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Expanded hospital testing improves respiratory pathogen detection
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
SOURCE: Steffens A et al. Abstract 885.
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
SOURCE: Steffens A et al. Abstract 885.
SAN DIEGO – Systematic testing of acute respiratory illness patients can increase the likelihood of finding relevant pathogens, according to a study presented at an annual scientific meeting on infectious diseases.
Currently, hospitals conduct either nonroutine assessments or rely heavily on clinical laboratory testing among severe acute respiratory illness patients, which can lead to missing clinically key viruses.
Systematic testing expands on tests ordered and carried out at hospitals, expanding on them by testing for influenza, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus and enterovirus, adenovirus, coronavirus, and parainfluenza viruses 1-4. To test the efficacy of systematic testing, investigators studied 2,216 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota during September 2015-August 2016. Patients were predominantly younger than 5 years old (57%) and had one or more chronic medical condition (63%).
Detection of at least one virus increased from 1,062 patients (48%) to 1,600 patients (72%) when comparing clinically ordered tests against expanded, systematic RT-PCR testing conducted through the Minnesota Health Department (MDH).
By patient age, viral detection increased by 27%, 24%, 18%, and 21% for patients aged younger than 5 years, 5-17 years, 18-64 years, and 65 years and older, respectively. Except for influenza viruses and RSV, the proportions of viruses identified, regardless of age, were all lower in hospital testing, compared with MDH testing.
“RSV targeting was almost systematic among children less than 5 years, but [accounted for] only 28% of RSV detection,” said Dr. Steffen in her presentation. “A smaller proportion of other respiratory viruses, including the human metapneumovirus, were detected at the hospital, and this was especially true for adults.”
Patients with rhinovirus and enterovirus saw a difference between hospital and expanded testing, increasing from a little over 300 patients detected, to nearly 800 patients.
“Patients admitted to the ICU were less likely to have a pathogen detection than those not admitted to the ICU, and those with one or more chronic medical condition had lower viral detection than those without,” Dr. Steffens said. “While testing at MDH did increase the percent of patients in each category, trends remained consistent and significant.”
Since testing information was only collected for patients with positive test results at the hospital, investigators were not able to compare testing practices between patients with and without viruses. This study may also have underrepresented pathogens detected through means other than the hospital laboratory, like rapid tests in emergency departments. The study was also limited by the short time frame of only 1 year.
The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
SOURCE: Steffens A et al. Abstract 885.
REPORTING FROM ID WEEK 2017
Key clinical point:
Major finding: Among 2,216 patients studied, 1,600 (72%) were found to have at least one respiratory virus through expanded testing, compared with 1,062 (48%) patients tested through clincian-directed testing.
Study details: 2,351 severe acute respiratory illness patients hospitalized in one of three hospitals in Minnesota.
Disclosures: The presenter reported no relevant financial disclosures.
Source: Steffens A et al. Abstract 885.
ACTH and other standard treatments prove best for infantile spasms
WASHINGTON – Standard infantile spasm therapies such as adrenocorticotropic hormone appear to be significantly more effective than nonstandard therapies, according to a prospective study presented at the annual meeting of the American Epilepsy Society.
If infants currently treated with nonstandard therapies switched to adrenocorticotropic hormone (ACTH), there would be an increase of “one additional responder for every four infants with infantile spasms,” according to Renee Shellhaas, MD, a pediatric neurologist at the University of Michigan, Ann Arbor.
Dr. Shellhaas and her colleagues conducted a prospective study of 352 infants recorded to have spasms in the National Infantile Spasms Consortium from 2012 to 2016 and compared successful responses with the use of ACTH and other standard therapies against those with nonstandard therapies. They defined a successful response as a patient who did not take any other medication for infantile spasms for 60 days and had no infantile spasms for 30 days after finishing 30 days of treatment. Infants were split into four treatment arms: ACTH (n = 150), vigabatrin (68), oral steroids (90), and nonstandard therapies (44). Nonstandard therapies included topiramate, levetiracetam, clobazam, zonisamide, ketogenic diet, oxcarbazepine, and phenobarbital.
The proportion of male infants across all arms was 50%-64%, with an average age of 6.2 months in the ACTH group, 5.5 months in the vigabatrin group, 6.7 months in the oral steroids group, and 5.5 months in the nonstandard group. A majority of infants across all arms had hypsarrhythmia on EEG, ranging from 57% to 84%.
Dr. Shellhaas and her colleagues sought to answer the question, “What would happen if this infant had been treated with ACTH instead of the given medication?” They controlled these comparisons for selection bias by weighting them for various factors that may have increased the odds of using the comparison treatment. They also controlled for potential medical center effects, but did not adjust for dosing regimen.
If the infants who had received nonstandard therapies had instead received ACTH, their response rate would have improved from 5% to 32%, according to this analysis (P less than .01).
In comparisons against other standard treatments, response rates would not have been significantly better if patients had instead received ACTH: 29% for vigabatrin vs. an estimated 37% for ACTH and 46% for oral steroids vs. an estimated 44% for ACTH.
If there was one thing to take away from this, it is that nonstandard therapies do not work nearly as well as ACTH or other standard treatments,” Dr. Shellhaas said. “It is crucial to treat these infants with treatments that are effective.”
