For children who are or are at risk of being overweight or obese, weight-based teasing was associated with further weight and fat gain, according to Natasha A. Schvey, PhD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and her associates.

BananaStock / Getty Images Plus

The investigators conducted a longitudinal, observational study of 110 children who were either in the 85th body mass index (BMI) percentile or greater or had two parents with a BMI of at least 25 kg/m². Children were recruited between July 12, 1996, and July 6, 2009, administered the Perception of Teasing Scale at baseline and during follow-up, and followed for up to 15 years. Children were aged a mean of 12 years at baseline, and attended an average of nine visits.

At baseline, 53% of children were overweight, with overweight being more common in girls and in non-Hispanic whites. A total of 62% of children who were overweight at baseline reported at least one incidence of weight-based teasing (WBT), compared with 21% of children at risk. WBT at baseline was associated with BMI throughout the study (P less than .001). In addition, children who reported more WBT showed a steeper gain in BMI (P = .007). Overall, children who reported high levels of WBT had 33% greater gains in BMI per year than those with no WBT.

Fat mass was associated with WBT in a similar manner, but to an increased extent, as children who reported high levels of WBT gained 91% more fat per year than those with no WBT.

“As adolescence marks a critical period for the study of weight gain, it will be important to further explore the effects of WBT and weight‐related pressures on indices of weight and health throughout development and to identify both risk and protective factors. The present findings ... may provide a foundation upon which to initiate clinical pediatric interventions to determine whether reducing WBT affects weight and fat gain trajectory,” the investigators concluded.

The study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The investigators did not report any conflicts of interest.

lfranki@mdedge.com

SOURCE: Schvey NA et al. Pediatr Obes. 2019 May 29. doi: 10.1111/ijpo.12538.

For children who are or are at risk of being overweight or obese, weight-based teasing was associated with further weight and fat gain, according to Natasha A. Schvey, PhD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and her associates.

BananaStock / Getty Images Plus

The investigators conducted a longitudinal, observational study of 110 children who were either in the 85th body mass index (BMI) percentile or greater or had two parents with a BMI of at least 25 kg/m². Children were recruited between July 12, 1996, and July 6, 2009, administered the Perception of Teasing Scale at baseline and during follow-up, and followed for up to 15 years. Children were aged a mean of 12 years at baseline, and attended an average of nine visits.

At baseline, 53% of children were overweight, with overweight being more common in girls and in non-Hispanic whites. A total of 62% of children who were overweight at baseline reported at least one incidence of weight-based teasing (WBT), compared with 21% of children at risk. WBT at baseline was associated with BMI throughout the study (P less than .001). In addition, children who reported more WBT showed a steeper gain in BMI (P = .007). Overall, children who reported high levels of WBT had 33% greater gains in BMI per year than those with no WBT.

Fat mass was associated with WBT in a similar manner, but to an increased extent, as children who reported high levels of WBT gained 91% more fat per year than those with no WBT.

“As adolescence marks a critical period for the study of weight gain, it will be important to further explore the effects of WBT and weight‐related pressures on indices of weight and health throughout development and to identify both risk and protective factors. The present findings ... may provide a foundation upon which to initiate clinical pediatric interventions to determine whether reducing WBT affects weight and fat gain trajectory,” the investigators concluded.

The study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The investigators did not report any conflicts of interest.

lfranki@mdedge.com

SOURCE: Schvey NA et al. Pediatr Obes. 2019 May 29. doi: 10.1111/ijpo.12538.

For children who are or are at risk of being overweight or obese, weight-based teasing was associated with further weight and fat gain, according to Natasha A. Schvey, PhD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and her associates.

BananaStock / Getty Images Plus

The investigators conducted a longitudinal, observational study of 110 children who were either in the 85th body mass index (BMI) percentile or greater or had two parents with a BMI of at least 25 kg/m². Children were recruited between July 12, 1996, and July 6, 2009, administered the Perception of Teasing Scale at baseline and during follow-up, and followed for up to 15 years. Children were aged a mean of 12 years at baseline, and attended an average of nine visits.

At baseline, 53% of children were overweight, with overweight being more common in girls and in non-Hispanic whites. A total of 62% of children who were overweight at baseline reported at least one incidence of weight-based teasing (WBT), compared with 21% of children at risk. WBT at baseline was associated with BMI throughout the study (P less than .001). In addition, children who reported more WBT showed a steeper gain in BMI (P = .007). Overall, children who reported high levels of WBT had 33% greater gains in BMI per year than those with no WBT.

Fat mass was associated with WBT in a similar manner, but to an increased extent, as children who reported high levels of WBT gained 91% more fat per year than those with no WBT.

“As adolescence marks a critical period for the study of weight gain, it will be important to further explore the effects of WBT and weight‐related pressures on indices of weight and health throughout development and to identify both risk and protective factors. The present findings ... may provide a foundation upon which to initiate clinical pediatric interventions to determine whether reducing WBT affects weight and fat gain trajectory,” the investigators concluded.

The study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The investigators did not report any conflicts of interest.

lfranki@mdedge.com

SOURCE: Schvey NA et al. Pediatr Obes. 2019 May 29. doi: 10.1111/ijpo.12538.

SAN FRANCISCO – It’s important to check for complementopathies in pregnant women with lupus, according to Michelle Petri, MD, a professor of rheumatology at Johns Hopkins University, Baltimore.

A new diagnosis being developed at Hopkins and elsewhere, complementopathies involve an inappropriate activation of the alternative pathway of complement (APC), either from a mutation in a complement control protein, or, in the case of lupus, an autoantibody against one. They’ve been implicated as a major cause of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, a condition to which women with lupus are particularly prone.

Hopkins has developed a serum test to diagnose inappropriate APC activation in a few hours, the modified Ham test. When HELLP develops in a woman with a complementopathy, the complement inhibitor eculizumab (Soliris) is proving to be a safe alternative to pregnancy termination.

“I urge you to think about using the modified Ham test, because if it is positive, you can treat HELLP without having to stop the pregnancy,” said Dr. Petri, also codirector of the Hopkins Lupus Pregnancy Center.

Lupus management has come a long way from the days when women were counseled to avoid or terminate pregnancy. Risks remain, “but many pregnancies are successful. I think that for every woman with lupus, we do want to offer the possibility of successful pregnancy,” she said.

Disease control is key. Preterm birth, the most common adverse outcome in lupus, correlates closely with disease activity, and disease activity can be controlled with hydroxychloroquine, and, when needed, azathioprine and tacrolimus for renal flairs.

“But these kinds of basic lessons – we need hydroxychloroquine in pregnancy; we must control disease activity – are not heard out in the real world. Claims data have shown that pregnant women with lupus actually take fewer prescribed medications, and they have fewer rheumatology visits.” It’s a problem that needs to be addressed, Dr. Petri said.

Vitamin D is also important. Hopkins has shown that supplementation to hit a level of 40 ng/mL reduces both global and renal disease activity without toxicity; studies in the general population have shown reduced preeclampsia, preterm birth, and low birth weight, all concerns in lupus.

“I haven’t convinced the world of lupus how important vitamin D is,” but “I actually love it just as much as I love hydroxychloroquine,” Dr. Petri said.

Cosupplementation with calcium complicates matters. Together, they seem to reduce the risk of preeclampsia, but increase the risk of preterm birth. More needs to be known, so “for all of us with pregnancy cohorts, it’s time to start to record vitamin D and calcium levels so we can look at this,” she said.

Dr. Petri has worked with numerous companies.

aotto@mdedge.com

SAN FRANCISCO – It’s important to check for complementopathies in pregnant women with lupus, according to Michelle Petri, MD, a professor of rheumatology at Johns Hopkins University, Baltimore.

A new diagnosis being developed at Hopkins and elsewhere, complementopathies involve an inappropriate activation of the alternative pathway of complement (APC), either from a mutation in a complement control protein, or, in the case of lupus, an autoantibody against one. They’ve been implicated as a major cause of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, a condition to which women with lupus are particularly prone.

Hopkins has developed a serum test to diagnose inappropriate APC activation in a few hours, the modified Ham test. When HELLP develops in a woman with a complementopathy, the complement inhibitor eculizumab (Soliris) is proving to be a safe alternative to pregnancy termination.

“I urge you to think about using the modified Ham test, because if it is positive, you can treat HELLP without having to stop the pregnancy,” said Dr. Petri, also codirector of the Hopkins Lupus Pregnancy Center.

Lupus management has come a long way from the days when women were counseled to avoid or terminate pregnancy. Risks remain, “but many pregnancies are successful. I think that for every woman with lupus, we do want to offer the possibility of successful pregnancy,” she said.

Disease control is key. Preterm birth, the most common adverse outcome in lupus, correlates closely with disease activity, and disease activity can be controlled with hydroxychloroquine, and, when needed, azathioprine and tacrolimus for renal flairs.

“But these kinds of basic lessons – we need hydroxychloroquine in pregnancy; we must control disease activity – are not heard out in the real world. Claims data have shown that pregnant women with lupus actually take fewer prescribed medications, and they have fewer rheumatology visits.” It’s a problem that needs to be addressed, Dr. Petri said.

