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Marijuana use triples risk of death from hypertension
The risk of death from hypertension is three times greater in adults who use marijuana, compared with nonusers, based on data from a retrospective study of 1,213 adults.
Changes in the legalization of marijuana may promote increased recreational use, but data on the long-term effects of marijuana use on cardiovascular and cerebrovascular mortality are limited, wrote Barbara A. Yankey, PhD, of Georgia State University, Atlanta, and her colleagues.
Data on 686 users and 527 nonusers were combined with the 2011 mortality data from the National Center for Health Statistics (Eur J Prev Cardiol. 2017 Aug 9; doi: 10.1177/2047487317723212).
Overall, marijuana users had a 3.42 times greater risk of death from hypertension than did nonusers (95% confidence interval, 1.20-9.79), and the risk increased by 1.04 for each year of use (95% CI, 1.00-1.07). The average duration of marijuana use was 11.5 years. At the time of study entry, the average age of the participants was 38 years, and the average body mass index was 29 kg/m2; 23% of marijuana users and 21% of nonusers had a prior diagnosis of hypertension.
Of the study participants, 20% used marijuana and smoked cigarettes, 16% used marijuana and were past smokers, 5% were past smokers, and 4% only smoked cigarettes. “In our study, increase in risk for hypertension, [heart disease], or cerebrovascular disease mortality associated with cigarette use was not significant,” the researchers wrote. They attributed this factor to the small sample size and noted that the dangers of cigarette smoking to the cardiovascular system are well established.
The study findings were limited by the relatively small sample size and potentially inaccurate data on the duration of marijuana use, the researchers said.
However, the results suggest that “cardiovascular risk associated with marijuana use may be greater than the cardiovascular risk already established for cigarette smoking,” and longitudinal studies are warranted, they concluded.
The researchers had no financial conflicts to disclose.
The risk of death from hypertension is three times greater in adults who use marijuana, compared with nonusers, based on data from a retrospective study of 1,213 adults.
Changes in the legalization of marijuana may promote increased recreational use, but data on the long-term effects of marijuana use on cardiovascular and cerebrovascular mortality are limited, wrote Barbara A. Yankey, PhD, of Georgia State University, Atlanta, and her colleagues.
Data on 686 users and 527 nonusers were combined with the 2011 mortality data from the National Center for Health Statistics (Eur J Prev Cardiol. 2017 Aug 9; doi: 10.1177/2047487317723212).
Overall, marijuana users had a 3.42 times greater risk of death from hypertension than did nonusers (95% confidence interval, 1.20-9.79), and the risk increased by 1.04 for each year of use (95% CI, 1.00-1.07). The average duration of marijuana use was 11.5 years. At the time of study entry, the average age of the participants was 38 years, and the average body mass index was 29 kg/m2; 23% of marijuana users and 21% of nonusers had a prior diagnosis of hypertension.
Of the study participants, 20% used marijuana and smoked cigarettes, 16% used marijuana and were past smokers, 5% were past smokers, and 4% only smoked cigarettes. “In our study, increase in risk for hypertension, [heart disease], or cerebrovascular disease mortality associated with cigarette use was not significant,” the researchers wrote. They attributed this factor to the small sample size and noted that the dangers of cigarette smoking to the cardiovascular system are well established.
The study findings were limited by the relatively small sample size and potentially inaccurate data on the duration of marijuana use, the researchers said.
However, the results suggest that “cardiovascular risk associated with marijuana use may be greater than the cardiovascular risk already established for cigarette smoking,” and longitudinal studies are warranted, they concluded.
The researchers had no financial conflicts to disclose.
The risk of death from hypertension is three times greater in adults who use marijuana, compared with nonusers, based on data from a retrospective study of 1,213 adults.
Changes in the legalization of marijuana may promote increased recreational use, but data on the long-term effects of marijuana use on cardiovascular and cerebrovascular mortality are limited, wrote Barbara A. Yankey, PhD, of Georgia State University, Atlanta, and her colleagues.
Data on 686 users and 527 nonusers were combined with the 2011 mortality data from the National Center for Health Statistics (Eur J Prev Cardiol. 2017 Aug 9; doi: 10.1177/2047487317723212).
Overall, marijuana users had a 3.42 times greater risk of death from hypertension than did nonusers (95% confidence interval, 1.20-9.79), and the risk increased by 1.04 for each year of use (95% CI, 1.00-1.07). The average duration of marijuana use was 11.5 years. At the time of study entry, the average age of the participants was 38 years, and the average body mass index was 29 kg/m2; 23% of marijuana users and 21% of nonusers had a prior diagnosis of hypertension.
Of the study participants, 20% used marijuana and smoked cigarettes, 16% used marijuana and were past smokers, 5% were past smokers, and 4% only smoked cigarettes. “In our study, increase in risk for hypertension, [heart disease], or cerebrovascular disease mortality associated with cigarette use was not significant,” the researchers wrote. They attributed this factor to the small sample size and noted that the dangers of cigarette smoking to the cardiovascular system are well established.
The study findings were limited by the relatively small sample size and potentially inaccurate data on the duration of marijuana use, the researchers said.
However, the results suggest that “cardiovascular risk associated with marijuana use may be greater than the cardiovascular risk already established for cigarette smoking,” and longitudinal studies are warranted, they concluded.
The researchers had no financial conflicts to disclose.
FROM THE EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
Key clinical point: A history of marijuana use significantly increases the risk of death from hypertension.
Major finding: Marijuana users had a 3.42 times higher risk of death from hypertension and a 1.04 times increased risk of death for each year of use.
Data source: A retrospective study of 1,213 adults aged 20 years and older using data from National Health and Nutrition Examination Survey and the National Center for Health Statistics.
Disclosures: The researchers had no financial conflicts to disclose.
Childhood poverty sets stage for adult heart disease
Children from the poorest families show signs of thicker carotid artery walls that may raise their risk for heart attack and stroke as adults, according to data from a longitudinal study of more than 1,000 families in Australia.
“Understanding when associations between SEP [socioeconomic position] and CVD [cardiovascular disease] first appear may help address the increasing social gradients in CVD outcomes and risk factors,” wrote Richard S. Liu, MD, of the Murdoch Children’s Research Institute, Parkville, Australia, and colleagues.
The researchers reviewed data from 1,477 families in Australia. Socioeconomic position of the children’s families was measured biennially at age 0-1 year and onward, and the researchers used imaging to measure the right carotid arteries of children between age 11 and 12 years. Overall, children in the lowest socioeconomic quartile at age 11-12 years were 46% more likely than those in the highest quartile to have thicker carotid arteries (defined as greater than the 75th percentile).
“In univariable analyses, each quartile increment higher of family SEP was associated with a 3.7-micrometer thicker carotid intima-media thickness [IMT],” and the association remained significant in a multivariate analysis controlling for cardiovascular risk factors including secondhand smoke, body weight, and blood pressure, the researchers wrote.
The socioeconomic status of the family had a greater impact than that of the neighborhood, they noted.
In addition, low socioeconomic status of a child’s family at age 2-3 years was associated with thickness in carotid artery measurements at age 11-12 years.
The study findings were limited by several factors, including a lack of data on the clinical consequences of increased carotid thickness in children, as well as the need for investigation of other signs of subclinical atherosclerosis, the researchers said. However, “consistent evidence showed an association between SEP from early life and midchildhood carotid IMT,” and additional research is needed to explore the impact of household factors on childhood health, they emphasized.
The findings were published online Aug. 9 in the Journal of the American Heart Association (J Am Heart Assoc. 2017;6:e0059255).
The study was funded by the National Health and Medical Research Council of Australia and several research institutions. The researchers had no financial conflicts to disclose.
Children from the poorest families show signs of thicker carotid artery walls that may raise their risk for heart attack and stroke as adults, according to data from a longitudinal study of more than 1,000 families in Australia.
“Understanding when associations between SEP [socioeconomic position] and CVD [cardiovascular disease] first appear may help address the increasing social gradients in CVD outcomes and risk factors,” wrote Richard S. Liu, MD, of the Murdoch Children’s Research Institute, Parkville, Australia, and colleagues.
The researchers reviewed data from 1,477 families in Australia. Socioeconomic position of the children’s families was measured biennially at age 0-1 year and onward, and the researchers used imaging to measure the right carotid arteries of children between age 11 and 12 years. Overall, children in the lowest socioeconomic quartile at age 11-12 years were 46% more likely than those in the highest quartile to have thicker carotid arteries (defined as greater than the 75th percentile).
