymen at the University of Nottingham, England, have already performed an interventional study involving the use of water-softening devices. In the Softened Water Eczema Trial (SWET), the Nottingham group found no beneficial effect on pediatric eczema (PLoS Med. 2011; doi: 10.1371/journal.pmed.1000395).

“That is true, but it was a 12-week trial in children with established moderate to severe eczema,” Dr. Flohr replied. “What I’m suggesting is that potentially calcium carbonate concentration could be involved in the initiation of the skin inflammation, even if fitting a water softener once you’ve got established skin inflammation doesn’t seem to make much of a difference.”

“So this interesting story continues,” Dr. Darsow observed.

Dr. Flohr’s study was funded by the UK National Institute for Health Research. He reported having no financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – Living in a locale with hard water – defined as a calcium carbonate concentration of 258 mg/L or more in the domestic water supply – was associated with significantly increased risk of eczema at 3 months of age in a large study conducted across England and Wales.

The study findings have potentially far-reaching implications for the prevention of childhood eczema, as well as halting what is often called the “atopic march” from eczema to food allergies to asthma. A national follow-up study is now being prepared in which families will be given an effective water softener machine when a child is born, with randomization to the machine being switched on or off.

“We want to see whether we might be able to prevent eczema by removing calcium carbonate from domestic water,” Dr. Carsten Flohr explained at a meeting of the European Task Force on Atopic Dermatitis held in conjunction with the annual congress of the European Academy of Dermatology and Venereology.

He reported on 1,303 infants who at 3 months of age underwent a structured skin examination with SCORAD (SCORing Atopic Dermatitis) measurement. Twenty-four percent were diagnosed as having eczema, which was typically mild.

Calcium carbonate concentrations in the local water supply vary enormously across England and Wales because rich limestone beds are found in some areas, notably the south and east, Dr. Flohr noted.

Babies living in areas with a calcium carbonate water concentration above the median level had a 45% increase in eczema risk. This risk was mediated by filaggrin loss-of-function (FLG) mutations. All study participants underwent testing for the six most common such mutations. In children without an FLG mutation, water hardness made little difference in eczema risk.

But FLG carriers living in the third quartile for water hardness – defined as a calcium carbonate concentration of 258-285 mg/L – had a 4.9-fold greater risk of eczema than did the general study population. Those in the highest quartile were at 2.67-fold increased risk, which just missed achieving statistical significance.

Looking at calcium carbonate concentration as a continuous variable, FLG carriers had an impressive 1% increase in the risk of eczema for each 1 mg/L rise in domestic water hardness, added Dr. Flohr, a pediatric dermatologist at St. Thomas’ Hospital, London.

The investigators also measured transepidermal water loss (TEWL) as an indicator of skin barrier function. FLG carriers without eczema living in hard-water areas had a high rate of excessive TEWL, defined as at least 15 g/m² per hour. Those in the third quartile for calcium carbonate were at a 4.63-fold greater risk of abnormal TEWL, compared with FLG carriers living in areas in the two lowest quartiles of water hardness. The risk of excessive TEWL among FLG carriers without eczema rose by 1% for every 1 mg/L increase in calcium carbonate concentration.

“This suggests that the interaction between filaggrin mutation, water hardness, and eczema is related to a direct skin barrier effect,” Dr. Flohr said.

©jarih/thinkstockphotos.com

He and his coinvestigators have found supporting evidence in an adult population for their findings of a link between water hardness and infant eczema and TEWL. In a large national United Kingdom cohort of individuals born in 1958, who are part of an ongoing epidemiologic study, data show that those living in areas of high water hardness have increased rates of atopic disease.

As to the possible mechanism involved, Dr. Flohr said it’s known that as calcium carbonate concentration increases, it alters the skin surface pH. This could potentially have a detrimental effect on skin barrier function, although such an effect remains speculative. The attenuated risks of eczema and TEWL seen in FLG-carrying infants in the fourth water hardness quartile as compared to the third water hardness quartile warrants further study, but it might be the result of a calcium-scavenging effect, perhaps because of magnesium in the water, he added.

