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Psychiatrists urged to raise awareness about human trafficking
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
REPORTING FROM APA 2019
In duodenal neuroendocrine tumors, resection technique matters
SAN DIEGO – according to a study presented at the annual Digestive Disease Week.
In a retrospective case series of 20 patients, local recurrence was seen primarily in patients who had cold forceps, rather than deeper, excision techniques. However, most patients who had cold forceps resections also remained recurrence-free, said Jonathan Ragheb, MD, a resident physician at the Cleveland Clinic.
Duodenal neuroendocrine tumors are becoming increasingly prevalent, so Dr. Ragheb and colleagues were interested in “seeing what we should do with them when we encounter them in clinical practice – whether it be surgery or endoscopic intervention,” he said.
In an interview, Dr. Ragheb said that he and his colleagues structured the study to answer the question: “What is the impact of the margin status on the recurrence of the tumor?” This relationship is important in guiding neuroendocrine tumor (NET) management, he said. The technique used for NET removal may also have effects on recurrence rates, so Dr. Ragheb and his collaborators were also interested in answering that question.
The investigators looked at patients at two facilities with a histopathologic diagnosis of duodenal NET who had endoscopic tumor resection during 2004-2018. They excluded patients who had cold forceps endoscopic resection (ER) and clear margins, patients who had further surgical therapy, and those who were lost to endoscopic follow-up.
Assessment of resection margin status was performed independently by pathologists at each study center.
“We found that people with clear margins tend not to have any recurrence, and this is over the course of a year to a year and a half of follow-up,” said Dr. Ragheb, adding, “Those patients who did have some positive margins – whether lateral margins or vertical margins – the majority of them did not have recurrence over that time period.” However, 4 of the patients in the 20-patient cohort did have some tumor recurrence, and all of these patients had an incomplete initial resection.
The investigators took a closer look at which resection techniques were most likely to result in clear margins and no recurrences, and they found that deeper techniques were associated with fewer recurrences. These included endoscopic submucosal or mucosal resection and en bloc snare polypectomy; all were associated with fewer recurrences than resections performed with cold forceps biopsy.
In all, 7 patients had clear (R0) margins, while 13 patients had an incomplete (R1) resection from the biopsy. Of the patients who had R1 margins with local recurrence, three had received a cold forceps biopsy. The other recurrence was in a patient who had endoscopic mucosal resection.
“Margin status is not the sole contributor to recurrence rates of these duodenal neuroendocrine tumors,” said Dr. Ragheb, noting that previous work has identified other possible factors, including tumor grade and biology, that can affect recurrence.
Knowledge gaps still exist regarding best practices for biopsy and decision of duodenal NETs, acknowledged Dr. Ragheb. The present study only followed patients for about a year and a half, so longer-term recurrence patterns and their relationship with various resection techniques aren’t known.
“Larger studies considering tumor grading and ER [endoscopic resection] technique are needed to fully elucidate the risk of local recurrences after ER,” wrote Dr. Ragheb and colleagues.
Dr. Ragheb reported no outside sources of funding and no conflicts of interest.
SAN DIEGO – according to a study presented at the annual Digestive Disease Week.
In a retrospective case series of 20 patients, local recurrence was seen primarily in patients who had cold forceps, rather than deeper, excision techniques. However, most patients who had cold forceps resections also remained recurrence-free, said Jonathan Ragheb, MD, a resident physician at the Cleveland Clinic.
Duodenal neuroendocrine tumors are becoming increasingly prevalent, so Dr. Ragheb and colleagues were interested in “seeing what we should do with them when we encounter them in clinical practice – whether it be surgery or endoscopic intervention,” he said.
In an interview, Dr. Ragheb said that he and his colleagues structured the study to answer the question: “What is the impact of the margin status on the recurrence of the tumor?” This relationship is important in guiding neuroendocrine tumor (NET) management, he said. The technique used for NET removal may also have effects on recurrence rates, so Dr. Ragheb and his collaborators were also interested in answering that question.
The investigators looked at patients at two facilities with a histopathologic diagnosis of duodenal NET who had endoscopic tumor resection during 2004-2018. They excluded patients who had cold forceps endoscopic resection (ER) and clear margins, patients who had further surgical therapy, and those who were lost to endoscopic follow-up.
