A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

NEW ORLEANS – Hot flash frequency was reduced by up to threefold in phase 2b results for fezolinetant, a novel nonhormonal therapy.

Vidyard Video

The neurokinin-3–receptor (NK3R) antagonist showed a significant reduction of 1.8-2.6 mean hot flashes daily from placebo in twice-daily dosing at the end of 12 weeks, despite a strong 55% response rate to placebo, Graeme Fraser, PhD, said at the annual meeting of the Endocrine Society.

Once-daily dosing also significantly dropped the frequency of moderate to severe vasomotor symptoms by 2.1-2.6 events daily, compared with placebo at the end of 12 weeks.

“This phase 2b trial was really about looking at different dose levels and looking at the once-daily versus twice-daily dosing,” Dr. Fraser said in a video interview. “The efficacy of both, with regard to once-daily and twice-daily dosing, was clear.”

The investigators looked at doses ranging from 15 mg to 90 mg twice daily and 30-120 mg daily. Significant reductions in frequency of moderate to severe hot flashes were seen at all doses and frequencies at 4 weeks and 12 weeks.

A coprimary endpoint, vasomotor severity, was also significantly reduced at 12 weeks for the two highest twice-daily doses. Hot flash severity was similarly reduced at 12 weeks for the two highest once-daily doses.

The safety profile was generally good; there were no signs of suicidality, no changes in endometrial thickness judged by ultrasound or endometrial biopsy, and estradiol levels were unchanged. Plasma bone markers, other laboratory values, and electrocardiograms were also unchanged.

A total of nine women experienced asymptomatic elevations in liver enzymes without bilirubin elevation. Most of these elevations were below three times the upper limit of normal.

Across 51 study sites in the United States, a total of 352 women received one dose of study drug and were included in the safety analysis. Efficacy was analyzed for 349 women, and 287 (81%) were considered completers.

Women were included in the randomized, double-blind, placebo-controlled study if they were naturally or surgically menopausal and aged 40-65 years, and experiencing at least 50 moderate to severe hot flashes weekly.

Fezolinetant acts on the KNDy neuron by replacing estrogen’s inhibitory effects. “Normally the firing is controlled by estrogen, but of course, in menopause, estrogen levels drop, and that control is lost,” explained Dr. Fraser. Fezolinetant exerts antagonism on the KNDy neuron’s NK3 receptor. “Why that’s important is that this neuron synapses at the thermoregulatory centers of the brain.”

Dr. Fraser said that discussions are underway with regulatory authorities to proceed to phase 3 clinical trials.

Dr. Fraser is a consultant to Astellas and was formerly a principal in Ogeda, the developer of fezolinetant. Ogeda is now a wholly owned subsidiary of Astellas, which funded the phase 2B trial.

koakes@mdedge.com

NEW ORLEANS – Hot flash frequency was reduced by up to threefold in phase 2b results for fezolinetant, a novel nonhormonal therapy.

Vidyard Video

The neurokinin-3–receptor (NK3R) antagonist showed a significant reduction of 1.8-2.6 mean hot flashes daily from placebo in twice-daily dosing at the end of 12 weeks, despite a strong 55% response rate to placebo, Graeme Fraser, PhD, said at the annual meeting of the Endocrine Society.

Once-daily dosing also significantly dropped the frequency of moderate to severe vasomotor symptoms by 2.1-2.6 events daily, compared with placebo at the end of 12 weeks.

“This phase 2b trial was really about looking at different dose levels and looking at the once-daily versus twice-daily dosing,” Dr. Fraser said in a video interview. “The efficacy of both, with regard to once-daily and twice-daily dosing, was clear.”

The investigators looked at doses ranging from 15 mg to 90 mg twice daily and 30-120 mg daily. Significant reductions in frequency of moderate to severe hot flashes were seen at all doses and frequencies at 4 weeks and 12 weeks.

A coprimary endpoint, vasomotor severity, was also significantly reduced at 12 weeks for the two highest twice-daily doses. Hot flash severity was similarly reduced at 12 weeks for the two highest once-daily doses.

The safety profile was generally good; there were no signs of suicidality, no changes in endometrial thickness judged by ultrasound or endometrial biopsy, and estradiol levels were unchanged. Plasma bone markers, other laboratory values, and electrocardiograms were also unchanged.