Dr. Shellhaas and her associates uncovered certain clinical factors associated with treatment selections. Among infants with unknown infantile spasm etiology, 30% were given nonstandard treatment, whereas 47% received ACTH. Infants who were not already on antiepileptic drugs more often received nonstandard therapies than ACTH (45% vs. 17%).
However, ACTH was still more likely to be given over nonstandard therapies to infants who had hypsarrhythmia (84% vs. 57%) or a normal head circumference (77% vs. 57%).
Dr. Shellhaas reported no relevant financial disclosures. The Pediatric Epilepsy Research Foundation funded the study.
ezimmerman@frontlinemedcom.com
SOURCE: AES 2017 abstract 1.303
WASHINGTON – Standard infantile spasm therapies such as adrenocorticotropic hormone appear to be significantly more effective than nonstandard therapies, according to a prospective study presented at the annual meeting of the American Epilepsy Society.
If infants currently treated with nonstandard therapies switched to adrenocorticotropic hormone (ACTH), there would be an increase of “one additional responder for every four infants with infantile spasms,” according to Renee Shellhaas, MD, a pediatric neurologist at the University of Michigan, Ann Arbor.
Dr. Shellhaas and her colleagues conducted a prospective study of 352 infants recorded to have spasms in the National Infantile Spasms Consortium from 2012 to 2016 and compared successful responses with the use of ACTH and other standard therapies against those with nonstandard therapies. They defined a successful response as a patient who did not take any other medication for infantile spasms for 60 days and had no infantile spasms for 30 days after finishing 30 days of treatment. Infants were split into four treatment arms: ACTH (n = 150), vigabatrin (68), oral steroids (90), and nonstandard therapies (44). Nonstandard therapies included topiramate, levetiracetam, clobazam, zonisamide, ketogenic diet, oxcarbazepine, and phenobarbital.
The proportion of male infants across all arms was 50%-64%, with an average age of 6.2 months in the ACTH group, 5.5 months in the vigabatrin group, 6.7 months in the oral steroids group, and 5.5 months in the nonstandard group. A majority of infants across all arms had hypsarrhythmia on EEG, ranging from 57% to 84%.
Dr. Shellhaas and her colleagues sought to answer the question, “What would happen if this infant had been treated with ACTH instead of the given medication?” They controlled these comparisons for selection bias by weighting them for various factors that may have increased the odds of using the comparison treatment. They also controlled for potential medical center effects, but did not adjust for dosing regimen.
If the infants who had received nonstandard therapies had instead received ACTH, their response rate would have improved from 5% to 32%, according to this analysis (P less than .01).
In comparisons against other standard treatments, response rates would not have been significantly better if patients had instead received ACTH: 29% for vigabatrin vs. an estimated 37% for ACTH and 46% for oral steroids vs. an estimated 44% for ACTH.
If there was one thing to take away from this, it is that nonstandard therapies do not work nearly as well as ACTH or other standard treatments,” Dr. Shellhaas said. “It is crucial to treat these infants with treatments that are effective.”
Dr. Shellhaas and her associates uncovered certain clinical factors associated with treatment selections. Among infants with unknown infantile spasm etiology, 30% were given nonstandard treatment, whereas 47% received ACTH. Infants who were not already on antiepileptic drugs more often received nonstandard therapies than ACTH (45% vs. 17%).
However, ACTH was still more likely to be given over nonstandard therapies to infants who had hypsarrhythmia (84% vs. 57%) or a normal head circumference (77% vs. 57%).
Dr. Shellhaas reported no relevant financial disclosures. The Pediatric Epilepsy Research Foundation funded the study.
ezimmerman@frontlinemedcom.com
SOURCE: AES 2017 abstract 1.303
WASHINGTON – Standard infantile spasm therapies such as adrenocorticotropic hormone appear to be significantly more effective than nonstandard therapies, according to a prospective study presented at the annual meeting of the American Epilepsy Society.
If infants currently treated with nonstandard therapies switched to adrenocorticotropic hormone (ACTH), there would be an increase of “one additional responder for every four infants with infantile spasms,” according to Renee Shellhaas, MD, a pediatric neurologist at the University of Michigan, Ann Arbor.
Dr. Shellhaas and her colleagues conducted a prospective study of 352 infants recorded to have spasms in the National Infantile Spasms Consortium from 2012 to 2016 and compared successful responses with the use of ACTH and other standard therapies against those with nonstandard therapies. They defined a successful response as a patient who did not take any other medication for infantile spasms for 60 days and had no infantile spasms for 30 days after finishing 30 days of treatment. Infants were split into four treatment arms: ACTH (n = 150), vigabatrin (68), oral steroids (90), and nonstandard therapies (44). Nonstandard therapies included topiramate, levetiracetam, clobazam, zonisamide, ketogenic diet, oxcarbazepine, and phenobarbital.
The proportion of male infants across all arms was 50%-64%, with an average age of 6.2 months in the ACTH group, 5.5 months in the vigabatrin group, 6.7 months in the oral steroids group, and 5.5 months in the nonstandard group. A majority of infants across all arms had hypsarrhythmia on EEG, ranging from 57% to 84%.
