Doug Brunk

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

SAN DIEGO – Survival rates of patients implanted with the HeartMate II have improved significantly, according to a long-term multicenter analysis designed to compare outcomes from the time of the clinical trial to those in the post–Food and Drug Administration approval period.

Excellent outcomes have been maintained and the incidence of adverse events has trended downward with the HeartMate II, a continuous-flow left ventricular assist device (LVAD) for bridge to heart transplantation, Dr. Ranjit John said at the annual meeting of the Society of Thoracic Surgeons.

A multicenter trial of the HeartMate II, manufactured by Thoratec Corp., was conducted from 2005 to 2008 and led to FDA clearance of the device for bridge to transplantation (BTT). Since FDA clearance in April 2008, more than 1,400 additional patients implanted with the device for BTT have been tracked by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), which is funded by the National Institutes of Health.

The HeartMate II, also cleared for destination therapy, has been implanted in more than 6,000 patients worldwide, with more than 5,000 patient years of support, according to Dr. John, of the department of cardiothoracic surgery at the University of Minnesota, Minneapolis.

The original trial of the device enrolled 486 BTT patients at 36 centers in North America between March 2005 and April 2008. The post-trial commercial use study enrolled 1,496 patients at 83 centers between April 2008 and September 2010. The study’s primary end point was survival. Secondary end points included frequency of adverse events and complications, functional status as assessed by the 6-minute walk, and quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire in the original trial and the EuroQol (EQ-5D) instrument in the post-trial.

Dr. John reported that the 1-year survival rate improved significantly from 76% in the original trial to 85% in post trial. "With every era of the trial, there was a stepwise incremental improvement in survival, probably from all lessons learned from the early phases of the original trial," he commented.

The percentage of patients transplanted by 1 year decreased from 48% in the original trial to 39% in the post-trial, while the percentage of patients receiving ongoing support increased from 32% in the original trial to 45% in the post-trial.

The overall incidences of bleeding and infection in the post-trial were 36% and 38%, respectively. Specifically, the incidence of bleeding requiring surgical reexploration was 7%, while the incidence of driveline infections was 13%.

The incidence of adverse events trended downward in the post-trial, compared with the original trial. For example, the incidence of bleeding requiring reexploration was 21% in the original trial vs. 7% in the post-trial group. Similar declines were seen in the incidence of percutaneous lead infections (20% vs. 13%, respectively), right heart failure requiring right ventricular assist device (7% vs. 1%), and the need for device replacement (5% vs. 1%).

At baseline, only 13% of patients in the original trial and 16% of patients in the post-trial could complete the 6-minute walk test. At 6 months, the proportion of patients who could complete the test improved to 92% and 94%, respectively.

Dr. John also reported that quality of life measures improved in up to 6 months in the original trial and up to 12 months in the post-trial.

The invited discussant, Dr. Michael A. Acker, said that the results of the post-trial demonstrate "that new VAD technology that utilizes continuous flow – a disruptive concept compared to pulsatile flow – can be taught, along with appropriate patient selection, and can be disseminated to a broad range of clinical centers. If similar successful dissemination occurs after the destination therapy approval, small continuous-flow pumps will constitute a paradigm shift for the treatment of end-stage heart failure."

Dr. Acker, who heads the cardiovascular surgery division at the University of Pennsylvania Medical Center, Philadelphia, noted that the trial also demonstrates "that mandatory prospective databases such as INTERMACS are essential for monitoring outcomes and providing feedback needed to improve results."

Dr. John disclosed that he received a research grant from Thoratec to conduct the study. One of the study investigators is employed by the company.

Dr. Acker disclosed that he is a consultant and adviser to Thoratec.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

DENVER – The risk of death for patients with hepatitis C is higher than that of patients with chronic kidney disease, but when both conditions are present, chronic kidney disease does not significantly increase mortality beyond the risk associated with hepatitis C alone.

"Both patients with hepatitis C and [those with] chronic kidney disease die of similar causes," Dr. Rajiv J. Gandhi said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Overall, many of them die from heart disease. Albuminuria has been linked to cardiovascular risk and cardiovascular disease. Hepatitis C patients have more albuminuria than those without hepatitis. This might be a target for intervention to decrease cardiovascular risk."