A total of nine women experienced asymptomatic elevations in liver enzymes without bilirubin elevation. Most of these elevations were below three times the upper limit of normal.

Across 51 study sites in the United States, a total of 352 women received one dose of study drug and were included in the safety analysis. Efficacy was analyzed for 349 women, and 287 (81%) were considered completers.

Women were included in the randomized, double-blind, placebo-controlled study if they were naturally or surgically menopausal and aged 40-65 years, and experiencing at least 50 moderate to severe hot flashes weekly.

Fezolinetant acts on the KNDy neuron by replacing estrogen’s inhibitory effects. “Normally the firing is controlled by estrogen, but of course, in menopause, estrogen levels drop, and that control is lost,” explained Dr. Fraser. Fezolinetant exerts antagonism on the KNDy neuron’s NK3 receptor. “Why that’s important is that this neuron synapses at the thermoregulatory centers of the brain.”

Dr. Fraser said that discussions are underway with regulatory authorities to proceed to phase 3 clinical trials.

Dr. Fraser is a consultant to Astellas and was formerly a principal in Ogeda, the developer of fezolinetant. Ogeda is now a wholly owned subsidiary of Astellas, which funded the phase 2B trial.

koakes@mdedge.com

NEW ORLEANS – Hot flash frequency was reduced by up to threefold in phase 2b results for fezolinetant, a novel nonhormonal therapy.

Vidyard Video

The neurokinin-3–receptor (NK3R) antagonist showed a significant reduction of 1.8-2.6 mean hot flashes daily from placebo in twice-daily dosing at the end of 12 weeks, despite a strong 55% response rate to placebo, Graeme Fraser, PhD, said at the annual meeting of the Endocrine Society.

Once-daily dosing also significantly dropped the frequency of moderate to severe vasomotor symptoms by 2.1-2.6 events daily, compared with placebo at the end of 12 weeks.

“This phase 2b trial was really about looking at different dose levels and looking at the once-daily versus twice-daily dosing,” Dr. Fraser said in a video interview. “The efficacy of both, with regard to once-daily and twice-daily dosing, was clear.”

The investigators looked at doses ranging from 15 mg to 90 mg twice daily and 30-120 mg daily. Significant reductions in frequency of moderate to severe hot flashes were seen at all doses and frequencies at 4 weeks and 12 weeks.

A coprimary endpoint, vasomotor severity, was also significantly reduced at 12 weeks for the two highest twice-daily doses. Hot flash severity was similarly reduced at 12 weeks for the two highest once-daily doses.

The safety profile was generally good; there were no signs of suicidality, no changes in endometrial thickness judged by ultrasound or endometrial biopsy, and estradiol levels were unchanged. Plasma bone markers, other laboratory values, and electrocardiograms were also unchanged.

A total of nine women experienced asymptomatic elevations in liver enzymes without bilirubin elevation. Most of these elevations were below three times the upper limit of normal.

Across 51 study sites in the United States, a total of 352 women received one dose of study drug and were included in the safety analysis. Efficacy was analyzed for 349 women, and 287 (81%) were considered completers.

Women were included in the randomized, double-blind, placebo-controlled study if they were naturally or surgically menopausal and aged 40-65 years, and experiencing at least 50 moderate to severe hot flashes weekly.

Fezolinetant acts on the KNDy neuron by replacing estrogen’s inhibitory effects. “Normally the firing is controlled by estrogen, but of course, in menopause, estrogen levels drop, and that control is lost,” explained Dr. Fraser. Fezolinetant exerts antagonism on the KNDy neuron’s NK3 receptor. “Why that’s important is that this neuron synapses at the thermoregulatory centers of the brain.”

Dr. Fraser said that discussions are underway with regulatory authorities to proceed to phase 3 clinical trials.

Dr. Fraser is a consultant to Astellas and was formerly a principal in Ogeda, the developer of fezolinetant. Ogeda is now a wholly owned subsidiary of Astellas, which funded the phase 2B trial.

koakes@mdedge.com

HM19 attendees explain what they learned at the meeting today.

Vidyard Video

HM19 attendees explain what they learned at the meeting today.