“In univariable analyses, each quartile increment higher of family SEP was associated with a 3.7-micrometer thicker carotid intima-media thickness [IMT],” and the association remained significant in a multivariate analysis controlling for cardiovascular risk factors including secondhand smoke, body weight, and blood pressure, the researchers wrote.
The socioeconomic status of the family had a greater impact than that of the neighborhood, they noted.
In addition, low socioeconomic status of a child’s family at age 2-3 years was associated with thickness in carotid artery measurements at age 11-12 years.
The study findings were limited by several factors, including a lack of data on the clinical consequences of increased carotid thickness in children, as well as the need for investigation of other signs of subclinical atherosclerosis, the researchers said. However, “consistent evidence showed an association between SEP from early life and midchildhood carotid IMT,” and additional research is needed to explore the impact of household factors on childhood health, they emphasized.
The findings were published online Aug. 9 in the Journal of the American Heart Association (J Am Heart Assoc. 2017;6:e0059255).
The study was funded by the National Health and Medical Research Council of Australia and several research institutions. The researchers had no financial conflicts to disclose.
Children from the poorest families show signs of thicker carotid artery walls that may raise their risk for heart attack and stroke as adults, according to data from a longitudinal study of more than 1,000 families in Australia.
“Understanding when associations between SEP [socioeconomic position] and CVD [cardiovascular disease] first appear may help address the increasing social gradients in CVD outcomes and risk factors,” wrote Richard S. Liu, MD, of the Murdoch Children’s Research Institute, Parkville, Australia, and colleagues.
The researchers reviewed data from 1,477 families in Australia. Socioeconomic position of the children’s families was measured biennially at age 0-1 year and onward, and the researchers used imaging to measure the right carotid arteries of children between age 11 and 12 years. Overall, children in the lowest socioeconomic quartile at age 11-12 years were 46% more likely than those in the highest quartile to have thicker carotid arteries (defined as greater than the 75th percentile).
“In univariable analyses, each quartile increment higher of family SEP was associated with a 3.7-micrometer thicker carotid intima-media thickness [IMT],” and the association remained significant in a multivariate analysis controlling for cardiovascular risk factors including secondhand smoke, body weight, and blood pressure, the researchers wrote.
The socioeconomic status of the family had a greater impact than that of the neighborhood, they noted.
In addition, low socioeconomic status of a child’s family at age 2-3 years was associated with thickness in carotid artery measurements at age 11-12 years.
The study findings were limited by several factors, including a lack of data on the clinical consequences of increased carotid thickness in children, as well as the need for investigation of other signs of subclinical atherosclerosis, the researchers said. However, “consistent evidence showed an association between SEP from early life and midchildhood carotid IMT,” and additional research is needed to explore the impact of household factors on childhood health, they emphasized.
The findings were published online Aug. 9 in the Journal of the American Heart Association (J Am Heart Assoc. 2017;6:e0059255).
The study was funded by the National Health and Medical Research Council of Australia and several research institutions. The researchers had no financial conflicts to disclose.
FROM THE JOURNAL OF THE AMERICAN HEART ASSOCIATION
Key clinical point: Low socioeconomic status of families was significantly linked with thicker carotid arteries in children at age 11-12 years, which could increase the risk of stroke in adulthood.
Major finding: Children in the lowest socioeconomic group at age 11-12 years were 46% more likely to have carotid intima-media thickness at a level above the 75th percentile.
Data source: A longitudinal study of children from 1,477 families in Australia.
Disclosures: The study was funded by the National Health and Medical Research Council of Australia and several research institutions. The researchers had no financial conflicts to disclose.
Botox smooths prep for hernia surgery
Injections of onabotulinumtoxinA prior to hernia surgery relaxed the abdominal muscles and increased abdominal wall length by an average of 8 cm, based on data from an observational study of 56 patients. The findings were published online in Surgical Endoscopy.
Although laparoscopic ventral hernia repair has a lower recurrence rate than open repair, expanding the abdominal wall remains a challenge, wrote Omar Rodriguez-Acevedo, MD, of the Hernia Institute Australia, Edgecliff, New South Wales, Australia, and colleagues (Surg Endosc. 2017 Jul 21. doi: 10.1007/s00464-017-5750-3).
Nearly three-fourths of the patients (73%) had at least one previous repair. The patients underwent injections of either 200 units or 300 units of BTA between 7 and 14 days before surgery. The average age of the patients was 60 years, and the average body mass index was 40 kg/m2. A subset of 18 patients with larger defects underwent preoperative progressive pneumoperitoneum (PPP) in addition to receiving BTA injections.
Overall, BTA injections significantly increased lateral abdominal length in all subgroups. On average, the length increase per side was 4.4 cm in the 300-unit group, 3.6 cm in the 200-unit group, 4.2 cm in the BtA-only group, and 3.7 cm in the BTA-plus-PPP group. In a pooled analysis, the average gain in length was 4.0 per side.
No significant difference in abdominal wall lengthening was observed between the 200-unit and 300-unit patients or between the BTA-plus-PPP and BTA-only patients.
Overall, the injections were well tolerated, and no complications required intervention, the researchers said. The most common side effects included superficial bruising at the injection site, bloating sensations, weak coughing, and back pain.
The findings were limited by the small study population and by the short follow-up period, and additional long-term follow-up is needed to identify delayed hernia recurrence, the researchers noted. However, the results suggest that “the flaccid paralysis delivered by BTA resulted in the relaxation, elongation, and thinning of the chronically contracted abdominal lateral wall musculature,” which “consequently facilitates laparoscopic repair and primary closure of large defects under minimal tension,” they said.
The researchers had no financial conflicts to disclose.
Injections of onabotulinumtoxinA prior to hernia surgery relaxed the abdominal muscles and increased abdominal wall length by an average of 8 cm, based on data from an observational study of 56 patients. The findings were published online in Surgical Endoscopy.
Although laparoscopic ventral hernia repair has a lower recurrence rate than open repair, expanding the abdominal wall remains a challenge, wrote Omar Rodriguez-Acevedo, MD, of the Hernia Institute Australia, Edgecliff, New South Wales, Australia, and colleagues (Surg Endosc. 2017 Jul 21. doi: 10.1007/s00464-017-5750-3).
Nearly three-fourths of the patients (73%) had at least one previous repair. The patients underwent injections of either 200 units or 300 units of BTA between 7 and 14 days before surgery. The average age of the patients was 60 years, and the average body mass index was 40 kg/m2. A subset of 18 patients with larger defects underwent preoperative progressive pneumoperitoneum (PPP) in addition to receiving BTA injections.
Overall, BTA injections significantly increased lateral abdominal length in all subgroups. On average, the length increase per side was 4.4 cm in the 300-unit group, 3.6 cm in the 200-unit group, 4.2 cm in the BtA-only group, and 3.7 cm in the BTA-plus-PPP group. In a pooled analysis, the average gain in length was 4.0 per side.
No significant difference in abdominal wall lengthening was observed between the 200-unit and 300-unit patients or between the BTA-plus-PPP and BTA-only patients.
Overall, the injections were well tolerated, and no complications required intervention, the researchers said. The most common side effects included superficial bruising at the injection site, bloating sensations, weak coughing, and back pain.
The findings were limited by the small study population and by the short follow-up period, and additional long-term follow-up is needed to identify delayed hernia recurrence, the researchers noted. However, the results suggest that “the flaccid paralysis delivered by BTA resulted in the relaxation, elongation, and thinning of the chronically contracted abdominal lateral wall musculature,” which “consequently facilitates laparoscopic repair and primary closure of large defects under minimal tension,” they said.
The researchers had no financial conflicts to disclose.
Injections of onabotulinumtoxinA prior to hernia surgery relaxed the abdominal muscles and increased abdominal wall length by an average of 8 cm, based on data from an observational study of 56 patients. The findings were published online in Surgical Endoscopy.
Although laparoscopic ventral hernia repair has a lower recurrence rate than open repair, expanding the abdominal wall remains a challenge, wrote Omar Rodriguez-Acevedo, MD, of the Hernia Institute Australia, Edgecliff, New South Wales, Australia, and colleagues (Surg Endosc. 2017 Jul 21. doi: 10.1007/s00464-017-5750-3).