Dr. Gandhi of the University of Minnesota, Minneapolis, and his associate Dr. Robert N. Foley studied 15,540 people aged 20 years and older in the National Health and Nutrition Examination Survey 1988-1994 who completed examination and laboratory testing for HCV antibody and serum creatinine, and were included in the mortality file linking them to the National Death Index.

The researchers performed descriptive analysis comparing participants on demographic, examination, laboratory, and questionnaire variables grouped by HCV antibody status and went on to compare mortality based on HCV and chronic kidney disease status, with follow-up through 2006.

The mean age of study participants was 43 years, and 57% were white. Overall, 388 of the study participants (2.5%) were HCV positive. Compared with HCV-negative patients, those who were HCV positive tended to have higher albumin-to-creatinine ratios, lower blood urea nitrogen levels, and higher estimated glomerular filtration rates.

At the end of follow-up, a higher proportion of HCV-positive individuals had died, compared with HCV-negative individuals (22.2% vs. 17.2%, respectively), but this difference did not reach statistical significance.

An analysis adjusted for age, sex, and race revealed that the hazard ratio for all-cause mortality was 2.5 for participants with chronic kidney disease alone, 3.9 for those with HCV alone and 4.2 when both conditions were present.

The researchers also found that albuminuria was associated with similarly increased mortality in HCV-negative and HCV-positive study participants (hazard ratio, 5.6 and 5.1, respectively). In addition, a glomerular filtration rate of less than 60 mL/min per1.73 m2 was associated with increased mortality in HCV-negative individuals (HR, 10.3), and mortality was markedly higher in HCV-positive individuals (HR, 54.3).

"Overall, HCV-positive participants have higher mean estimated glomerular filtration rates and albumin to creatinine ratios, which likely indicates early stages of kidney disease characterized by hyperfiltration and increased albuminuria," the researchers wrote in their poster. "Screening for early markers of kidney disease such as albuminuria among HCV-positive individuals may allow early intervention and could potentially decrease the mortality observed in this group."

Dr. Gandhi acknowledged certain limitations of the study, including its cross-sectional design and the fact that lab measurements were taken at one point in time.

Dr. Gandhi said that he had no relevant financial disclosures to make.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients hospitalized for hypertensive emergencies had higher mortality and other complications if they were admitted on a weekend instead of on a weekday, results from a large national analysis demonstrated.

Published studies have shown that patients admitted with acute myocardial infarction, stroke, and GI bleeding tend to have worse outcomes if they’re admitted on a weekend instead of on a weekday – the so-called weekend effect, Dr. Amit Taneja said at the annual congress of the Society of Critical Care Medicine. Possible reasons for this association, he continued, include the fact that hospital staffing fluctuates around the clock and throughout the week and that fewer medical and paramedical staff are present on weekends, resulting in decreased and possibly delayed access to radiology, interventions, and procedures on Saturday and Sunday.

"With that background, we hypothesized that patients admitted with hypertensive emergencies over the weekends have worse outcomes, when compared to those admitted on weekdays," said Dr. Taneja of the division of pulmonary and critical care medicine at the Medical College of Wisconsin, Milwaukee.

To test this hypothesis, he and his associates evaluated the Nationwide Inpatient Sample database from 2000 through 2008 to identify patients discharged with a primary diagnosis of hypertensive emergency based on International Statistical Classification of Diseases, 9th Revision, Clinical Modification codes 401.0, 402.00, 402.01, 403.00, 403.01, 404.00. 404.01, 404.02, 404.03, 405.01, and 405.09. They defined weekend admissions as those that occurred between midnight Friday and midnight Sunday. The primary outcome was hospital mortality.

The researchers used chi-square analysis and t tests to compare variables for unadjusted analysis. They used multivariate logistic regression to obtain odds ratios and adjusted for age, demographics, hospital characteristics, and the Elixhauser comorbidity index.

Dr. Taneja reported that of the 1,213,109 patients discharged with a hypertensive emergency, 264,587 (21.8%) were admitted on a weekend, while the remainder (948,522 or 78.2%) were admitted on a weekday.

An adjusted analysis revealed that patients who were admitted on a weekend had a significantly higher mortality, compared with those who were admitted on a weekday (3.11% vs. 2.54%, respectively), for an absolute increase in mortality of 0.57%. This translated into one excess death on weekend admission for every 175 discharges.