“I really think that the skin pH is involved in this,” Dr. Flohr emphasized.

Session cochair Dr. Ulf Darsow of Technical University, Munich, noted that Dr. Flohr’s countrymen at the University of Nottingham, England, have already performed an interventional study involving the use of water-softening devices. In the Softened Water Eczema Trial (SWET), the Nottingham group found no beneficial effect on pediatric eczema (PLoS Med. 2011; doi: 10.1371/journal.pmed.1000395).

“That is true, but it was a 12-week trial in children with established moderate to severe eczema,” Dr. Flohr replied. “What I’m suggesting is that potentially calcium carbonate concentration could be involved in the initiation of the skin inflammation, even if fitting a water softener once you’ve got established skin inflammation doesn’t seem to make much of a difference.”

“So this interesting story continues,” Dr. Darsow observed.

Dr. Flohr’s study was funded by the UK National Institute for Health Research. He reported having no financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – Living in a locale with hard water – defined as a calcium carbonate concentration of 258 mg/L or more in the domestic water supply – was associated with significantly increased risk of eczema at 3 months of age in a large study conducted across England and Wales.

The study findings have potentially far-reaching implications for the prevention of childhood eczema, as well as halting what is often called the “atopic march” from eczema to food allergies to asthma. A national follow-up study is now being prepared in which families will be given an effective water softener machine when a child is born, with randomization to the machine being switched on or off.

“We want to see whether we might be able to prevent eczema by removing calcium carbonate from domestic water,” Dr. Carsten Flohr explained at a meeting of the European Task Force on Atopic Dermatitis held in conjunction with the annual congress of the European Academy of Dermatology and Venereology.

He reported on 1,303 infants who at 3 months of age underwent a structured skin examination with SCORAD (SCORing Atopic Dermatitis) measurement. Twenty-four percent were diagnosed as having eczema, which was typically mild.

Calcium carbonate concentrations in the local water supply vary enormously across England and Wales because rich limestone beds are found in some areas, notably the south and east, Dr. Flohr noted.

Babies living in areas with a calcium carbonate water concentration above the median level had a 45% increase in eczema risk. This risk was mediated by filaggrin loss-of-function (FLG) mutations. All study participants underwent testing for the six most common such mutations. In children without an FLG mutation, water hardness made little difference in eczema risk.

But FLG carriers living in the third quartile for water hardness – defined as a calcium carbonate concentration of 258-285 mg/L – had a 4.9-fold greater risk of eczema than did the general study population. Those in the highest quartile were at 2.67-fold increased risk, which just missed achieving statistical significance.

Looking at calcium carbonate concentration as a continuous variable, FLG carriers had an impressive 1% increase in the risk of eczema for each 1 mg/L rise in domestic water hardness, added Dr. Flohr, a pediatric dermatologist at St. Thomas’ Hospital, London.

The investigators also measured transepidermal water loss (TEWL) as an indicator of skin barrier function. FLG carriers without eczema living in hard-water areas had a high rate of excessive TEWL, defined as at least 15 g/m² per hour. Those in the third quartile for calcium carbonate were at a 4.63-fold greater risk of abnormal TEWL, compared with FLG carriers living in areas in the two lowest quartiles of water hardness. The risk of excessive TEWL among FLG carriers without eczema rose by 1% for every 1 mg/L increase in calcium carbonate concentration.

“This suggests that the interaction between filaggrin mutation, water hardness, and eczema is related to a direct skin barrier effect,” Dr. Flohr said.

©jarih/thinkstockphotos.com

He and his coinvestigators have found supporting evidence in an adult population for their findings of a link between water hardness and infant eczema and TEWL. In a large national United Kingdom cohort of individuals born in 1958, who are part of an ongoing epidemiologic study, data show that those living in areas of high water hardness have increased rates of atopic disease.

As to the possible mechanism involved, Dr. Flohr said it’s known that as calcium carbonate concentration increases, it alters the skin surface pH. This could potentially have a detrimental effect on skin barrier function, although such an effect remains speculative. The attenuated risks of eczema and TEWL seen in FLG-carrying infants in the fourth water hardness quartile as compared to the third water hardness quartile warrants further study, but it might be the result of a calcium-scavenging effect, perhaps because of magnesium in the water, he added.

