Asymptomatic first-degree relatives of multiple sclerosis patients at high risk for developing the disease were significantly more likely to show subclinical signs of MS than were family members at lower risk, in the Genes and Environment in Multiple Sclerosis prospective cohort study. The findings were published online on Jan. 17 in JAMA Neurology.

The Genes and Environment in Multiple Sclerosis (GEMS) project is the first prospective study of populations at risk for MS and is the first detailed cross-sectional examination of higher-risk and lower-risk family members to date, according to investigators led by Zongqi Xia, MD, PhD, of Brigham and Women’s Hospital, Boston. Although the totality of evidence put together through neuroimaging and numerous clinical tests in the study indicate that individuals with the highest risk for MS have higher risk for the disease than do those with the lowest risk, simple vibration threshold testing gave the best results, Dr. Xia and his colleagues reported.

copyright Zerbor/Thinkstock

Asymptomatic first-degree relatives of multiple sclerosis patients at high risk for developing the disease were significantly more likely to show subclinical signs of MS than were family members at lower risk, in the Genes and Environment in Multiple Sclerosis prospective cohort study. The findings were published online on Jan. 17 in JAMA Neurology.

The Genes and Environment in Multiple Sclerosis (GEMS) project is the first prospective study of populations at risk for MS and is the first detailed cross-sectional examination of higher-risk and lower-risk family members to date, according to investigators led by Zongqi Xia, MD, PhD, of Brigham and Women’s Hospital, Boston. Although the totality of evidence put together through neuroimaging and numerous clinical tests in the study indicate that individuals with the highest risk for MS have higher risk for the disease than do those with the lowest risk, simple vibration threshold testing gave the best results, Dr. Xia and his colleagues reported.

copyright Zerbor/Thinkstock

Asymptomatic first-degree relatives of multiple sclerosis patients at high risk for developing the disease were significantly more likely to show subclinical signs of MS than were family members at lower risk, in the Genes and Environment in Multiple Sclerosis prospective cohort study. The findings were published online on Jan. 17 in JAMA Neurology.

The Genes and Environment in Multiple Sclerosis (GEMS) project is the first prospective study of populations at risk for MS and is the first detailed cross-sectional examination of higher-risk and lower-risk family members to date, according to investigators led by Zongqi Xia, MD, PhD, of Brigham and Women’s Hospital, Boston. Although the totality of evidence put together through neuroimaging and numerous clinical tests in the study indicate that individuals with the highest risk for MS have higher risk for the disease than do those with the lowest risk, simple vibration threshold testing gave the best results, Dr. Xia and his colleagues reported.

copyright Zerbor/Thinkstock

Want to know what your colleagues are talking about? Here are the top discussion threads in ACS Communities (all from the General Surgery community):
 

1. A lap appy ain’t always easy ...

To join communities, log in to ACS Communities at http://acscommunities.facs.org/home, go to “Browse All Communities” near the top of any page, and click the blue “Join” button next to the community you’d like to join. If you have any questions, please send them to acscommunities@facs.org.

Want to know what your colleagues are talking about? Here are the top discussion threads in ACS Communities (all from the General Surgery community):
 

1. A lap appy ain’t always easy ...

To join communities, log in to ACS Communities at http://acscommunities.facs.org/home, go to “Browse All Communities” near the top of any page, and click the blue “Join” button next to the community you’d like to join. If you have any questions, please send them to acscommunities@facs.org.

Want to know what your colleagues are talking about? Here are the top discussion threads in ACS Communities (all from the General Surgery community):
 

1. A lap appy ain’t always easy ...

To join communities, log in to ACS Communities at http://acscommunities.facs.org/home, go to “Browse All Communities” near the top of any page, and click the blue “Join” button next to the community you’d like to join. If you have any questions, please send them to acscommunities@facs.org.

Two new studies of the genetic relationships between the seven designated categories of juvenile idiopathic arthritis (JIA) provide compelling support for reclassification of the categories, particularly for systemic JIA, and give evidence that some of the categories have clear equivalents in the realm of adult-onset diseases.

The International League of Associations for Rheumatology (ILAR) classification system (J Rheumatol. 2004;31:390-2) that defined the seven juvenile idiopathic arthritis (JIA) categories – systemic arthritis, oligoarticular arthritis, rheumatoid factor (RF)–negative polyarticular arthritis, RF-positive polyarticular arthritis, psoriatic arthritis (PsA), enthesitis-related arthritis (ERA), and undifferentiated arthritis – is problematic because the long-term outcome and response to treatment varies not only between subtypes but also within the subtypes, suggesting that these subgroups do not yet represent uniform groups of patients,” Wendy Thomson, PhD, professor of genetic epidemiology at the University of Manchester (England) and a senior author on both studies, explained in an interview.

Courtesy University of Manchester

Interrelationships between JIA categories and adult disease

The first of these studies found that particular alleles in the human leukocyte antigen (HLA) region that have been associated with the different JIA categories strongly correlate some of the categories with one another, and that each JIA category potentially has an adult-onset counterpart based on shared HLA associations. It is the largest investigation of association of the HLA region with JIA and its categories to date, according to the researchers (Ann Rheum Dis. 2016 Dec 20. doi: 10.1136/annrheumdis-2016-210025).

In particular, the investigators demonstrated for the first time that RF-negative polyarticular JIA and oligoarticular JIA are genetically similar in their HLA associations. They also reported that RF-positive polyarthritis shares an association with adult seropositive rheumatoid arthritis and that combined data for oligoarthritis and RF-negative polyarthritis share the same association with adult seronegative RA. In addition, the researchers generated support for genetic associations between the particular JIA categories that are most commonly thought to have adult counterparts, such as ERA and adult ankylosing spondylitis (AS) as well as juvenile PsA and adult PsA.

Dr. Thomson and her coinvestigators used ImmunoChip genotype array data for 191,494 single nucleotide polymorphism (SNP) markers from the HLA region of 5,737 JIA patients and 16,403 controls in the United States, United Kingdom, Canada, Norway, and Germany to impute classical HLA alleles as well as specific amino acid positions within HLA alleles that may play an important functional role. After quality-control measures for the data were put in place, comparisons between 5,043 JIA cases and 14,390 controls showed that oligoarthritis and RF-negative polyarthritis were the most common and homogeneous JIA categories investigated (2,409 and 1,525 patients, respectively), and that they share a significant association across the HLA spectrum, meaning that they are genetically similar. When combined, the data from these two JIA categories correspond with seronegative rheumatoid arthritis in adults, while RF-positive polyarthritis on its own has an association with seropositive rheumatoid arthritis involving histidine at position 13 of the HLA-DRB1 allele. As expected, the most significant association between the ERA category and AS was for HLA-B*27. For juvenile PsA, no associations reached genome-wide level of significance, although HLA-C*0602 was modestly associated with juvenile PsA, and it is known to be associated with adult-onset PsA and is the primary HLA association in psoriasis.