The association persisted on multivariate analysis, which determined that the odds of mortality were 1.16 times higher for patients who were admitted on a weekend, compared with those who were admitted on a weekday.

Dr. Taneja and his associates also observed that it took longer for patients admitted on a weekend to undergo certain procedures, compared with patients who were admitted on a weekday. For example, 40% of patients with aortic dissection who were admitted on a weekend underwent surgery on the first day of admission, compared with 51% of their counterparts who were admitted on a weekday.

Dr. Taneja acknowledged certain limitations of the study, including its retrospective design and the potential for ICD coding errors. Also, "assessment of severity of disease may be inaccurate due to unmeasured confounders," he said. "Further studies are needed to look into this weekend effect."

Dr. Taneja said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).

New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.

Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.

Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.

Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.

New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."

New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.

Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.

Time and again, parents come to Dr. Michael Rich overwhelmed by the role that texting, Facebook, Twitter, and other social media are playing in the lives of their children and adolescents.

"Most parents are coming with no idea or fairly misinformed ideas about what these media are," said Dr. Rich, director of the center on media and child health at Children’s Hospital Boston. "They’re either lumping texting, Facebook, and Twitter – all of which behave differently – into one, or they don’t want to know about it because they’re scared of it. Others say they’re so far behind in technology they could never catch up."

Some report that their daughter is losing sleep and failing in school because she stays up until 2 or 3 a.m. texting her friends.

Others tell him that their son has becoming increasingly violent and disrespectful since playing war games online with friends and perfect strangers.

Still others inform him that their child has been cyberbullied by a classmate and refuses to attend school.

Photo credit: Denise Fulton/Elsevier Global Medical News

Welcome to the world of social media, a place Dr. Donald Shifrin calls the world’s largest cocktail party, where you’ll encounter every kind of experience and personality imaginable. It’s not inherently good or bad, but rather "a great uncontrolled experiment on our children," said Dr. Shifrin, a Bellevue, Wash.–based pediatrician who served as the American Academy of Pediatrics’ consultant to Microsoft when it developed a family safety setting for Windows XP. "There’s no question that social media can make you a better person because there are various ways for you to send out things and ask, ‘What does everybody think about this?’ and consider those responses in your decision making if indeed you’re cognitively able to make a conscious and rational decision. But that’s not usually the purview of most tweens and teens, who are messaging and texting as fast as their fingers can fly."

According to a 2009 survey by the Kaiser Family Foundation, young people aged 8-18 years spend an average of 7 hours and 38 minutes each day with TV, video games, or computers, an increase of 1 hour and 17 minutes over the average in 2004. In addition, 66% of these youngsters own a cell phone (on which they text or talk for another 2 hours each day), 76% of them have an iPod or other media player, and 74% of kids in grades 7-12 say they have a profile on a social networking site such as Facebook.

What about the long-term effects of social media on the development and behavior of today’s children and adolescents? Experts interviewed for this story say there is no way to tell for sure what kind of impact routine use of social media will have on current children and adolescents as they become adults.

But one thing’s for sure, said Dr. Susan Greenfield, a neuroscientist who directs the Institute for the Future of the Mind at the Oxford Martin School, Oxford (England) University: "It’s a given that it will affect the brain, because the human brain adapts to whatever environment it’s placed in. If you’re in an environment as different as the cyberworld is from the real world, I don’t think there’s any question that we’ll adapt to it. The big question is, How will we adapt to it? Is it good or bad? What can we do about it?"

Social media have revolutionized the way children learn about the world and communicate with each other, said Dr. Gwenn Schurgin O’Keeffe, a pediatrician and author of "CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming, and Social Media" (Elk Grove Village, Ill.: American Academy of Pediatrics, 2010). Even families who struggle to put food on the table "will get their kids a digital device because they want them to be a part of society," she said.

She describes Facebook as their "neighborhood hangout," which "they do well if they get online in an age-appropriate way. You don’t want a 10-year-old hanging out on Facebook because they don’t have the social skills, and there are too many older people on it. But if you help them get online in an age-appropriate way, they learn how to post well. They learn how to interact better online than some adults do. It can be powerful.

"I have a theory that cyberbullying and sexting is partly our fault as adults because we’re still catching up to the digital world, and we’ve never really taught kids how to use it well. It’s kind of like putting them in a car without teaching them how to drive. So it’s no wonder mistakes have happened."