“I really think that the skin pH is involved in this,” Dr. Flohr emphasized.

Session cochair Dr. Ulf Darsow of Technical University, Munich, noted that Dr. Flohr’s countrymen at the University of Nottingham, England, have already performed an interventional study involving the use of water-softening devices. In the Softened Water Eczema Trial (SWET), the Nottingham group found no beneficial effect on pediatric eczema (PLoS Med. 2011; doi: 10.1371/journal.pmed.1000395).

“That is true, but it was a 12-week trial in children with established moderate to severe eczema,” Dr. Flohr replied. “What I’m suggesting is that potentially calcium carbonate concentration could be involved in the initiation of the skin inflammation, even if fitting a water softener once you’ve got established skin inflammation doesn’t seem to make much of a difference.”

“So this interesting story continues,” Dr. Darsow observed.

Dr. Flohr’s study was funded by the UK National Institute for Health Research. He reported having no financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – Rosacea is associated with increased risk of a range of chronic systemic diseases, including allergies and urogential disorders, a case-control study showed.

The common denominator among this linked diverse collection of diseases is probably underlying systemic inflammation, Dr. Barbara M. Rainer explained at the annual congress of the European Academy of Dermatology and Venereology. But regardless of the pathophysiologic mechanisms at work, the important thing is that physicians be on the lookout for these comorbid conditions in their patients with rosacea.

Dr. Rainer of Johns Hopkins University in Baltimore presented a case-control study involving 130 subjects: 65 rosacea patients and an equal number of controls matched for age, sex, and race.

The most common comorbidity was food allergies (odds ratio, 10), followed by urogenital disorders (OR, 7.5).

The rosacea patients averaged 50 years of age and had a mean 11.8-year history of their skin disease. Body mass index, smoking status, alcohol intake, and coffee consumption were similar in cases and controls. Two-thirds of subjects were women. Relative risks for comorbid conditions were calculated using logistic regression analysis.

Dr. Rainer reported no relevant financial conflicts.

bjancin@frontlinemedcom.com

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

bjancin@frontlinemedcom.com

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

bjancin@frontlinemedcom.com

LAS VEGAS – Laparoscopic splenectomy has become the preferred surgical approach in the literature, but the number of such procedures performed in the United States remains relatively low, according to Dr. John Afthinos.

National data for 2005-2010 showed a total of 37,006 elective total splenectomies were performed. Only 4,938 of them, or 13.3%, began as laparoscopic procedures, of which 40% had to be converted to open splenectomies, he reported at the annual Minimally Invasive Surgery Week.

“Laparoscopic splenectomy remains underutilized,” Dr. Afthinos commented. “This is one of the lowest recorded rates of laparoscopic completion of any advanced procedure that we know of.”

For example, other investigators have demonstrated that laparoscopic colectomies and bariatric surgical procedures are typically completed laparoscopically in 85%-95% of cases, noted Dr. Afthinos of Staten Island (N.Y.) University Hospital.

The laparoscopic approach has convincingly been shown to result in less pain, shorter hospital length of stay, faster recovery, and improved cosmetic results, compared with the open surgical versions of various operations.

“In the U.S., laparoscopic splenectomy is not well incorporated into the armamentarium of the average general surgeon. We can speculate that the underutilization of this approach around the country prevents development of the familiarity and skill that you need to perform the operation safely without conversion,” he said at the meeting, presented by the Society of Laparoscopic Surgeons and affiliated societies.

Dr. Afthinos’s data were drawn from the Nationwide Inpatient Sample maintained by the U.S. Agency for Healthcare Research and Quality. In this database, patients who had a laparoscopic splenectomy had the shortest average hospital length of stay: 5.6 days, compared with 7.5 in those who underwent open splenectomy and 7.1 for conversion procedures. The overall morbidity rate was significantly lower in the laparoscopic group, too: 7.4%, compared with 10.4% in the open splenectomy group.