Vitamin D is also important. Hopkins has shown that supplementation to hit a level of 40 ng/mL reduces both global and renal disease activity without toxicity; studies in the general population have shown reduced preeclampsia, preterm birth, and low birth weight, all concerns in lupus.

“I haven’t convinced the world of lupus how important vitamin D is,” but “I actually love it just as much as I love hydroxychloroquine,” Dr. Petri said.

Cosupplementation with calcium complicates matters. Together, they seem to reduce the risk of preeclampsia, but increase the risk of preterm birth. More needs to be known, so “for all of us with pregnancy cohorts, it’s time to start to record vitamin D and calcium levels so we can look at this,” she said.

Dr. Petri has worked with numerous companies.

aotto@mdedge.com

SAN FRANCISCO – It’s important to check for complementopathies in pregnant women with lupus, according to Michelle Petri, MD, a professor of rheumatology at Johns Hopkins University, Baltimore.

A new diagnosis being developed at Hopkins and elsewhere, complementopathies involve an inappropriate activation of the alternative pathway of complement (APC), either from a mutation in a complement control protein, or, in the case of lupus, an autoantibody against one. They’ve been implicated as a major cause of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, a condition to which women with lupus are particularly prone.

Hopkins has developed a serum test to diagnose inappropriate APC activation in a few hours, the modified Ham test. When HELLP develops in a woman with a complementopathy, the complement inhibitor eculizumab (Soliris) is proving to be a safe alternative to pregnancy termination.

“I urge you to think about using the modified Ham test, because if it is positive, you can treat HELLP without having to stop the pregnancy,” said Dr. Petri, also codirector of the Hopkins Lupus Pregnancy Center.

Lupus management has come a long way from the days when women were counseled to avoid or terminate pregnancy. Risks remain, “but many pregnancies are successful. I think that for every woman with lupus, we do want to offer the possibility of successful pregnancy,” she said.

Disease control is key. Preterm birth, the most common adverse outcome in lupus, correlates closely with disease activity, and disease activity can be controlled with hydroxychloroquine, and, when needed, azathioprine and tacrolimus for renal flairs.

“But these kinds of basic lessons – we need hydroxychloroquine in pregnancy; we must control disease activity – are not heard out in the real world. Claims data have shown that pregnant women with lupus actually take fewer prescribed medications, and they have fewer rheumatology visits.” It’s a problem that needs to be addressed, Dr. Petri said.

Vitamin D is also important. Hopkins has shown that supplementation to hit a level of 40 ng/mL reduces both global and renal disease activity without toxicity; studies in the general population have shown reduced preeclampsia, preterm birth, and low birth weight, all concerns in lupus.

“I haven’t convinced the world of lupus how important vitamin D is,” but “I actually love it just as much as I love hydroxychloroquine,” Dr. Petri said.

Cosupplementation with calcium complicates matters. Together, they seem to reduce the risk of preeclampsia, but increase the risk of preterm birth. More needs to be known, so “for all of us with pregnancy cohorts, it’s time to start to record vitamin D and calcium levels so we can look at this,” she said.

Dr. Petri has worked with numerous companies.

aotto@mdedge.com

Physician burnout has been linked to medical errors, decreased patient satisfaction, and reduced career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern because of the impact on the adequacy of the vascular surgery workforce. Dawn Coleman, MD, and her colleagues, performed a study on behalf of the Society for Vascular Surgery (SVS) Wellness Task Force to define the prevalence of burnout among practicing vascular surgeons, and to identify the risk factors for burnout. Such information will be used to facilitate future SVS initiatives to avert this crisis.

In Thursday’s von Liebig Forum, Dr. Coleman, of the University of Michigan, Ann Arbor, will present the results of their 2018 anonymous survey of active SVS members. The survey used a validated burnout assessment, Maslach Burnout Index (MBI), embedded in a questionnaire that also captured demographic and practice-related characteristics.

The survey was personalized for the specialty and did allow for free text. according to Dr. Coleman, and “we specifically analyzed emotional exhaustion, one dimension of burnout.”

The accepted threshold of a score of 27 or greater on the MBI Emotional Exhaustion module was used to identify surgeons suffering from burnout. Risk factors for such were identified using bivariate analyses (Chi-square, Kruskal-Wallis), and multivariate logistic regression models were developed to identify independent risk factors for burnout, she added.

Dr. Coleman will present the results from the 960 out of 2,905 active SVS members who responded to the survey (33%). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were finally analyzed. The mean respondent age was 49.7 years; and the majority of respondents (81%) were men. The primary practice settings were academic (40%), community practice (41%), Veterans Administration hospital (3.3%), active military practice (1.5%), or “other.” Mean years in practice was 15.7.

Overall, 30% of the respondents met criteria for burnout, 37% screened positive for symptoms of depression in the past month and 8% supported thoughts of taking their own life during the last 12 months.

By unadjusted analysis, factors significantly associated with burnout included clinical work hours, on-call frequency, electronic medical record/documentation requirements, perceived conflict between work and personal responsibilities, and physical pain. Multivariate analysis revealed age, work-related physical pain, and conflict between work and personal responsibilities as independent risk factors for burnout, said Dr. Coleman.

“Approximately one-third of practicing vascular surgeons self-report burnout and depression, according to our survey. Advancing age, physical pain, and work-life conflict are each independent predictors for burnout among vascular surgeons. These findings will facilitate SVS efforts to improve vascular surgeon well-being, in an effort to mitigate the personal, economic, and social impact of vascular surgeon burnout,” Dr. Coleman concluded.

See more on the work of the SVS Wellness Task Force in the June issue of Vascular Specialist. 

Physician burnout has been linked to medical errors, decreased patient satisfaction, and reduced career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern because of the impact on the adequacy of the vascular surgery workforce. Dawn Coleman, MD, and her colleagues, performed a study on behalf of the Society for Vascular Surgery (SVS) Wellness Task Force to define the prevalence of burnout among practicing vascular surgeons, and to identify the risk factors for burnout. Such information will be used to facilitate future SVS initiatives to avert this crisis.

In Thursday’s von Liebig Forum, Dr. Coleman, of the University of Michigan, Ann Arbor, will present the results of their 2018 anonymous survey of active SVS members. The survey used a validated burnout assessment, Maslach Burnout Index (MBI), embedded in a questionnaire that also captured demographic and practice-related characteristics.

The survey was personalized for the specialty and did allow for free text. according to Dr. Coleman, and “we specifically analyzed emotional exhaustion, one dimension of burnout.”

The accepted threshold of a score of 27 or greater on the MBI Emotional Exhaustion module was used to identify surgeons suffering from burnout. Risk factors for such were identified using bivariate analyses (Chi-square, Kruskal-Wallis), and multivariate logistic regression models were developed to identify independent risk factors for burnout, she added.

Dr. Coleman will present the results from the 960 out of 2,905 active SVS members who responded to the survey (33%). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were finally analyzed. The mean respondent age was 49.7 years; and the majority of respondents (81%) were men. The primary practice settings were academic (40%), community practice (41%), Veterans Administration hospital (3.3%), active military practice (1.5%), or “other.” Mean years in practice was 15.7.

Overall, 30% of the respondents met criteria for burnout, 37% screened positive for symptoms of depression in the past month and 8% supported thoughts of taking their own life during the last 12 months.

By unadjusted analysis, factors significantly associated with burnout included clinical work hours, on-call frequency, electronic medical record/documentation requirements, perceived conflict between work and personal responsibilities, and physical pain. Multivariate analysis revealed age, work-related physical pain, and conflict between work and personal responsibilities as independent risk factors for burnout, said Dr. Coleman.

“Approximately one-third of practicing vascular surgeons self-report burnout and depression, according to our survey. Advancing age, physical pain, and work-life conflict are each independent predictors for burnout among vascular surgeons. These findings will facilitate SVS efforts to improve vascular surgeon well-being, in an effort to mitigate the personal, economic, and social impact of vascular surgeon burnout,” Dr. Coleman concluded.

See more on the work of the SVS Wellness Task Force in the June issue of Vascular Specialist. 

Physician burnout has been linked to medical errors, decreased patient satisfaction, and reduced career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern because of the impact on the adequacy of the vascular surgery workforce. Dawn Coleman, MD, and her colleagues, performed a study on behalf of the Society for Vascular Surgery (SVS) Wellness Task Force to define the prevalence of burnout among practicing vascular surgeons, and to identify the risk factors for burnout. Such information will be used to facilitate future SVS initiatives to avert this crisis.

In Thursday’s von Liebig Forum, Dr. Coleman, of the University of Michigan, Ann Arbor, will present the results of their 2018 anonymous survey of active SVS members. The survey used a validated burnout assessment, Maslach Burnout Index (MBI), embedded in a questionnaire that also captured demographic and practice-related characteristics.

The survey was personalized for the specialty and did allow for free text. according to Dr. Coleman, and “we specifically analyzed emotional exhaustion, one dimension of burnout.”

The accepted threshold of a score of 27 or greater on the MBI Emotional Exhaustion module was used to identify surgeons suffering from burnout. Risk factors for such were identified using bivariate analyses (Chi-square, Kruskal-Wallis), and multivariate logistic regression models were developed to identify independent risk factors for burnout, she added.