“The results of this study have important implications for understanding disease pathogenesis, etiology, and potential future therapeutic strategies for JIA categories,” Dr. Thomson and her coauthors wrote, adding that “heterogeneity of JIA remains a key challenge to pediatric rheumatologists; however, these results may inform the debate on classification and help define a more biological-driven and molecular-driven classification system.”
 

Uniqueness of systemic JIA

In the second of the two studies, investigators from many different childhood arthritis study groups focused on systemic JIA (sJIA), also known in the past as Still’s disease. According to the authors, it is the first large-scale genomic study of sJIA ever published (Ann Rheum Dis. 2016 Dec 7. doi: 10.1136/annrheumdis-2016-210324).

“[sJIA] is characterized by prominent systemic inflammation and has a rare adult-onset counterpart; and undifferentiated arthritis includes arthritis that does not fit into any single category,” the authors wrote, adding that the “unique clinical characteristics of sJIA suggest that it is distinct from other forms of JIA, leading to the contention by some that sJIA should be separated from other forms of JIA and labeled as an autoinflammatory disease.”

The investigators carried out SNP genotyping on 982 children with sJIA in the United States, United Kingdom, Germany, Turkey, Italy, Brazil, Argentina, Canada, and Spain, along with 431 healthy children without sJIA who came from the same countries. A total of 7,579 control patients also underwent genotyping. Ultimately, 770 sJIA and 6,947 control subjects completed the study. sJIA was then compared with other JIA subtypes by using weighted genetic risk scores.

Comparison of the data sets for sJIA with those for the combined categories of RF-negative polyarticular JIA and oligoarticular JIA, as well as for the individual category of RF-positive polyarticular JIA, showed that sJIA has a distinct genetic architecture that separates it from those JIA categories, providing further evidence that sJIA should be classified separately from other forms of JIA and, potentially, treated differently as well.

According to Dr. Thomson, the finding “provides important evidence that sJIA should be considered a unique disease with its own specific disease mechanisms.” Dr. Thomson explained that “knowing more about the genetic risk factors of this disease might give a greater understanding of the disease processes involved in this condition and ultimately lead to novel therapies for this severely disabling disease.”

Funding for the first study was provided by the Wellcome Trust, the National Institutes of Health, the Doris Duke Charitable Foundation, the Medical Research Council, the Canadian Institutes of Health Research, the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Juvenile Diabetes Research Foundation International, and the Texas Scottish Rite Hospital for Children. Funding for the second study was provided by intramural research programs of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Human Genome Research Institute, individual NIH grants, and grants from charitable foundations, advocacy organizations, and the governments of individual researchers’ countries. Dr. Thomson did not report any relevant financial disclosures; however, a number of coauthors reported potential conflicts of interest.

dchitnis@frontlinemedcom.com

Two new studies of the genetic relationships between the seven designated categories of juvenile idiopathic arthritis (JIA) provide compelling support for reclassification of the categories, particularly for systemic JIA, and give evidence that some of the categories have clear equivalents in the realm of adult-onset diseases.

The International League of Associations for Rheumatology (ILAR) classification system (J Rheumatol. 2004;31:390-2) that defined the seven juvenile idiopathic arthritis (JIA) categories – systemic arthritis, oligoarticular arthritis, rheumatoid factor (RF)–negative polyarticular arthritis, RF-positive polyarticular arthritis, psoriatic arthritis (PsA), enthesitis-related arthritis (ERA), and undifferentiated arthritis – is problematic because the long-term outcome and response to treatment varies not only between subtypes but also within the subtypes, suggesting that these subgroups do not yet represent uniform groups of patients,” Wendy Thomson, PhD, professor of genetic epidemiology at the University of Manchester (England) and a senior author on both studies, explained in an interview.

Courtesy University of Manchester

Interrelationships between JIA categories and adult disease

The first of these studies found that particular alleles in the human leukocyte antigen (HLA) region that have been associated with the different JIA categories strongly correlate some of the categories with one another, and that each JIA category potentially has an adult-onset counterpart based on shared HLA associations. It is the largest investigation of association of the HLA region with JIA and its categories to date, according to the researchers (Ann Rheum Dis. 2016 Dec 20. doi: 10.1136/annrheumdis-2016-210025).

In particular, the investigators demonstrated for the first time that RF-negative polyarticular JIA and oligoarticular JIA are genetically similar in their HLA associations. They also reported that RF-positive polyarthritis shares an association with adult seropositive rheumatoid arthritis and that combined data for oligoarthritis and RF-negative polyarthritis share the same association with adult seronegative RA. In addition, the researchers generated support for genetic associations between the particular JIA categories that are most commonly thought to have adult counterparts, such as ERA and adult ankylosing spondylitis (AS) as well as juvenile PsA and adult PsA.

Dr. Thomson and her coinvestigators used ImmunoChip genotype array data for 191,494 single nucleotide polymorphism (SNP) markers from the HLA region of 5,737 JIA patients and 16,403 controls in the United States, United Kingdom, Canada, Norway, and Germany to impute classical HLA alleles as well as specific amino acid positions within HLA alleles that may play an important functional role. After quality-control measures for the data were put in place, comparisons between 5,043 JIA cases and 14,390 controls showed that oligoarthritis and RF-negative polyarthritis were the most common and homogeneous JIA categories investigated (2,409 and 1,525 patients, respectively), and that they share a significant association across the HLA spectrum, meaning that they are genetically similar. When combined, the data from these two JIA categories correspond with seronegative rheumatoid arthritis in adults, while RF-positive polyarthritis on its own has an association with seropositive rheumatoid arthritis involving histidine at position 13 of the HLA-DRB1 allele. As expected, the most significant association between the ERA category and AS was for HLA-B*27. For juvenile PsA, no associations reached genome-wide level of significance, although HLA-C*0602 was modestly associated with juvenile PsA, and it is known to be associated with adult-onset PsA and is the primary HLA association in psoriasis.

“The results of this study have important implications for understanding disease pathogenesis, etiology, and potential future therapeutic strategies for JIA categories,” Dr. Thomson and her coauthors wrote, adding that “heterogeneity of JIA remains a key challenge to pediatric rheumatologists; however, these results may inform the debate on classification and help define a more biological-driven and molecular-driven classification system.”
 

Uniqueness of systemic JIA

In the second of the two studies, investigators from many different childhood arthritis study groups focused on systemic JIA (sJIA), also known in the past as Still’s disease. According to the authors, it is the first large-scale genomic study of sJIA ever published (Ann Rheum Dis. 2016 Dec 7. doi: 10.1136/annrheumdis-2016-210324).

“[sJIA] is characterized by prominent systemic inflammation and has a rare adult-onset counterpart; and undifferentiated arthritis includes arthritis that does not fit into any single category,” the authors wrote, adding that the “unique clinical characteristics of sJIA suggest that it is distinct from other forms of JIA, leading to the contention by some that sJIA should be separated from other forms of JIA and labeled as an autoinflammatory disease.”