Assessment of resection margin status was performed independently by pathologists at each study center.
“We found that people with clear margins tend not to have any recurrence, and this is over the course of a year to a year and a half of follow-up,” said Dr. Ragheb, adding, “Those patients who did have some positive margins – whether lateral margins or vertical margins – the majority of them did not have recurrence over that time period.” However, 4 of the patients in the 20-patient cohort did have some tumor recurrence, and all of these patients had an incomplete initial resection.
The investigators took a closer look at which resection techniques were most likely to result in clear margins and no recurrences, and they found that deeper techniques were associated with fewer recurrences. These included endoscopic submucosal or mucosal resection and en bloc snare polypectomy; all were associated with fewer recurrences than resections performed with cold forceps biopsy.
In all, 7 patients had clear (R0) margins, while 13 patients had an incomplete (R1) resection from the biopsy. Of the patients who had R1 margins with local recurrence, three had received a cold forceps biopsy. The other recurrence was in a patient who had endoscopic mucosal resection.
“Margin status is not the sole contributor to recurrence rates of these duodenal neuroendocrine tumors,” said Dr. Ragheb, noting that previous work has identified other possible factors, including tumor grade and biology, that can affect recurrence.
Knowledge gaps still exist regarding best practices for biopsy and decision of duodenal NETs, acknowledged Dr. Ragheb. The present study only followed patients for about a year and a half, so longer-term recurrence patterns and their relationship with various resection techniques aren’t known.
“Larger studies considering tumor grading and ER [endoscopic resection] technique are needed to fully elucidate the risk of local recurrences after ER,” wrote Dr. Ragheb and colleagues.
Dr. Ragheb reported no outside sources of funding and no conflicts of interest.
SAN DIEGO – according to a study presented at the annual Digestive Disease Week.
In a retrospective case series of 20 patients, local recurrence was seen primarily in patients who had cold forceps, rather than deeper, excision techniques. However, most patients who had cold forceps resections also remained recurrence-free, said Jonathan Ragheb, MD, a resident physician at the Cleveland Clinic.
Duodenal neuroendocrine tumors are becoming increasingly prevalent, so Dr. Ragheb and colleagues were interested in “seeing what we should do with them when we encounter them in clinical practice – whether it be surgery or endoscopic intervention,” he said.
In an interview, Dr. Ragheb said that he and his colleagues structured the study to answer the question: “What is the impact of the margin status on the recurrence of the tumor?” This relationship is important in guiding neuroendocrine tumor (NET) management, he said. The technique used for NET removal may also have effects on recurrence rates, so Dr. Ragheb and his collaborators were also interested in answering that question.
The investigators looked at patients at two facilities with a histopathologic diagnosis of duodenal NET who had endoscopic tumor resection during 2004-2018. They excluded patients who had cold forceps endoscopic resection (ER) and clear margins, patients who had further surgical therapy, and those who were lost to endoscopic follow-up.
Assessment of resection margin status was performed independently by pathologists at each study center.
“We found that people with clear margins tend not to have any recurrence, and this is over the course of a year to a year and a half of follow-up,” said Dr. Ragheb, adding, “Those patients who did have some positive margins – whether lateral margins or vertical margins – the majority of them did not have recurrence over that time period.” However, 4 of the patients in the 20-patient cohort did have some tumor recurrence, and all of these patients had an incomplete initial resection.
The investigators took a closer look at which resection techniques were most likely to result in clear margins and no recurrences, and they found that deeper techniques were associated with fewer recurrences. These included endoscopic submucosal or mucosal resection and en bloc snare polypectomy; all were associated with fewer recurrences than resections performed with cold forceps biopsy.
In all, 7 patients had clear (R0) margins, while 13 patients had an incomplete (R1) resection from the biopsy. Of the patients who had R1 margins with local recurrence, three had received a cold forceps biopsy. The other recurrence was in a patient who had endoscopic mucosal resection.
“Margin status is not the sole contributor to recurrence rates of these duodenal neuroendocrine tumors,” said Dr. Ragheb, noting that previous work has identified other possible factors, including tumor grade and biology, that can affect recurrence.