Dr. Shellhaas and her colleagues sought to answer the question, “What would happen if this infant had been treated with ACTH instead of the given medication?” They controlled these comparisons for selection bias by weighting them for various factors that may have increased the odds of using the comparison treatment. They also controlled for potential medical center effects, but did not adjust for dosing regimen.
If the infants who had received nonstandard therapies had instead received ACTH, their response rate would have improved from 5% to 32%, according to this analysis (P less than .01).
In comparisons against other standard treatments, response rates would not have been significantly better if patients had instead received ACTH: 29% for vigabatrin vs. an estimated 37% for ACTH and 46% for oral steroids vs. an estimated 44% for ACTH.
If there was one thing to take away from this, it is that nonstandard therapies do not work nearly as well as ACTH or other standard treatments,” Dr. Shellhaas said. “It is crucial to treat these infants with treatments that are effective.”
Dr. Shellhaas and her associates uncovered certain clinical factors associated with treatment selections. Among infants with unknown infantile spasm etiology, 30% were given nonstandard treatment, whereas 47% received ACTH. Infants who were not already on antiepileptic drugs more often received nonstandard therapies than ACTH (45% vs. 17%).
However, ACTH was still more likely to be given over nonstandard therapies to infants who had hypsarrhythmia (84% vs. 57%) or a normal head circumference (77% vs. 57%).
Dr. Shellhaas reported no relevant financial disclosures. The Pediatric Epilepsy Research Foundation funded the study.
ezimmerman@frontlinemedcom.com
SOURCE: AES 2017 abstract 1.303
REPORTING FROM AES 2017
Key clinical point:
Major finding: If the infants who had received nonstandard therapies had instead received ACTH, their response rate would have improved from 5% to 32% (P less than .01).
Data source: Prospective study of 352 infants gathered from the National Infantile Spasms Consortium database from 2012-2016.
Disclosures: The presenter reported no relevant financial disclosures. The Pediatric Epilepsy Research Foundation funded the study.
Source: R. Shellhaas, et al. AES 2017 abstract 1.303
Hippocampal features may predispose children with febrile status epilepticus to poorer memory
WASHINGTON – Children with febrile status epilepticus (FSE) may be at risk for memory impairment when abnormal hippocampal development or acute injury is also present, according to research presented at the annual meeting of the American Epilepsy Society.
This analysis of patients enrolled in the FEBSTAT study presents some of the first prospective data available regarding significant risk factors for cognitive dysfunction in children with FSE.
“Overall, children with FSE have generally intact memory function and generally intact IQ,” said Erica Weiss, PhD, a neurology instructor at the Albert Einstein College of Medicine, New York. “However, children with acute T2 [hyperintensities on MRI] and kids who have hippocampal malrotation [HIMAL] tend to have weaker memory scores.”
The investigators conducted a prospective study of 113 children with FSE using data gathered from five medical centers across the United States between June 2003 and March 2010.
Children included in the study were followed with serial MRIs and electroencephalograms for more than 5 years after their having FSE; during this time, their verbal, visual, and screening memory abilities were tested using the Wide Range Assessment of Memory and Learning, Second Edition, (WRAML2) test.
Patients had an average age of 15.5 months at time of FSE. Of the children in the study, 46% were female, and 46% were non-white.
Overall, mean scores at baseline on the WRAML2 were significantly lower for children with acute hippocampal injury shown on T2 hyperintensities or HIMAL than they were for children with a normal MRI scan. On individual memory functions of the WRAML2, mean scores at baseline for children with acute T2 hyperintensities were lower than they were for those with a normal MRI on the verbal index (79 vs. 102.3), visual index (81 vs. 93.7), and screening memory index (76 vs. 97.7). Children with HIMAL at baseline also had lower scores on those indexes (94.9 for verbal memory, 82.5 for visual memory, and 97 for screening memory) than did children with a normal MRI.
The differences were statistically significant for lower verbal memory and screening memory scores in patients with acute T2 hyperintensities and for lower visual memory scores in patients with HIMAL. The differences trended toward statistical significance for lower visual memory scores in children with acute T2 hyperintensities and for lower verbal memory scores in children with focal FSE seizures.
The researchers found no significant differences in memory task performances when stratifying for age at time of FSE, duration of FSE, or patients’ sex, according to Dr. Weiss.
With this initial connection uncovered, Dr. Weiss and her colleagues are looking to dive deeper into different aspects of hippocampal properties and FSE.
“We’re looking into the relationship between hippocampus size and memory performances, as well as continue to track these studies,” Dr. Weiss said in an interview. “Another factor to consider when you talk about memory is attention, and we have looked into it a bit, but we need more information.”
This study was funded by a grant from the National Institute of Neurological Disorders and Stroke. The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
WASHINGTON – Children with febrile status epilepticus (FSE) may be at risk for memory impairment when abnormal hippocampal development or acute injury is also present, according to research presented at the annual meeting of the American Epilepsy Society.
This analysis of patients enrolled in the FEBSTAT study presents some of the first prospective data available regarding significant risk factors for cognitive dysfunction in children with FSE.
“Overall, children with FSE have generally intact memory function and generally intact IQ,” said Erica Weiss, PhD, a neurology instructor at the Albert Einstein College of Medicine, New York. “However, children with acute T2 [hyperintensities on MRI] and kids who have hippocampal malrotation [HIMAL] tend to have weaker memory scores.”