The investigators carried out SNP genotyping on 982 children with sJIA in the United States, United Kingdom, Germany, Turkey, Italy, Brazil, Argentina, Canada, and Spain, along with 431 healthy children without sJIA who came from the same countries. A total of 7,579 control patients also underwent genotyping. Ultimately, 770 sJIA and 6,947 control subjects completed the study. sJIA was then compared with other JIA subtypes by using weighted genetic risk scores.

Comparison of the data sets for sJIA with those for the combined categories of RF-negative polyarticular JIA and oligoarticular JIA, as well as for the individual category of RF-positive polyarticular JIA, showed that sJIA has a distinct genetic architecture that separates it from those JIA categories, providing further evidence that sJIA should be classified separately from other forms of JIA and, potentially, treated differently as well.

According to Dr. Thomson, the finding “provides important evidence that sJIA should be considered a unique disease with its own specific disease mechanisms.” Dr. Thomson explained that “knowing more about the genetic risk factors of this disease might give a greater understanding of the disease processes involved in this condition and ultimately lead to novel therapies for this severely disabling disease.”

Funding for the first study was provided by the Wellcome Trust, the National Institutes of Health, the Doris Duke Charitable Foundation, the Medical Research Council, the Canadian Institutes of Health Research, the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Juvenile Diabetes Research Foundation International, and the Texas Scottish Rite Hospital for Children. Funding for the second study was provided by intramural research programs of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Human Genome Research Institute, individual NIH grants, and grants from charitable foundations, advocacy organizations, and the governments of individual researchers’ countries. Dr. Thomson did not report any relevant financial disclosures; however, a number of coauthors reported potential conflicts of interest.

dchitnis@frontlinemedcom.com

Two new studies of the genetic relationships between the seven designated categories of juvenile idiopathic arthritis (JIA) provide compelling support for reclassification of the categories, particularly for systemic JIA, and give evidence that some of the categories have clear equivalents in the realm of adult-onset diseases.

The International League of Associations for Rheumatology (ILAR) classification system (J Rheumatol. 2004;31:390-2) that defined the seven juvenile idiopathic arthritis (JIA) categories – systemic arthritis, oligoarticular arthritis, rheumatoid factor (RF)–negative polyarticular arthritis, RF-positive polyarticular arthritis, psoriatic arthritis (PsA), enthesitis-related arthritis (ERA), and undifferentiated arthritis – is problematic because the long-term outcome and response to treatment varies not only between subtypes but also within the subtypes, suggesting that these subgroups do not yet represent uniform groups of patients,” Wendy Thomson, PhD, professor of genetic epidemiology at the University of Manchester (England) and a senior author on both studies, explained in an interview.

Courtesy University of Manchester

Interrelationships between JIA categories and adult disease

The first of these studies found that particular alleles in the human leukocyte antigen (HLA) region that have been associated with the different JIA categories strongly correlate some of the categories with one another, and that each JIA category potentially has an adult-onset counterpart based on shared HLA associations. It is the largest investigation of association of the HLA region with JIA and its categories to date, according to the researchers (Ann Rheum Dis. 2016 Dec 20. doi: 10.1136/annrheumdis-2016-210025).

In particular, the investigators demonstrated for the first time that RF-negative polyarticular JIA and oligoarticular JIA are genetically similar in their HLA associations. They also reported that RF-positive polyarthritis shares an association with adult seropositive rheumatoid arthritis and that combined data for oligoarthritis and RF-negative polyarthritis share the same association with adult seronegative RA. In addition, the researchers generated support for genetic associations between the particular JIA categories that are most commonly thought to have adult counterparts, such as ERA and adult ankylosing spondylitis (AS) as well as juvenile PsA and adult PsA.

Dr. Thomson and her coinvestigators used ImmunoChip genotype array data for 191,494 single nucleotide polymorphism (SNP) markers from the HLA region of 5,737 JIA patients and 16,403 controls in the United States, United Kingdom, Canada, Norway, and Germany to impute classical HLA alleles as well as specific amino acid positions within HLA alleles that may play an important functional role. After quality-control measures for the data were put in place, comparisons between 5,043 JIA cases and 14,390 controls showed that oligoarthritis and RF-negative polyarthritis were the most common and homogeneous JIA categories investigated (2,409 and 1,525 patients, respectively), and that they share a significant association across the HLA spectrum, meaning that they are genetically similar. When combined, the data from these two JIA categories correspond with seronegative rheumatoid arthritis in adults, while RF-positive polyarthritis on its own has an association with seropositive rheumatoid arthritis involving histidine at position 13 of the HLA-DRB1 allele. As expected, the most significant association between the ERA category and AS was for HLA-B*27. For juvenile PsA, no associations reached genome-wide level of significance, although HLA-C*0602 was modestly associated with juvenile PsA, and it is known to be associated with adult-onset PsA and is the primary HLA association in psoriasis.

“The results of this study have important implications for understanding disease pathogenesis, etiology, and potential future therapeutic strategies for JIA categories,” Dr. Thomson and her coauthors wrote, adding that “heterogeneity of JIA remains a key challenge to pediatric rheumatologists; however, these results may inform the debate on classification and help define a more biological-driven and molecular-driven classification system.”
 

Uniqueness of systemic JIA

In the second of the two studies, investigators from many different childhood arthritis study groups focused on systemic JIA (sJIA), also known in the past as Still’s disease. According to the authors, it is the first large-scale genomic study of sJIA ever published (Ann Rheum Dis. 2016 Dec 7. doi: 10.1136/annrheumdis-2016-210324).

“[sJIA] is characterized by prominent systemic inflammation and has a rare adult-onset counterpart; and undifferentiated arthritis includes arthritis that does not fit into any single category,” the authors wrote, adding that the “unique clinical characteristics of sJIA suggest that it is distinct from other forms of JIA, leading to the contention by some that sJIA should be separated from other forms of JIA and labeled as an autoinflammatory disease.”

The investigators carried out SNP genotyping on 982 children with sJIA in the United States, United Kingdom, Germany, Turkey, Italy, Brazil, Argentina, Canada, and Spain, along with 431 healthy children without sJIA who came from the same countries. A total of 7,579 control patients also underwent genotyping. Ultimately, 770 sJIA and 6,947 control subjects completed the study. sJIA was then compared with other JIA subtypes by using weighted genetic risk scores.

Comparison of the data sets for sJIA with those for the combined categories of RF-negative polyarticular JIA and oligoarticular JIA, as well as for the individual category of RF-positive polyarticular JIA, showed that sJIA has a distinct genetic architecture that separates it from those JIA categories, providing further evidence that sJIA should be classified separately from other forms of JIA and, potentially, treated differently as well.

According to Dr. Thomson, the finding “provides important evidence that sJIA should be considered a unique disease with its own specific disease mechanisms.” Dr. Thomson explained that “knowing more about the genetic risk factors of this disease might give a greater understanding of the disease processes involved in this condition and ultimately lead to novel therapies for this severely disabling disease.”