Vidyard Video

HM19 attendees explain what they learned at the meeting today.

Vidyard Video

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

LAS VEGAS – Once reserved for the most obese patients, bariatric surgery is on the road to becoming an option for millions of Americans who are just a step beyond overweight, even those with a body mass index as low as 30 kg/m².

In regard to patients with lower levels of obesity, “we should be intervening in this chronic disease earlier rather than later,” said Stacy A. Brethauer, MD, professor of surgery at the Ohio State University, Columbus, in a presentation about new standards for bariatric surgery at the 2019 Annual Minimally Invasive Surgery Symposium by Global Academy for Medical Education.

Bariatric treatment “should be offered after nonsurgical [weight-loss] therapy has failed,” he said. “That’s not where you stop. You continue to escalate as you would for heart disease or cancer.”

As Dr. Brethauer noted, research suggests that all categories of obesity – including so-called class 1 obesity (defined as a BMI from 30.0 to 34.9 kg/m²) – boost the risk of multiple diseases, including hypertension, coronary artery disease, congestive heart failure, stroke, asthma, pulmonary embolism, gallbladder disease, several types of cancer, osteoarthritis, knee pain and chronic back pain.

“There is no question that class 1 obesity is clearly putting people at risk,” he said. “Ultimately, you can conclude from all this evidence that class 1 is a chronic disease, and it deserves to be treated effectively.”

There are, of course, various nonsurgical treatments for obesity, including diet and exercise and pharmacotherapy. However, systematic reviews have found that people find it extremely difficult to keep the weight off after 1 year regardless of the strategy they adopt.

Beyond a year, Dr. Brethauer said, “you get poor maintenance of weight control, and you get poor control of metabolic burden. You don’t have a durable efficacy.”

In the past, bariatric surgery wasn’t considered an option for patients with class 1 obesity. It’s traditionally been reserved for patients with BMIs at or above 35 kg/m². But this standard has evolved in recent years.

In 2018, Dr. Brethauer coauthored an updated position statement by the American Society for Metabolic and Bariatric Surgery that encouraged bariatric surgery in certain mildly obese patients.

“For most people with class I obesity,” the statement on bariatric surgery states, “it is clear that the nonsurgical group of therapies will not provide a durable solution to their disease of obesity.”

The statement went on to say that “surgical intervention should be considered after failure of nonsurgical treatments” in the class 1 population.

Bariatric surgery in the class 1 population does more than reduce obesity, Dr. Brethauer said. “Over the last 5 years or so, a large body of literature has emerged,” he said, and both systematic reviews and randomized trails have shown significant postsurgery improvements in comorbidities such as diabetes.

“It’s important to emphasize that these patients don’t become underweight,” he said. “The body finds a healthy set point. They don’t become underweight or malnourished because you’re operating on a lower-weight group.”

Are weight-loss operations safe in class 1 patients? The American Society for Metabolic and Bariatric Surgery statement says that research has found “bariatric surgery is associated with modest morbidity and very low mortality in patients with class I obesity.”

In fact, Dr. Brethauer said, the mortality rate in this population is “less than gallbladder surgery, less than hip surgery, less than hysterectomy, less than knee surgery – operations people are being referred for and undergoing all the time.”

He added: “The case can be made very clearly based on this data that these operations are safe in this patient population. Not only are they safe, they have durable and significant impact on comorbidities.”

Global Academy for Medical Education and this news organization are owned by the same parent company. Dr. Brethauer discloses relationships with Medtronic (speaker) and GI Windows (consultant).

LAS VEGAS – Once reserved for the most obese patients, bariatric surgery is on the road to becoming an option for millions of Americans who are just a step beyond overweight, even those with a body mass index as low as 30 kg/m².

In regard to patients with lower levels of obesity, “we should be intervening in this chronic disease earlier rather than later,” said Stacy A. Brethauer, MD, professor of surgery at the Ohio State University, Columbus, in a presentation about new standards for bariatric surgery at the 2019 Annual Minimally Invasive Surgery Symposium by Global Academy for Medical Education.

Bariatric treatment “should be offered after nonsurgical [weight-loss] therapy has failed,” he said. “That’s not where you stop. You continue to escalate as you would for heart disease or cancer.”