In a multivariate analysis, he and his coworkers identified three independent risk factors for conversion from laparoscopic to open splenectomy: hemorrhage, with a 3.23-fold increased risk; splenomegaly, with a 1.3-fold increased risk; and autoimmune hemolytic anemia, with an associated 1.36-fold elevated risk of conversion.

Dr. Catalin Vasilescu of Carol Davila University in Bucharest, Romania, rose from the audience to voice his incredulity at the American data: “I am really surprised at your national conversion rate of well over 30%. That is really a problem. Earlier at this meeting, we presented 520 laparoscopic splenectomy patients with a conversion rate over 20 years of 4%-5%,” the Romanian general surgeon said.

“How do you explain this? I have a hypothesis: Perhaps there are so many surgeons each performing very few of these procedures, instead of referring patients to an experienced center,” he said.

“It was surprising to us, too,” Dr. Afthinos replied. “I mean, I was expecting the conversion rate to be high, but not that high.”

He said Dr. Vasilescu was right on the mark. In addition, he explained, it’s important to understand that there are vast rural areas of the United States, and some rural patients are reluctant to travel hundreds of miles to undergo laparoscopic splenectomy at a large experienced center, especially in the winter or if their family can’t come along for support. And a rural general surgeon is not going to risk a patient’s life if he or she isn’t comfortable with a laparoscopic approach.

There is hope that the situation will improve, however, as more fellowship-trained minimally invasive surgeons enter clinical practice, according to Dr. Afthinos. He cited a recent report from a Columbus, Ohio, general surgery practice that after a fellowship-trained minimally invasive surgeon joined the practice, the group – excluding their fellowship-trained recent hire – increased its rate of various advanced procedures being performed laparoscopically from 12% to 48%. The five established surgeons indicated they found mentoring by a colleague with minimally invasive surgery training was a better way to learn the procedures than via weekend courses, videos, traveling proctors, and other methods (Surg. Endosc. 2013;27:1267-72).

Dr. Afthinos reported having no relevant financial conflicts.

bjancin@frontlinemedcom.com

AMSTERDAM – One in five psoriasis patients lost more than 5% of baseline body weight while on oral apremilast for 52 weeks in the phase III ESTEEM 1 and ESTEEM 2 trials.

Patients taking apremilast not only experienced marked improvement in their psoriasis, but also much-needed weight loss, Dr. Kristian Reich observed in presenting the ESTEEM trials analysis at the annual congress of the European Academy of Dermatology and Venereology.

“You could see the weight loss in these studies as a side effect. But I think many of us would think that, in a psoriasis population with a mean baseline weight greater than 90 kg, that’s a very good thing to have,” said Dr. Reich of Dermatologikum Hamburg (Germany).

The mechanism for this weight loss remains unclear, Dr. Reich said. The important point is that it proved completely unrelated to the diarrhea, nausea, and vomiting that are common, albeit mild and transient, side effects associated with apremilast, a phosphodiesterase 4 inhibitor. That is, patients who lost significant weight did not have an increased incidence of these GI adverse events. Nor was there any correlation between baseline body weight and weight loss on the drug, he added.

Apremilast (Otezla) was approved by the Food and Drug Administration earlier in 2014 for the treatment of psoriatic arthritis, and in late September for psoriasis, and is the only systemic psoriasis drug that requires no tuberculosis screening or laboratory monitoring. The drug also is being developed as a medication for rheumatoid arthritis and ankylosing spondylitis.

The prospective ESTEEM I and II trials totaled 1,250 patients with moderate to severe psoriasis and a mean baseline weight of 92.6 kg. They were initially randomized 2:1 to 16 weeks of double-blind apremilast at 30 mg twice daily or placebo. At 16 weeks, everyone was placed on apremilast 30 mg b.i.d. through week 32, when a randomized treatment withdrawal phase began that lasted through week 52.

The weight loss associated with apremilast was progressive. Patients continued to lose weight while taking the drug until approximately week 65 of therapy, when weight loss has plateaued in long-term extension studies.