Funding for the first study was provided by the Wellcome Trust, the National Institutes of Health, the Doris Duke Charitable Foundation, the Medical Research Council, the Canadian Institutes of Health Research, the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Juvenile Diabetes Research Foundation International, and the Texas Scottish Rite Hospital for Children. Funding for the second study was provided by intramural research programs of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Human Genome Research Institute, individual NIH grants, and grants from charitable foundations, advocacy organizations, and the governments of individual researchers’ countries. Dr. Thomson did not report any relevant financial disclosures; however, a number of coauthors reported potential conflicts of interest.

dchitnis@frontlinemedcom.com

SAN DIEGO – Rituximab can at least temporarily vanquish minimal residual disease (MRD) in mantle cell lymphoma (MCL) patients who relapse after induction therapy and autologous stem cell transplantation (ASCT), researchers reported at the annual meeting of the American Society of Hematology.

Of 58 patients whose MCL relapsed after induction therapy and ASCT, 82% converted back to an MRD-negative state after receiving 4 weekly doses of rituximab (375 mg/m²), Arne Kolstad, MD, PhD, and his associates. The data “strongly suggest that preemptive rituximab treatment delayed clinical relapse in MCL,” they wrote in their abstract. They recommended molecular and clinical monitoring after ASCT, not only “as an alternative to maintenance therapy for all MCL patients” but to identify MRD-positive candidates for clinical trials.

The study was an analysis of the Nordic Lymphoma Group phase II MCL2 and MCL3 trials (NTC 00514475), in which patients received six alternating cycles of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab) and R-Ara-C (rituximab-cytarabine). followed by high-dose ASCT. In MCL3, responders who fell short of complete remission also received intensification with yttium-90 ibritumomab tiuxetan (0.4 mCi/kg) 1 week before treatment with BEAM/C (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide). Patients were evaluated 2-3 months after completing ASCT, and then every 6 months for 5 years or until relapse. Survivors were followed for a median of 8.5 years, noted Dr. Kolstad, who is with Oslo University Hospital in Norway.

Among 183 patients who underwent polymerase chain reaction–based testing for markers of MRD, median time to molecular relapse was 55 months. However, the relapse-free survival curve did not plateau – patients in all risk groups continued to relapse 5-10 years after undergoing ASCT, the researchers said. “Hence, it is fair to consider MCL as a chronic incurable lymphoma entity, and novel approaches will be necessary to change the natural course of this disease,” they wrote.

After controlling for potential confounders, significant predictors of molecular relapse included high MCL international prognostic index at diagnosis (hazard ratio, 1.9; 95% confidence interval 1.4-2.7; P = .0001) and detection of MRD before patients underwent ASCT (HR, 2.5; 95% CI, 1.5-4.1; P = .0005). Minimal residual disease predicted clinical relapse and shorter survival (P less than .001 for both associations). In contrast, the 86 patients who remained in continuous molecular remission had a 76% chance of having at least a 10-year clinical remission, the investigators said.

Minimal residual disease was assessed by testing bone marrow and blood samples with combined standard nested and quantitative real-time polymerase chain reaction (PCR) for Bcl-1 or IgH rearrangement. They defined molecular relapse as conversion from a negative to a positive result on standard nested PCR, or, for patients who were MRD positive after ASCT, as a more than fivefold rise in real-time quantitative PCR levels in two consecutive bone marrow samples.

Oslo University sponsored the trials. Dr. Kolstad reported ties to Nordic Nanovector, Bayer Schering Pharma, Merck, and Roche.

SAN DIEGO – Rituximab can at least temporarily vanquish minimal residual disease (MRD) in mantle cell lymphoma (MCL) patients who relapse after induction therapy and autologous stem cell transplantation (ASCT), researchers reported at the annual meeting of the American Society of Hematology.

Of 58 patients whose MCL relapsed after induction therapy and ASCT, 82% converted back to an MRD-negative state after receiving 4 weekly doses of rituximab (375 mg/m²), Arne Kolstad, MD, PhD, and his associates. The data “strongly suggest that preemptive rituximab treatment delayed clinical relapse in MCL,” they wrote in their abstract. They recommended molecular and clinical monitoring after ASCT, not only “as an alternative to maintenance therapy for all MCL patients” but to identify MRD-positive candidates for clinical trials.

The study was an analysis of the Nordic Lymphoma Group phase II MCL2 and MCL3 trials (NTC 00514475), in which patients received six alternating cycles of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab) and R-Ara-C (rituximab-cytarabine). followed by high-dose ASCT. In MCL3, responders who fell short of complete remission also received intensification with yttium-90 ibritumomab tiuxetan (0.4 mCi/kg) 1 week before treatment with BEAM/C (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide). Patients were evaluated 2-3 months after completing ASCT, and then every 6 months for 5 years or until relapse. Survivors were followed for a median of 8.5 years, noted Dr. Kolstad, who is with Oslo University Hospital in Norway.

Among 183 patients who underwent polymerase chain reaction–based testing for markers of MRD, median time to molecular relapse was 55 months. However, the relapse-free survival curve did not plateau – patients in all risk groups continued to relapse 5-10 years after undergoing ASCT, the researchers said. “Hence, it is fair to consider MCL as a chronic incurable lymphoma entity, and novel approaches will be necessary to change the natural course of this disease,” they wrote.

After controlling for potential confounders, significant predictors of molecular relapse included high MCL international prognostic index at diagnosis (hazard ratio, 1.9; 95% confidence interval 1.4-2.7; P = .0001) and detection of MRD before patients underwent ASCT (HR, 2.5; 95% CI, 1.5-4.1; P = .0005). Minimal residual disease predicted clinical relapse and shorter survival (P less than .001 for both associations). In contrast, the 86 patients who remained in continuous molecular remission had a 76% chance of having at least a 10-year clinical remission, the investigators said.

Minimal residual disease was assessed by testing bone marrow and blood samples with combined standard nested and quantitative real-time polymerase chain reaction (PCR) for Bcl-1 or IgH rearrangement. They defined molecular relapse as conversion from a negative to a positive result on standard nested PCR, or, for patients who were MRD positive after ASCT, as a more than fivefold rise in real-time quantitative PCR levels in two consecutive bone marrow samples.

Oslo University sponsored the trials. Dr. Kolstad reported ties to Nordic Nanovector, Bayer Schering Pharma, Merck, and Roche.

SAN DIEGO – Rituximab can at least temporarily vanquish minimal residual disease (MRD) in mantle cell lymphoma (MCL) patients who relapse after induction therapy and autologous stem cell transplantation (ASCT), researchers reported at the annual meeting of the American Society of Hematology.

Of 58 patients whose MCL relapsed after induction therapy and ASCT, 82% converted back to an MRD-negative state after receiving 4 weekly doses of rituximab (375 mg/m²), Arne Kolstad, MD, PhD, and his associates. The data “strongly suggest that preemptive rituximab treatment delayed clinical relapse in MCL,” they wrote in their abstract. They recommended molecular and clinical monitoring after ASCT, not only “as an alternative to maintenance therapy for all MCL patients” but to identify MRD-positive candidates for clinical trials.