As Dr. Brethauer noted, research suggests that all categories of obesity – including so-called class 1 obesity (defined as a BMI from 30.0 to 34.9 kg/m²) – boost the risk of multiple diseases, including hypertension, coronary artery disease, congestive heart failure, stroke, asthma, pulmonary embolism, gallbladder disease, several types of cancer, osteoarthritis, knee pain and chronic back pain.

“There is no question that class 1 obesity is clearly putting people at risk,” he said. “Ultimately, you can conclude from all this evidence that class 1 is a chronic disease, and it deserves to be treated effectively.”

There are, of course, various nonsurgical treatments for obesity, including diet and exercise and pharmacotherapy. However, systematic reviews have found that people find it extremely difficult to keep the weight off after 1 year regardless of the strategy they adopt.

Beyond a year, Dr. Brethauer said, “you get poor maintenance of weight control, and you get poor control of metabolic burden. You don’t have a durable efficacy.”

In the past, bariatric surgery wasn’t considered an option for patients with class 1 obesity. It’s traditionally been reserved for patients with BMIs at or above 35 kg/m². But this standard has evolved in recent years.

In 2018, Dr. Brethauer coauthored an updated position statement by the American Society for Metabolic and Bariatric Surgery that encouraged bariatric surgery in certain mildly obese patients.

“For most people with class I obesity,” the statement on bariatric surgery states, “it is clear that the nonsurgical group of therapies will not provide a durable solution to their disease of obesity.”

The statement went on to say that “surgical intervention should be considered after failure of nonsurgical treatments” in the class 1 population.

Bariatric surgery in the class 1 population does more than reduce obesity, Dr. Brethauer said. “Over the last 5 years or so, a large body of literature has emerged,” he said, and both systematic reviews and randomized trails have shown significant postsurgery improvements in comorbidities such as diabetes.

“It’s important to emphasize that these patients don’t become underweight,” he said. “The body finds a healthy set point. They don’t become underweight or malnourished because you’re operating on a lower-weight group.”

Are weight-loss operations safe in class 1 patients? The American Society for Metabolic and Bariatric Surgery statement says that research has found “bariatric surgery is associated with modest morbidity and very low mortality in patients with class I obesity.”

In fact, Dr. Brethauer said, the mortality rate in this population is “less than gallbladder surgery, less than hip surgery, less than hysterectomy, less than knee surgery – operations people are being referred for and undergoing all the time.”

He added: “The case can be made very clearly based on this data that these operations are safe in this patient population. Not only are they safe, they have durable and significant impact on comorbidities.”

Global Academy for Medical Education and this news organization are owned by the same parent company. Dr. Brethauer discloses relationships with Medtronic (speaker) and GI Windows (consultant).

LAS VEGAS – Once reserved for the most obese patients, bariatric surgery is on the road to becoming an option for millions of Americans who are just a step beyond overweight, even those with a body mass index as low as 30 kg/m².

In regard to patients with lower levels of obesity, “we should be intervening in this chronic disease earlier rather than later,” said Stacy A. Brethauer, MD, professor of surgery at the Ohio State University, Columbus, in a presentation about new standards for bariatric surgery at the 2019 Annual Minimally Invasive Surgery Symposium by Global Academy for Medical Education.

Bariatric treatment “should be offered after nonsurgical [weight-loss] therapy has failed,” he said. “That’s not where you stop. You continue to escalate as you would for heart disease or cancer.”

As Dr. Brethauer noted, research suggests that all categories of obesity – including so-called class 1 obesity (defined as a BMI from 30.0 to 34.9 kg/m²) – boost the risk of multiple diseases, including hypertension, coronary artery disease, congestive heart failure, stroke, asthma, pulmonary embolism, gallbladder disease, several types of cancer, osteoarthritis, knee pain and chronic back pain.

“There is no question that class 1 obesity is clearly putting people at risk,” he said. “Ultimately, you can conclude from all this evidence that class 1 is a chronic disease, and it deserves to be treated effectively.”

There are, of course, various nonsurgical treatments for obesity, including diet and exercise and pharmacotherapy. However, systematic reviews have found that people find it extremely difficult to keep the weight off after 1 year regardless of the strategy they adopt.