At 16 weeks in the ESTEEM trials, patients on apremilast had a mean 1.51-kg weight loss compared to baseline, while the mean body weight in placebo-treated controls remained unchanged. Also at week 16, 13.7% of the apremilast group and 5.5% of controls demonstrated a greater than 5% weight reduction from baseline.

The 564 patients on apremilast for the full 52 weeks had a mean weight loss from baseline of 1.99 kg, and 19.2% of patients had a weight loss in excess of 5%.

“I would call a 2-kg weight loss over a 1-year period a moderate weight loss. But a greater than 5% weight loss is generally classified by experts as clinically meaningful,” Dr. Reich noted.

While weight loss increased with time on apremilast, the drug’s GI side effects peaked during the first 2 weeks of therapy and tailed off after the first month.

Weight loss in apremilast-treated patients did not lead to any overt medical sequelae. Only 0.2% of patients discontinued the drug because of weight loss.

The ESTEEM analysis showed no sign of any increased risks of major adverse cardiovascular events, malignancies, serious infections, depressive symptoms, or suicidality in apremilast-treated patients, according to Dr. Reich.

“This is a drug known for having a very good safety profile,” he said.

The ESTEEM trials were funded by Celgene, which markets apremilast. Dr. Reich reported receiving research grants from and serving as a consultant to the company.

bjancin@frontlinemedcom.com

AMSTERDAM – One in five psoriasis patients lost more than 5% of baseline body weight while on oral apremilast for 52 weeks in the phase III ESTEEM 1 and ESTEEM 2 trials.

Patients taking apremilast not only experienced marked improvement in their psoriasis, but also much-needed weight loss, Dr. Kristian Reich observed in presenting the ESTEEM trials analysis at the annual congress of the European Academy of Dermatology and Venereology.

“You could see the weight loss in these studies as a side effect. But I think many of us would think that, in a psoriasis population with a mean baseline weight greater than 90 kg, that’s a very good thing to have,” said Dr. Reich of Dermatologikum Hamburg (Germany).

The mechanism for this weight loss remains unclear, Dr. Reich said. The important point is that it proved completely unrelated to the diarrhea, nausea, and vomiting that are common, albeit mild and transient, side effects associated with apremilast, a phosphodiesterase 4 inhibitor. That is, patients who lost significant weight did not have an increased incidence of these GI adverse events. Nor was there any correlation between baseline body weight and weight loss on the drug, he added.

Apremilast (Otezla) was approved by the Food and Drug Administration earlier in 2014 for the treatment of psoriatic arthritis, and in late September for psoriasis, and is the only systemic psoriasis drug that requires no tuberculosis screening or laboratory monitoring. The drug also is being developed as a medication for rheumatoid arthritis and ankylosing spondylitis.

The prospective ESTEEM I and II trials totaled 1,250 patients with moderate to severe psoriasis and a mean baseline weight of 92.6 kg. They were initially randomized 2:1 to 16 weeks of double-blind apremilast at 30 mg twice daily or placebo. At 16 weeks, everyone was placed on apremilast 30 mg b.i.d. through week 32, when a randomized treatment withdrawal phase began that lasted through week 52.

The weight loss associated with apremilast was progressive. Patients continued to lose weight while taking the drug until approximately week 65 of therapy, when weight loss has plateaued in long-term extension studies.

At 16 weeks in the ESTEEM trials, patients on apremilast had a mean 1.51-kg weight loss compared to baseline, while the mean body weight in placebo-treated controls remained unchanged. Also at week 16, 13.7% of the apremilast group and 5.5% of controls demonstrated a greater than 5% weight reduction from baseline.

The 564 patients on apremilast for the full 52 weeks had a mean weight loss from baseline of 1.99 kg, and 19.2% of patients had a weight loss in excess of 5%.

“I would call a 2-kg weight loss over a 1-year period a moderate weight loss. But a greater than 5% weight loss is generally classified by experts as clinically meaningful,” Dr. Reich noted.

While weight loss increased with time on apremilast, the drug’s GI side effects peaked during the first 2 weeks of therapy and tailed off after the first month.