Dr. Rich said that Facebook can be used in positive ways by kids who are trying to understand themselves, to understand that they’re not alone in their challenges and struggles growing up, "whether it’s confronting the fact that their parents aren’t perfect, or that the world isn’t the way they magically thought it should be, or whether they are confused and conflicted about their sexuality. Social media can be particularly empowering for kids who are marginalized or minority groups of any kind. It is a wonderful environment for connecting with ‘people like me,’ and feeling that you’re not alone. And as a social equalizer, they create a fabulous place for kids to develop a sense of participatory democracy, a place where they have a voice. They start to see how their voice can make a difference in the world."

Some experts suggest that social media are having a certain benefit on the smarts of youngsters. In his 2005 book "Everything Bad Is Good for You: How Today’s Popular Culture Is Making Us Smarter" (New York: Riverhead Books, 2005), author Steven Johnson notes that IQ scores have improved in several different countries around the world in recent years, likely because youngsters are rehearsing the kind of skills required for IQ tests when they play computer games.

However, Dr. Shifrin pointed out that other research has shown that frequent exposure to videos and other screen-based media slows down language acquisition in toddlers.

Social media also have the potential to unite families in shared activities such as playing chess online, tennis on Nintendo’s Wii console, football on the Madden NFL video series, or updating the family Facebook page.

For some families, though, social media eat into quality time together, said Dr. O’Keeffe, who has two teenaged daughters and who authors a syndicated blog called "Dr. Gwenn Is In."

"We’ve all been at restaurants where mom and dad are plugged into their Blackberries or iPhones and the kids have their game systems or their cell phones, and no one’s talking to one another," she said. "We have a pretty strict rule at our house: no digital stuff or picking up the phone during family meals. When we go on vacation we lock the phones away. We go unplugged a few times a year. That teaches our kids that you can do it. Sometimes my 16-year-old will not turn on her computer for a few days in a row. I think you have to teach your kids when they’re young to resist the temptation. If they see you do it, they’ll do it."

Dr. Rich authors a blog called "Ask the Mediatrician," which answers parents’ questions about media and health. He worries that social networking sites such as Facebook are altering traditional notions of what it means to be a friend. "To a certain degree Facebook has made friends something you can compete on, the idea that I friended more people than you," he observed. "And social media fundamentally alter how we interact with other people. When you see two kids who are sitting at a table together texting each other, it’s a very different dynamic than if they were actually talking to each other. Why they make the choice to text as opposed to talk has something to do with it, but if it is the primary form of interaction, how do you learn to read people’s facial expressions or body language? To include others in a conversation? Or speak with nuances and empathy that text cannot convey?"

Dr. Greenfield is concerned that children and adolescents who spend too much time on social media may be compromising the proper development of certain cognitive skills. "We know that people are getting good at processing information very quickly and efficiently – the kind of skills you have when you’re driving," she said. "What we’re talking about is turning yourself into kind of a computer in a way: making efficient and fast responses as appropriate. This is very different from reading a book, which is very linear and slow. That’s what the brain needs to understand something usually; you don’t want to have it diluted and distracted, because the brain only has so much power. If it’s being employed in attending to lots of different things, it’s not going to be able to pursue a linear train of thought."

The result, Dr. Greenfield offered, "could be an infantilizing of the brain, that we are going to create a generation of Peter Pans who live in a world that is a literal one, dominated by sensory content over cognitive significance, a world where what you see is what you get."

Dr. O’Keeffe acknowledged the potential for an inattentive future generation, "but I think we can reel them in while they’re still teenagers and younger kids. Each generation that passes is going to be more digital. So while we still remember what an offline world is, if we can instill in the current teenagers and elementary school kids what it’s like to be unplugged, they’ll instill it in their kids, and it should pay forward."

Much of the onus is on parents, Dr. Rich said, to learn how social media work and to help their kids become good citizens of the digital world. "You can’t afford to check out because you don’t know the digital world. The default is that your children will be raised by whomever and whatever is in the digital domain. We know from ‘Lord of the Flies’ what happens when the kids are left in charge of society. We have a responsibility to parent in the digital domain, because our kids are spending most of their time there."

Time and again, parents come to Dr. Michael Rich overwhelmed by the role that texting, Facebook, Twitter, and other social media are playing in the lives of their children and adolescents.