The study was an analysis of the Nordic Lymphoma Group phase II MCL2 and MCL3 trials (NTC 00514475), in which patients received six alternating cycles of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab) and R-Ara-C (rituximab-cytarabine). followed by high-dose ASCT. In MCL3, responders who fell short of complete remission also received intensification with yttium-90 ibritumomab tiuxetan (0.4 mCi/kg) 1 week before treatment with BEAM/C (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide). Patients were evaluated 2-3 months after completing ASCT, and then every 6 months for 5 years or until relapse. Survivors were followed for a median of 8.5 years, noted Dr. Kolstad, who is with Oslo University Hospital in Norway.

Among 183 patients who underwent polymerase chain reaction–based testing for markers of MRD, median time to molecular relapse was 55 months. However, the relapse-free survival curve did not plateau – patients in all risk groups continued to relapse 5-10 years after undergoing ASCT, the researchers said. “Hence, it is fair to consider MCL as a chronic incurable lymphoma entity, and novel approaches will be necessary to change the natural course of this disease,” they wrote.

After controlling for potential confounders, significant predictors of molecular relapse included high MCL international prognostic index at diagnosis (hazard ratio, 1.9; 95% confidence interval 1.4-2.7; P = .0001) and detection of MRD before patients underwent ASCT (HR, 2.5; 95% CI, 1.5-4.1; P = .0005). Minimal residual disease predicted clinical relapse and shorter survival (P less than .001 for both associations). In contrast, the 86 patients who remained in continuous molecular remission had a 76% chance of having at least a 10-year clinical remission, the investigators said.

Minimal residual disease was assessed by testing bone marrow and blood samples with combined standard nested and quantitative real-time polymerase chain reaction (PCR) for Bcl-1 or IgH rearrangement. They defined molecular relapse as conversion from a negative to a positive result on standard nested PCR, or, for patients who were MRD positive after ASCT, as a more than fivefold rise in real-time quantitative PCR levels in two consecutive bone marrow samples.

Oslo University sponsored the trials. Dr. Kolstad reported ties to Nordic Nanovector, Bayer Schering Pharma, Merck, and Roche.

HOLLYWOOD, FLA. – Low-molecular-weight heparin (LMWH) decreased the risk of venous thromboembolism in trauma patients significantly more than did unfractionated heparin, a large state database review has found.

It also was associated with a 37% decrease in overall mortality, compared with unfractionated heparin, Benjamin Jacobs, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

HOLLYWOOD, FLA. – Low-molecular-weight heparin (LMWH) decreased the risk of venous thromboembolism in trauma patients significantly more than did unfractionated heparin, a large state database review has found.

It also was associated with a 37% decrease in overall mortality, compared with unfractionated heparin, Benjamin Jacobs, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

HOLLYWOOD, FLA. – Low-molecular-weight heparin (LMWH) decreased the risk of venous thromboembolism in trauma patients significantly more than did unfractionated heparin, a large state database review has found.

It also was associated with a 37% decrease in overall mortality, compared with unfractionated heparin, Benjamin Jacobs, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

A neonatal diagnostic code of neonatal abstinence syndrome (NAS) is strongly associated with poor and deteriorating school performance, according to Ju Lee Oei, MD, of the University of New South Wales, Sydney, and her associates.

In a study of 604,829 children born in 2000-2006 in New South Wales, linkage rates were similar between matched controls (77.6% of 4,330) and other NSW children (77.4% of 598,265; P = .83) but were significantly lower in children with NAS (75.6% of 2,234; P = .03). The controls were matched for gender,gestation, and socioeconomic status.

The children with NAS had significantly lower scores than the controls and other NSW children in every grade and every domain of testing (reading, writing, numeracy, spelling, and grammar/punctuation). By grade 7, 38% of children with NAS did not meet National Minimum Standard (NMS) in one or more domains (versus 18.4% of controls and 14.5% of other NSW children). The mean serial composite scores also were lower in children with NAS from grades 3 to 7, compared with the other two groups; the difference was progressive, the investigators said. And by grade 7, the scores for children with NAS were lower than other children’s scores in grade 5.

It was noted that children with NAS, indigenous status (adjusted odds ratio, 1.7), male gender (aOR, 1.3), and having a primary parent without a grade 9 education (aOR, 1.3) increased the risk of failure to meet NMS. Overall, NAS (aOR, 2.5), indigenous status (aOR, 2.2), male gender (aOR, 1.3), and prematurity (less than 37 weeks’ gestation [aOR, 1.2]) increased the risk of failure to meet NMS.

“To date these are the only data demonstrating long-term school outcomes for children with a history of NAS. Similar data for children born from the current opioid epidemic gripping much of the Northern Hemisphere, assuming linkage is possible, will be available only in 7-10 years,” researchers concluded. “Although this study was conducted in Australia, the high risk of poor academic performance in this vulnerable group of children is applicable to all countries, and strategies to address this risk and prevent poor adult outcomes and intergenerational vulnerability must be urgently addressed.”

Read the full study in Pediatrics (doi: 10.1542/peds.2016-2651).

llaubach@frontlinemedcom.com

A neonatal diagnostic code of neonatal abstinence syndrome (NAS) is strongly associated with poor and deteriorating school performance, according to Ju Lee Oei, MD, of the University of New South Wales, Sydney, and her associates.

In a study of 604,829 children born in 2000-2006 in New South Wales, linkage rates were similar between matched controls (77.6% of 4,330) and other NSW children (77.4% of 598,265; P = .83) but were significantly lower in children with NAS (75.6% of 2,234; P = .03). The controls were matched for gender,gestation, and socioeconomic status.

The children with NAS had significantly lower scores than the controls and other NSW children in every grade and every domain of testing (reading, writing, numeracy, spelling, and grammar/punctuation). By grade 7, 38% of children with NAS did not meet National Minimum Standard (NMS) in one or more domains (versus 18.4% of controls and 14.5% of other NSW children). The mean serial composite scores also were lower in children with NAS from grades 3 to 7, compared with the other two groups; the difference was progressive, the investigators said. And by grade 7, the scores for children with NAS were lower than other children’s scores in grade 5.

It was noted that children with NAS, indigenous status (adjusted odds ratio, 1.7), male gender (aOR, 1.3), and having a primary parent without a grade 9 education (aOR, 1.3) increased the risk of failure to meet NMS. Overall, NAS (aOR, 2.5), indigenous status (aOR, 2.2), male gender (aOR, 1.3), and prematurity (less than 37 weeks’ gestation [aOR, 1.2]) increased the risk of failure to meet NMS.

“To date these are the only data demonstrating long-term school outcomes for children with a history of NAS. Similar data for children born from the current opioid epidemic gripping much of the Northern Hemisphere, assuming linkage is possible, will be available only in 7-10 years,” researchers concluded. “Although this study was conducted in Australia, the high risk of poor academic performance in this vulnerable group of children is applicable to all countries, and strategies to address this risk and prevent poor adult outcomes and intergenerational vulnerability must be urgently addressed.”