Dr. Coleman will present the results from the 960 out of 2,905 active SVS members who responded to the survey (33%). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were finally analyzed. The mean respondent age was 49.7 years; and the majority of respondents (81%) were men. The primary practice settings were academic (40%), community practice (41%), Veterans Administration hospital (3.3%), active military practice (1.5%), or “other.” Mean years in practice was 15.7.

Overall, 30% of the respondents met criteria for burnout, 37% screened positive for symptoms of depression in the past month and 8% supported thoughts of taking their own life during the last 12 months.

By unadjusted analysis, factors significantly associated with burnout included clinical work hours, on-call frequency, electronic medical record/documentation requirements, perceived conflict between work and personal responsibilities, and physical pain. Multivariate analysis revealed age, work-related physical pain, and conflict between work and personal responsibilities as independent risk factors for burnout, said Dr. Coleman.

“Approximately one-third of practicing vascular surgeons self-report burnout and depression, according to our survey. Advancing age, physical pain, and work-life conflict are each independent predictors for burnout among vascular surgeons. These findings will facilitate SVS efforts to improve vascular surgeon well-being, in an effort to mitigate the personal, economic, and social impact of vascular surgeon burnout,” Dr. Coleman concluded.

See more on the work of the SVS Wellness Task Force in the June issue of Vascular Specialist. 

Sexual harassment is known to be more pervasive in male-dominated workplaces and flourishes in a climate of tolerance and culture of silence, according to Bernadette Aulivola, MD, of Loyola University Medical Center, Maywood, Ill.

“We sought to examine the prevalence of sexual harassment in academic vascular surgery practices, identify factors associated with occurrence, determine reporting barriers, and identify any gender bias that exists,” said Dr. Aulivola.

In Wednesday’s VESS session, Dr. Aulivola will present the results of an anonymous survey that she and Matthew R. Smeds, MD, of Saint Louis University, conducted to examine the issue. The survey was emailed to 346 vascular surgery faculty members at 52 training sites in the United States.

“This research stemmed from a similar project done in vascular surgery trainees (residents and trainees) that identified a significant amount of harassment occurring at this level with a concomitant fear of reporting and lack of knowledge of institutional reporting mechanisms. We thought an analysis of harassment at the attending physician level may be relevant. There is significant gender bias in medicine in general and a not insignificant rate of harassment that occurs,” Dr. Smeds said in an interview.

Of the invitations sent, 149 (43%) completed the survey. Among these, 48/149 (32%) thought harassment occurred more commonly in surgical specialties with historical male dominance. In addition, ignoring the behavior, and hierarchy/power dynamics were the most common reasons given for its occurrence. Overall, 61/149 (41%) reported experiencing workplace harassment. Being told unwanted sexually explicit comments/questions/jokes, being called a sexist slur/nickname, or being paid unwanted flirtation were the most commonly described behaviors.

Those harassed were significantly more likely to be female (37% vs. 13%), and on average had experienced 2.6 (of 10) types of harassment. Despite 84% of respondents acknowledging institutional reporting mechanisms, only 7.2% of the harassing behaviors were reported.

The most common reasons for not reporting including feeling the behavior was “harmless” (67%) or “nothing positive would come of it” (28%), although 30% of respondents feared repercussions or felt uncomfortable identifying as a target of sexual harassment and only 59% of respondents reported that they would feel comfortable discussing the issue with departmental/divisional leadership.

“A significant number of vascular surgeons in academic practice have experienced workplace sexual harassment,” Dr. Aulivola said. “While most are aware of institutional reporting mechanisms, very few events are reported and less than 60% of respondents feel comfortable reporting to departmental/divisional leadership. Female vascular surgeons believe gender influences hiring, promotion, compensation, and attainment of life goals. Further work is necessary to identify methods of reducing workplace sexual harassment and optimize gender disparity in academic vascular surgery practice,” she concluded. 

Wednesday, June 12
12:30-4:15 p.m.
Gaylord National, Maryland D
V2: VESS Paper Session 2: VESS18

Sexual harassment is known to be more pervasive in male-dominated workplaces and flourishes in a climate of tolerance and culture of silence, according to Bernadette Aulivola, MD, of Loyola University Medical Center, Maywood, Ill.

“We sought to examine the prevalence of sexual harassment in academic vascular surgery practices, identify factors associated with occurrence, determine reporting barriers, and identify any gender bias that exists,” said Dr. Aulivola.

In Wednesday’s VESS session, Dr. Aulivola will present the results of an anonymous survey that she and Matthew R. Smeds, MD, of Saint Louis University, conducted to examine the issue. The survey was emailed to 346 vascular surgery faculty members at 52 training sites in the United States.

“This research stemmed from a similar project done in vascular surgery trainees (residents and trainees) that identified a significant amount of harassment occurring at this level with a concomitant fear of reporting and lack of knowledge of institutional reporting mechanisms. We thought an analysis of harassment at the attending physician level may be relevant. There is significant gender bias in medicine in general and a not insignificant rate of harassment that occurs,” Dr. Smeds said in an interview.

Of the invitations sent, 149 (43%) completed the survey. Among these, 48/149 (32%) thought harassment occurred more commonly in surgical specialties with historical male dominance. In addition, ignoring the behavior, and hierarchy/power dynamics were the most common reasons given for its occurrence. Overall, 61/149 (41%) reported experiencing workplace harassment. Being told unwanted sexually explicit comments/questions/jokes, being called a sexist slur/nickname, or being paid unwanted flirtation were the most commonly described behaviors.

Those harassed were significantly more likely to be female (37% vs. 13%), and on average had experienced 2.6 (of 10) types of harassment. Despite 84% of respondents acknowledging institutional reporting mechanisms, only 7.2% of the harassing behaviors were reported.

The most common reasons for not reporting including feeling the behavior was “harmless” (67%) or “nothing positive would come of it” (28%), although 30% of respondents feared repercussions or felt uncomfortable identifying as a target of sexual harassment and only 59% of respondents reported that they would feel comfortable discussing the issue with departmental/divisional leadership.

“A significant number of vascular surgeons in academic practice have experienced workplace sexual harassment,” Dr. Aulivola said. “While most are aware of institutional reporting mechanisms, very few events are reported and less than 60% of respondents feel comfortable reporting to departmental/divisional leadership. Female vascular surgeons believe gender influences hiring, promotion, compensation, and attainment of life goals. Further work is necessary to identify methods of reducing workplace sexual harassment and optimize gender disparity in academic vascular surgery practice,” she concluded. 

Wednesday, June 12
12:30-4:15 p.m.
Gaylord National, Maryland D
V2: VESS Paper Session 2: VESS18

Sexual harassment is known to be more pervasive in male-dominated workplaces and flourishes in a climate of tolerance and culture of silence, according to Bernadette Aulivola, MD, of Loyola University Medical Center, Maywood, Ill.

“We sought to examine the prevalence of sexual harassment in academic vascular surgery practices, identify factors associated with occurrence, determine reporting barriers, and identify any gender bias that exists,” said Dr. Aulivola.

In Wednesday’s VESS session, Dr. Aulivola will present the results of an anonymous survey that she and Matthew R. Smeds, MD, of Saint Louis University, conducted to examine the issue. The survey was emailed to 346 vascular surgery faculty members at 52 training sites in the United States.

“This research stemmed from a similar project done in vascular surgery trainees (residents and trainees) that identified a significant amount of harassment occurring at this level with a concomitant fear of reporting and lack of knowledge of institutional reporting mechanisms. We thought an analysis of harassment at the attending physician level may be relevant. There is significant gender bias in medicine in general and a not insignificant rate of harassment that occurs,” Dr. Smeds said in an interview.

Of the invitations sent, 149 (43%) completed the survey. Among these, 48/149 (32%) thought harassment occurred more commonly in surgical specialties with historical male dominance. In addition, ignoring the behavior, and hierarchy/power dynamics were the most common reasons given for its occurrence. Overall, 61/149 (41%) reported experiencing workplace harassment. Being told unwanted sexually explicit comments/questions/jokes, being called a sexist slur/nickname, or being paid unwanted flirtation were the most commonly described behaviors.

Those harassed were significantly more likely to be female (37% vs. 13%), and on average had experienced 2.6 (of 10) types of harassment. Despite 84% of respondents acknowledging institutional reporting mechanisms, only 7.2% of the harassing behaviors were reported.

The most common reasons for not reporting including feeling the behavior was “harmless” (67%) or “nothing positive would come of it” (28%), although 30% of respondents feared repercussions or felt uncomfortable identifying as a target of sexual harassment and only 59% of respondents reported that they would feel comfortable discussing the issue with departmental/divisional leadership.

“A significant number of vascular surgeons in academic practice have experienced workplace sexual harassment,” Dr. Aulivola said. “While most are aware of institutional reporting mechanisms, very few events are reported and less than 60% of respondents feel comfortable reporting to departmental/divisional leadership. Female vascular surgeons believe gender influences hiring, promotion, compensation, and attainment of life goals. Further work is necessary to identify methods of reducing workplace sexual harassment and optimize gender disparity in academic vascular surgery practice,” she concluded. 

Wednesday, June 12
12:30-4:15 p.m.
Gaylord National, Maryland D
V2: VESS Paper Session 2: VESS18

SAN DIEGO – Colorectal cancer clinicians who demonstrate high levels of behavioral cultural competence skills are more likely to have higher Press Ganey provider care satisfaction scores, results from a single-center study showed.