Nearly three-fourths of the patients (73%) had at least one previous repair. The patients underwent injections of either 200 units or 300 units of BTA between 7 and 14 days before surgery. The average age of the patients was 60 years, and the average body mass index was 40 kg/m2. A subset of 18 patients with larger defects underwent preoperative progressive pneumoperitoneum (PPP) in addition to receiving BTA injections.
Overall, BTA injections significantly increased lateral abdominal length in all subgroups. On average, the length increase per side was 4.4 cm in the 300-unit group, 3.6 cm in the 200-unit group, 4.2 cm in the BtA-only group, and 3.7 cm in the BTA-plus-PPP group. In a pooled analysis, the average gain in length was 4.0 per side.
No significant difference in abdominal wall lengthening was observed between the 200-unit and 300-unit patients or between the BTA-plus-PPP and BTA-only patients.
Overall, the injections were well tolerated, and no complications required intervention, the researchers said. The most common side effects included superficial bruising at the injection site, bloating sensations, weak coughing, and back pain.
The findings were limited by the small study population and by the short follow-up period, and additional long-term follow-up is needed to identify delayed hernia recurrence, the researchers noted. However, the results suggest that “the flaccid paralysis delivered by BTA resulted in the relaxation, elongation, and thinning of the chronically contracted abdominal lateral wall musculature,” which “consequently facilitates laparoscopic repair and primary closure of large defects under minimal tension,” they said.
The researchers had no financial conflicts to disclose.
FROM SURGICAL ENDOSCOPY
Key clinical point: Injection with botulinum toxin A prior to hernia repair serves as an effective surgical preparation by temporarily paralyzing the lateral abdominal wall muscles.
Major finding: A comparison of pre- and post-onabotulinumtoxinA images of the abdominal wall showed an unstretched average increase in length of 8.0 cm.
Data source: A prospective, observational study of 56 adults who underwent elective ventral hernia repairs at a single center.
Disclosures: The researchers had no financial conflicts to disclose.
Hormonal IUD is most cost-effective menorrhagia management
Quality of life was higher, and costs were lower, with the levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding than with three other common treatments, according to data from a model and a hypothetical population of 100,000 premenopausal women. The findings were published online in the American Journal of Obstetrics and Gynecology.
“As health systems and policies continue to emphasize value-based treatment decisions, it is important to give physicians and patients the tools to understand the health and economic trade-offs associated with each of these options,” Jennifer C. Spencer of the University of North Carolina, Chapel Hill, and her colleagues wrote (Am J Obstet Gynecol. 2017 Jul 25. doi: 10.1016/j.ajog.2017.07.024).
Overall, LNG-IUS was superior to hysterectomy and both types of endometrial ablation in terms of cost and quality of life, although quality of life scores were similar across all four treatments.
LNG-IUS was cost effective, compared with hysterectomy, in 90% of scenarios. Both types of ablation were similarly more cost effective, compared with hysterectomy; resectoscopic endometrial ablation was more cost effective in 44% of scenarios, nonresectoscopic endometrial ablation was more cost effective in 53% of scenarios.
“The 5-year cost of women undergoing LNG-IUS was $4,500, about half the cost of endometrial ablation ($9,500) and about one-third the cost of hysterectomy ($13,500),” the researchers noted.
“Our analysis finds strong evidence in favor of LNG-IUS as a cost-saving, dominant alternative to hysterectomy for women with heavy menstrual bleeding,” they wrote.
If LNG-IUS is not an option, the model shows that hysterectomy resulted in better quality of life in the majority of simulations but is cost effective in just over half of the simulations, compared with either resectoscopic or nonresectoscopic ablation.
“The comparative cost effectiveness of endometrial ablation and hysterectomy highlights important trade-offs for patients and providers to consider when selecting between treatment options, such as the need for future procedures or the potential for rare, but serious, complications,” the researchers wrote.
No other studies on this topic have been conducted in the United States, but the findings are consistent with results from studies conducted outside the United States, the researchers wrote.
The study was limited by the short follow-up period and the inability to extend the model to women with large fibroids, polyps, or other uterine pathologies.
Two of the authors reported receiving grant funding from Pfizer for an unrelated study. Other authors reported serving as consultants for Teleflex Medical, Applied Medical, and Olympus.
Quality of life was higher, and costs were lower, with the levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding than with three other common treatments, according to data from a model and a hypothetical population of 100,000 premenopausal women. The findings were published online in the American Journal of Obstetrics and Gynecology.
“As health systems and policies continue to emphasize value-based treatment decisions, it is important to give physicians and patients the tools to understand the health and economic trade-offs associated with each of these options,” Jennifer C. Spencer of the University of North Carolina, Chapel Hill, and her colleagues wrote (Am J Obstet Gynecol. 2017 Jul 25. doi: 10.1016/j.ajog.2017.07.024).
Overall, LNG-IUS was superior to hysterectomy and both types of endometrial ablation in terms of cost and quality of life, although quality of life scores were similar across all four treatments.
LNG-IUS was cost effective, compared with hysterectomy, in 90% of scenarios. Both types of ablation were similarly more cost effective, compared with hysterectomy; resectoscopic endometrial ablation was more cost effective in 44% of scenarios, nonresectoscopic endometrial ablation was more cost effective in 53% of scenarios.
“The 5-year cost of women undergoing LNG-IUS was $4,500, about half the cost of endometrial ablation ($9,500) and about one-third the cost of hysterectomy ($13,500),” the researchers noted.
“Our analysis finds strong evidence in favor of LNG-IUS as a cost-saving, dominant alternative to hysterectomy for women with heavy menstrual bleeding,” they wrote.
If LNG-IUS is not an option, the model shows that hysterectomy resulted in better quality of life in the majority of simulations but is cost effective in just over half of the simulations, compared with either resectoscopic or nonresectoscopic ablation.
“The comparative cost effectiveness of endometrial ablation and hysterectomy highlights important trade-offs for patients and providers to consider when selecting between treatment options, such as the need for future procedures or the potential for rare, but serious, complications,” the researchers wrote.
No other studies on this topic have been conducted in the United States, but the findings are consistent with results from studies conducted outside the United States, the researchers wrote.
The study was limited by the short follow-up period and the inability to extend the model to women with large fibroids, polyps, or other uterine pathologies.
Two of the authors reported receiving grant funding from Pfizer for an unrelated study. Other authors reported serving as consultants for Teleflex Medical, Applied Medical, and Olympus.
Quality of life was higher, and costs were lower, with the levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding than with three other common treatments, according to data from a model and a hypothetical population of 100,000 premenopausal women. The findings were published online in the American Journal of Obstetrics and Gynecology.
“As health systems and policies continue to emphasize value-based treatment decisions, it is important to give physicians and patients the tools to understand the health and economic trade-offs associated with each of these options,” Jennifer C. Spencer of the University of North Carolina, Chapel Hill, and her colleagues wrote (Am J Obstet Gynecol. 2017 Jul 25. doi: 10.1016/j.ajog.2017.07.024).
Overall, LNG-IUS was superior to hysterectomy and both types of endometrial ablation in terms of cost and quality of life, although quality of life scores were similar across all four treatments.
LNG-IUS was cost effective, compared with hysterectomy, in 90% of scenarios. Both types of ablation were similarly more cost effective, compared with hysterectomy; resectoscopic endometrial ablation was more cost effective in 44% of scenarios, nonresectoscopic endometrial ablation was more cost effective in 53% of scenarios.
“The 5-year cost of women undergoing LNG-IUS was $4,500, about half the cost of endometrial ablation ($9,500) and about one-third the cost of hysterectomy ($13,500),” the researchers noted.
“Our analysis finds strong evidence in favor of LNG-IUS as a cost-saving, dominant alternative to hysterectomy for women with heavy menstrual bleeding,” they wrote.
If LNG-IUS is not an option, the model shows that hysterectomy resulted in better quality of life in the majority of simulations but is cost effective in just over half of the simulations, compared with either resectoscopic or nonresectoscopic ablation.
“The comparative cost effectiveness of endometrial ablation and hysterectomy highlights important trade-offs for patients and providers to consider when selecting between treatment options, such as the need for future procedures or the potential for rare, but serious, complications,” the researchers wrote.
No other studies on this topic have been conducted in the United States, but the findings are consistent with results from studies conducted outside the United States, the researchers wrote.
The study was limited by the short follow-up period and the inability to extend the model to women with large fibroids, polyps, or other uterine pathologies.
Two of the authors reported receiving grant funding from Pfizer for an unrelated study. Other authors reported serving as consultants for Teleflex Medical, Applied Medical, and Olympus.