Read the full study in Pediatrics (doi: 10.1542/peds.2016-2651).

llaubach@frontlinemedcom.com

A neonatal diagnostic code of neonatal abstinence syndrome (NAS) is strongly associated with poor and deteriorating school performance, according to Ju Lee Oei, MD, of the University of New South Wales, Sydney, and her associates.

In a study of 604,829 children born in 2000-2006 in New South Wales, linkage rates were similar between matched controls (77.6% of 4,330) and other NSW children (77.4% of 598,265; P = .83) but were significantly lower in children with NAS (75.6% of 2,234; P = .03). The controls were matched for gender,gestation, and socioeconomic status.

The children with NAS had significantly lower scores than the controls and other NSW children in every grade and every domain of testing (reading, writing, numeracy, spelling, and grammar/punctuation). By grade 7, 38% of children with NAS did not meet National Minimum Standard (NMS) in one or more domains (versus 18.4% of controls and 14.5% of other NSW children). The mean serial composite scores also were lower in children with NAS from grades 3 to 7, compared with the other two groups; the difference was progressive, the investigators said. And by grade 7, the scores for children with NAS were lower than other children’s scores in grade 5.

It was noted that children with NAS, indigenous status (adjusted odds ratio, 1.7), male gender (aOR, 1.3), and having a primary parent without a grade 9 education (aOR, 1.3) increased the risk of failure to meet NMS. Overall, NAS (aOR, 2.5), indigenous status (aOR, 2.2), male gender (aOR, 1.3), and prematurity (less than 37 weeks’ gestation [aOR, 1.2]) increased the risk of failure to meet NMS.

“To date these are the only data demonstrating long-term school outcomes for children with a history of NAS. Similar data for children born from the current opioid epidemic gripping much of the Northern Hemisphere, assuming linkage is possible, will be available only in 7-10 years,” researchers concluded. “Although this study was conducted in Australia, the high risk of poor academic performance in this vulnerable group of children is applicable to all countries, and strategies to address this risk and prevent poor adult outcomes and intergenerational vulnerability must be urgently addressed.”

Read the full study in Pediatrics (doi: 10.1542/peds.2016-2651).

llaubach@frontlinemedcom.com

Hartmut Döhner, MD
Photo courtesy of
University Hospital Ulm

Research published in Nature Genetics suggests a knowledge bank

can reveal the optimal treatment for patients with acute

myeloid leukemia (AML), although more research is needed before such

banks can be used in the clinic.

Researchers built a knowledge

bank using data from 1540 AML patients enrolled in clinical

trials in Germany and Austria.

The bank includes information on genetic features, treatment, and outcomes for each patient.

The researchers used this information to develop models that could predict a patient’s likelihood of remission, relapse, and mortality.

The team then validated those results using data from patients in The Cancer Genome Atlas.

The researchers estimate that up to 1 in 3 AML patients would be prescribed a different treatment regimen if physicians used the knowledge bank approach rather than current practice.

“The knowledge bank approach makes far more detailed and accurate predictions about the likely future course of a patient with AML than what we can make in the clinic at the moment,” said study author Peter Campbell, PhD, of the Wellcome Trust Sanger Institute in Hinxton, UK.

“Current guides use a simple set of rules based on only a few genetic findings. For any given patient, using the new tool, we can compare the likely future outcomes under a transplant route versus a standard chemotherapy route. This means that we can make a treatment choice that is personally tailored to the unique features of that particular patient.”

However, the researchers said the knowledge bank approach requires further testing before it can be used to prescribe treatment in AML clinics.

“Our analysis reveals that knowledge banks of up to 10,000 patients would be needed to obtain the precision needed for routine clinical application,” said study author Moritz Gerstung, PhD, of the European Bioinformatics Institute in Hinxton, UK.

“Building knowledge banks is not easy,” added author Hartmut Döhner, MD, of the University of Ulm in Germany. “To get accurate treatment predictions, you need data from thousands of patients and all tumor types.”

“Furthermore, such knowledge banks will need continuous updating as new therapies become approved and available. As genetic testing enters routine clinical practice, there is an opportunity to learn from patients undergoing care in our health systems. Our paper gives the first real evidence that the approach is worthwhile, how it could be used, and what the scale needs to be.”

Hartmut Döhner, MD
Photo courtesy of
University Hospital Ulm

Research published in Nature Genetics suggests a knowledge bank

can reveal the optimal treatment for patients with acute

myeloid leukemia (AML), although more research is needed before such

banks can be used in the clinic.

Researchers built a knowledge

bank using data from 1540 AML patients enrolled in clinical

trials in Germany and Austria.

The bank includes information on genetic features, treatment, and outcomes for each patient.

The researchers used this information to develop models that could predict a patient’s likelihood of remission, relapse, and mortality.

The team then validated those results using data from patients in The Cancer Genome Atlas.

The researchers estimate that up to 1 in 3 AML patients would be prescribed a different treatment regimen if physicians used the knowledge bank approach rather than current practice.

“The knowledge bank approach makes far more detailed and accurate predictions about the likely future course of a patient with AML than what we can make in the clinic at the moment,” said study author Peter Campbell, PhD, of the Wellcome Trust Sanger Institute in Hinxton, UK.

“Current guides use a simple set of rules based on only a few genetic findings. For any given patient, using the new tool, we can compare the likely future outcomes under a transplant route versus a standard chemotherapy route. This means that we can make a treatment choice that is personally tailored to the unique features of that particular patient.”

However, the researchers said the knowledge bank approach requires further testing before it can be used to prescribe treatment in AML clinics.

“Our analysis reveals that knowledge banks of up to 10,000 patients would be needed to obtain the precision needed for routine clinical application,” said study author Moritz Gerstung, PhD, of the European Bioinformatics Institute in Hinxton, UK.

“Building knowledge banks is not easy,” added author Hartmut Döhner, MD, of the University of Ulm in Germany. “To get accurate treatment predictions, you need data from thousands of patients and all tumor types.”

“Furthermore, such knowledge banks will need continuous updating as new therapies become approved and available. As genetic testing enters routine clinical practice, there is an opportunity to learn from patients undergoing care in our health systems. Our paper gives the first real evidence that the approach is worthwhile, how it could be used, and what the scale needs to be.”

Hartmut Döhner, MD
Photo courtesy of
University Hospital Ulm

Research published in Nature Genetics suggests a knowledge bank

can reveal the optimal treatment for patients with acute

myeloid leukemia (AML), although more research is needed before such

banks can be used in the clinic.

Researchers built a knowledge

bank using data from 1540 AML patients enrolled in clinical

trials in Germany and Austria.

The bank includes information on genetic features, treatment, and outcomes for each patient.

The researchers used this information to develop models that could predict a patient’s likelihood of remission, relapse, and mortality.