Weight loss in apremilast-treated patients did not lead to any overt medical sequelae. Only 0.2% of patients discontinued the drug because of weight loss.

The ESTEEM analysis showed no sign of any increased risks of major adverse cardiovascular events, malignancies, serious infections, depressive symptoms, or suicidality in apremilast-treated patients, according to Dr. Reich.

“This is a drug known for having a very good safety profile,” he said.

The ESTEEM trials were funded by Celgene, which markets apremilast. Dr. Reich reported receiving research grants from and serving as a consultant to the company.

bjancin@frontlinemedcom.com

AMSTERDAM – One in five psoriasis patients lost more than 5% of baseline body weight while on oral apremilast for 52 weeks in the phase III ESTEEM 1 and ESTEEM 2 trials.

Patients taking apremilast not only experienced marked improvement in their psoriasis, but also much-needed weight loss, Dr. Kristian Reich observed in presenting the ESTEEM trials analysis at the annual congress of the European Academy of Dermatology and Venereology.

“You could see the weight loss in these studies as a side effect. But I think many of us would think that, in a psoriasis population with a mean baseline weight greater than 90 kg, that’s a very good thing to have,” said Dr. Reich of Dermatologikum Hamburg (Germany).

The mechanism for this weight loss remains unclear, Dr. Reich said. The important point is that it proved completely unrelated to the diarrhea, nausea, and vomiting that are common, albeit mild and transient, side effects associated with apremilast, a phosphodiesterase 4 inhibitor. That is, patients who lost significant weight did not have an increased incidence of these GI adverse events. Nor was there any correlation between baseline body weight and weight loss on the drug, he added.

Apremilast (Otezla) was approved by the Food and Drug Administration earlier in 2014 for the treatment of psoriatic arthritis, and in late September for psoriasis, and is the only systemic psoriasis drug that requires no tuberculosis screening or laboratory monitoring. The drug also is being developed as a medication for rheumatoid arthritis and ankylosing spondylitis.

The prospective ESTEEM I and II trials totaled 1,250 patients with moderate to severe psoriasis and a mean baseline weight of 92.6 kg. They were initially randomized 2:1 to 16 weeks of double-blind apremilast at 30 mg twice daily or placebo. At 16 weeks, everyone was placed on apremilast 30 mg b.i.d. through week 32, when a randomized treatment withdrawal phase began that lasted through week 52.

The weight loss associated with apremilast was progressive. Patients continued to lose weight while taking the drug until approximately week 65 of therapy, when weight loss has plateaued in long-term extension studies.

At 16 weeks in the ESTEEM trials, patients on apremilast had a mean 1.51-kg weight loss compared to baseline, while the mean body weight in placebo-treated controls remained unchanged. Also at week 16, 13.7% of the apremilast group and 5.5% of controls demonstrated a greater than 5% weight reduction from baseline.

The 564 patients on apremilast for the full 52 weeks had a mean weight loss from baseline of 1.99 kg, and 19.2% of patients had a weight loss in excess of 5%.

“I would call a 2-kg weight loss over a 1-year period a moderate weight loss. But a greater than 5% weight loss is generally classified by experts as clinically meaningful,” Dr. Reich noted.

While weight loss increased with time on apremilast, the drug’s GI side effects peaked during the first 2 weeks of therapy and tailed off after the first month.

Weight loss in apremilast-treated patients did not lead to any overt medical sequelae. Only 0.2% of patients discontinued the drug because of weight loss.

The ESTEEM analysis showed no sign of any increased risks of major adverse cardiovascular events, malignancies, serious infections, depressive symptoms, or suicidality in apremilast-treated patients, according to Dr. Reich.

“This is a drug known for having a very good safety profile,” he said.

The ESTEEM trials were funded by Celgene, which markets apremilast. Dr. Reich reported receiving research grants from and serving as a consultant to the company.

bjancin@frontlinemedcom.com

LAS VEGAS– As the volume of bariatric surgery climbs sharply in response to the obesity epidemic, the need for revision procedures due to weight regain is also on the rise.