Beyond a year, Dr. Brethauer said, “you get poor maintenance of weight control, and you get poor control of metabolic burden. You don’t have a durable efficacy.”

In the past, bariatric surgery wasn’t considered an option for patients with class 1 obesity. It’s traditionally been reserved for patients with BMIs at or above 35 kg/m². But this standard has evolved in recent years.

In 2018, Dr. Brethauer coauthored an updated position statement by the American Society for Metabolic and Bariatric Surgery that encouraged bariatric surgery in certain mildly obese patients.

“For most people with class I obesity,” the statement on bariatric surgery states, “it is clear that the nonsurgical group of therapies will not provide a durable solution to their disease of obesity.”

The statement went on to say that “surgical intervention should be considered after failure of nonsurgical treatments” in the class 1 population.

Bariatric surgery in the class 1 population does more than reduce obesity, Dr. Brethauer said. “Over the last 5 years or so, a large body of literature has emerged,” he said, and both systematic reviews and randomized trails have shown significant postsurgery improvements in comorbidities such as diabetes.

“It’s important to emphasize that these patients don’t become underweight,” he said. “The body finds a healthy set point. They don’t become underweight or malnourished because you’re operating on a lower-weight group.”

Are weight-loss operations safe in class 1 patients? The American Society for Metabolic and Bariatric Surgery statement says that research has found “bariatric surgery is associated with modest morbidity and very low mortality in patients with class I obesity.”

In fact, Dr. Brethauer said, the mortality rate in this population is “less than gallbladder surgery, less than hip surgery, less than hysterectomy, less than knee surgery – operations people are being referred for and undergoing all the time.”

He added: “The case can be made very clearly based on this data that these operations are safe in this patient population. Not only are they safe, they have durable and significant impact on comorbidities.”

Global Academy for Medical Education and this news organization are owned by the same parent company. Dr. Brethauer discloses relationships with Medtronic (speaker) and GI Windows (consultant).

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

LAS VEGAS – Colorectal surgeon Jamie Cannon, MD, doesn’t think there’s a rivalry between laparoscopic surgery and robotic surgery. Instead, she told colleagues, they should be seen as parts of the same whole: “Robotics is laparoscopy. It’s just a tool that allows us to do laparoscopic surgery better.”

Master Video/Shutterstock

LAS VEGAS – Colorectal surgeon Jamie Cannon, MD, doesn’t think there’s a rivalry between laparoscopic surgery and robotic surgery. Instead, she told colleagues, they should be seen as parts of the same whole: “Robotics is laparoscopy. It’s just a tool that allows us to do laparoscopic surgery better.”

Master Video/Shutterstock

LAS VEGAS – Colorectal surgeon Jamie Cannon, MD, doesn’t think there’s a rivalry between laparoscopic surgery and robotic surgery. Instead, she told colleagues, they should be seen as parts of the same whole: “Robotics is laparoscopy. It’s just a tool that allows us to do laparoscopic surgery better.”

Master Video/Shutterstock

WASHINGTON – Expenditures for combination acne products increased from $82 million in 1996 to $487 million in 2016, according to an analysis presented at the annual meeting of the American Academy of Dermatology.

During a late-breaking research session, David Li, a fourth-year medical student at Tufts University, Boston, presented the results of a retrospective cost analysis study, conducted to identify trends in overall spending for combination acne products. Spending measures were adjusted for inflation to 2016 U.S. dollars.

While spending on combination products for acne has increased significantly over the past 2 decades, comparative efficacy data for these products are limited, he noted. Combination products are more expensive than the sum of their component parts, and prescribing generic formulations of individual acne treatments could potentially reduce costs, but possible advantages of combination products for acne include improved patient adherence and increased efficacy.

Mr. Li, a research fellow in the department of dermatology at Brigham and Women’s Hospital in Boston, and his colleagues drafted a comprehensive list of available combination products (eight brand-name products and two generics). Most combine benzoyl peroxide with another common acne medication. To analyze trends in medication use, they performed a retrospective cost analysis using Medical Expenditure Panel Survey (MEPS) data from 1996 to 2016, searching for these combination medications to gather the annual number of prescriptions, number of users, expenditures, and aggregate demographics for each product. The data were weighted to represent national estimates.