The team then validated those results using data from patients in The Cancer Genome Atlas.

The researchers estimate that up to 1 in 3 AML patients would be prescribed a different treatment regimen if physicians used the knowledge bank approach rather than current practice.

“The knowledge bank approach makes far more detailed and accurate predictions about the likely future course of a patient with AML than what we can make in the clinic at the moment,” said study author Peter Campbell, PhD, of the Wellcome Trust Sanger Institute in Hinxton, UK.

“Current guides use a simple set of rules based on only a few genetic findings. For any given patient, using the new tool, we can compare the likely future outcomes under a transplant route versus a standard chemotherapy route. This means that we can make a treatment choice that is personally tailored to the unique features of that particular patient.”

However, the researchers said the knowledge bank approach requires further testing before it can be used to prescribe treatment in AML clinics.

“Our analysis reveals that knowledge banks of up to 10,000 patients would be needed to obtain the precision needed for routine clinical application,” said study author Moritz Gerstung, PhD, of the European Bioinformatics Institute in Hinxton, UK.

“Building knowledge banks is not easy,” added author Hartmut Döhner, MD, of the University of Ulm in Germany. “To get accurate treatment predictions, you need data from thousands of patients and all tumor types.”

“Furthermore, such knowledge banks will need continuous updating as new therapies become approved and available. As genetic testing enters routine clinical practice, there is an opportunity to learn from patients undergoing care in our health systems. Our paper gives the first real evidence that the approach is worthwhile, how it could be used, and what the scale needs to be.”

A little over a year ago David J. Shulkin, MD, was approved by Senate to take over the position of under secretary for health at the VA, after being nominated by President Obama in March 2015. Since his appointment, Shulkin has strongly voiced the importance of improving VA wait times, providing veterans with the utmost quality of care, and championing the VA health care system for its ability to provide services that the private sector cannot.

Here is a collection of articles published by Federal Practitioner featuring David Shulkin, MD, including exclusive interviews and an editorial written by the VA Secretary Nominee himself.  

• Shulkin Nominated to Replace McDonald at VA
• Why VA Health Care Is Different
• Shulkin: VA "Not a Political Issue”
• Shulkin Addresses APRN Rule, Health Care Vacancies, and Access
• A New View for the VA
• Nearly 20,000 Comment on Controversial APRN Rule
• McDonald and Shulkin Lay Out Strategies for Eliminating VA Wait Times in 2016
• "Call to Action" on Veteran Suicide Yields Policy Shifts
• New VA Under Secretary of Health Focuses on Access, Employee Engagement
• Senate Confirms New VA Under Secretary for Health

A little over a year ago David J. Shulkin, MD, was approved by Senate to take over the position of under secretary for health at the VA, after being nominated by President Obama in March 2015. Since his appointment, Shulkin has strongly voiced the importance of improving VA wait times, providing veterans with the utmost quality of care, and championing the VA health care system for its ability to provide services that the private sector cannot.

Here is a collection of articles published by Federal Practitioner featuring David Shulkin, MD, including exclusive interviews and an editorial written by the VA Secretary Nominee himself.  

• Shulkin Nominated to Replace McDonald at VA
• Why VA Health Care Is Different
• Shulkin: VA "Not a Political Issue”
• Shulkin Addresses APRN Rule, Health Care Vacancies, and Access
• A New View for the VA
• Nearly 20,000 Comment on Controversial APRN Rule
• McDonald and Shulkin Lay Out Strategies for Eliminating VA Wait Times in 2016
• "Call to Action" on Veteran Suicide Yields Policy Shifts
• New VA Under Secretary of Health Focuses on Access, Employee Engagement
• Senate Confirms New VA Under Secretary for Health

A little over a year ago David J. Shulkin, MD, was approved by Senate to take over the position of under secretary for health at the VA, after being nominated by President Obama in March 2015. Since his appointment, Shulkin has strongly voiced the importance of improving VA wait times, providing veterans with the utmost quality of care, and championing the VA health care system for its ability to provide services that the private sector cannot.

Here is a collection of articles published by Federal Practitioner featuring David Shulkin, MD, including exclusive interviews and an editorial written by the VA Secretary Nominee himself.  

• Shulkin Nominated to Replace McDonald at VA
• Why VA Health Care Is Different
• Shulkin: VA "Not a Political Issue”
• Shulkin Addresses APRN Rule, Health Care Vacancies, and Access
• A New View for the VA
• Nearly 20,000 Comment on Controversial APRN Rule
• McDonald and Shulkin Lay Out Strategies for Eliminating VA Wait Times in 2016
• "Call to Action" on Veteran Suicide Yields Policy Shifts
• New VA Under Secretary of Health Focuses on Access, Employee Engagement
• Senate Confirms New VA Under Secretary for Health

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Editor’s note: Each month, SHM puts the spotlight on our most active members and explores how they are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise and help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Alessandra G. Cornelio, MPH, the acquisition manager at Hartford Healthcare Medical Group in Connecticut. Ms. Cornelio is an active member of SHM’s Practice Administrators Committee. She developed and now directs the Practice Administrators’ Mentor Program.

To complement my career goals, SHM helped my professional growth by exposing me to the variety of topics and issues that practice administrators deal with regularly in their practices. I was also able to review and learn from the many resources available on the SHM website, such as white papers and articles, which were extremely useful for a new administrator.
 

Q: What prompted you to join the Practice Administrators Committee? What are some of the most impactful projects the committee is currently working on?

A: Within my first year of being a practice administrator, I attended a practice administrators’ forum at the SHM annual meeting in Washington. I found that the information was relevant to my daily functions as an administrator, and I was also able to meet and share ideas with other practice administrators from throughout the country. Down the line, I learned that SHM needed new members for the Practice Administrators Committee. I wanted to become more involved in a meaningful way, so I decided to apply.

The Practice Administrators Committee is a hardworking committee that takes on many meaningful projects. Most recently, the team has been working on developing a more user-friendly website for practice administrators, and a subgroup of the committee has cross-referenced “The Key Principles and Characteristics of an Effective Hospital Medicine Group” with existing resources, which will prove valuable to all administrators in the final product.
 

Q: Can you discuss how you began leading the work group for the Practice Administrators’ Mentor Program and how it has evolved since its inception?

A: As part of the committee’s initiative to help fellow practice administrators, we formed a subcommittee to begin developing a mentor program. (Former SHM staffer) Joseph Miller and I worked together to create an appropriate program model through research and brainstorming. We also utilized the HMX Practice Administrators Community to ask fellow practice administrators what they would expect from a mentor program and if they would participate. There was a strong favorable response rate, and we were able to implement a pilot program.

We implemented two different tracks for the program – the buddy system track and the career development track. The buddy system track is for those of any level of expertise or experience who are more interested in short-term assistance or in need of a sounding board. The career development track is a more traditional approach, matching a seasoned practice administrator with a less experienced practice administrator.