"Most parents are coming with no idea or fairly misinformed ideas about what these media are," said Dr. Rich, director of the center on media and child health at Children’s Hospital Boston. "They’re either lumping texting, Facebook, and Twitter – all of which behave differently – into one, or they don’t want to know about it because they’re scared of it. Others say they’re so far behind in technology they could never catch up."

Some report that their daughter is losing sleep and failing in school because she stays up until 2 or 3 a.m. texting her friends.

Others tell him that their son has becoming increasingly violent and disrespectful since playing war games online with friends and perfect strangers.

Still others inform him that their child has been cyberbullied by a classmate and refuses to attend school.

Photo credit: Denise Fulton/Elsevier Global Medical News

Welcome to the world of social media, a place Dr. Donald Shifrin calls the world’s largest cocktail party, where you’ll encounter every kind of experience and personality imaginable. It’s not inherently good or bad, but rather "a great uncontrolled experiment on our children," said Dr. Shifrin, a Bellevue, Wash.–based pediatrician who served as the American Academy of Pediatrics’ consultant to Microsoft when it developed a family safety setting for Windows XP. "There’s no question that social media can make you a better person because there are various ways for you to send out things and ask, ‘What does everybody think about this?’ and consider those responses in your decision making if indeed you’re cognitively able to make a conscious and rational decision. But that’s not usually the purview of most tweens and teens, who are messaging and texting as fast as their fingers can fly."

According to a 2009 survey by the Kaiser Family Foundation, young people aged 8-18 years spend an average of 7 hours and 38 minutes each day with TV, video games, or computers, an increase of 1 hour and 17 minutes over the average in 2004. In addition, 66% of these youngsters own a cell phone (on which they text or talk for another 2 hours each day), 76% of them have an iPod or other media player, and 74% of kids in grades 7-12 say they have a profile on a social networking site such as Facebook.

What about the long-term effects of social media on the development and behavior of today’s children and adolescents? Experts interviewed for this story say there is no way to tell for sure what kind of impact routine use of social media will have on current children and adolescents as they become adults.

But one thing’s for sure, said Dr. Susan Greenfield, a neuroscientist who directs the Institute for the Future of the Mind at the Oxford Martin School, Oxford (England) University: "It’s a given that it will affect the brain, because the human brain adapts to whatever environment it’s placed in. If you’re in an environment as different as the cyberworld is from the real world, I don’t think there’s any question that we’ll adapt to it. The big question is, How will we adapt to it? Is it good or bad? What can we do about it?"

Social media have revolutionized the way children learn about the world and communicate with each other, said Dr. Gwenn Schurgin O’Keeffe, a pediatrician and author of "CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming, and Social Media" (Elk Grove Village, Ill.: American Academy of Pediatrics, 2010). Even families who struggle to put food on the table "will get their kids a digital device because they want them to be a part of society," she said.

She describes Facebook as their "neighborhood hangout," which "they do well if they get online in an age-appropriate way. You don’t want a 10-year-old hanging out on Facebook because they don’t have the social skills, and there are too many older people on it. But if you help them get online in an age-appropriate way, they learn how to post well. They learn how to interact better online than some adults do. It can be powerful.

"I have a theory that cyberbullying and sexting is partly our fault as adults because we’re still catching up to the digital world, and we’ve never really taught kids how to use it well. It’s kind of like putting them in a car without teaching them how to drive. So it’s no wonder mistakes have happened."

Dr. Rich said that Facebook can be used in positive ways by kids who are trying to understand themselves, to understand that they’re not alone in their challenges and struggles growing up, "whether it’s confronting the fact that their parents aren’t perfect, or that the world isn’t the way they magically thought it should be, or whether they are confused and conflicted about their sexuality. Social media can be particularly empowering for kids who are marginalized or minority groups of any kind. It is a wonderful environment for connecting with ‘people like me,’ and feeling that you’re not alone. And as a social equalizer, they create a fabulous place for kids to develop a sense of participatory democracy, a place where they have a voice. They start to see how their voice can make a difference in the world."

Some experts suggest that social media are having a certain benefit on the smarts of youngsters. In his 2005 book "Everything Bad Is Good for You: How Today’s Popular Culture Is Making Us Smarter" (New York: Riverhead Books, 2005), author Steven Johnson notes that IQ scores have improved in several different countries around the world in recent years, likely because youngsters are rehearsing the kind of skills required for IQ tests when they play computer games.