Doug Brunk/MDedge News

“Cultural competence is valued by patients, and there is a potential for training providers to be more culturally competent, focusing on their behaviors,” lead study author Miquell O. Miller, MD, said at the annual Digestive Disease Week.

While the Society for Surgery of the Alimentary Tract (J Gastrointest Surg 2016;20[5]:879-84) and other medical organizations have recognized the importance of workforce diversity and cultural competence of providers, little is known of the relationship between cultural competence and patient-reported outcomes in surgery, said Dr. Miller, who is a general surgery resident at Stanford (Calif.) University. To investigate this relationship, she and her colleagues recruited surgeons, oncologists, gastroenterologists, and advanced practice providers to complete a validated online survey that measured two domains of cultural competency: awareness and behaviors. They matched these scores with the 10-item Press Ganey provider care scores from 2017 to 2018. Next, the researchers conducted a linear regression analysis with mixed effects to account for clustering of patients within providers. They also adjusted for provider bias by measuring social desirability, “which is the tendency for respondents to put a more socially appropriate answer as opposed to the true answer on the cultural competence survey,” Dr. Miller explained.

A total of 1,322 Press Ganey satisfaction surveys were available for 29 providers. Their mean age was 48 years, 59% were white, 72% were physicians, and 28% were advanced practice providers. They practiced in GI oncology (41%), gastroenterology (31%) and colorectal surgery (28%). Dr. Miller reported that providers who participated in the survey had a mean cultural awareness score of 6.2 out of a possible 7 points, while the mean cultural behavior score was a 4.1 out of a possible 7 points. She and her colleagues observed that providers who had high levels of cultural competence on the behavioral assessment were positively associated with Press Ganey patient satisfaction (P = .039).

“I think we do a poor job of training our providers to be culturally competent, but there are multiple ways to improve behaviors, by teaching people and by having real training for our providers,” Dr. Miller said.

She acknowledged certain limitations of the study, including its single-center design and the fact that not all providers had Press Ganey scores available. The study was funded by the Society for Surgery of the Alimentary Tract and the Black Academic Surgeons Resident Research Award. Dr. Miller reported having no financial disclosures.

dbrunk@mdedge.com

SAN DIEGO – Colorectal cancer clinicians who demonstrate high levels of behavioral cultural competence skills are more likely to have higher Press Ganey provider care satisfaction scores, results from a single-center study showed.

Doug Brunk/MDedge News

“Cultural competence is valued by patients, and there is a potential for training providers to be more culturally competent, focusing on their behaviors,” lead study author Miquell O. Miller, MD, said at the annual Digestive Disease Week.

While the Society for Surgery of the Alimentary Tract (J Gastrointest Surg 2016;20[5]:879-84) and other medical organizations have recognized the importance of workforce diversity and cultural competence of providers, little is known of the relationship between cultural competence and patient-reported outcomes in surgery, said Dr. Miller, who is a general surgery resident at Stanford (Calif.) University. To investigate this relationship, she and her colleagues recruited surgeons, oncologists, gastroenterologists, and advanced practice providers to complete a validated online survey that measured two domains of cultural competency: awareness and behaviors. They matched these scores with the 10-item Press Ganey provider care scores from 2017 to 2018. Next, the researchers conducted a linear regression analysis with mixed effects to account for clustering of patients within providers. They also adjusted for provider bias by measuring social desirability, “which is the tendency for respondents to put a more socially appropriate answer as opposed to the true answer on the cultural competence survey,” Dr. Miller explained.

A total of 1,322 Press Ganey satisfaction surveys were available for 29 providers. Their mean age was 48 years, 59% were white, 72% were physicians, and 28% were advanced practice providers. They practiced in GI oncology (41%), gastroenterology (31%) and colorectal surgery (28%). Dr. Miller reported that providers who participated in the survey had a mean cultural awareness score of 6.2 out of a possible 7 points, while the mean cultural behavior score was a 4.1 out of a possible 7 points. She and her colleagues observed that providers who had high levels of cultural competence on the behavioral assessment were positively associated with Press Ganey patient satisfaction (P = .039).

“I think we do a poor job of training our providers to be culturally competent, but there are multiple ways to improve behaviors, by teaching people and by having real training for our providers,” Dr. Miller said.

She acknowledged certain limitations of the study, including its single-center design and the fact that not all providers had Press Ganey scores available. The study was funded by the Society for Surgery of the Alimentary Tract and the Black Academic Surgeons Resident Research Award. Dr. Miller reported having no financial disclosures.

dbrunk@mdedge.com

SAN DIEGO – Colorectal cancer clinicians who demonstrate high levels of behavioral cultural competence skills are more likely to have higher Press Ganey provider care satisfaction scores, results from a single-center study showed.

Doug Brunk/MDedge News

“Cultural competence is valued by patients, and there is a potential for training providers to be more culturally competent, focusing on their behaviors,” lead study author Miquell O. Miller, MD, said at the annual Digestive Disease Week.

While the Society for Surgery of the Alimentary Tract (J Gastrointest Surg 2016;20[5]:879-84) and other medical organizations have recognized the importance of workforce diversity and cultural competence of providers, little is known of the relationship between cultural competence and patient-reported outcomes in surgery, said Dr. Miller, who is a general surgery resident at Stanford (Calif.) University. To investigate this relationship, she and her colleagues recruited surgeons, oncologists, gastroenterologists, and advanced practice providers to complete a validated online survey that measured two domains of cultural competency: awareness and behaviors. They matched these scores with the 10-item Press Ganey provider care scores from 2017 to 2018. Next, the researchers conducted a linear regression analysis with mixed effects to account for clustering of patients within providers. They also adjusted for provider bias by measuring social desirability, “which is the tendency for respondents to put a more socially appropriate answer as opposed to the true answer on the cultural competence survey,” Dr. Miller explained.

A total of 1,322 Press Ganey satisfaction surveys were available for 29 providers. Their mean age was 48 years, 59% were white, 72% were physicians, and 28% were advanced practice providers. They practiced in GI oncology (41%), gastroenterology (31%) and colorectal surgery (28%). Dr. Miller reported that providers who participated in the survey had a mean cultural awareness score of 6.2 out of a possible 7 points, while the mean cultural behavior score was a 4.1 out of a possible 7 points. She and her colleagues observed that providers who had high levels of cultural competence on the behavioral assessment were positively associated with Press Ganey patient satisfaction (P = .039).

“I think we do a poor job of training our providers to be culturally competent, but there are multiple ways to improve behaviors, by teaching people and by having real training for our providers,” Dr. Miller said.

She acknowledged certain limitations of the study, including its single-center design and the fact that not all providers had Press Ganey scores available. The study was funded by the Society for Surgery of the Alimentary Tract and the Black Academic Surgeons Resident Research Award. Dr. Miller reported having no financial disclosures.

dbrunk@mdedge.com

Come see exhibitors present new ideas, showcase new technologies, and discuss the latest trends in vascular surgery. All Vascular Live events will take place at the Vascular Live stage in the Auditorium, on the lower level of the convention center.

Thursday, June 13

12:15 – 12:45 p.m.
Sponsored by Gore
Case Examples from the EU of the New GORE^® TAG^® Conformable Thoracic Stent Graft with ACTIVE CONTROL^® System
Speaker: Prof. Dittmar Böckler

12:45 – 1:15 p.m.
Sponsored by Gore
Lower Limb Stent Grafting: Complex Cases and Techniques in SFA and Aortoiliac Disease
Speaker: Krishna Mannava, MD

3 – 3:30 p.m.
Sponsored by Silk Road Medical
Latest (Breaking) Clinical Evidence Strongly Supports Developing a TCAR Program – Why and How from a Vascular Surgery Perspective
Speakers: Sumaira Macdonald, MD; Jeffrey Jim, MD; Marc L. Schermerhorn, MD; and Michael C. Stoner, MD
 

5:30 – 6 p.m.
Sponsored by Thompson Surgical
Technological Advances and the Evolution of the ‘Mini-Open’ Anterior Spine Exposure Technique
Speaker: Jonathan E. Schoeff, MD

6 – 6:30 p.m.
Sponsored by Amgen
Criticality of LDC-C Lowering in Patients with PAD
Speaker: Marc P. Bonaca, MD
 

Friday, June 14

9:30 – 10 a.m.
Sponsored by Abbott
Access & Closure Techniques for Complex Aortic Cases
Speaker: Jason T. Lee, MD

12:30 – 1 p.m.
Sponsored by Abbott
A Clinical Review of the WavelineQ 4F EndoAVF System
Speakers: Todd Berland, MD; Paul B. Kreienberg, MD; and Eric K. Peden, MD

1 – 1:30 p.m.
Sponsored by Abbott
EPDs in the Lower Limb: Why and When to Use Them
Speaker: April Estelle Nedeau, MD

3 – 3:30 p.m.
Sponsored by Medtronic
Clinical Significance of Sac Regression with Case Examples
Speaker: TBD
 

Vascular Live presentations are not eligible for CME credit. 

Come see exhibitors present new ideas, showcase new technologies, and discuss the latest trends in vascular surgery. All Vascular Live events will take place at the Vascular Live stage in the Auditorium, on the lower level of the convention center.