The investigators conducted a prospective study of 113 children with FSE using data gathered from five medical centers across the United States between June 2003 and March 2010.
Children included in the study were followed with serial MRIs and electroencephalograms for more than 5 years after their having FSE; during this time, their verbal, visual, and screening memory abilities were tested using the Wide Range Assessment of Memory and Learning, Second Edition, (WRAML2) test.
Patients had an average age of 15.5 months at time of FSE. Of the children in the study, 46% were female, and 46% were non-white.
Overall, mean scores at baseline on the WRAML2 were significantly lower for children with acute hippocampal injury shown on T2 hyperintensities or HIMAL than they were for children with a normal MRI scan. On individual memory functions of the WRAML2, mean scores at baseline for children with acute T2 hyperintensities were lower than they were for those with a normal MRI on the verbal index (79 vs. 102.3), visual index (81 vs. 93.7), and screening memory index (76 vs. 97.7). Children with HIMAL at baseline also had lower scores on those indexes (94.9 for verbal memory, 82.5 for visual memory, and 97 for screening memory) than did children with a normal MRI.
The differences were statistically significant for lower verbal memory and screening memory scores in patients with acute T2 hyperintensities and for lower visual memory scores in patients with HIMAL. The differences trended toward statistical significance for lower visual memory scores in children with acute T2 hyperintensities and for lower verbal memory scores in children with focal FSE seizures.
The researchers found no significant differences in memory task performances when stratifying for age at time of FSE, duration of FSE, or patients’ sex, according to Dr. Weiss.
With this initial connection uncovered, Dr. Weiss and her colleagues are looking to dive deeper into different aspects of hippocampal properties and FSE.
“We’re looking into the relationship between hippocampus size and memory performances, as well as continue to track these studies,” Dr. Weiss said in an interview. “Another factor to consider when you talk about memory is attention, and we have looked into it a bit, but we need more information.”
This study was funded by a grant from the National Institute of Neurological Disorders and Stroke. The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
WASHINGTON – Children with febrile status epilepticus (FSE) may be at risk for memory impairment when abnormal hippocampal development or acute injury is also present, according to research presented at the annual meeting of the American Epilepsy Society.
This analysis of patients enrolled in the FEBSTAT study presents some of the first prospective data available regarding significant risk factors for cognitive dysfunction in children with FSE.
“Overall, children with FSE have generally intact memory function and generally intact IQ,” said Erica Weiss, PhD, a neurology instructor at the Albert Einstein College of Medicine, New York. “However, children with acute T2 [hyperintensities on MRI] and kids who have hippocampal malrotation [HIMAL] tend to have weaker memory scores.”
The investigators conducted a prospective study of 113 children with FSE using data gathered from five medical centers across the United States between June 2003 and March 2010.
Children included in the study were followed with serial MRIs and electroencephalograms for more than 5 years after their having FSE; during this time, their verbal, visual, and screening memory abilities were tested using the Wide Range Assessment of Memory and Learning, Second Edition, (WRAML2) test.
Patients had an average age of 15.5 months at time of FSE. Of the children in the study, 46% were female, and 46% were non-white.
Overall, mean scores at baseline on the WRAML2 were significantly lower for children with acute hippocampal injury shown on T2 hyperintensities or HIMAL than they were for children with a normal MRI scan. On individual memory functions of the WRAML2, mean scores at baseline for children with acute T2 hyperintensities were lower than they were for those with a normal MRI on the verbal index (79 vs. 102.3), visual index (81 vs. 93.7), and screening memory index (76 vs. 97.7). Children with HIMAL at baseline also had lower scores on those indexes (94.9 for verbal memory, 82.5 for visual memory, and 97 for screening memory) than did children with a normal MRI.
The differences were statistically significant for lower verbal memory and screening memory scores in patients with acute T2 hyperintensities and for lower visual memory scores in patients with HIMAL. The differences trended toward statistical significance for lower visual memory scores in children with acute T2 hyperintensities and for lower verbal memory scores in children with focal FSE seizures.
The researchers found no significant differences in memory task performances when stratifying for age at time of FSE, duration of FSE, or patients’ sex, according to Dr. Weiss.
With this initial connection uncovered, Dr. Weiss and her colleagues are looking to dive deeper into different aspects of hippocampal properties and FSE.
“We’re looking into the relationship between hippocampus size and memory performances, as well as continue to track these studies,” Dr. Weiss said in an interview. “Another factor to consider when you talk about memory is attention, and we have looked into it a bit, but we need more information.”
This study was funded by a grant from the National Institute of Neurological Disorders and Stroke. The presenters reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AES 2017
Key clinical point:
Major finding: On individual memory functions of the Wide Range Assessment of Memory and Learning, Second Edition, test, mean scores at baseline for children with acute T2 hyperintensities or hippocampal malrotation were lower than they were for those with a normal MRI on the verbal index (79 and 94.9, respectively, vs. 102.3), the visual index (81 and 82.5 vs. 93.7), and the screening memory (76 and 97 vs. 97.7) index.
Data source: Prospective study of 113 children, the data for which was gathered from five medical centers across the United States between 2003 and 2010.
Disclosures: The study was funded by a grant from the National Institute of Neurological Disorders and Stroke. The presenters reported no relevant financial disclosures.