FROM AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Key clinical point:
Major finding: LNG-IUS is the most cost-effective option in 90% of scenarios, compared with hysterectomy.
Data source: The data come from a model created using a literature review of four treatment options: resectoscopic ablation, nonresectoscopic ablation, hysterectomy, and LNG-IUS. It included a hypothetical cohort of 100,000 premenopausal women.
Disclosures: Two of the authors reported receiving grant funding from Pfizer for an unrelated study. Other authors reported serving as consultants for Teleflex Medical, Applied Medical, and Olympus.
One-third of sunscreens fall short of AAD recommendations
Sunscreens sold by two major retailers in the United States in 2017 are more adherent to the American Academy of Dermatology recommendations for sun protection than in 2014, but approximately 35% still do not meet the AAD criteria, according to results of a new study.
The results are based on data from a review of 472 products, available for sale on-line, a follow-up to a 2014 study that examined the proportion of sunscreen products that met three AAD recommendations: a sun protection factor of 30 or higher, broad-spectrum coverage, and 40-80 minutes of water resistance. In the 2014 study, almost 35% of sunscreens sold at Walmart and 41% of sunscreens sold at Walgreens met all three recommendations (J Am Acad Dermatol. 2014;71[5]:1011-2).
Overall, about 65% of Walmart products and 73% of Walgreens products met all three recommendations, a significant increase from 2014 (P less than .01). When the products were broken down by recommendation, more than 90% in 2017 offered broad-spectrum coverage, and more than 75% offered 40-80 minutes of water resistance, representing significant increases from 2014(J Am Acad Dermatol. 2017 Aug;77[2]:377-9).
The proportion of products with SPF 30 or higher “remained stable, possibly because there were already many to begin with,” noted the authors, who found that 82% of the Walmart products and 86% of the Walgreens products had an SPF of at least 30.
Of the 31 products with tanning and bronzing on their primary display, however, only 6 met the three AAD criteria for sun protection; these findings were similar to the findings in 2014.
“Our study demonstrates that sunscreens available at major retailers more closely adhere to AAD guidelines in 2017 than in 2014, but there remains room for improvement,” they said, pointing out that almost 35% of products sold at Walmart, the largest U.S. retailer, did not meet all three recommendations and that “tanning and bronzing products continue to fail to meet AAD criteria.”
The researchers had no financial conflicts to disclose.
Sunscreens sold by two major retailers in the United States in 2017 are more adherent to the American Academy of Dermatology recommendations for sun protection than in 2014, but approximately 35% still do not meet the AAD criteria, according to results of a new study.
The results are based on data from a review of 472 products, available for sale on-line, a follow-up to a 2014 study that examined the proportion of sunscreen products that met three AAD recommendations: a sun protection factor of 30 or higher, broad-spectrum coverage, and 40-80 minutes of water resistance. In the 2014 study, almost 35% of sunscreens sold at Walmart and 41% of sunscreens sold at Walgreens met all three recommendations (J Am Acad Dermatol. 2014;71[5]:1011-2).
Overall, about 65% of Walmart products and 73% of Walgreens products met all three recommendations, a significant increase from 2014 (P less than .01). When the products were broken down by recommendation, more than 90% in 2017 offered broad-spectrum coverage, and more than 75% offered 40-80 minutes of water resistance, representing significant increases from 2014(J Am Acad Dermatol. 2017 Aug;77[2]:377-9).
The proportion of products with SPF 30 or higher “remained stable, possibly because there were already many to begin with,” noted the authors, who found that 82% of the Walmart products and 86% of the Walgreens products had an SPF of at least 30.
Of the 31 products with tanning and bronzing on their primary display, however, only 6 met the three AAD criteria for sun protection; these findings were similar to the findings in 2014.
“Our study demonstrates that sunscreens available at major retailers more closely adhere to AAD guidelines in 2017 than in 2014, but there remains room for improvement,” they said, pointing out that almost 35% of products sold at Walmart, the largest U.S. retailer, did not meet all three recommendations and that “tanning and bronzing products continue to fail to meet AAD criteria.”
The researchers had no financial conflicts to disclose.
Sunscreens sold by two major retailers in the United States in 2017 are more adherent to the American Academy of Dermatology recommendations for sun protection than in 2014, but approximately 35% still do not meet the AAD criteria, according to results of a new study.
The results are based on data from a review of 472 products, available for sale on-line, a follow-up to a 2014 study that examined the proportion of sunscreen products that met three AAD recommendations: a sun protection factor of 30 or higher, broad-spectrum coverage, and 40-80 minutes of water resistance. In the 2014 study, almost 35% of sunscreens sold at Walmart and 41% of sunscreens sold at Walgreens met all three recommendations (J Am Acad Dermatol. 2014;71[5]:1011-2).
Overall, about 65% of Walmart products and 73% of Walgreens products met all three recommendations, a significant increase from 2014 (P less than .01). When the products were broken down by recommendation, more than 90% in 2017 offered broad-spectrum coverage, and more than 75% offered 40-80 minutes of water resistance, representing significant increases from 2014(J Am Acad Dermatol. 2017 Aug;77[2]:377-9).
The proportion of products with SPF 30 or higher “remained stable, possibly because there were already many to begin with,” noted the authors, who found that 82% of the Walmart products and 86% of the Walgreens products had an SPF of at least 30.
Of the 31 products with tanning and bronzing on their primary display, however, only 6 met the three AAD criteria for sun protection; these findings were similar to the findings in 2014.
“Our study demonstrates that sunscreens available at major retailers more closely adhere to AAD guidelines in 2017 than in 2014, but there remains room for improvement,” they said, pointing out that almost 35% of products sold at Walmart, the largest U.S. retailer, did not meet all three recommendations and that “tanning and bronzing products continue to fail to meet AAD criteria.”
The researchers had no financial conflicts to disclose.
FROM JAAD
Key clinical point: Significantly more sunscreen products that meet AAD recommendations are available to consumers in 2017 than in 2014, but there is still room for improvement.
Major finding: Approximately 35% of sunscreen products at two major retailers failed to meet AAD recommendations.
Data source: A review of 472 sunscreen products sold at Walmart and Walgreens stores.
Disclosures: The researchers had no relevant financial conflicts to disclose.
Mobile messages support safe sleep practices
Mobile health interventions targeting mothers of healthy newborns significantly improved safe sleep practices, compared with controls, in a randomized trial of 1,600 mothers published online July 25 in JAMA.
Despite the success of the Back to Sleep campaign in reducing rates of sudden infant death syndrome, approximately 3,500 infant deaths due to SIDS, accidental suffocation, or strangulation in bed occurred in 2014, wrote Rachel Y. Moon, MD, of the University of Virginia, Charlottesville, and her colleagues (JAMA. 2017;318:351-9).
A total of 1,263 mothers completed the study, and mothers who received the mobile messages about safe sleep were significantly more likely than those who received the control messages to engage in safe sleep practices, including placing babies on their backs (89% vs. 80%), sharing a room without cosleeping (83% vs. 70%), avoiding the use of soft bedding (79% vs. 68%), and use of pacifiers (69% vs. 60%). The initial nursing quality intervention alone had no significant impact on any of the safe sleep practices, the researchers noted.
The results were limited by several factors, including the 21% lost to follow up and lack of data on adverse events and clinical outcomes, the researchers said. However, the results suggest that mobile messages could be cost effective and easily implemented by hospitals.
“Furthermore, because the rates of opening and viewing messages in this study were consistently higher than 50%, and almost all adults now have cell phones or email access, it is likely that this type of intervention would be feasible and well received by parents,” Dr. Moon and her associates added. “Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied.”
“The messages and videos were timed to address challenges and questions that arise at specific time points; therefore, providing this additional information to parents at critical times may have been important in assuaging concerns about adherence to recommended practices. Furthermore, receiving frequent videos and email or text messages may have served as a virtual support system for mothers, reinforcing safe parental practices,” Dr. Moon and her associates noted.
The researchers had no financial conflicts to disclose. The study was supported in part by the National Institute of Child Health and Human Development and by the CJ Foundation for SIDS.
In this study by Dr. Moon and her associates, new mothers who received both the nursing educational intervention and mobile intervention for safe sleep reported the highest percentages for adhering to safe sleep practices, and moms who received the safe sleep mobile intervention alone had the second-highest percentages.
However, the study was underpowered and too short termed to determine whether this intervention actually will reduce the occurrence of SIDS.