Thursday, June 13

12:15 – 12:45 p.m.
Sponsored by Gore
Case Examples from the EU of the New GORE^® TAG^® Conformable Thoracic Stent Graft with ACTIVE CONTROL^® System
Speaker: Prof. Dittmar Böckler

12:45 – 1:15 p.m.
Sponsored by Gore
Lower Limb Stent Grafting: Complex Cases and Techniques in SFA and Aortoiliac Disease
Speaker: Krishna Mannava, MD

3 – 3:30 p.m.
Sponsored by Silk Road Medical
Latest (Breaking) Clinical Evidence Strongly Supports Developing a TCAR Program – Why and How from a Vascular Surgery Perspective
Speakers: Sumaira Macdonald, MD; Jeffrey Jim, MD; Marc L. Schermerhorn, MD; and Michael C. Stoner, MD
 

5:30 – 6 p.m.
Sponsored by Thompson Surgical
Technological Advances and the Evolution of the ‘Mini-Open’ Anterior Spine Exposure Technique
Speaker: Jonathan E. Schoeff, MD

6 – 6:30 p.m.
Sponsored by Amgen
Criticality of LDC-C Lowering in Patients with PAD
Speaker: Marc P. Bonaca, MD
 

Friday, June 14

9:30 – 10 a.m.
Sponsored by Abbott
Access & Closure Techniques for Complex Aortic Cases
Speaker: Jason T. Lee, MD

12:30 – 1 p.m.
Sponsored by Abbott
A Clinical Review of the WavelineQ 4F EndoAVF System
Speakers: Todd Berland, MD; Paul B. Kreienberg, MD; and Eric K. Peden, MD

1 – 1:30 p.m.
Sponsored by Abbott
EPDs in the Lower Limb: Why and When to Use Them
Speaker: April Estelle Nedeau, MD

3 – 3:30 p.m.
Sponsored by Medtronic
Clinical Significance of Sac Regression with Case Examples
Speaker: TBD
 

Vascular Live presentations are not eligible for CME credit. 

Come see exhibitors present new ideas, showcase new technologies, and discuss the latest trends in vascular surgery. All Vascular Live events will take place at the Vascular Live stage in the Auditorium, on the lower level of the convention center.

Thursday, June 13

12:15 – 12:45 p.m.
Sponsored by Gore
Case Examples from the EU of the New GORE^® TAG^® Conformable Thoracic Stent Graft with ACTIVE CONTROL^® System
Speaker: Prof. Dittmar Böckler

12:45 – 1:15 p.m.
Sponsored by Gore
Lower Limb Stent Grafting: Complex Cases and Techniques in SFA and Aortoiliac Disease
Speaker: Krishna Mannava, MD

3 – 3:30 p.m.
Sponsored by Silk Road Medical
Latest (Breaking) Clinical Evidence Strongly Supports Developing a TCAR Program – Why and How from a Vascular Surgery Perspective
Speakers: Sumaira Macdonald, MD; Jeffrey Jim, MD; Marc L. Schermerhorn, MD; and Michael C. Stoner, MD
 

5:30 – 6 p.m.
Sponsored by Thompson Surgical
Technological Advances and the Evolution of the ‘Mini-Open’ Anterior Spine Exposure Technique
Speaker: Jonathan E. Schoeff, MD

6 – 6:30 p.m.
Sponsored by Amgen
Criticality of LDC-C Lowering in Patients with PAD
Speaker: Marc P. Bonaca, MD
 

Friday, June 14

9:30 – 10 a.m.
Sponsored by Abbott
Access & Closure Techniques for Complex Aortic Cases
Speaker: Jason T. Lee, MD

12:30 – 1 p.m.
Sponsored by Abbott
A Clinical Review of the WavelineQ 4F EndoAVF System
Speakers: Todd Berland, MD; Paul B. Kreienberg, MD; and Eric K. Peden, MD

1 – 1:30 p.m.
Sponsored by Abbott
EPDs in the Lower Limb: Why and When to Use Them
Speaker: April Estelle Nedeau, MD

3 – 3:30 p.m.
Sponsored by Medtronic
Clinical Significance of Sac Regression with Case Examples
Speaker: TBD
 

Vascular Live presentations are not eligible for CME credit. 

SAN FRANCISCO – Serial ketamine infusions eliminated suicidal ideation in more than two-thirds of patients at a psychiatry office in Connecticut but at significantly higher doses than those recently approved for Janssen’s new esketamine nasal spray (Spravato).

M. Alexander Otto/MDedge News

The patients were treated by Lori V. Calabrese, MD, at Innovative Psychiatry, her private outpatient practice in South Windsor. She presented her first 235 IV ketamine cases at the American Psychiatric Association annual meeting. It was likely the largest real-world series to date of ketamine infusions for treatment-resistant depression and suicidality.

The patients, 14-84 years old but mostly middle-aged, received six infusions over 2-3 weeks, starting at 0.5 mg/kg over 40-50 minutes, then titrated upward for dissociative effect to a maximum of 1.7 mg/kg. Subjects filled out the nine-item Patient Health Questionnaire (PHQ-9) at baseline and before each infusion. Item nine – “thoughts that you would be better off dead or of hurting yourself in some way” – was used to gauge suicidality. That item has been validated as a predictor of suicide risk.

Among 144 patients (62%) who were markedly suicidal, ketamine infusions were tied to diminished ideation in 118 (82%) and eliminated ideation in 98 (68%). They were severely depressed at baseline; PHQ-9 scores fell in 127 (89%), and depression went into remission in 89 (62%). There were no suicide attempts, ED visits, or hospitalizations during treatment and at 4-week follow-up.

“Even if they had been suicidal for a long time, been hospitalized, and made suicide attempts, 68% had full remission of suicidality. This is a life-saving treatment, a breakthrough option for psychiatrists,” Dr. Calabrese said.

The results are “fabulous,” said Jaskaran Singh, MD, who said he was clinical leader of the esketamine program at Janssen.

M. Alexander Otto/MDedge News

aotto@mdedge.com

SAN FRANCISCO – Serial ketamine infusions eliminated suicidal ideation in more than two-thirds of patients at a psychiatry office in Connecticut but at significantly higher doses than those recently approved for Janssen’s new esketamine nasal spray (Spravato).

M. Alexander Otto/MDedge News

The patients were treated by Lori V. Calabrese, MD, at Innovative Psychiatry, her private outpatient practice in South Windsor. She presented her first 235 IV ketamine cases at the American Psychiatric Association annual meeting. It was likely the largest real-world series to date of ketamine infusions for treatment-resistant depression and suicidality.

The patients, 14-84 years old but mostly middle-aged, received six infusions over 2-3 weeks, starting at 0.5 mg/kg over 40-50 minutes, then titrated upward for dissociative effect to a maximum of 1.7 mg/kg. Subjects filled out the nine-item Patient Health Questionnaire (PHQ-9) at baseline and before each infusion. Item nine – “thoughts that you would be better off dead or of hurting yourself in some way” – was used to gauge suicidality. That item has been validated as a predictor of suicide risk.

Among 144 patients (62%) who were markedly suicidal, ketamine infusions were tied to diminished ideation in 118 (82%) and eliminated ideation in 98 (68%). They were severely depressed at baseline; PHQ-9 scores fell in 127 (89%), and depression went into remission in 89 (62%). There were no suicide attempts, ED visits, or hospitalizations during treatment and at 4-week follow-up.

“Even if they had been suicidal for a long time, been hospitalized, and made suicide attempts, 68% had full remission of suicidality. This is a life-saving treatment, a breakthrough option for psychiatrists,” Dr. Calabrese said.

The results are “fabulous,” said Jaskaran Singh, MD, who said he was clinical leader of the esketamine program at Janssen.

M. Alexander Otto/MDedge News

aotto@mdedge.com

SAN FRANCISCO – Serial ketamine infusions eliminated suicidal ideation in more than two-thirds of patients at a psychiatry office in Connecticut but at significantly higher doses than those recently approved for Janssen’s new esketamine nasal spray (Spravato).

M. Alexander Otto/MDedge News

The patients were treated by Lori V. Calabrese, MD, at Innovative Psychiatry, her private outpatient practice in South Windsor. She presented her first 235 IV ketamine cases at the American Psychiatric Association annual meeting. It was likely the largest real-world series to date of ketamine infusions for treatment-resistant depression and suicidality.

The patients, 14-84 years old but mostly middle-aged, received six infusions over 2-3 weeks, starting at 0.5 mg/kg over 40-50 minutes, then titrated upward for dissociative effect to a maximum of 1.7 mg/kg. Subjects filled out the nine-item Patient Health Questionnaire (PHQ-9) at baseline and before each infusion. Item nine – “thoughts that you would be better off dead or of hurting yourself in some way” – was used to gauge suicidality. That item has been validated as a predictor of suicide risk.

Among 144 patients (62%) who were markedly suicidal, ketamine infusions were tied to diminished ideation in 118 (82%) and eliminated ideation in 98 (68%). They were severely depressed at baseline; PHQ-9 scores fell in 127 (89%), and depression went into remission in 89 (62%). There were no suicide attempts, ED visits, or hospitalizations during treatment and at 4-week follow-up.