However, Dr. Shifrin pointed out that other research has shown that frequent exposure to videos and other screen-based media slows down language acquisition in toddlers.

Social media also have the potential to unite families in shared activities such as playing chess online, tennis on Nintendo’s Wii console, football on the Madden NFL video series, or updating the family Facebook page.

For some families, though, social media eat into quality time together, said Dr. O’Keeffe, who has two teenaged daughters and who authors a syndicated blog called "Dr. Gwenn Is In."

"We’ve all been at restaurants where mom and dad are plugged into their Blackberries or iPhones and the kids have their game systems or their cell phones, and no one’s talking to one another," she said. "We have a pretty strict rule at our house: no digital stuff or picking up the phone during family meals. When we go on vacation we lock the phones away. We go unplugged a few times a year. That teaches our kids that you can do it. Sometimes my 16-year-old will not turn on her computer for a few days in a row. I think you have to teach your kids when they’re young to resist the temptation. If they see you do it, they’ll do it."

Dr. Rich authors a blog called "Ask the Mediatrician," which answers parents’ questions about media and health. He worries that social networking sites such as Facebook are altering traditional notions of what it means to be a friend. "To a certain degree Facebook has made friends something you can compete on, the idea that I friended more people than you," he observed. "And social media fundamentally alter how we interact with other people. When you see two kids who are sitting at a table together texting each other, it’s a very different dynamic than if they were actually talking to each other. Why they make the choice to text as opposed to talk has something to do with it, but if it is the primary form of interaction, how do you learn to read people’s facial expressions or body language? To include others in a conversation? Or speak with nuances and empathy that text cannot convey?"

Dr. Greenfield is concerned that children and adolescents who spend too much time on social media may be compromising the proper development of certain cognitive skills. "We know that people are getting good at processing information very quickly and efficiently – the kind of skills you have when you’re driving," she said. "What we’re talking about is turning yourself into kind of a computer in a way: making efficient and fast responses as appropriate. This is very different from reading a book, which is very linear and slow. That’s what the brain needs to understand something usually; you don’t want to have it diluted and distracted, because the brain only has so much power. If it’s being employed in attending to lots of different things, it’s not going to be able to pursue a linear train of thought."

The result, Dr. Greenfield offered, "could be an infantilizing of the brain, that we are going to create a generation of Peter Pans who live in a world that is a literal one, dominated by sensory content over cognitive significance, a world where what you see is what you get."

Dr. O’Keeffe acknowledged the potential for an inattentive future generation, "but I think we can reel them in while they’re still teenagers and younger kids. Each generation that passes is going to be more digital. So while we still remember what an offline world is, if we can instill in the current teenagers and elementary school kids what it’s like to be unplugged, they’ll instill it in their kids, and it should pay forward."

Much of the onus is on parents, Dr. Rich said, to learn how social media work and to help their kids become good citizens of the digital world. "You can’t afford to check out because you don’t know the digital world. The default is that your children will be raised by whomever and whatever is in the digital domain. We know from ‘Lord of the Flies’ what happens when the kids are left in charge of society. We have a responsibility to parent in the digital domain, because our kids are spending most of their time there."

Time and again, parents come to Dr. Michael Rich overwhelmed by the role that texting, Facebook, Twitter, and other social media are playing in the lives of their children and adolescents.

"Most parents are coming with no idea or fairly misinformed ideas about what these media are," said Dr. Rich, director of the center on media and child health at Children’s Hospital Boston. "They’re either lumping texting, Facebook, and Twitter – all of which behave differently – into one, or they don’t want to know about it because they’re scared of it. Others say they’re so far behind in technology they could never catch up."

Some report that their daughter is losing sleep and failing in school because she stays up until 2 or 3 a.m. texting her friends.

Others tell him that their son has becoming increasingly violent and disrespectful since playing war games online with friends and perfect strangers.

Still others inform him that their child has been cyberbullied by a classmate and refuses to attend school.