Limitations of this study include that the mothers who did not respond at follow-up were more likely to be younger, black, single, and less educated – all risk factors for SIDS. The study also was restricted to healthy term infants, and preterm babies are another high-risk SIDS group.
Nonetheless, the fact that this study chose to use multifaceted approaches was promising, combining “health messaging, education of health care professionals, and interventions aimed at reducing barriers to safe sleep practices for infant caregivers.” Whatever interventions are tried, they “need to be adapted for implementation among the highest-risk groups such as non-Hispanic black, American Indian, and Alaskan Native mothers and families because these are the populations with the highest rates of SIDS and sleep-related infant death.”
Carrie K. Shapiro-Mendoza, PhD, MPH is affiliated with the division of reproductive health at the Centers for Disease Control and Prevention in Atlanta, Georgia. She commented in an editorial accompanying the report by Moon et al. (JAMA. 2017;318:336-8). Dr. Shapiro-Mendoza had no financial conflicts to disclose.
In this study by Dr. Moon and her associates, new mothers who received both the nursing educational intervention and mobile intervention for safe sleep reported the highest percentages for adhering to safe sleep practices, and moms who received the safe sleep mobile intervention alone had the second-highest percentages.
However, the study was underpowered and too short termed to determine whether this intervention actually will reduce the occurrence of SIDS.
Limitations of this study include that the mothers who did not respond at follow-up were more likely to be younger, black, single, and less educated – all risk factors for SIDS. The study also was restricted to healthy term infants, and preterm babies are another high-risk SIDS group.
Nonetheless, the fact that this study chose to use multifaceted approaches was promising, combining “health messaging, education of health care professionals, and interventions aimed at reducing barriers to safe sleep practices for infant caregivers.” Whatever interventions are tried, they “need to be adapted for implementation among the highest-risk groups such as non-Hispanic black, American Indian, and Alaskan Native mothers and families because these are the populations with the highest rates of SIDS and sleep-related infant death.”
Carrie K. Shapiro-Mendoza, PhD, MPH is affiliated with the division of reproductive health at the Centers for Disease Control and Prevention in Atlanta, Georgia. She commented in an editorial accompanying the report by Moon et al. (JAMA. 2017;318:336-8). Dr. Shapiro-Mendoza had no financial conflicts to disclose.
In this study by Dr. Moon and her associates, new mothers who received both the nursing educational intervention and mobile intervention for safe sleep reported the highest percentages for adhering to safe sleep practices, and moms who received the safe sleep mobile intervention alone had the second-highest percentages.
However, the study was underpowered and too short termed to determine whether this intervention actually will reduce the occurrence of SIDS.
Limitations of this study include that the mothers who did not respond at follow-up were more likely to be younger, black, single, and less educated – all risk factors for SIDS. The study also was restricted to healthy term infants, and preterm babies are another high-risk SIDS group.
Nonetheless, the fact that this study chose to use multifaceted approaches was promising, combining “health messaging, education of health care professionals, and interventions aimed at reducing barriers to safe sleep practices for infant caregivers.” Whatever interventions are tried, they “need to be adapted for implementation among the highest-risk groups such as non-Hispanic black, American Indian, and Alaskan Native mothers and families because these are the populations with the highest rates of SIDS and sleep-related infant death.”
Carrie K. Shapiro-Mendoza, PhD, MPH is affiliated with the division of reproductive health at the Centers for Disease Control and Prevention in Atlanta, Georgia. She commented in an editorial accompanying the report by Moon et al. (JAMA. 2017;318:336-8). Dr. Shapiro-Mendoza had no financial conflicts to disclose.
Mobile health interventions targeting mothers of healthy newborns significantly improved safe sleep practices, compared with controls, in a randomized trial of 1,600 mothers published online July 25 in JAMA.
Despite the success of the Back to Sleep campaign in reducing rates of sudden infant death syndrome, approximately 3,500 infant deaths due to SIDS, accidental suffocation, or strangulation in bed occurred in 2014, wrote Rachel Y. Moon, MD, of the University of Virginia, Charlottesville, and her colleagues (JAMA. 2017;318:351-9).
A total of 1,263 mothers completed the study, and mothers who received the mobile messages about safe sleep were significantly more likely than those who received the control messages to engage in safe sleep practices, including placing babies on their backs (89% vs. 80%), sharing a room without cosleeping (83% vs. 70%), avoiding the use of soft bedding (79% vs. 68%), and use of pacifiers (69% vs. 60%). The initial nursing quality intervention alone had no significant impact on any of the safe sleep practices, the researchers noted.
The results were limited by several factors, including the 21% lost to follow up and lack of data on adverse events and clinical outcomes, the researchers said. However, the results suggest that mobile messages could be cost effective and easily implemented by hospitals.
“Furthermore, because the rates of opening and viewing messages in this study were consistently higher than 50%, and almost all adults now have cell phones or email access, it is likely that this type of intervention would be feasible and well received by parents,” Dr. Moon and her associates added. “Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied.”
“The messages and videos were timed to address challenges and questions that arise at specific time points; therefore, providing this additional information to parents at critical times may have been important in assuaging concerns about adherence to recommended practices. Furthermore, receiving frequent videos and email or text messages may have served as a virtual support system for mothers, reinforcing safe parental practices,” Dr. Moon and her associates noted.
The researchers had no financial conflicts to disclose. The study was supported in part by the National Institute of Child Health and Human Development and by the CJ Foundation for SIDS.
Mobile health interventions targeting mothers of healthy newborns significantly improved safe sleep practices, compared with controls, in a randomized trial of 1,600 mothers published online July 25 in JAMA.
Despite the success of the Back to Sleep campaign in reducing rates of sudden infant death syndrome, approximately 3,500 infant deaths due to SIDS, accidental suffocation, or strangulation in bed occurred in 2014, wrote Rachel Y. Moon, MD, of the University of Virginia, Charlottesville, and her colleagues (JAMA. 2017;318:351-9).
A total of 1,263 mothers completed the study, and mothers who received the mobile messages about safe sleep were significantly more likely than those who received the control messages to engage in safe sleep practices, including placing babies on their backs (89% vs. 80%), sharing a room without cosleeping (83% vs. 70%), avoiding the use of soft bedding (79% vs. 68%), and use of pacifiers (69% vs. 60%). The initial nursing quality intervention alone had no significant impact on any of the safe sleep practices, the researchers noted.
The results were limited by several factors, including the 21% lost to follow up and lack of data on adverse events and clinical outcomes, the researchers said. However, the results suggest that mobile messages could be cost effective and easily implemented by hospitals.
“Furthermore, because the rates of opening and viewing messages in this study were consistently higher than 50%, and almost all adults now have cell phones or email access, it is likely that this type of intervention would be feasible and well received by parents,” Dr. Moon and her associates added. “Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied.”
“The messages and videos were timed to address challenges and questions that arise at specific time points; therefore, providing this additional information to parents at critical times may have been important in assuaging concerns about adherence to recommended practices. Furthermore, receiving frequent videos and email or text messages may have served as a virtual support system for mothers, reinforcing safe parental practices,” Dr. Moon and her associates noted.
The researchers had no financial conflicts to disclose. The study was supported in part by the National Institute of Child Health and Human Development and by the CJ Foundation for SIDS.
FROM JAMA
Key clinical point: Email and text messages effectively communicated safe infant sleep practices to mothers.
Major finding: Overall,
Data source: The data come from a randomized trial of 1,600 mothers with healthy newborns.
Disclosures: The researchers had no financial conflicts to disclose. The study was supported in part by the National Institute of Child Health and Human Development and by the CJ Foundation for SIDS.
Minor measles vaccination decline could triple childhood cases
, based on data from a mathematical model published in JAMA Pediatrics.
Increased reluctance among parents to vaccinate children has led to calls for a government commission on vaccine safety, wrote Nathan C. Lo of Stanford (Calif.) University, and Peter J. Hotez, MD, PhD, of Baylor College of Medicine, Houston (JAMA Pediatr. 2017 Jul 24. doi: 10.1001/jamapediatrics.2017.1695).
The researchers sought to estimate the potential impact of reduced vaccination on public health and the economy, using the MMR vaccine as an example. They collected vaccination data from the Centers for Disease Control and Prevention, created a mathematical model, and estimated $20,000 per case of measles from a public health perspective. They simulated a measles outbreak following the importation of measles into a county in the United States, and estimated the size of an outbreak based on local vaccine coverage.