They also used data from the National Average Drug Acquisition Cost (NADAC) database, used by the Centers for Medicare & Medicaid Services as a pricing benchmark, and calculated the difference between the unit price of each combination product and the sum of the prices of its generic components. They multiplied this difference by the median number of units prescribed annually for the given combination.

The researchers found that most users of combination acne products were younger than 18 years (23%), female (55%), and white (83%), and the most commonly prescribed combination product changed over time. From 1996 to 2002, Benzamycin (benzoyl peroxide and erythromycin) was the most frequently prescribed combination. Several years later, its place was taken by BenzaClin (benzoyl peroxide and clindamycin) from 2003 to 2010, followed by Ziana (clindamycin and tretinoin) in 2011 and Epiduo (adapalene and benzoyl peroxide) from 2012 to 2016.

“Spending has increased steadily from a little bit over $82 million in 1996 to nearly half a billion dollars in 2016,” Mr. Li said. “That’s a rise of more than 500% in the last 20 years. Based on the median pricing and utilization data that we derived from the NADAC database, we determined that substitution with component generics can provide median annual savings of at least a quarter billion dollars each year.”

Although the data indicate a trend toward increased use of and spending on new, branded combination products, the literature includes “minimal data to suggest whether one combination acne product is better than the next one, or how it compares to its component medications when used in combination,” he said. He and his colleagues found no comparative data apart from a 2001 study that examined Benzamycin and BenzaClin, which suggested that there was no difference in efficacy or tolerability between the products.

The present study is limited by reporting bias and recall bias because it relies partly on MEPS, a survey, and the NADAC pricing database had information only for 2013-2016. The researchers consequently used the most recent prices to calculate potential savings.

“Until we have more meaningful data to suggest otherwise, we’re in a state of equipoise,” said Mr. Li.

The research was funded by the National Center for Advancing Translational Sciences, part of the National Institutes of Health.
 

egreb@mdedge.com

SOURCE: Li D et al. AAD 2019, Abstract 11333.

WASHINGTON – Expenditures for combination acne products increased from $82 million in 1996 to $487 million in 2016, according to an analysis presented at the annual meeting of the American Academy of Dermatology.

During a late-breaking research session, David Li, a fourth-year medical student at Tufts University, Boston, presented the results of a retrospective cost analysis study, conducted to identify trends in overall spending for combination acne products. Spending measures were adjusted for inflation to 2016 U.S. dollars.

While spending on combination products for acne has increased significantly over the past 2 decades, comparative efficacy data for these products are limited, he noted. Combination products are more expensive than the sum of their component parts, and prescribing generic formulations of individual acne treatments could potentially reduce costs, but possible advantages of combination products for acne include improved patient adherence and increased efficacy.

Mr. Li, a research fellow in the department of dermatology at Brigham and Women’s Hospital in Boston, and his colleagues drafted a comprehensive list of available combination products (eight brand-name products and two generics). Most combine benzoyl peroxide with another common acne medication. To analyze trends in medication use, they performed a retrospective cost analysis using Medical Expenditure Panel Survey (MEPS) data from 1996 to 2016, searching for these combination medications to gather the annual number of prescriptions, number of users, expenditures, and aggregate demographics for each product. The data were weighted to represent national estimates.

They also used data from the National Average Drug Acquisition Cost (NADAC) database, used by the Centers for Medicare & Medicaid Services as a pricing benchmark, and calculated the difference between the unit price of each combination product and the sum of the prices of its generic components. They multiplied this difference by the median number of units prescribed annually for the given combination.

The researchers found that most users of combination acne products were younger than 18 years (23%), female (55%), and white (83%), and the most commonly prescribed combination product changed over time. From 1996 to 2002, Benzamycin (benzoyl peroxide and erythromycin) was the most frequently prescribed combination. Several years later, its place was taken by BenzaClin (benzoyl peroxide and clindamycin) from 2003 to 2010, followed by Ziana (clindamycin and tretinoin) in 2011 and Epiduo (adapalene and benzoyl peroxide) from 2012 to 2016.

“Spending has increased steadily from a little bit over $82 million in 1996 to nearly half a billion dollars in 2016,” Mr. Li said. “That’s a rise of more than 500% in the last 20 years. Based on the median pricing and utilization data that we derived from the NADAC database, we determined that substitution with component generics can provide median annual savings of at least a quarter billion dollars each year.”