Knowledge gaps still exist regarding best practices for biopsy and decision of duodenal NETs, acknowledged Dr. Ragheb. The present study only followed patients for about a year and a half, so longer-term recurrence patterns and their relationship with various resection techniques aren’t known.
“Larger studies considering tumor grading and ER [endoscopic resection] technique are needed to fully elucidate the risk of local recurrences after ER,” wrote Dr. Ragheb and colleagues.
Dr. Ragheb reported no outside sources of funding and no conflicts of interest.
REPORTING FROM DDW 2019
Physical activity linked to less cirrhosis-related mortality
SAN DIEGO – People who were more physically active, including those who did strength training, had significantly reduced risks of cirrhosis-related and liver cancer–related mortality, based on 26 years of prospective data from 113,000 participants in the Nurses Health Study and the Health Professionals Follow-Up Study.
Adults in the highest quintile of physical activity in the study had a 73% lower risk for cirrhosis-related death than did those in the lowest quintile, according to researchers at Massachusetts General Hospital and Harvard Medical School, Boston, who presented the study findings at Digestive Disease Week 2019.
One of the researchers, Tracey Simon, MD, MPH, of Massachusetts General Hospital, Boston, broke down the major take-home messages from the study in this video interview.
For example, vigorous activity was not necessary to improve hepatic health, she said. Walking for 4 hours per week made a big difference.
Dr. Simon has no relevant financial disclosures.
SAN DIEGO – People who were more physically active, including those who did strength training, had significantly reduced risks of cirrhosis-related and liver cancer–related mortality, based on 26 years of prospective data from 113,000 participants in the Nurses Health Study and the Health Professionals Follow-Up Study.
Adults in the highest quintile of physical activity in the study had a 73% lower risk for cirrhosis-related death than did those in the lowest quintile, according to researchers at Massachusetts General Hospital and Harvard Medical School, Boston, who presented the study findings at Digestive Disease Week 2019.
One of the researchers, Tracey Simon, MD, MPH, of Massachusetts General Hospital, Boston, broke down the major take-home messages from the study in this video interview.
For example, vigorous activity was not necessary to improve hepatic health, she said. Walking for 4 hours per week made a big difference.
Dr. Simon has no relevant financial disclosures.
SAN DIEGO – People who were more physically active, including those who did strength training, had significantly reduced risks of cirrhosis-related and liver cancer–related mortality, based on 26 years of prospective data from 113,000 participants in the Nurses Health Study and the Health Professionals Follow-Up Study.
Adults in the highest quintile of physical activity in the study had a 73% lower risk for cirrhosis-related death than did those in the lowest quintile, according to researchers at Massachusetts General Hospital and Harvard Medical School, Boston, who presented the study findings at Digestive Disease Week 2019.
One of the researchers, Tracey Simon, MD, MPH, of Massachusetts General Hospital, Boston, broke down the major take-home messages from the study in this video interview.
For example, vigorous activity was not necessary to improve hepatic health, she said. Walking for 4 hours per week made a big difference.
Dr. Simon has no relevant financial disclosures.
REPORTING FROM DDW 2019
Immunostaining boosts pathologists’ accuracy in Barrett’s esophagus
SAN DIEGO – Years of experience and an academic medical center affiliation predicted the accuracy of pathologists reviewing biopsies from patients with Barrett’s esophagus, according to the results of a multinational study.
Those with 5 or more years of experience were less likely to make major diagnostic errors in reviewing Barrett’s esophagus biopsies (odds ratio [OR], 0.48, 95% confidence interval, 0.31-0.74). Pathologists who worked in nonacademic settings were more likely to make a major diagnostic error (OR, 1.76; 95% CI, 1.15-2.69) when reviewing hematoxylin and eosin-stained slides alone, but the addition of p53 immunostaining greatly improved accuracy.
Current guidelines recommend expert evaluation of Barrett’s esophagus biopsies that show dysplasia, but exact determination of expert review status had been lacking, according to Marnix Jansen, MD, a pathologist at University College London.
“The guidelines say that biopsies with dysplasia need to be reviewed by an expert pathologist, but don’t define what makes an expert pathologist,” Dr. Jansen said in an interview at the annual Digestive Disease Week.