“Even if they had been suicidal for a long time, been hospitalized, and made suicide attempts, 68% had full remission of suicidality. This is a life-saving treatment, a breakthrough option for psychiatrists,” Dr. Calabrese said.

The results are “fabulous,” said Jaskaran Singh, MD, who said he was clinical leader of the esketamine program at Janssen.

M. Alexander Otto/MDedge News

aotto@mdedge.com

The novel anti–programmed cell death antibody PF-06801591 had tolerable safety and efficacy outcomes when given subcutaneously to patients with advanced solid tumors, based on results from an ongoing phase 1 trial.

“We assessed feasibility of monthly subcutaneous administration of PF-06801591, a humanized immunoglobulin G4 monoclonal antibody that binds to the programmed cell death [PD-1] receptor,” Melissa L. Johnson, MD, of the Sarah Cannon Research Institute, Nashville, Tenn., and colleagues wrote in JAMA Oncology. “Subcutaneous administration of an anti-PD-1 antibody in patients with advanced solid tumors appears to be feasible.”

The researchers evaluated the efficacy, safety, and pharmacokinetics of the novel anti-PD-1 therapy in a group of 40 patients with locally advanced or metastatic solid tumors. The antibody was administered in both subcutaneous and intravenous forms.

Study participants were administered the subcutaneous form of the antibody at 300 mg every 4 weeks or the intravenous form at 0.5, 1, 3, or 10 mg/kg every 3 weeks.

“Dose escalation occurred after two to four patients were enrolled per dose level, with additional patients enrolled in each cohort for further assessment,” the researchers wrote.

The primary endpoints were safety and dose-limiting adverse effects. Efficacy, immunogenicity, pharmacokinetics, and PD-1 receptor occupancy were secondary endpoints.

After analysis, Dr. Johnson and colleagues reported that the overall response rate was 18.4%. In addition, no dose-limiting toxicities were detected in both intravenous and subcutaneous groups, but grade 3 or greater adverse events were reported in 6.7% and 16% of patients treated with subcutaneous and intravenous dosage forms, respectively.

“No dose–adverse event associations were observed during intravenous dose escalation, and no serious skin toxic effects occurred with subcutaneous delivery,” they reported.

Based on the findings, the team selected the subcutaneous form (300 mg) of the therapy for additional assessment in the second half of this ongoing trial.

The study was funded by Pfizer. The authors reported financial affiliations with BerGenBio, EMD Serono, Janssen, Mirati Therapeutics, Pfizer, and several others.

SOURCE: Johnson ML et al. JAMA Oncol. 2019 May 30. doi: 10.1001/jamaoncol.2019.0836.

The novel anti–programmed cell death antibody PF-06801591 had tolerable safety and efficacy outcomes when given subcutaneously to patients with advanced solid tumors, based on results from an ongoing phase 1 trial.

“We assessed feasibility of monthly subcutaneous administration of PF-06801591, a humanized immunoglobulin G4 monoclonal antibody that binds to the programmed cell death [PD-1] receptor,” Melissa L. Johnson, MD, of the Sarah Cannon Research Institute, Nashville, Tenn., and colleagues wrote in JAMA Oncology. “Subcutaneous administration of an anti-PD-1 antibody in patients with advanced solid tumors appears to be feasible.”

The researchers evaluated the efficacy, safety, and pharmacokinetics of the novel anti-PD-1 therapy in a group of 40 patients with locally advanced or metastatic solid tumors. The antibody was administered in both subcutaneous and intravenous forms.

Study participants were administered the subcutaneous form of the antibody at 300 mg every 4 weeks or the intravenous form at 0.5, 1, 3, or 10 mg/kg every 3 weeks.

“Dose escalation occurred after two to four patients were enrolled per dose level, with additional patients enrolled in each cohort for further assessment,” the researchers wrote.

The primary endpoints were safety and dose-limiting adverse effects. Efficacy, immunogenicity, pharmacokinetics, and PD-1 receptor occupancy were secondary endpoints.

After analysis, Dr. Johnson and colleagues reported that the overall response rate was 18.4%. In addition, no dose-limiting toxicities were detected in both intravenous and subcutaneous groups, but grade 3 or greater adverse events were reported in 6.7% and 16% of patients treated with subcutaneous and intravenous dosage forms, respectively.

“No dose–adverse event associations were observed during intravenous dose escalation, and no serious skin toxic effects occurred with subcutaneous delivery,” they reported.

Based on the findings, the team selected the subcutaneous form (300 mg) of the therapy for additional assessment in the second half of this ongoing trial.

The study was funded by Pfizer. The authors reported financial affiliations with BerGenBio, EMD Serono, Janssen, Mirati Therapeutics, Pfizer, and several others.

SOURCE: Johnson ML et al. JAMA Oncol. 2019 May 30. doi: 10.1001/jamaoncol.2019.0836.

The novel anti–programmed cell death antibody PF-06801591 had tolerable safety and efficacy outcomes when given subcutaneously to patients with advanced solid tumors, based on results from an ongoing phase 1 trial.

“We assessed feasibility of monthly subcutaneous administration of PF-06801591, a humanized immunoglobulin G4 monoclonal antibody that binds to the programmed cell death [PD-1] receptor,” Melissa L. Johnson, MD, of the Sarah Cannon Research Institute, Nashville, Tenn., and colleagues wrote in JAMA Oncology. “Subcutaneous administration of an anti-PD-1 antibody in patients with advanced solid tumors appears to be feasible.”

The researchers evaluated the efficacy, safety, and pharmacokinetics of the novel anti-PD-1 therapy in a group of 40 patients with locally advanced or metastatic solid tumors. The antibody was administered in both subcutaneous and intravenous forms.

Study participants were administered the subcutaneous form of the antibody at 300 mg every 4 weeks or the intravenous form at 0.5, 1, 3, or 10 mg/kg every 3 weeks.

“Dose escalation occurred after two to four patients were enrolled per dose level, with additional patients enrolled in each cohort for further assessment,” the researchers wrote.

The primary endpoints were safety and dose-limiting adverse effects. Efficacy, immunogenicity, pharmacokinetics, and PD-1 receptor occupancy were secondary endpoints.

After analysis, Dr. Johnson and colleagues reported that the overall response rate was 18.4%. In addition, no dose-limiting toxicities were detected in both intravenous and subcutaneous groups, but grade 3 or greater adverse events were reported in 6.7% and 16% of patients treated with subcutaneous and intravenous dosage forms, respectively.

“No dose–adverse event associations were observed during intravenous dose escalation, and no serious skin toxic effects occurred with subcutaneous delivery,” they reported.

Based on the findings, the team selected the subcutaneous form (300 mg) of the therapy for additional assessment in the second half of this ongoing trial.

The study was funded by Pfizer. The authors reported financial affiliations with BerGenBio, EMD Serono, Janssen, Mirati Therapeutics, Pfizer, and several others.

SOURCE: Johnson ML et al. JAMA Oncol. 2019 May 30. doi: 10.1001/jamaoncol.2019.0836.

The Exhibit Hall is an integral part of the Vascular Annual Meeting. All members of the vascular team, as well as other attendees, will be able to see a wide-ranging array of products of interest to vascular surgeons and their teams from dozens of vendors.

The VAM website (vsweb.org/VAM19) and mobile app offer a listing of exhibitors. A real-time floor plan (vsweb.org/FloorMap) helps attendees navigate the Exhibit Hall to find the products they most want to see.

Martin Allred

This year’s Exhibit Hall also will include the Office Vascular Care Pavilion, of interest particularly for those clinicians who perform procedures in outpatient and office-based settings. Five vendors currently plan to exhibit at the pavilion, and four presentations for office-based providers are scheduled. 

The Exhibit Hall on the lower level also hosts fun and games – literally. It’s the site for the Opening and Closing receptions, on Thursday and Friday evenings, respectively and the Scavenger Hunt. And attendees can also take advantage of non-CME learning opportunities, giveaways, training opportunities and networking potential.

The Opening Reception takes place from 5 to 6:30 p.m., coinciding with the Interactive Poster Session. The Closing Reception is from 4:30 to 5:30 p.m. Friday. It’s a great time to browse the exhibits, talk with vendors, meet up with friends and colleagues, sip on a beverage, and enjoy the food.

Participate in Scavenger Hunt

Games? That would be the Vascular Annual Meeting Scavenger Hunt, sure to be a hit with those with even a bit of a competitive streak. It’s simple and it’s fun. Just download the Mobile App to scan the QR codes found in sponsors’ booths throughout the Exhibit Hall. When a multiple-choice question appears on the display, answer it. Correct answers earn 10 points. 

Vascular Live hosts innovative sessions about the latest products and development related to vascular surgery, in a theater-in-the-round setting during Thursday and Friday’s coffee breaks and lunch hours. These frequently are standing-room only, so be sure to arrive early for a good seat. (See the VAM Planner and the mobile app.)

The Exhibit Hall also is the place to be for coffee breaks, 10 a.m. and 3 p.m. Thursday and 9:30 a.m. and 3 p.m. Friday as well as lunch, at 12 p.m. Thursday and 12:15 p.m. Friday. Food stations offer box lunches – free to attendees, though tickets are required. And there are plenty of tables to permit sitting down and chatting with colleagues for a bit.