Pediatricians urge focus on human trafficking victims
For pediatricians to better help victims of human trafficking, it is critical that there be improvements in research, medical education, advocacy, and community collaborations, according to a policy statement issued by the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect, Section on International Child Health.
The full effects of human trafficking are still very much hidden in shadows, leading the AAP to add human trafficking education to its list of top 10 priorities at the 2014 AAP Annual Leadership Forum.
The policy statement is the latest step in the AAP’s effort to involve medical professionals more heavily in combating child sex and labor trafficking, which the AAP asserts is a critical role for pediatricians. Even with the limited information available, the United Nations Office of Drugs and Crime 2016 report found 33% of the 40,000 trafficking victims reported were children, an indication of the vulnerability of younger populations.
“We wanted to give not just background information on trafficking, but we also wanted to give some guidance for academy members in regard to how we can increase awareness of human trafficking, how we can start to implement it into medical education for medical trainees and practicing pediatricians,” Nia Bodrick, MD, MPH, coauthor of the statement and a member of the AAP Section on International Child Health, said in an interview. “Due to the very narrow amount of evidence-based research that is available on this issue, there is a call to look more deeply into the topic.”
Currently, many health care professionals may be more exposed to child trafficking than they think because of a lack knowledge on how to recognize it. Victims can pass unnoticed.
“Most victims and survivors of human trafficking have had some sort of interaction with the health care setting at some point before they escape their situation,” said Dr. Bodrick. “So whether we as pediatricians realize it or not, we are more than likely interacting with young people who are in these situations.”
There are not enough data to list definitive characteristics of trafficking victims; however, there are certain signs associated with those who have been identified as victims so far. While history of neglect, homelessness, substance abuse, mental disorder, and identifying as a member of the LGBTQ community are more common among trafficking victims, many doctors are not equipped to handle confronting patients about the possibility of sex or labor trafficking, nor do they know what resources are available.
The AAP emphasized a need to expand the current scope of knowledge medical professionals have regarding such victims to create better, evidence-based care programs and protective policies.
An influx of information would help pediatricians understand the prevalence of trafficking, the extent of physical and emotional harm victims experience, and the effectiveness of psychological and mental health interventions, according to the statement (Pediatrics. 2017 November. doi: 10.1542/peds.2017-3138).
It also may help shed light on male trafficking victims, which Dr. Bodrick and coauthor Jordan Greenbaum, MD, of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, assert are highly underrepresented.
Separating human trafficking from other types of violence and exploitation in the International Classification of Diseases codes may improve research initiatives, according to Dr. Bodrick.
There is also a need to delve deeper into the social determinants of health to better predict what makes victims more vulnerable.
While improving the number of studies on trafficking is essential, the results are more long term, which means in the mean time other actions can, and should, be made, according to the statement.
One of the best things pediatricians can do is gather as much knowledge on the topic as they can, according to Dr. Bodrick.
“For the average pediatrician, one of the first things one could do is educate oneself on the topic,” she explained. “Look for CME associated with your local AAP chapter or even on a national level online or even if you just have a couple hours for lunch, to become aware of what’s happening.”
The AAP also is encouraging physicians to advocate for legislative policies that will help improve victim care and to create partnerships within the community.
“In DC, in our local AAP chapter, we have opportunities to go to the Hill and advocate for bills, and while not everyone can do that, there are always local legislators that pediatricians can push to do more,” said Dr. Bodrick. “If you have a local paper, you could write an op-ed about the topic, you could educate your local schools about the topic by talking to the school board, or you could even engage in interviews on a local radio or television station.”
While many states have laws protecting victims of sex trafficking from being prosecuted for performing illegal acts, many have not passed such legislation.
Pediatricians can see what protections their states have through the National Conference of State Legislatures’ web page, as well as review current human trafficking laws.
Dr. Greenbaum and Dr. Bodrick reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter@eaztweets
This statement does a good job bringing the health aspects of human trafficking into the open. Human trafficking has become a significant issue in the United States, and this document serves as a way to open the door for discussion on how pediatricians can become a part of the solution.
Armed with a clearer idea of the issues of child trafficking, pediatricians should take this document as a call to increase their – and their colleagues’ – awareness on this issue. Whether that involves a deeper focus on the social environmental determinants of health or political advocacy, education is key to developing a better role as a pediatrician as we work together to help those who have experienced trafficking first hand.
Francis Rushton Jr., MD, practiced pediatrics in Beaufort, S.C. for 32 years. He also is a member of the Pediatric News editorial advisory board.
This statement does a good job bringing the health aspects of human trafficking into the open. Human trafficking has become a significant issue in the United States, and this document serves as a way to open the door for discussion on how pediatricians can become a part of the solution.
Armed with a clearer idea of the issues of child trafficking, pediatricians should take this document as a call to increase their – and their colleagues’ – awareness on this issue. Whether that involves a deeper focus on the social environmental determinants of health or political advocacy, education is key to developing a better role as a pediatrician as we work together to help those who have experienced trafficking first hand.
Francis Rushton Jr., MD, practiced pediatrics in Beaufort, S.C. for 32 years. He also is a member of the Pediatric News editorial advisory board.
This statement does a good job bringing the health aspects of human trafficking into the open. Human trafficking has become a significant issue in the United States, and this document serves as a way to open the door for discussion on how pediatricians can become a part of the solution.