“We wanted to advance the field by for the first time creating objective and quantitative standards” to delineate the characteristics of an expert pathologist in reviewing Barrett’s esophagus tissue samples, said Dr. Jansen. The study’s first author is Myrtle J. van der Wel, MD, of Amsterdam University Medical Center, the Netherlands.
More than 6,000 individual case diagnoses were used in the study, which included pathologists from more than 20 countries. Before the pathologists began reviewing the case set, they answered a questionnaire about training, practice context, years of experience, case volume, and other demographic characteristics.
“We then sent those biopsies around the world to ... 55 pathologists in the U.S., in Europe, Japan, Australia, even some in South America – so really around the whole globe,” explained Dr. Jansen. Biopsies were assessed by each pathologist before and after p53 immunostaining.
“Once we had the final dataset – which is massive, because we had 6,000 case diagnoses within our dataset – we could then regress those variables back onto the consensus data,” providing a first-ever look at “clear predictors of what the pathologist looks like that will score on a par with where the experts are,” said Dr. Jansen.
The results? “You need at least 5 years of experience. On top of that, if you are a pathologist working in a [nonacademic center], you are at a slightly increased risk of making major diagnostic errors,” said Dr. Jansen. However, the analysis convincingly showed that the addition of p53 immunostaining neutralized the risk for these pathologists – a strength of having such a large dataset, he said.
The study also affirmed the safety of digital pathology for expert review, said Dr. Jansen: “One of the reassuring points of our study was that we found that the best concordance was for nondysplastic Barrett’s, and high-grade dysplasia, which really replicates known glass slide characteristics. So we can really say that digital pathology is safe for this application – which is very relevant for pathologists that are taking in cases from outside for expert review.”
Concordance rates for nondysplastic Barrett’s esophagus and high-grade dysplasia were over 70%; for low-grade dysplasia, rates were intermediate at 42%.
Going forward, the study can inform the next iteration of guidelines for pathologist review of Barrett’s dysplasia, said Dr. Jansen. Rather than just recommending expert review, the guidelines can include a quantitative assessment of what’s needed. “You need to have to have at least 5 years of experience, and if you work in a [community hospital], to use a p53, and that is collectively what amounts to expertise in Barrett’s pathology.”
A follow-up study with a similar design is planned within the United Kingdom, the Netherlands, and the United States. This study, which Dr. Jansen said would enroll hundreds of pathologists, will include an intervention arm that administers a tutorial with the aim of improving concordance scoring.
Dr. Jansen reported no relevant conflicts of interest.
SAN DIEGO – Years of experience and an academic medical center affiliation predicted the accuracy of pathologists reviewing biopsies from patients with Barrett’s esophagus, according to the results of a multinational study.
Those with 5 or more years of experience were less likely to make major diagnostic errors in reviewing Barrett’s esophagus biopsies (odds ratio [OR], 0.48, 95% confidence interval, 0.31-0.74). Pathologists who worked in nonacademic settings were more likely to make a major diagnostic error (OR, 1.76; 95% CI, 1.15-2.69) when reviewing hematoxylin and eosin-stained slides alone, but the addition of p53 immunostaining greatly improved accuracy.
Current guidelines recommend expert evaluation of Barrett’s esophagus biopsies that show dysplasia, but exact determination of expert review status had been lacking, according to Marnix Jansen, MD, a pathologist at University College London.
“The guidelines say that biopsies with dysplasia need to be reviewed by an expert pathologist, but don’t define what makes an expert pathologist,” Dr. Jansen said in an interview at the annual Digestive Disease Week.
“We wanted to advance the field by for the first time creating objective and quantitative standards” to delineate the characteristics of an expert pathologist in reviewing Barrett’s esophagus tissue samples, said Dr. Jansen. The study’s first author is Myrtle J. van der Wel, MD, of Amsterdam University Medical Center, the Netherlands.
More than 6,000 individual case diagnoses were used in the study, which included pathologists from more than 20 countries. Before the pathologists began reviewing the case set, they answered a questionnaire about training, practice context, years of experience, case volume, and other demographic characteristics.
“We then sent those biopsies around the world to ... 55 pathologists in the U.S., in Europe, Japan, Australia, even some in South America – so really around the whole globe,” explained Dr. Jansen. Biopsies were assessed by each pathologist before and after p53 immunostaining.