In the model population, the average baseline coverage for MMR vaccination was 93% prevalence (varying by state from 87% to 97%). The average prevalence of nonmedical exemptions was 2%; state prevalence ranged from 0.4% to 6.2%. The annual number of measles cases was 48.
Using the model, a drop in MMR vaccination as little as 5% “would result in a threefold increase in national measles cases in this age group, for a total of 150 cases and an additional $2.1 million in economic costs to the public sector,” the researchers said. By contrast, increasing national MMR coverage to 95% would reduce the number of cases by 20%, they predicted.
“These estimates would be substantially higher if unvaccinated infants, adolescents, and adult populations are also considered,” Mr. Lo and Dr. Hotez said.
The study findings were limited by the use of a model and simulation of vaccine coverage, and by restricting the study to children aged 2-11 years.
However, the results “directly confront the notion that measles is no longer a threat in the United States,” and suggest “substantial public health and economic consequences with even minor reductions in MMR coverage due to vaccine hesitancy,” they emphasized. “Removal of the nonmedical personal belief exemptions for childhood vaccination may mitigate these consequences.”
Mr. Lo disclosed funding from Stanford’s Medical Scientist Training Program; no financial conflicts were disclosed.
, based on data from a mathematical model published in JAMA Pediatrics.
Increased reluctance among parents to vaccinate children has led to calls for a government commission on vaccine safety, wrote Nathan C. Lo of Stanford (Calif.) University, and Peter J. Hotez, MD, PhD, of Baylor College of Medicine, Houston (JAMA Pediatr. 2017 Jul 24. doi: 10.1001/jamapediatrics.2017.1695).
The researchers sought to estimate the potential impact of reduced vaccination on public health and the economy, using the MMR vaccine as an example. They collected vaccination data from the Centers for Disease Control and Prevention, created a mathematical model, and estimated $20,000 per case of measles from a public health perspective. They simulated a measles outbreak following the importation of measles into a county in the United States, and estimated the size of an outbreak based on local vaccine coverage.
In the model population, the average baseline coverage for MMR vaccination was 93% prevalence (varying by state from 87% to 97%). The average prevalence of nonmedical exemptions was 2%; state prevalence ranged from 0.4% to 6.2%. The annual number of measles cases was 48.
Using the model, a drop in MMR vaccination as little as 5% “would result in a threefold increase in national measles cases in this age group, for a total of 150 cases and an additional $2.1 million in economic costs to the public sector,” the researchers said. By contrast, increasing national MMR coverage to 95% would reduce the number of cases by 20%, they predicted.
“These estimates would be substantially higher if unvaccinated infants, adolescents, and adult populations are also considered,” Mr. Lo and Dr. Hotez said.
The study findings were limited by the use of a model and simulation of vaccine coverage, and by restricting the study to children aged 2-11 years.
However, the results “directly confront the notion that measles is no longer a threat in the United States,” and suggest “substantial public health and economic consequences with even minor reductions in MMR coverage due to vaccine hesitancy,” they emphasized. “Removal of the nonmedical personal belief exemptions for childhood vaccination may mitigate these consequences.”
Mr. Lo disclosed funding from Stanford’s Medical Scientist Training Program; no financial conflicts were disclosed.
, based on data from a mathematical model published in JAMA Pediatrics.
Increased reluctance among parents to vaccinate children has led to calls for a government commission on vaccine safety, wrote Nathan C. Lo of Stanford (Calif.) University, and Peter J. Hotez, MD, PhD, of Baylor College of Medicine, Houston (JAMA Pediatr. 2017 Jul 24. doi: 10.1001/jamapediatrics.2017.1695).
The researchers sought to estimate the potential impact of reduced vaccination on public health and the economy, using the MMR vaccine as an example. They collected vaccination data from the Centers for Disease Control and Prevention, created a mathematical model, and estimated $20,000 per case of measles from a public health perspective. They simulated a measles outbreak following the importation of measles into a county in the United States, and estimated the size of an outbreak based on local vaccine coverage.
In the model population, the average baseline coverage for MMR vaccination was 93% prevalence (varying by state from 87% to 97%). The average prevalence of nonmedical exemptions was 2%; state prevalence ranged from 0.4% to 6.2%. The annual number of measles cases was 48.
Using the model, a drop in MMR vaccination as little as 5% “would result in a threefold increase in national measles cases in this age group, for a total of 150 cases and an additional $2.1 million in economic costs to the public sector,” the researchers said. By contrast, increasing national MMR coverage to 95% would reduce the number of cases by 20%, they predicted.
“These estimates would be substantially higher if unvaccinated infants, adolescents, and adult populations are also considered,” Mr. Lo and Dr. Hotez said.
The study findings were limited by the use of a model and simulation of vaccine coverage, and by restricting the study to children aged 2-11 years.
However, the results “directly confront the notion that measles is no longer a threat in the United States,” and suggest “substantial public health and economic consequences with even minor reductions in MMR coverage due to vaccine hesitancy,” they emphasized. “Removal of the nonmedical personal belief exemptions for childhood vaccination may mitigate these consequences.”
Mr. Lo disclosed funding from Stanford’s Medical Scientist Training Program; no financial conflicts were disclosed.
FROM JAMA PEDIATRICS
Key clinical point: Even a small reduction in vaccination rates has significant public health and economic implications.
Major finding: A 5% decline in MMR vaccine coverage among children aged 2-11 years in the United States would yield an additional 150 measles cases at an economic cost of $2.1 million.
Data source: The data come from an analysis of children aged 2-11 years based on a mathematical model of MMR vaccination.
Disclosures: Mr. Lo disclosed funding from Stanford’s Medical Scientist Training Program; no financial conflicts were disclosed.
EUS beats MRCP on sensitivity for bile duct stones
Endoscopic ultrasound (EUS) beat magnetic resonance cholangiopancreatography (MRCP) on diagnostic accuracy for choledocholithiasis, but both provided similar specificity, according to data from a meta-analysis of head-to-head comparisons. The findings were published in Gastrointestinal Endoscopy.
EUS and MRCP can provide accurate diagnosis of choledocholithiasis with lower adverse event rates than the clinical standards of endoscopic retrograde cholangiopancreatography and intraoperative cholangiography, but a meta-analysis of the diagnostic test accuracy (DTA) of the two methods was lacking, wrote Mohammad Yaghoobi, MD, of McMaster University, Hamilton, Ont., and his colleagues (Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.06.009).
“The methodology of a meta-analysis of DTA is different from a conventional meta-analysis in several aspects, including statistical analysis and quality assessment of the included trials,” the researchers wrote.
They reviewed data from studies conducted between 1980 and January 2017 and identified five studies of head-to-head comparisons of EUS and MRCP. Studies involving children, and those with insufficient data, no reference standards, and a gap of more than 48 hours between two index tests were excluded.
Overall, the diagnostic odds ratio was significantly higher for EUS than MRCP (P = .008). This difference was mainly a factor of the significantly higher sensitivity of EUS vs. MRCP (P = .006). Specificity was not significantly different between the two tests.
The results were limited by several factors, including inadequate data for a subgroup analysis based on stone size and the relatively small number of studies included in the analysis, but the strict inclusion criteria add to the strength of the findings, the researchers noted.
“EUS should be incorporated in the diagnostic algorithm in patients suspected for choledocholithiasis, whenever appropriate, given its reasonable safety profile,” the researchers said. “This might specially apply to the patients who need an esophagogastroduodenoscopy for investigating other alternative causes of abdominal pain,” they added. The researchers had no financial conflicts to disclose.
Endoscopic ultrasound (EUS) beat magnetic resonance cholangiopancreatography (MRCP) on diagnostic accuracy for choledocholithiasis, but both provided similar specificity, according to data from a meta-analysis of head-to-head comparisons. The findings were published in Gastrointestinal Endoscopy.
EUS and MRCP can provide accurate diagnosis of choledocholithiasis with lower adverse event rates than the clinical standards of endoscopic retrograde cholangiopancreatography and intraoperative cholangiography, but a meta-analysis of the diagnostic test accuracy (DTA) of the two methods was lacking, wrote Mohammad Yaghoobi, MD, of McMaster University, Hamilton, Ont., and his colleagues (Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.06.009).
“The methodology of a meta-analysis of DTA is different from a conventional meta-analysis in several aspects, including statistical analysis and quality assessment of the included trials,” the researchers wrote.
They reviewed data from studies conducted between 1980 and January 2017 and identified five studies of head-to-head comparisons of EUS and MRCP. Studies involving children, and those with insufficient data, no reference standards, and a gap of more than 48 hours between two index tests were excluded.