Armed with a clearer idea of the issues of child trafficking, pediatricians should take this document as a call to increase their – and their colleagues’ – awareness on this issue. Whether that involves a deeper focus on the social environmental determinants of health or political advocacy, education is key to developing a better role as a pediatrician as we work together to help those who have experienced trafficking first hand.
Francis Rushton Jr., MD, practiced pediatrics in Beaufort, S.C. for 32 years. He also is a member of the Pediatric News editorial advisory board.
For pediatricians to better help victims of human trafficking, it is critical that there be improvements in research, medical education, advocacy, and community collaborations, according to a policy statement issued by the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect, Section on International Child Health.
The full effects of human trafficking are still very much hidden in shadows, leading the AAP to add human trafficking education to its list of top 10 priorities at the 2014 AAP Annual Leadership Forum.
The policy statement is the latest step in the AAP’s effort to involve medical professionals more heavily in combating child sex and labor trafficking, which the AAP asserts is a critical role for pediatricians. Even with the limited information available, the United Nations Office of Drugs and Crime 2016 report found 33% of the 40,000 trafficking victims reported were children, an indication of the vulnerability of younger populations.
“We wanted to give not just background information on trafficking, but we also wanted to give some guidance for academy members in regard to how we can increase awareness of human trafficking, how we can start to implement it into medical education for medical trainees and practicing pediatricians,” Nia Bodrick, MD, MPH, coauthor of the statement and a member of the AAP Section on International Child Health, said in an interview. “Due to the very narrow amount of evidence-based research that is available on this issue, there is a call to look more deeply into the topic.”
Currently, many health care professionals may be more exposed to child trafficking than they think because of a lack knowledge on how to recognize it. Victims can pass unnoticed.
“Most victims and survivors of human trafficking have had some sort of interaction with the health care setting at some point before they escape their situation,” said Dr. Bodrick. “So whether we as pediatricians realize it or not, we are more than likely interacting with young people who are in these situations.”
There are not enough data to list definitive characteristics of trafficking victims; however, there are certain signs associated with those who have been identified as victims so far. While history of neglect, homelessness, substance abuse, mental disorder, and identifying as a member of the LGBTQ community are more common among trafficking victims, many doctors are not equipped to handle confronting patients about the possibility of sex or labor trafficking, nor do they know what resources are available.
The AAP emphasized a need to expand the current scope of knowledge medical professionals have regarding such victims to create better, evidence-based care programs and protective policies.
An influx of information would help pediatricians understand the prevalence of trafficking, the extent of physical and emotional harm victims experience, and the effectiveness of psychological and mental health interventions, according to the statement (Pediatrics. 2017 November. doi: 10.1542/peds.2017-3138).
It also may help shed light on male trafficking victims, which Dr. Bodrick and coauthor Jordan Greenbaum, MD, of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, assert are highly underrepresented.
Separating human trafficking from other types of violence and exploitation in the International Classification of Diseases codes may improve research initiatives, according to Dr. Bodrick.
There is also a need to delve deeper into the social determinants of health to better predict what makes victims more vulnerable.
While improving the number of studies on trafficking is essential, the results are more long term, which means in the mean time other actions can, and should, be made, according to the statement.
One of the best things pediatricians can do is gather as much knowledge on the topic as they can, according to Dr. Bodrick.
“For the average pediatrician, one of the first things one could do is educate oneself on the topic,” she explained. “Look for CME associated with your local AAP chapter or even on a national level online or even if you just have a couple hours for lunch, to become aware of what’s happening.”
The AAP also is encouraging physicians to advocate for legislative policies that will help improve victim care and to create partnerships within the community.
“In DC, in our local AAP chapter, we have opportunities to go to the Hill and advocate for bills, and while not everyone can do that, there are always local legislators that pediatricians can push to do more,” said Dr. Bodrick. “If you have a local paper, you could write an op-ed about the topic, you could educate your local schools about the topic by talking to the school board, or you could even engage in interviews on a local radio or television station.”
While many states have laws protecting victims of sex trafficking from being prosecuted for performing illegal acts, many have not passed such legislation.
Pediatricians can see what protections their states have through the National Conference of State Legislatures’ web page, as well as review current human trafficking laws.
Dr. Greenbaum and Dr. Bodrick reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter@eaztweets
For pediatricians to better help victims of human trafficking, it is critical that there be improvements in research, medical education, advocacy, and community collaborations, according to a policy statement issued by the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect, Section on International Child Health.
The full effects of human trafficking are still very much hidden in shadows, leading the AAP to add human trafficking education to its list of top 10 priorities at the 2014 AAP Annual Leadership Forum.
The policy statement is the latest step in the AAP’s effort to involve medical professionals more heavily in combating child sex and labor trafficking, which the AAP asserts is a critical role for pediatricians. Even with the limited information available, the United Nations Office of Drugs and Crime 2016 report found 33% of the 40,000 trafficking victims reported were children, an indication of the vulnerability of younger populations.
“We wanted to give not just background information on trafficking, but we also wanted to give some guidance for academy members in regard to how we can increase awareness of human trafficking, how we can start to implement it into medical education for medical trainees and practicing pediatricians,” Nia Bodrick, MD, MPH, coauthor of the statement and a member of the AAP Section on International Child Health, said in an interview. “Due to the very narrow amount of evidence-based research that is available on this issue, there is a call to look more deeply into the topic.”