Industry participation in the VAM exhibits underwrites a significant portion of VAM, thereby allowing us to keep registration fees at a much lower rate than other industry meetings. Please support our industry partners. A complete list of exhibitors and their booth locations are found in the Connections on-site publication and in the Mobile App, VAM Planner and VAM website (vsweb.org/VAM19). 

The Exhibit Hall is an integral part of the Vascular Annual Meeting. All members of the vascular team, as well as other attendees, will be able to see a wide-ranging array of products of interest to vascular surgeons and their teams from dozens of vendors.

The VAM website (vsweb.org/VAM19) and mobile app offer a listing of exhibitors. A real-time floor plan (vsweb.org/FloorMap) helps attendees navigate the Exhibit Hall to find the products they most want to see.

Martin Allred

This year’s Exhibit Hall also will include the Office Vascular Care Pavilion, of interest particularly for those clinicians who perform procedures in outpatient and office-based settings. Five vendors currently plan to exhibit at the pavilion, and four presentations for office-based providers are scheduled. 

The Exhibit Hall on the lower level also hosts fun and games – literally. It’s the site for the Opening and Closing receptions, on Thursday and Friday evenings, respectively and the Scavenger Hunt. And attendees can also take advantage of non-CME learning opportunities, giveaways, training opportunities and networking potential.

The Opening Reception takes place from 5 to 6:30 p.m., coinciding with the Interactive Poster Session. The Closing Reception is from 4:30 to 5:30 p.m. Friday. It’s a great time to browse the exhibits, talk with vendors, meet up with friends and colleagues, sip on a beverage, and enjoy the food.

Participate in Scavenger Hunt

Games? That would be the Vascular Annual Meeting Scavenger Hunt, sure to be a hit with those with even a bit of a competitive streak. It’s simple and it’s fun. Just download the Mobile App to scan the QR codes found in sponsors’ booths throughout the Exhibit Hall. When a multiple-choice question appears on the display, answer it. Correct answers earn 10 points. 

Vascular Live hosts innovative sessions about the latest products and development related to vascular surgery, in a theater-in-the-round setting during Thursday and Friday’s coffee breaks and lunch hours. These frequently are standing-room only, so be sure to arrive early for a good seat. (See the VAM Planner and the mobile app.)

The Exhibit Hall also is the place to be for coffee breaks, 10 a.m. and 3 p.m. Thursday and 9:30 a.m. and 3 p.m. Friday as well as lunch, at 12 p.m. Thursday and 12:15 p.m. Friday. Food stations offer box lunches – free to attendees, though tickets are required. And there are plenty of tables to permit sitting down and chatting with colleagues for a bit.

Industry participation in the VAM exhibits underwrites a significant portion of VAM, thereby allowing us to keep registration fees at a much lower rate than other industry meetings. Please support our industry partners. A complete list of exhibitors and their booth locations are found in the Connections on-site publication and in the Mobile App, VAM Planner and VAM website (vsweb.org/VAM19). 

The Exhibit Hall is an integral part of the Vascular Annual Meeting. All members of the vascular team, as well as other attendees, will be able to see a wide-ranging array of products of interest to vascular surgeons and their teams from dozens of vendors.

The VAM website (vsweb.org/VAM19) and mobile app offer a listing of exhibitors. A real-time floor plan (vsweb.org/FloorMap) helps attendees navigate the Exhibit Hall to find the products they most want to see.

Martin Allred

This year’s Exhibit Hall also will include the Office Vascular Care Pavilion, of interest particularly for those clinicians who perform procedures in outpatient and office-based settings. Five vendors currently plan to exhibit at the pavilion, and four presentations for office-based providers are scheduled. 

The Exhibit Hall on the lower level also hosts fun and games – literally. It’s the site for the Opening and Closing receptions, on Thursday and Friday evenings, respectively and the Scavenger Hunt. And attendees can also take advantage of non-CME learning opportunities, giveaways, training opportunities and networking potential.

The Opening Reception takes place from 5 to 6:30 p.m., coinciding with the Interactive Poster Session. The Closing Reception is from 4:30 to 5:30 p.m. Friday. It’s a great time to browse the exhibits, talk with vendors, meet up with friends and colleagues, sip on a beverage, and enjoy the food.

Participate in Scavenger Hunt

Games? That would be the Vascular Annual Meeting Scavenger Hunt, sure to be a hit with those with even a bit of a competitive streak. It’s simple and it’s fun. Just download the Mobile App to scan the QR codes found in sponsors’ booths throughout the Exhibit Hall. When a multiple-choice question appears on the display, answer it. Correct answers earn 10 points. 

Vascular Live hosts innovative sessions about the latest products and development related to vascular surgery, in a theater-in-the-round setting during Thursday and Friday’s coffee breaks and lunch hours. These frequently are standing-room only, so be sure to arrive early for a good seat. (See the VAM Planner and the mobile app.)

The Exhibit Hall also is the place to be for coffee breaks, 10 a.m. and 3 p.m. Thursday and 9:30 a.m. and 3 p.m. Friday as well as lunch, at 12 p.m. Thursday and 12:15 p.m. Friday. Food stations offer box lunches – free to attendees, though tickets are required. And there are plenty of tables to permit sitting down and chatting with colleagues for a bit.

Industry participation in the VAM exhibits underwrites a significant portion of VAM, thereby allowing us to keep registration fees at a much lower rate than other industry meetings. Please support our industry partners. A complete list of exhibitors and their booth locations are found in the Connections on-site publication and in the Mobile App, VAM Planner and VAM website (vsweb.org/VAM19). 

BALTIMORE – Experiencing panic-fear during asthma exacerbations predicted several beneficial outcomes in Mexican and Puerto Rican children with asthma, according to new research.

Tara Haelle/MDedge News

“When kids are anxious specifically during their asthma attacks, that can be a good thing because it means that they’re more vigilant,” lead author Jonathan M. Feldman, PhD, of the Albert Einstein College of Medicine’s Children’s Hospital at Montefiore and of Yeshiva University in the New York said in an interview. “They may be more likely to react during the early stages of an attack, and they may be more likely to be using self-management strategies at home and using their controller medications on a daily basis.”

He said pediatric providers can ask their patients with asthma how they feel during asthma attacks, such as whether they ever feel scared or worried.

“If a kid says no, not at all, then I would be concerned as a provider because they may not be paying attention to their asthma symptoms and they may not be taking it seriously,” Dr. Feldman said.

Past research has suggested that “illness-specific panic-fear” – the amount of anxiety someone experiences during asthma exacerbations – helps adults develop adaptive asthma management strategies, so Dr. Feldman and his colleagues examined the phenomenon as a potential protective factor in children. They shared their findings at the annual meeting of the Pediatric Academic Societies.

The research focused on Puerto Rican (n = 79) and Mexican (n = 188) children because of the substantial disparity in asthma prevalence and control between these two different Latino populations. Puerto Rican children have the highest asthma prevalence and morbidity among American children, whereas Mexican children have the lowest rates.

The 267 participants, aged 5-12 years, included 110 children from two inner-city hospitals in the New York and 157 children from two school-based health clinics and a Breathmobile in Phoenix. Nearly all the Arizona children were Mexican, and most (71%) of the Bronx children were Puerto Rican.

The authors collected the following measures at baseline and at 3, 6, 9, and 12 months follow-up: spirometry (forced expiratory volume in 1 second [FEV₁]), Childhood Asthma Control Test (CACT) for children 5-11 years old, the Asthma Control Test (ACT) for 12-year-olds, adherence to inhaled corticosteroids (ICS), and acute health care utilizations (clinic sick visits, ED visits, and hospitalizations).

The authors also queried patients on four illness-specific panic-fear measures from the Childhood Asthma Symptoms Checklist: how often they felt frightened, panicky, afraid of being alone, and afraid of dying during an asthma attack (Likert 1-5 scale).

Mexican children reported higher levels of illness-specific panic-fear at the start of the study. They also tended to have lower severity of asthma, better asthma control, and better adherence to ICS, compared with Puerto Rican children.

Also at baseline, the Mexican children’s caregivers tended to be younger, poorer, and more likely to be married and to speak Spanish. The Puerto Rican caregivers, on the other hand, had a higher educational level, including 61% high school graduates, and had more depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D).

One-year data revealed several links between baseline reports of panic-fear and better outcomes. Mexican children who reported experiencing panic-fear at baseline were more likely to have higher FEV₁ measures at 1 year of follow-up than were those who didn’t experience panic-fear (P = .02). Similarly, Puerto Rican children initially reporting panic-fear had better asthma control at 1 year, compared with those who didn’t report panic-fear (P = .007).

The researchers reported their effect sizes in terms of predicted variance in a model that accounted for the child’s age, sex, asthma duration, asthma severity, social support, acculturation, health care provider relationship, and number of family members with asthma. The model also factored in the caregiver’s age, sex, marital status, poverty level, education, and depressive symptoms.

For example, in their model, experiencing panic-fear accounted for 67% of the variance in FEV₁ levels in Mexican children and 53% of the variance in asthma control in Puerto Rican children.

Less acute health care utilization also was associated with children’s baseline levels of illness-specific panic-fear. In the model, 12% of the variance in acute health care utilization among Mexican children (P = .03) and 41% of the variance among Puerto Rican children (P = .02) was explained by child-reported panic-fear. No association was seen with medication adherence.