Overall, the diagnostic odds ratio was significantly higher for EUS than MRCP (P = .008). This difference was mainly a factor of the significantly higher sensitivity of EUS vs. MRCP (P = .006). Specificity was not significantly different between the two tests.
The results were limited by several factors, including inadequate data for a subgroup analysis based on stone size and the relatively small number of studies included in the analysis, but the strict inclusion criteria add to the strength of the findings, the researchers noted.
“EUS should be incorporated in the diagnostic algorithm in patients suspected for choledocholithiasis, whenever appropriate, given its reasonable safety profile,” the researchers said. “This might specially apply to the patients who need an esophagogastroduodenoscopy for investigating other alternative causes of abdominal pain,” they added. The researchers had no financial conflicts to disclose.
Endoscopic ultrasound (EUS) beat magnetic resonance cholangiopancreatography (MRCP) on diagnostic accuracy for choledocholithiasis, but both provided similar specificity, according to data from a meta-analysis of head-to-head comparisons. The findings were published in Gastrointestinal Endoscopy.
EUS and MRCP can provide accurate diagnosis of choledocholithiasis with lower adverse event rates than the clinical standards of endoscopic retrograde cholangiopancreatography and intraoperative cholangiography, but a meta-analysis of the diagnostic test accuracy (DTA) of the two methods was lacking, wrote Mohammad Yaghoobi, MD, of McMaster University, Hamilton, Ont., and his colleagues (Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.06.009).
“The methodology of a meta-analysis of DTA is different from a conventional meta-analysis in several aspects, including statistical analysis and quality assessment of the included trials,” the researchers wrote.
They reviewed data from studies conducted between 1980 and January 2017 and identified five studies of head-to-head comparisons of EUS and MRCP. Studies involving children, and those with insufficient data, no reference standards, and a gap of more than 48 hours between two index tests were excluded.
Overall, the diagnostic odds ratio was significantly higher for EUS than MRCP (P = .008). This difference was mainly a factor of the significantly higher sensitivity of EUS vs. MRCP (P = .006). Specificity was not significantly different between the two tests.
The results were limited by several factors, including inadequate data for a subgroup analysis based on stone size and the relatively small number of studies included in the analysis, but the strict inclusion criteria add to the strength of the findings, the researchers noted.
“EUS should be incorporated in the diagnostic algorithm in patients suspected for choledocholithiasis, whenever appropriate, given its reasonable safety profile,” the researchers said. “This might specially apply to the patients who need an esophagogastroduodenoscopy for investigating other alternative causes of abdominal pain,” they added. The researchers had no financial conflicts to disclose.
FROM GASTROINTESTINAL ENDOSCOPY
Key clinical point: EUS offers greater sensitivity and similar specificity compared with MRCP in detecting choledocholithiasis.
Major finding: The diagnostic odds ratio was significantly higher for EUS than MRCP (P = .008).
Data source: A meta-analysis of diagnostic test accuracy including five head-to-head studies.
Disclosures: The researchers had no financial conflicts to disclose.
Bowel prep score helps predict missed polyps
“Several recent prospective studies of one-time colonoscopies have demonstrated an association between higher BBPS (Boston Bowel Preparation Scale) scores and higher polyp and adenoma detection rates,” wrote Matthew A. Kluge, MD, of Boston University Medical Center, and his colleagues.
“We hypothesized that the BBPS could predict the likelihood of missed polyps based on initial BBPS segment scores among a large consortium of gastroenterology practices throughout the United States, thereby providing evidence to inform recommendations for repeat colonoscopy after less-than-perfect bowel preparation,” they said.
The researchers reviewed data from 335 pairs of colonoscopy exams in which the second exam (C2) was performed within 3 years of the first exam (C1). The primary endpoint was the detection of polyps and advanced polyps among colon segments at C2 stratified by BBPS scores at C1 (Gastrointest Endosc. 2017 Jun 22. doi: 10.1016/j.gie.2017.06.012).
Overall, patients with inadequate bowel prep were significantly more likely than those with adequate prep to be male (71% vs. 60%) and younger (average age, 59 years vs. 61 years). *
In a multivariate model, the risk of advanced polyps at C2 was significantly higher for patients who had advanced polyps at C1 (odds ratio, 3.5), but inadequate BBPS scores at C1 had no significant impact on advanced polyp risk at C2. The risk of advanced polyps at C2 increased slightly with each year of age (OR, 1.1), but was not impacted by sex or time between C1 and C2 visits.
In addition, polyps at C2 were significantly more likely in patients with inadequate examinations at C1 vs. adequate C1 exams (18% vs. 7%).
The study’s strengths include the use of a large database, but limitations include lack of information about pathology and the use of surrogate measures of polyp size, the researchers noted. However, the results highlight the importance of proper bowel prep and support previous observations that “individuals with a BBPS segment score of 0 and 1 may be at increased risk for missed polyps, especially if advanced polyps are detected,” they said.
The study was supported in part by the Clinical Outcomes Research Initiative (CORI) and by the National Institutes of Health, and CORI has received infrastructure support from companies including AstraZeneca, Bard International, Endosoft, Ethicon, GIVEN Imaging, Pentax USA, and ProVation. Lead author Dr. Kluge had no financial conflicts to disclose.
* This story was updated on 7/26/2017
“Several recent prospective studies of one-time colonoscopies have demonstrated an association between higher BBPS (Boston Bowel Preparation Scale) scores and higher polyp and adenoma detection rates,” wrote Matthew A. Kluge, MD, of Boston University Medical Center, and his colleagues.
“We hypothesized that the BBPS could predict the likelihood of missed polyps based on initial BBPS segment scores among a large consortium of gastroenterology practices throughout the United States, thereby providing evidence to inform recommendations for repeat colonoscopy after less-than-perfect bowel preparation,” they said.
The researchers reviewed data from 335 pairs of colonoscopy exams in which the second exam (C2) was performed within 3 years of the first exam (C1). The primary endpoint was the detection of polyps and advanced polyps among colon segments at C2 stratified by BBPS scores at C1 (Gastrointest Endosc. 2017 Jun 22. doi: 10.1016/j.gie.2017.06.012).
Overall, patients with inadequate bowel prep were significantly more likely than those with adequate prep to be male (71% vs. 60%) and younger (average age, 59 years vs. 61 years). *
In a multivariate model, the risk of advanced polyps at C2 was significantly higher for patients who had advanced polyps at C1 (odds ratio, 3.5), but inadequate BBPS scores at C1 had no significant impact on advanced polyp risk at C2. The risk of advanced polyps at C2 increased slightly with each year of age (OR, 1.1), but was not impacted by sex or time between C1 and C2 visits.
In addition, polyps at C2 were significantly more likely in patients with inadequate examinations at C1 vs. adequate C1 exams (18% vs. 7%).
The study’s strengths include the use of a large database, but limitations include lack of information about pathology and the use of surrogate measures of polyp size, the researchers noted. However, the results highlight the importance of proper bowel prep and support previous observations that “individuals with a BBPS segment score of 0 and 1 may be at increased risk for missed polyps, especially if advanced polyps are detected,” they said.
The study was supported in part by the Clinical Outcomes Research Initiative (CORI) and by the National Institutes of Health, and CORI has received infrastructure support from companies including AstraZeneca, Bard International, Endosoft, Ethicon, GIVEN Imaging, Pentax USA, and ProVation. Lead author Dr. Kluge had no financial conflicts to disclose.
* This story was updated on 7/26/2017
“Several recent prospective studies of one-time colonoscopies have demonstrated an association between higher BBPS (Boston Bowel Preparation Scale) scores and higher polyp and adenoma detection rates,” wrote Matthew A. Kluge, MD, of Boston University Medical Center, and his colleagues.
“We hypothesized that the BBPS could predict the likelihood of missed polyps based on initial BBPS segment scores among a large consortium of gastroenterology practices throughout the United States, thereby providing evidence to inform recommendations for repeat colonoscopy after less-than-perfect bowel preparation,” they said.
The researchers reviewed data from 335 pairs of colonoscopy exams in which the second exam (C2) was performed within 3 years of the first exam (C1). The primary endpoint was the detection of polyps and advanced polyps among colon segments at C2 stratified by BBPS scores at C1 (Gastrointest Endosc. 2017 Jun 22. doi: 10.1016/j.gie.2017.06.012).