The program was designed to have annual cohorts, with the Practice Administrators Committee members as mentors. There is a detailed application process to ensure that each mentee is matched with an appropriate mentor, based on their interests and needs. We provide an orientation webinar to both parties before kicking off the relationship to present program expectations. The pilot program used this model, and comments from 6-month and annual evaluations showed tremendous satisfaction with the structure and value of this program.

There were approximately 16 pairs during the pilot year, and the following year, we grew to almost 20 pairs. Our goal as a committee is to maintain this program year after year, and in order to expand, we’ll need more than just the committee members to volunteer as mentors. There are so many talented practice administrators, and it would be wonderful to fold them into this gratifying program to pay it forward.

Many mentors, including myself, found value in acting as a mentor. I learned from my mentees as well as made connections and friendships with other professionals in the field.
 

Q: Given your intimate involvement, how have you seen the Practice Administrators’ Mentor Program benefit both the mentors and the mentees? Can you provide any specific examples?

A: Mentees are able to connect with seasoned mentors and can ask specific questions about career development and any issues they may be experiencing. Mentors are able to share their experiences and pass along important and valuable lessons learned to mentees. I served as a mentor, even though I did not yet consider myself a qualified candidate. However, I found that I was more equipped than I had realized, and I was able to assist my mentee with many aspects of career development (i.e., resume building, discussions with the C-suite, etc.).

My mentee was a practice coordinator who had only been in hospital medicine for 1 year. She had little experience hiring hospitalists, so this was a major area that we worked on together during our yearlong connection. I introduced her to collaborating with her HR department when posting positions, as well as working with permanent placement agencies. Her service was also undergoing a change in leadership, which can be difficult for any service line to experience. We discussed ways in which she could present important information to the new medical director that would produce a meaningful conversation.

In turn, my mentee introduced me to new online resources and was able to connect me with the manager of her practice, who assisted me with streamlining the payroll structure in my practice. I truly enjoyed my experience developing and participating in the program.

Felicia Steele is SHM’s communications coordinator.

Learn more about how you can benefit from the Practice Administrators’ Mentor program via the SHM website.

Sleeping newborn
Photo by Bertrand Devouard

Data from hospitals in 29 European countries suggest that healthcare-associated infections (HAIs) reported in children occur most often in infants younger than 12 months of age.

And the prevalence of infection is highest for children in intensive care units (ICUs).

Walter Zingg, MD, of Imperial College London in the UK, and his colleagues conducted this research and detailed the results in The Lancet Infectious Diseases.

The researchers analyzed data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of HAIs and antimicrobial use in European acute care hospitals.

The data encompassed 17,273 children and adolescents (ages 0 to 18) treated at 1149 hospitals in 29 European countries* from May 2011 to November 2012.

During that time, there were 770 infections reported in 726 children and adolescents.

The researchers found that most HAIs (77%) occurred in infants younger than 12 months. And the prevalence of infections was highest in pediatric ICUs and neonatal ICUs—15.5% and 10.7%, respectively.

Bloodstream infections were the most common type (45%), followed by lower respiratory tract infections (22%); gastrointestinal infections (8%); eye, ear, nose, and throat infections (7%); urinary tract infections (5%); and surgical-site infections (4%).

Analyses suggested that independent risk factors for infection included being younger than 12 months, having a fatal disease, a prolonged length of hospital stay, and receiving treatment with invasive medical devices.

The researchers said a pan-European program is urgently needed to prevent and reduce the unacceptably high rates of HAIs in children in Europe, with a focus in neonatal and pediatric ICUs and addressing the issues related to healthcare-associated bloodstream infections.

The team said this is the largest multinational study describing HAIs in children thus far.

A second point prevalence survey is ongoing in Europe, and its results are expected to be published by the ECDC after 2017.

Sleeping newborn
Photo by Bertrand Devouard

Data from hospitals in 29 European countries suggest that healthcare-associated infections (HAIs) reported in children occur most often in infants younger than 12 months of age.

And the prevalence of infection is highest for children in intensive care units (ICUs).

Walter Zingg, MD, of Imperial College London in the UK, and his colleagues conducted this research and detailed the results in The Lancet Infectious Diseases.

The researchers analyzed data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of HAIs and antimicrobial use in European acute care hospitals.

The data encompassed 17,273 children and adolescents (ages 0 to 18) treated at 1149 hospitals in 29 European countries* from May 2011 to November 2012.

During that time, there were 770 infections reported in 726 children and adolescents.

The researchers found that most HAIs (77%) occurred in infants younger than 12 months. And the prevalence of infections was highest in pediatric ICUs and neonatal ICUs—15.5% and 10.7%, respectively.

Bloodstream infections were the most common type (45%), followed by lower respiratory tract infections (22%); gastrointestinal infections (8%); eye, ear, nose, and throat infections (7%); urinary tract infections (5%); and surgical-site infections (4%).

Analyses suggested that independent risk factors for infection included being younger than 12 months, having a fatal disease, a prolonged length of hospital stay, and receiving treatment with invasive medical devices.

The researchers said a pan-European program is urgently needed to prevent and reduce the unacceptably high rates of HAIs in children in Europe, with a focus in neonatal and pediatric ICUs and addressing the issues related to healthcare-associated bloodstream infections.

The team said this is the largest multinational study describing HAIs in children thus far.

A second point prevalence survey is ongoing in Europe, and its results are expected to be published by the ECDC after 2017.

Sleeping newborn
Photo by Bertrand Devouard

Data from hospitals in 29 European countries suggest that healthcare-associated infections (HAIs) reported in children occur most often in infants younger than 12 months of age.

And the prevalence of infection is highest for children in intensive care units (ICUs).

Walter Zingg, MD, of Imperial College London in the UK, and his colleagues conducted this research and detailed the results in The Lancet Infectious Diseases.

The researchers analyzed data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of HAIs and antimicrobial use in European acute care hospitals.

The data encompassed 17,273 children and adolescents (ages 0 to 18) treated at 1149 hospitals in 29 European countries* from May 2011 to November 2012.

During that time, there were 770 infections reported in 726 children and adolescents.

The researchers found that most HAIs (77%) occurred in infants younger than 12 months. And the prevalence of infections was highest in pediatric ICUs and neonatal ICUs—15.5% and 10.7%, respectively.

Bloodstream infections were the most common type (45%), followed by lower respiratory tract infections (22%); gastrointestinal infections (8%); eye, ear, nose, and throat infections (7%); urinary tract infections (5%); and surgical-site infections (4%).

Analyses suggested that independent risk factors for infection included being younger than 12 months, having a fatal disease, a prolonged length of hospital stay, and receiving treatment with invasive medical devices.

The researchers said a pan-European program is urgently needed to prevent and reduce the unacceptably high rates of HAIs in children in Europe, with a focus in neonatal and pediatric ICUs and addressing the issues related to healthcare-associated bloodstream infections.

The team said this is the largest multinational study describing HAIs in children thus far.

A second point prevalence survey is ongoing in Europe, and its results are expected to be published by the ECDC after 2017.