Laparoscopic revision bariatric surgery, while more technically challenging, is safe and effective, and it entails less morbidity than typically seen with open revisions, Dr. Rana M. Ballo said at the annual Minimally Invasive Surgery Week.

Dr. Ballo, a fifth-year general surgery resident at Rush University Medical Center in Chicago, presented a retrospective single-center study involving 227 patients who during 2001-2011 underwent laparoscopic revision of bariatric procedures that had failed because of weight regain. The goal of the revision bariatric surgery was to restore the restrictive component and/or add a malabsorptive component in order to improve long-term weight loss.

The patients fell into four groups. Group 1 consisted of 53 patients who initially had a laparoscopic adjustable gastric band procedure which was converted to a gastric bypass. Group 2, the largest group, initially had a Roux-en-Y gastric bypass in which the pouch eventually became dilated, which is the No. 1 cause of failure of this operation in the literature; their revision surgery entailed laparoscopic pouch reduction. The 38 patients who comprised Group 3 had a Roux-en-Y gastric bypass with subsequent pouch reduction and elongation of the biliopancreatic limb. Group 4 consisted of 17 patients who initially had a vertical banded gastroplasty – a procedure with a restrictive component only – and subsequently underwent laparoscopic conversion to a gastric bypass.

After a median follow-up of 3.9 years, Group 2 had significantly less total body weight loss than the rest of the groups, all of which had similar weight losses. On the other hand, Group 2 also had a shorter operative time and briefer average hospital length of stay than the other three groups, and it was the only group with zero complications. Still, the lengths of stay and 30-day morbidity rates across the board in this laparoscopic revision series were impressively low in comparison to those previously reported in series involving open revision, Dr. Ballo noted at the meeting presented by the Society of Laparoscopic Surgeons and affiliated societies.

There was no mortality in this study. This is one of the largest series reported to date of laparoscopic revision of failed bariatric surgery. Most prior studies have involved 30-100 patients, according to Dr. Ballo.

In the 1990s, roughly 13,000 bariatric procedures were performed annually in the United States. Today that figure is in excess of 200,000 annually.

Dr. Ballo reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom

LAS VEGAS– As the volume of bariatric surgery climbs sharply in response to the obesity epidemic, the need for revision procedures due to weight regain is also on the rise.

Laparoscopic revision bariatric surgery, while more technically challenging, is safe and effective, and it entails less morbidity than typically seen with open revisions, Dr. Rana M. Ballo said at the annual Minimally Invasive Surgery Week.

Dr. Ballo, a fifth-year general surgery resident at Rush University Medical Center in Chicago, presented a retrospective single-center study involving 227 patients who during 2001-2011 underwent laparoscopic revision of bariatric procedures that had failed because of weight regain. The goal of the revision bariatric surgery was to restore the restrictive component and/or add a malabsorptive component in order to improve long-term weight loss.

The patients fell into four groups. Group 1 consisted of 53 patients who initially had a laparoscopic adjustable gastric band procedure which was converted to a gastric bypass. Group 2, the largest group, initially had a Roux-en-Y gastric bypass in which the pouch eventually became dilated, which is the No. 1 cause of failure of this operation in the literature; their revision surgery entailed laparoscopic pouch reduction. The 38 patients who comprised Group 3 had a Roux-en-Y gastric bypass with subsequent pouch reduction and elongation of the biliopancreatic limb. Group 4 consisted of 17 patients who initially had a vertical banded gastroplasty – a procedure with a restrictive component only – and subsequently underwent laparoscopic conversion to a gastric bypass.

After a median follow-up of 3.9 years, Group 2 had significantly less total body weight loss than the rest of the groups, all of which had similar weight losses. On the other hand, Group 2 also had a shorter operative time and briefer average hospital length of stay than the other three groups, and it was the only group with zero complications. Still, the lengths of stay and 30-day morbidity rates across the board in this laparoscopic revision series were impressively low in comparison to those previously reported in series involving open revision, Dr. Ballo noted at the meeting presented by the Society of Laparoscopic Surgeons and affiliated societies.