Overall, patients with inadequate bowel prep were significantly more likely than those with adequate prep to be male (71% vs. 60%) and younger (average age, 59 years vs. 61 years). *
In a multivariate model, the risk of advanced polyps at C2 was significantly higher for patients who had advanced polyps at C1 (odds ratio, 3.5), but inadequate BBPS scores at C1 had no significant impact on advanced polyp risk at C2. The risk of advanced polyps at C2 increased slightly with each year of age (OR, 1.1), but was not impacted by sex or time between C1 and C2 visits.
In addition, polyps at C2 were significantly more likely in patients with inadequate examinations at C1 vs. adequate C1 exams (18% vs. 7%).
The study’s strengths include the use of a large database, but limitations include lack of information about pathology and the use of surrogate measures of polyp size, the researchers noted. However, the results highlight the importance of proper bowel prep and support previous observations that “individuals with a BBPS segment score of 0 and 1 may be at increased risk for missed polyps, especially if advanced polyps are detected,” they said.
The study was supported in part by the Clinical Outcomes Research Initiative (CORI) and by the National Institutes of Health, and CORI has received infrastructure support from companies including AstraZeneca, Bard International, Endosoft, Ethicon, GIVEN Imaging, Pentax USA, and ProVation. Lead author Dr. Kluge had no financial conflicts to disclose.
* This story was updated on 7/26/2017
FROM GASTROINTESTINAL ENDOSCOPY
Key clinical point: Individuals with a score of 0 or 1 on the Boston Bowel Preparation Scale may be at increased risk for missed polyps.
Major finding: Polyps at a second colonoscopy were significantly more likely in patients who had advanced polyps at an initial visit (odds ratio, 3.5).
Data source: The data come from a prospective, observational study of adults aged 50-75 years who had average risk screening colonoscopies.
Disclosures: The study was supported in part by the Clinical Outcomes Research Initiative (CORI) and by the National Institutes of Health, and CORI has received infrastructure support from companies including AstraZeneca, Bard International, Endosoft, Ethicon, GIVEN Imaging, Pentax USA, and ProVation. Dr. Kluge had no financial conflicts to disclose.
New tool predicts antimicrobial resistance in sepsis
Use of a clinical decision tree predicted antibiotic resistance in sepsis patients infected with gram-negative bacteria, based on data from 1,618 patients.
Increasing rates of bacterial resistance have “contributed to the unwarranted empiric administration of broad-spectrum antibiotics, further promoting resistance emergence across microbial species,” said M. Cristina Vazquez Guillamet, MD, of the University of New Mexico, Albuquerque, and her colleagues (Clin Infect Dis. cix612. 2017 Jul 10. doi: 10.1093/cid/cix612).
The researchers identified adults with sepsis or septic shock caused by bloodstream infections who were treated at a single center between 2008 and 2015. They developed clinical decision trees using the CHAID algorithm (Chi squared Automatic Interaction Detection) to analyze risk factors for resistance associated with three antibiotics: piperacillin-tazobactam (PT), cefepime (CE), and meropenem (ME).
Overall, resistance rates to PT, CE, and ME were 29%, 22%, and 9%, respectively, and 6.6% of the isolates were resistant to all three antibiotics.
Factors associated with increased resistance risk included residence in a nursing home, transfer from an outside hospital, and prior antibiotics use. Resistance to ME was associated with infection with Pseudomonas or Acinetobacter spp, the researchers noted, and resistance to PT was associated with central nervous system and central venous catheter infections.
Clinical decision trees were able to separate patients at low risk for resistance to PT and CE, as well as those with a risk greater than 30% of resistance to PT, CE, or ME. “We also found good overall agreement between the accuracies of the [multivariable logistic regression] models and the decision tree analyses for predicting antibiotic resistance,” the researchers said.
The findings were limited by several factors, including the use of data from a single center and incomplete reporting of previous antibiotic exposure, the researchers noted. However, the results “provide a framework for how empiric antibiotics can be tailored according to decision tree patient clusters,” they said.
Combining user-friendly clinical decision trees and multivariable logistic regression models may offer the best opportunities for hospitals to derive local models to help with antimicrobial prescription.
The researchers had no financial conflicts to disclose.
Use of a clinical decision tree predicted antibiotic resistance in sepsis patients infected with gram-negative bacteria, based on data from 1,618 patients.
Increasing rates of bacterial resistance have “contributed to the unwarranted empiric administration of broad-spectrum antibiotics, further promoting resistance emergence across microbial species,” said M. Cristina Vazquez Guillamet, MD, of the University of New Mexico, Albuquerque, and her colleagues (Clin Infect Dis. cix612. 2017 Jul 10. doi: 10.1093/cid/cix612).
The researchers identified adults with sepsis or septic shock caused by bloodstream infections who were treated at a single center between 2008 and 2015. They developed clinical decision trees using the CHAID algorithm (Chi squared Automatic Interaction Detection) to analyze risk factors for resistance associated with three antibiotics: piperacillin-tazobactam (PT), cefepime (CE), and meropenem (ME).
Overall, resistance rates to PT, CE, and ME were 29%, 22%, and 9%, respectively, and 6.6% of the isolates were resistant to all three antibiotics.
Factors associated with increased resistance risk included residence in a nursing home, transfer from an outside hospital, and prior antibiotics use. Resistance to ME was associated with infection with Pseudomonas or Acinetobacter spp, the researchers noted, and resistance to PT was associated with central nervous system and central venous catheter infections.
Clinical decision trees were able to separate patients at low risk for resistance to PT and CE, as well as those with a risk greater than 30% of resistance to PT, CE, or ME. “We also found good overall agreement between the accuracies of the [multivariable logistic regression] models and the decision tree analyses for predicting antibiotic resistance,” the researchers said.
The findings were limited by several factors, including the use of data from a single center and incomplete reporting of previous antibiotic exposure, the researchers noted. However, the results “provide a framework for how empiric antibiotics can be tailored according to decision tree patient clusters,” they said.
Combining user-friendly clinical decision trees and multivariable logistic regression models may offer the best opportunities for hospitals to derive local models to help with antimicrobial prescription.
The researchers had no financial conflicts to disclose.
Use of a clinical decision tree predicted antibiotic resistance in sepsis patients infected with gram-negative bacteria, based on data from 1,618 patients.
Increasing rates of bacterial resistance have “contributed to the unwarranted empiric administration of broad-spectrum antibiotics, further promoting resistance emergence across microbial species,” said M. Cristina Vazquez Guillamet, MD, of the University of New Mexico, Albuquerque, and her colleagues (Clin Infect Dis. cix612. 2017 Jul 10. doi: 10.1093/cid/cix612).
The researchers identified adults with sepsis or septic shock caused by bloodstream infections who were treated at a single center between 2008 and 2015. They developed clinical decision trees using the CHAID algorithm (Chi squared Automatic Interaction Detection) to analyze risk factors for resistance associated with three antibiotics: piperacillin-tazobactam (PT), cefepime (CE), and meropenem (ME).
Overall, resistance rates to PT, CE, and ME were 29%, 22%, and 9%, respectively, and 6.6% of the isolates were resistant to all three antibiotics.
Factors associated with increased resistance risk included residence in a nursing home, transfer from an outside hospital, and prior antibiotics use. Resistance to ME was associated with infection with Pseudomonas or Acinetobacter spp, the researchers noted, and resistance to PT was associated with central nervous system and central venous catheter infections.
Clinical decision trees were able to separate patients at low risk for resistance to PT and CE, as well as those with a risk greater than 30% of resistance to PT, CE, or ME. “We also found good overall agreement between the accuracies of the [multivariable logistic regression] models and the decision tree analyses for predicting antibiotic resistance,” the researchers said.
The findings were limited by several factors, including the use of data from a single center and incomplete reporting of previous antibiotic exposure, the researchers noted. However, the results “provide a framework for how empiric antibiotics can be tailored according to decision tree patient clusters,” they said.
Combining user-friendly clinical decision trees and multivariable logistic regression models may offer the best opportunities for hospitals to derive local models to help with antimicrobial prescription.
The researchers had no financial conflicts to disclose.
FROM CLINICAL INFECTIOUS DISEASES
Key clinical point:
Major finding: The model found prevalence rates for resistance to piperacillin-tazobactam, cefepime, and meropenem of 28.6%, 21.8%, and 8.5%, respectively.
Data source: A review of 1,618 adults with sepsis.
Disclosures: The researchers had no financial conflicts to disclose.