Currently, many health care professionals may be more exposed to child trafficking than they think because of a lack knowledge on how to recognize it. Victims can pass unnoticed.
“Most victims and survivors of human trafficking have had some sort of interaction with the health care setting at some point before they escape their situation,” said Dr. Bodrick. “So whether we as pediatricians realize it or not, we are more than likely interacting with young people who are in these situations.”
There are not enough data to list definitive characteristics of trafficking victims; however, there are certain signs associated with those who have been identified as victims so far. While history of neglect, homelessness, substance abuse, mental disorder, and identifying as a member of the LGBTQ community are more common among trafficking victims, many doctors are not equipped to handle confronting patients about the possibility of sex or labor trafficking, nor do they know what resources are available.
The AAP emphasized a need to expand the current scope of knowledge medical professionals have regarding such victims to create better, evidence-based care programs and protective policies.
An influx of information would help pediatricians understand the prevalence of trafficking, the extent of physical and emotional harm victims experience, and the effectiveness of psychological and mental health interventions, according to the statement (Pediatrics. 2017 November. doi: 10.1542/peds.2017-3138).
It also may help shed light on male trafficking victims, which Dr. Bodrick and coauthor Jordan Greenbaum, MD, of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, assert are highly underrepresented.
Separating human trafficking from other types of violence and exploitation in the International Classification of Diseases codes may improve research initiatives, according to Dr. Bodrick.
There is also a need to delve deeper into the social determinants of health to better predict what makes victims more vulnerable.
While improving the number of studies on trafficking is essential, the results are more long term, which means in the mean time other actions can, and should, be made, according to the statement.
One of the best things pediatricians can do is gather as much knowledge on the topic as they can, according to Dr. Bodrick.
“For the average pediatrician, one of the first things one could do is educate oneself on the topic,” she explained. “Look for CME associated with your local AAP chapter or even on a national level online or even if you just have a couple hours for lunch, to become aware of what’s happening.”
The AAP also is encouraging physicians to advocate for legislative policies that will help improve victim care and to create partnerships within the community.
“In DC, in our local AAP chapter, we have opportunities to go to the Hill and advocate for bills, and while not everyone can do that, there are always local legislators that pediatricians can push to do more,” said Dr. Bodrick. “If you have a local paper, you could write an op-ed about the topic, you could educate your local schools about the topic by talking to the school board, or you could even engage in interviews on a local radio or television station.”
While many states have laws protecting victims of sex trafficking from being prosecuted for performing illegal acts, many have not passed such legislation.
Pediatricians can see what protections their states have through the National Conference of State Legislatures’ web page, as well as review current human trafficking laws.
Dr. Greenbaum and Dr. Bodrick reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter@eaztweets
FROM PEDIATRICS
VIDEO: Laparoscopy is a safe approach throughout pregnancy, expert says
NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.
“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”
Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.
The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.
“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”
Dr. Kaufman reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.
“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”
Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.
The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.
“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”
Dr. Kaufman reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.
“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”
Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.
The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.
“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”
Dr. Kaufman reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AAGL 2017
VIDEO: Dr. Charles E. Miller’s AAGL highlights
NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.
“It’s about doing surgery in the right place, in the right space,” he said.
One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”
In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.
In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.
The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.
“It’s about doing surgery in the right place, in the right space,” he said.
One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”
In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.
In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.
The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.
“It’s about doing surgery in the right place, in the right space,” he said.
One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”
In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.
In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.
The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AAGL 2017
Women with adult acne need more treatment options and support
Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.
In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.
“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.
Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.
More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.
Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.
Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”
In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.
Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.
“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.
Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.
SDEF and this news organization are owned by Frontline Medical Communications.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.
In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.
“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.
Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.
More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.
Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.
Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”
In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.
Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.
“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.
Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.
SDEF and this news organization are owned by Frontline Medical Communications.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.
In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.
“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.
Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.
More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.
Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.
Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”
In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.
Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.
“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.
Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.
SDEF and this news organization are owned by Frontline Medical Communications.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
FROM SDEF WOMEN’S & PEDIATRIC DERMATOLOGY SEMINAR
VIDEO: Outpatient hysterectomies offer advantages for surgeons, patients
NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.
“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”
But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.
Dr. Rosenfield reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.
“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”
But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.
Dr. Rosenfield reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.
“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”
But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.
Dr. Rosenfield reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AAGL 2017
Higher BMI linked to lower risk of hysterectomy reoperation
NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.
“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”
Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.
Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.
A majority of patients (13,000) had a BMI of 30 kg/m2 or greater.
Compared with patients with a normal BMI of 24 kg/m2, patients with a BMI of 39 kg/m2 had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m2 and 34 kg/m2 were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.
Patients with a low normal BMI of 18.5 kg/m2 were at a higher risk of reoperation (aOR = 1.33; P = .001).
Researchers were unable to comment on women with a BMI of 45 kg/m2 or greater, due to the limited number of women in this group.
Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.
“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.
The researchers reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.
“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”
Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.
Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.
A majority of patients (13,000) had a BMI of 30 kg/m2 or greater.