Photo credit: Denise Fulton/Elsevier Global Medical News

Welcome to the world of social media, a place Dr. Donald Shifrin calls the world’s largest cocktail party, where you’ll encounter every kind of experience and personality imaginable. It’s not inherently good or bad, but rather "a great uncontrolled experiment on our children," said Dr. Shifrin, a Bellevue, Wash.–based pediatrician who served as the American Academy of Pediatrics’ consultant to Microsoft when it developed a family safety setting for Windows XP. "There’s no question that social media can make you a better person because there are various ways for you to send out things and ask, ‘What does everybody think about this?’ and consider those responses in your decision making if indeed you’re cognitively able to make a conscious and rational decision. But that’s not usually the purview of most tweens and teens, who are messaging and texting as fast as their fingers can fly."

According to a 2009 survey by the Kaiser Family Foundation, young people aged 8-18 years spend an average of 7 hours and 38 minutes each day with TV, video games, or computers, an increase of 1 hour and 17 minutes over the average in 2004. In addition, 66% of these youngsters own a cell phone (on which they text or talk for another 2 hours each day), 76% of them have an iPod or other media player, and 74% of kids in grades 7-12 say they have a profile on a social networking site such as Facebook.

What about the long-term effects of social media on the development and behavior of today’s children and adolescents? Experts interviewed for this story say there is no way to tell for sure what kind of impact routine use of social media will have on current children and adolescents as they become adults.

But one thing’s for sure, said Dr. Susan Greenfield, a neuroscientist who directs the Institute for the Future of the Mind at the Oxford Martin School, Oxford (England) University: "It’s a given that it will affect the brain, because the human brain adapts to whatever environment it’s placed in. If you’re in an environment as different as the cyberworld is from the real world, I don’t think there’s any question that we’ll adapt to it. The big question is, How will we adapt to it? Is it good or bad? What can we do about it?"

Social media have revolutionized the way children learn about the world and communicate with each other, said Dr. Gwenn Schurgin O’Keeffe, a pediatrician and author of "CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming, and Social Media" (Elk Grove Village, Ill.: American Academy of Pediatrics, 2010). Even families who struggle to put food on the table "will get their kids a digital device because they want them to be a part of society," she said.

She describes Facebook as their "neighborhood hangout," which "they do well if they get online in an age-appropriate way. You don’t want a 10-year-old hanging out on Facebook because they don’t have the social skills, and there are too many older people on it. But if you help them get online in an age-appropriate way, they learn how to post well. They learn how to interact better online than some adults do. It can be powerful.

"I have a theory that cyberbullying and sexting is partly our fault as adults because we’re still catching up to the digital world, and we’ve never really taught kids how to use it well. It’s kind of like putting them in a car without teaching them how to drive. So it’s no wonder mistakes have happened."

Dr. Rich said that Facebook can be used in positive ways by kids who are trying to understand themselves, to understand that they’re not alone in their challenges and struggles growing up, "whether it’s confronting the fact that their parents aren’t perfect, or that the world isn’t the way they magically thought it should be, or whether they are confused and conflicted about their sexuality. Social media can be particularly empowering for kids who are marginalized or minority groups of any kind. It is a wonderful environment for connecting with ‘people like me,’ and feeling that you’re not alone. And as a social equalizer, they create a fabulous place for kids to develop a sense of participatory democracy, a place where they have a voice. They start to see how their voice can make a difference in the world."

Some experts suggest that social media are having a certain benefit on the smarts of youngsters. In his 2005 book "Everything Bad Is Good for You: How Today’s Popular Culture Is Making Us Smarter" (New York: Riverhead Books, 2005), author Steven Johnson notes that IQ scores have improved in several different countries around the world in recent years, likely because youngsters are rehearsing the kind of skills required for IQ tests when they play computer games.

However, Dr. Shifrin pointed out that other research has shown that frequent exposure to videos and other screen-based media slows down language acquisition in toddlers.

Social media also have the potential to unite families in shared activities such as playing chess online, tennis on Nintendo’s Wii console, football on the Madden NFL video series, or updating the family Facebook page.

For some families, though, social media eat into quality time together, said Dr. O’Keeffe, who has two teenaged daughters and who authors a syndicated blog called "Dr. Gwenn Is In."

"We’ve all been at restaurants where mom and dad are plugged into their Blackberries or iPhones and the kids have their game systems or their cell phones, and no one’s talking to one another," she said. "We have a pretty strict rule at our house: no digital stuff or picking up the phone during family meals. When we go on vacation we lock the phones away. We go unplugged a few times a year. That teaches our kids that you can do it. Sometimes my 16-year-old will not turn on her computer for a few days in a row. I think you have to teach your kids when they’re young to resist the temptation. If they see you do it, they’ll do it."