Although the data indicate a trend toward increased use of and spending on new, branded combination products, the literature includes “minimal data to suggest whether one combination acne product is better than the next one, or how it compares to its component medications when used in combination,” he said. He and his colleagues found no comparative data apart from a 2001 study that examined Benzamycin and BenzaClin, which suggested that there was no difference in efficacy or tolerability between the products.

The present study is limited by reporting bias and recall bias because it relies partly on MEPS, a survey, and the NADAC pricing database had information only for 2013-2016. The researchers consequently used the most recent prices to calculate potential savings.

“Until we have more meaningful data to suggest otherwise, we’re in a state of equipoise,” said Mr. Li.

The research was funded by the National Center for Advancing Translational Sciences, part of the National Institutes of Health.
 

egreb@mdedge.com

SOURCE: Li D et al. AAD 2019, Abstract 11333.

WASHINGTON – Expenditures for combination acne products increased from $82 million in 1996 to $487 million in 2016, according to an analysis presented at the annual meeting of the American Academy of Dermatology.

During a late-breaking research session, David Li, a fourth-year medical student at Tufts University, Boston, presented the results of a retrospective cost analysis study, conducted to identify trends in overall spending for combination acne products. Spending measures were adjusted for inflation to 2016 U.S. dollars.

While spending on combination products for acne has increased significantly over the past 2 decades, comparative efficacy data for these products are limited, he noted. Combination products are more expensive than the sum of their component parts, and prescribing generic formulations of individual acne treatments could potentially reduce costs, but possible advantages of combination products for acne include improved patient adherence and increased efficacy.

Mr. Li, a research fellow in the department of dermatology at Brigham and Women’s Hospital in Boston, and his colleagues drafted a comprehensive list of available combination products (eight brand-name products and two generics). Most combine benzoyl peroxide with another common acne medication. To analyze trends in medication use, they performed a retrospective cost analysis using Medical Expenditure Panel Survey (MEPS) data from 1996 to 2016, searching for these combination medications to gather the annual number of prescriptions, number of users, expenditures, and aggregate demographics for each product. The data were weighted to represent national estimates.

They also used data from the National Average Drug Acquisition Cost (NADAC) database, used by the Centers for Medicare & Medicaid Services as a pricing benchmark, and calculated the difference between the unit price of each combination product and the sum of the prices of its generic components. They multiplied this difference by the median number of units prescribed annually for the given combination.

The researchers found that most users of combination acne products were younger than 18 years (23%), female (55%), and white (83%), and the most commonly prescribed combination product changed over time. From 1996 to 2002, Benzamycin (benzoyl peroxide and erythromycin) was the most frequently prescribed combination. Several years later, its place was taken by BenzaClin (benzoyl peroxide and clindamycin) from 2003 to 2010, followed by Ziana (clindamycin and tretinoin) in 2011 and Epiduo (adapalene and benzoyl peroxide) from 2012 to 2016.

“Spending has increased steadily from a little bit over $82 million in 1996 to nearly half a billion dollars in 2016,” Mr. Li said. “That’s a rise of more than 500% in the last 20 years. Based on the median pricing and utilization data that we derived from the NADAC database, we determined that substitution with component generics can provide median annual savings of at least a quarter billion dollars each year.”

Although the data indicate a trend toward increased use of and spending on new, branded combination products, the literature includes “minimal data to suggest whether one combination acne product is better than the next one, or how it compares to its component medications when used in combination,” he said. He and his colleagues found no comparative data apart from a 2001 study that examined Benzamycin and BenzaClin, which suggested that there was no difference in efficacy or tolerability between the products.

The present study is limited by reporting bias and recall bias because it relies partly on MEPS, a survey, and the NADAC pricing database had information only for 2013-2016. The researchers consequently used the most recent prices to calculate potential savings.

“Until we have more meaningful data to suggest otherwise, we’re in a state of equipoise,” said Mr. Li.

The research was funded by the National Center for Advancing Translational Sciences, part of the National Institutes of Health.
 

egreb@mdedge.com

SOURCE: Li D et al. AAD 2019, Abstract 11333.