Compared with patients with a normal BMI of 24 kg/m2, patients with a BMI of 39 kg/m2 had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m2 and 34 kg/m2 were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.
Patients with a low normal BMI of 18.5 kg/m2 were at a higher risk of reoperation (aOR = 1.33; P = .001).
Researchers were unable to comment on women with a BMI of 45 kg/m2 or greater, due to the limited number of women in this group.
Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.
“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.
The researchers reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.
“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”
Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.
Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.
A majority of patients (13,000) had a BMI of 30 kg/m2 or greater.
Compared with patients with a normal BMI of 24 kg/m2, patients with a BMI of 39 kg/m2 had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m2 and 34 kg/m2 were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.
Patients with a low normal BMI of 18.5 kg/m2 were at a higher risk of reoperation (aOR = 1.33; P = .001).
Researchers were unable to comment on women with a BMI of 45 kg/m2 or greater, due to the limited number of women in this group.
Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.
“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.
The researchers reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AAGL 2017
Key clinical point:
Major finding: Patients with a BMI of 39 kg/m2 less likely to need a reoperation after hysterectomy (aOR, .73; P = .02).
Data source: Retrospective study of 28,487 women who underwent a hysterectomy from 2014 to 2015 from the American College of Surgeons National Surgical Quality Improvement Program database.
Disclosures: The researchers reported having no relevant financial disclosures.
VIDEO: Innovative technology is opening doors for vaginal hysterectomy
NATIONAL HARBOR, MD. – Innovative tools for vaginal hysterectomy were in the spotlight during a surgical demonstration at the AAGL Global Congress.
“I think it’s really compelling that we use the technologies that the AAGL is known for investigating and teaching each other,” said Charles Rardin, MD, director of the robotic surgery program at Women & Infants Hospital, Providence, R.I. “It’s nice to see a renewed interest in some newer technologies and applying them to vaginal hysterectomy.”
The presentation of new tools comes as the number of vaginal hysterectomies have decreased and laparoscopic procedures are on the rise. The rate of vaginal hysterectomy in the United States has fallen from 24.8% in 1998 to 16.7% in 2010, according to the Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality.
Surgeons demonstrated new tools with the intent of showing physicians that the benefits some associate with laparoscopic procedures, such as having easier access or a better sense of the uterus, can be associated with vaginal hysterectomy as well.
Advanced tools, such as a self-retaining retractor and 3-D camera systems, could make it easier to teach students by allowing more mobility and easier visual access, Dr. Rardin said in a video interview.
The tutorial ended with a demonstration of the natural orifice transluminal endoscopic surgery tool that allows laparoscopic tools to be introduced through the vaginal pathway.
All the tools exhibited at AAGL are currently available.
Dr. Rardin reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Innovative tools for vaginal hysterectomy were in the spotlight during a surgical demonstration at the AAGL Global Congress.
“I think it’s really compelling that we use the technologies that the AAGL is known for investigating and teaching each other,” said Charles Rardin, MD, director of the robotic surgery program at Women & Infants Hospital, Providence, R.I. “It’s nice to see a renewed interest in some newer technologies and applying them to vaginal hysterectomy.”
The presentation of new tools comes as the number of vaginal hysterectomies have decreased and laparoscopic procedures are on the rise. The rate of vaginal hysterectomy in the United States has fallen from 24.8% in 1998 to 16.7% in 2010, according to the Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality.
Surgeons demonstrated new tools with the intent of showing physicians that the benefits some associate with laparoscopic procedures, such as having easier access or a better sense of the uterus, can be associated with vaginal hysterectomy as well.
Advanced tools, such as a self-retaining retractor and 3-D camera systems, could make it easier to teach students by allowing more mobility and easier visual access, Dr. Rardin said in a video interview.
The tutorial ended with a demonstration of the natural orifice transluminal endoscopic surgery tool that allows laparoscopic tools to be introduced through the vaginal pathway.
All the tools exhibited at AAGL are currently available.
Dr. Rardin reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
NATIONAL HARBOR, MD. – Innovative tools for vaginal hysterectomy were in the spotlight during a surgical demonstration at the AAGL Global Congress.
“I think it’s really compelling that we use the technologies that the AAGL is known for investigating and teaching each other,” said Charles Rardin, MD, director of the robotic surgery program at Women & Infants Hospital, Providence, R.I. “It’s nice to see a renewed interest in some newer technologies and applying them to vaginal hysterectomy.”
The presentation of new tools comes as the number of vaginal hysterectomies have decreased and laparoscopic procedures are on the rise. The rate of vaginal hysterectomy in the United States has fallen from 24.8% in 1998 to 16.7% in 2010, according to the Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality.
Surgeons demonstrated new tools with the intent of showing physicians that the benefits some associate with laparoscopic procedures, such as having easier access or a better sense of the uterus, can be associated with vaginal hysterectomy as well.
Advanced tools, such as a self-retaining retractor and 3-D camera systems, could make it easier to teach students by allowing more mobility and easier visual access, Dr. Rardin said in a video interview.
The tutorial ended with a demonstration of the natural orifice transluminal endoscopic surgery tool that allows laparoscopic tools to be introduced through the vaginal pathway.
All the tools exhibited at AAGL are currently available.
Dr. Rardin reported having no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
On Twitter @eaztweets
AT AAGL 2017