Although caregivers’ reports of children feeling panic-fear were linked to better FEV₁ outcomes in Mexican children (P = .02), the association was only slightly significant in Puerto Rican children (P = .05). Caregiver reports of children’s panic-fear were not associated with asthma control, acute health care utilization, or medication adherence.

“Providers should be aware that anxiety focused on asthma may be beneficial and facilitate adaptive asthma management strategies,” the authors concluded.

The research was funded by the National Institutes of Health. The authors reported no relevant financial disclosures.

BALTIMORE – Experiencing panic-fear during asthma exacerbations predicted several beneficial outcomes in Mexican and Puerto Rican children with asthma, according to new research.

Tara Haelle/MDedge News

“When kids are anxious specifically during their asthma attacks, that can be a good thing because it means that they’re more vigilant,” lead author Jonathan M. Feldman, PhD, of the Albert Einstein College of Medicine’s Children’s Hospital at Montefiore and of Yeshiva University in the New York said in an interview. “They may be more likely to react during the early stages of an attack, and they may be more likely to be using self-management strategies at home and using their controller medications on a daily basis.”

He said pediatric providers can ask their patients with asthma how they feel during asthma attacks, such as whether they ever feel scared or worried.

“If a kid says no, not at all, then I would be concerned as a provider because they may not be paying attention to their asthma symptoms and they may not be taking it seriously,” Dr. Feldman said.

Past research has suggested that “illness-specific panic-fear” – the amount of anxiety someone experiences during asthma exacerbations – helps adults develop adaptive asthma management strategies, so Dr. Feldman and his colleagues examined the phenomenon as a potential protective factor in children. They shared their findings at the annual meeting of the Pediatric Academic Societies.

The research focused on Puerto Rican (n = 79) and Mexican (n = 188) children because of the substantial disparity in asthma prevalence and control between these two different Latino populations. Puerto Rican children have the highest asthma prevalence and morbidity among American children, whereas Mexican children have the lowest rates.

The 267 participants, aged 5-12 years, included 110 children from two inner-city hospitals in the New York and 157 children from two school-based health clinics and a Breathmobile in Phoenix. Nearly all the Arizona children were Mexican, and most (71%) of the Bronx children were Puerto Rican.

The authors collected the following measures at baseline and at 3, 6, 9, and 12 months follow-up: spirometry (forced expiratory volume in 1 second [FEV₁]), Childhood Asthma Control Test (CACT) for children 5-11 years old, the Asthma Control Test (ACT) for 12-year-olds, adherence to inhaled corticosteroids (ICS), and acute health care utilizations (clinic sick visits, ED visits, and hospitalizations).

The authors also queried patients on four illness-specific panic-fear measures from the Childhood Asthma Symptoms Checklist: how often they felt frightened, panicky, afraid of being alone, and afraid of dying during an asthma attack (Likert 1-5 scale).

Mexican children reported higher levels of illness-specific panic-fear at the start of the study. They also tended to have lower severity of asthma, better asthma control, and better adherence to ICS, compared with Puerto Rican children.

Also at baseline, the Mexican children’s caregivers tended to be younger, poorer, and more likely to be married and to speak Spanish. The Puerto Rican caregivers, on the other hand, had a higher educational level, including 61% high school graduates, and had more depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D).

One-year data revealed several links between baseline reports of panic-fear and better outcomes. Mexican children who reported experiencing panic-fear at baseline were more likely to have higher FEV₁ measures at 1 year of follow-up than were those who didn’t experience panic-fear (P = .02). Similarly, Puerto Rican children initially reporting panic-fear had better asthma control at 1 year, compared with those who didn’t report panic-fear (P = .007).

The researchers reported their effect sizes in terms of predicted variance in a model that accounted for the child’s age, sex, asthma duration, asthma severity, social support, acculturation, health care provider relationship, and number of family members with asthma. The model also factored in the caregiver’s age, sex, marital status, poverty level, education, and depressive symptoms.

For example, in their model, experiencing panic-fear accounted for 67% of the variance in FEV₁ levels in Mexican children and 53% of the variance in asthma control in Puerto Rican children.

Less acute health care utilization also was associated with children’s baseline levels of illness-specific panic-fear. In the model, 12% of the variance in acute health care utilization among Mexican children (P = .03) and 41% of the variance among Puerto Rican children (P = .02) was explained by child-reported panic-fear. No association was seen with medication adherence.

Although caregivers’ reports of children feeling panic-fear were linked to better FEV₁ outcomes in Mexican children (P = .02), the association was only slightly significant in Puerto Rican children (P = .05). Caregiver reports of children’s panic-fear were not associated with asthma control, acute health care utilization, or medication adherence.

“Providers should be aware that anxiety focused on asthma may be beneficial and facilitate adaptive asthma management strategies,” the authors concluded.

The research was funded by the National Institutes of Health. The authors reported no relevant financial disclosures.

BALTIMORE – Experiencing panic-fear during asthma exacerbations predicted several beneficial outcomes in Mexican and Puerto Rican children with asthma, according to new research.

Tara Haelle/MDedge News

“When kids are anxious specifically during their asthma attacks, that can be a good thing because it means that they’re more vigilant,” lead author Jonathan M. Feldman, PhD, of the Albert Einstein College of Medicine’s Children’s Hospital at Montefiore and of Yeshiva University in the New York said in an interview. “They may be more likely to react during the early stages of an attack, and they may be more likely to be using self-management strategies at home and using their controller medications on a daily basis.”

He said pediatric providers can ask their patients with asthma how they feel during asthma attacks, such as whether they ever feel scared or worried.

“If a kid says no, not at all, then I would be concerned as a provider because they may not be paying attention to their asthma symptoms and they may not be taking it seriously,” Dr. Feldman said.

Past research has suggested that “illness-specific panic-fear” – the amount of anxiety someone experiences during asthma exacerbations – helps adults develop adaptive asthma management strategies, so Dr. Feldman and his colleagues examined the phenomenon as a potential protective factor in children. They shared their findings at the annual meeting of the Pediatric Academic Societies.

The research focused on Puerto Rican (n = 79) and Mexican (n = 188) children because of the substantial disparity in asthma prevalence and control between these two different Latino populations. Puerto Rican children have the highest asthma prevalence and morbidity among American children, whereas Mexican children have the lowest rates.

The 267 participants, aged 5-12 years, included 110 children from two inner-city hospitals in the New York and 157 children from two school-based health clinics and a Breathmobile in Phoenix. Nearly all the Arizona children were Mexican, and most (71%) of the Bronx children were Puerto Rican.

The authors collected the following measures at baseline and at 3, 6, 9, and 12 months follow-up: spirometry (forced expiratory volume in 1 second [FEV₁]), Childhood Asthma Control Test (CACT) for children 5-11 years old, the Asthma Control Test (ACT) for 12-year-olds, adherence to inhaled corticosteroids (ICS), and acute health care utilizations (clinic sick visits, ED visits, and hospitalizations).

The authors also queried patients on four illness-specific panic-fear measures from the Childhood Asthma Symptoms Checklist: how often they felt frightened, panicky, afraid of being alone, and afraid of dying during an asthma attack (Likert 1-5 scale).

Mexican children reported higher levels of illness-specific panic-fear at the start of the study. They also tended to have lower severity of asthma, better asthma control, and better adherence to ICS, compared with Puerto Rican children.

Also at baseline, the Mexican children’s caregivers tended to be younger, poorer, and more likely to be married and to speak Spanish. The Puerto Rican caregivers, on the other hand, had a higher educational level, including 61% high school graduates, and had more depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D).

One-year data revealed several links between baseline reports of panic-fear and better outcomes. Mexican children who reported experiencing panic-fear at baseline were more likely to have higher FEV₁ measures at 1 year of follow-up than were those who didn’t experience panic-fear (P = .02). Similarly, Puerto Rican children initially reporting panic-fear had better asthma control at 1 year, compared with those who didn’t report panic-fear (P = .007).

The researchers reported their effect sizes in terms of predicted variance in a model that accounted for the child’s age, sex, asthma duration, asthma severity, social support, acculturation, health care provider relationship, and number of family members with asthma. The model also factored in the caregiver’s age, sex, marital status, poverty level, education, and depressive symptoms.

For example, in their model, experiencing panic-fear accounted for 67% of the variance in FEV₁ levels in Mexican children and 53% of the variance in asthma control in Puerto Rican children.

Less acute health care utilization also was associated with children’s baseline levels of illness-specific panic-fear. In the model, 12% of the variance in acute health care utilization among Mexican children (P = .03) and 41% of the variance among Puerto Rican children (P = .02) was explained by child-reported panic-fear. No association was seen with medication adherence.

Although caregivers’ reports of children feeling panic-fear were linked to better FEV₁ outcomes in Mexican children (P = .02), the association was only slightly significant in Puerto Rican children (P = .05). Caregiver reports of children’s panic-fear were not associated with asthma control, acute health care utilization, or medication adherence.

“Providers should be aware that anxiety focused on asthma may be beneficial and facilitate adaptive asthma management strategies,” the authors concluded.

The research was funded by the National Institutes of Health. The authors reported no relevant financial disclosures.