There was no mortality in this study. This is one of the largest series reported to date of laparoscopic revision of failed bariatric surgery. Most prior studies have involved 30-100 patients, according to Dr. Ballo.

In the 1990s, roughly 13,000 bariatric procedures were performed annually in the United States. Today that figure is in excess of 200,000 annually.

Dr. Ballo reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom

LAS VEGAS– As the volume of bariatric surgery climbs sharply in response to the obesity epidemic, the need for revision procedures due to weight regain is also on the rise.

Laparoscopic revision bariatric surgery, while more technically challenging, is safe and effective, and it entails less morbidity than typically seen with open revisions, Dr. Rana M. Ballo said at the annual Minimally Invasive Surgery Week.

Dr. Ballo, a fifth-year general surgery resident at Rush University Medical Center in Chicago, presented a retrospective single-center study involving 227 patients who during 2001-2011 underwent laparoscopic revision of bariatric procedures that had failed because of weight regain. The goal of the revision bariatric surgery was to restore the restrictive component and/or add a malabsorptive component in order to improve long-term weight loss.

The patients fell into four groups. Group 1 consisted of 53 patients who initially had a laparoscopic adjustable gastric band procedure which was converted to a gastric bypass. Group 2, the largest group, initially had a Roux-en-Y gastric bypass in which the pouch eventually became dilated, which is the No. 1 cause of failure of this operation in the literature; their revision surgery entailed laparoscopic pouch reduction. The 38 patients who comprised Group 3 had a Roux-en-Y gastric bypass with subsequent pouch reduction and elongation of the biliopancreatic limb. Group 4 consisted of 17 patients who initially had a vertical banded gastroplasty – a procedure with a restrictive component only – and subsequently underwent laparoscopic conversion to a gastric bypass.

After a median follow-up of 3.9 years, Group 2 had significantly less total body weight loss than the rest of the groups, all of which had similar weight losses. On the other hand, Group 2 also had a shorter operative time and briefer average hospital length of stay than the other three groups, and it was the only group with zero complications. Still, the lengths of stay and 30-day morbidity rates across the board in this laparoscopic revision series were impressively low in comparison to those previously reported in series involving open revision, Dr. Ballo noted at the meeting presented by the Society of Laparoscopic Surgeons and affiliated societies.

There was no mortality in this study. This is one of the largest series reported to date of laparoscopic revision of failed bariatric surgery. Most prior studies have involved 30-100 patients, according to Dr. Ballo.

In the 1990s, roughly 13,000 bariatric procedures were performed annually in the United States. Today that figure is in excess of 200,000 annually.

Dr. Ballo reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom.com

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom.com

LAS VEGAS – When it comes to managing patients hospitalized for heart failure, academic hospitalists are the experts – and cardiologists, primary care physicians, and nephrologists are the students.

That’s the lesson Dr. Paul M. Ndunda drew from his retrospective cohort study of 1,735 patients hospitalized for heart failure at three community hospitals. The patients admitted by members of the three teaching hospitalist groups had the lowest inpatient mortality, mean length of stay, and 30-day readmission rates compared to the other admitting physicians.

Although these data aren’t risk adjusted and its certainly possible that the academic hospitalists culled patients with a more favorable risk profile, it’s also likely that the explanation for the outcome differences is multifactorial and that specialty-specific differences in the care delivery process played a role. Indeed, it would appear that the hospitalist model of management of heart failure patients holds lessons of value for other types of physicians, Dr. Ndunda asserted at the annual meeting of the Heart Failure Society of America.

It’s also noteworthy that the teaching hospitalist groups achieved patient outcomes that were by and large better than the nonteaching hospitalist groups, added Dr. Ndunda of the University of Kansas, Wichita.

The major caveat, he conceded, is that outcomes weren’t risk adjusted. This takes on added weight in light of the fact that the teaching hospitalists’ patients were significantly younger than other physicians’ patients were. They were also more likely to be discharged home.

Dr. Ndunda reported having no financial conflicts with regard to this study.

bjancin@frontlinemedcom.com