Dr. Rich authors a blog called "Ask the Mediatrician," which answers parents’ questions about media and health. He worries that social networking sites such as Facebook are altering traditional notions of what it means to be a friend. "To a certain degree Facebook has made friends something you can compete on, the idea that I friended more people than you," he observed. "And social media fundamentally alter how we interact with other people. When you see two kids who are sitting at a table together texting each other, it’s a very different dynamic than if they were actually talking to each other. Why they make the choice to text as opposed to talk has something to do with it, but if it is the primary form of interaction, how do you learn to read people’s facial expressions or body language? To include others in a conversation? Or speak with nuances and empathy that text cannot convey?"

Dr. Greenfield is concerned that children and adolescents who spend too much time on social media may be compromising the proper development of certain cognitive skills. "We know that people are getting good at processing information very quickly and efficiently – the kind of skills you have when you’re driving," she said. "What we’re talking about is turning yourself into kind of a computer in a way: making efficient and fast responses as appropriate. This is very different from reading a book, which is very linear and slow. That’s what the brain needs to understand something usually; you don’t want to have it diluted and distracted, because the brain only has so much power. If it’s being employed in attending to lots of different things, it’s not going to be able to pursue a linear train of thought."

The result, Dr. Greenfield offered, "could be an infantilizing of the brain, that we are going to create a generation of Peter Pans who live in a world that is a literal one, dominated by sensory content over cognitive significance, a world where what you see is what you get."

Dr. O’Keeffe acknowledged the potential for an inattentive future generation, "but I think we can reel them in while they’re still teenagers and younger kids. Each generation that passes is going to be more digital. So while we still remember what an offline world is, if we can instill in the current teenagers and elementary school kids what it’s like to be unplugged, they’ll instill it in their kids, and it should pay forward."

Much of the onus is on parents, Dr. Rich said, to learn how social media work and to help their kids become good citizens of the digital world. "You can’t afford to check out because you don’t know the digital world. The default is that your children will be raised by whomever and whatever is in the digital domain. We know from ‘Lord of the Flies’ what happens when the kids are left in charge of society. We have a responsibility to parent in the digital domain, because our kids are spending most of their time there."

SAN DIEGO – Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line–associated bloodstream infections in a surgical intensive care unit over the course of 6 months.

Photo credit: © Vladimir Voronin/Fotolia.com

"If you look at how people address hand hygiene compliance overall, most of the time it’s with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the annual congress of the Society of Critical Care Medicine. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."

As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.

If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient’s immediate surroundings.

Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line–associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.

"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, ‘Hey, I didn’t see you wash your hands,’ " Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."

This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, ‘Hang on a second; you didn’t wash your hands.’ Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It’s a rare circumstance that someone gets upset by another health care provider who says, ‘Hey, you forgot to wash your hands.’ Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."

Dr. Pamplin said that he had no relevant financial disclosures to make.

SAN DIEGO – Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line–associated bloodstream infections in a surgical intensive care unit over the course of 6 months.

Photo credit: © Vladimir Voronin/Fotolia.com

"If you look at how people address hand hygiene compliance overall, most of the time it’s with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the annual congress of the Society of Critical Care Medicine. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."

As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.

If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient’s immediate surroundings.

Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line–associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.

"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, ‘Hey, I didn’t see you wash your hands,’ " Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."

This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, ‘Hang on a second; you didn’t wash your hands.’ Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It’s a rare circumstance that someone gets upset by another health care provider who says, ‘Hey, you forgot to wash your hands.’ Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."

Dr. Pamplin said that he had no relevant financial disclosures to make.

SAN DIEGO – Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line–associated bloodstream infections in a surgical intensive care unit over the course of 6 months.

Photo credit: © Vladimir Voronin/Fotolia.com

"If you look at how people address hand hygiene compliance overall, most of the time it’s with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the annual congress of the Society of Critical Care Medicine. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."

As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.

If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient’s immediate surroundings.

Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line–associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.

"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, ‘Hey, I didn’t see you wash your hands,’ " Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."

This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, ‘Hang on a second; you didn’t wash your hands.’ Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It’s a rare circumstance that someone gets upset by another health care provider who says, ‘Hey, you forgot to wash your hands.’ Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."

Dr. Pamplin said that he had no relevant financial disclosures to make.