“Once we had the final dataset – which is massive, because we had 6,000 case diagnoses within our dataset – we could then regress those variables back onto the consensus data,” providing a first-ever look at “clear predictors of what the pathologist looks like that will score on a par with where the experts are,” said Dr. Jansen.
The results? “You need at least 5 years of experience. On top of that, if you are a pathologist working in a [nonacademic center], you are at a slightly increased risk of making major diagnostic errors,” said Dr. Jansen. However, the analysis convincingly showed that the addition of p53 immunostaining neutralized the risk for these pathologists – a strength of having such a large dataset, he said.
The study also affirmed the safety of digital pathology for expert review, said Dr. Jansen: “One of the reassuring points of our study was that we found that the best concordance was for nondysplastic Barrett’s, and high-grade dysplasia, which really replicates known glass slide characteristics. So we can really say that digital pathology is safe for this application – which is very relevant for pathologists that are taking in cases from outside for expert review.”
Concordance rates for nondysplastic Barrett’s esophagus and high-grade dysplasia were over 70%; for low-grade dysplasia, rates were intermediate at 42%.
Going forward, the study can inform the next iteration of guidelines for pathologist review of Barrett’s dysplasia, said Dr. Jansen. Rather than just recommending expert review, the guidelines can include a quantitative assessment of what’s needed. “You need to have to have at least 5 years of experience, and if you work in a [community hospital], to use a p53, and that is collectively what amounts to expertise in Barrett’s pathology.”
A follow-up study with a similar design is planned within the United Kingdom, the Netherlands, and the United States. This study, which Dr. Jansen said would enroll hundreds of pathologists, will include an intervention arm that administers a tutorial with the aim of improving concordance scoring.
Dr. Jansen reported no relevant conflicts of interest.
SAN DIEGO – Years of experience and an academic medical center affiliation predicted the accuracy of pathologists reviewing biopsies from patients with Barrett’s esophagus, according to the results of a multinational study.
Those with 5 or more years of experience were less likely to make major diagnostic errors in reviewing Barrett’s esophagus biopsies (odds ratio [OR], 0.48, 95% confidence interval, 0.31-0.74). Pathologists who worked in nonacademic settings were more likely to make a major diagnostic error (OR, 1.76; 95% CI, 1.15-2.69) when reviewing hematoxylin and eosin-stained slides alone, but the addition of p53 immunostaining greatly improved accuracy.
Current guidelines recommend expert evaluation of Barrett’s esophagus biopsies that show dysplasia, but exact determination of expert review status had been lacking, according to Marnix Jansen, MD, a pathologist at University College London.
“The guidelines say that biopsies with dysplasia need to be reviewed by an expert pathologist, but don’t define what makes an expert pathologist,” Dr. Jansen said in an interview at the annual Digestive Disease Week.
“We wanted to advance the field by for the first time creating objective and quantitative standards” to delineate the characteristics of an expert pathologist in reviewing Barrett’s esophagus tissue samples, said Dr. Jansen. The study’s first author is Myrtle J. van der Wel, MD, of Amsterdam University Medical Center, the Netherlands.
More than 6,000 individual case diagnoses were used in the study, which included pathologists from more than 20 countries. Before the pathologists began reviewing the case set, they answered a questionnaire about training, practice context, years of experience, case volume, and other demographic characteristics.
“We then sent those biopsies around the world to ... 55 pathologists in the U.S., in Europe, Japan, Australia, even some in South America – so really around the whole globe,” explained Dr. Jansen. Biopsies were assessed by each pathologist before and after p53 immunostaining.
“Once we had the final dataset – which is massive, because we had 6,000 case diagnoses within our dataset – we could then regress those variables back onto the consensus data,” providing a first-ever look at “clear predictors of what the pathologist looks like that will score on a par with where the experts are,” said Dr. Jansen.
The results? “You need at least 5 years of experience. On top of that, if you are a pathologist working in a [nonacademic center], you are at a slightly increased risk of making major diagnostic errors,” said Dr. Jansen. However, the analysis convincingly showed that the addition of p53 immunostaining neutralized the risk for these pathologists – a strength of having such a large dataset, he said.
The study also affirmed the safety of digital pathology for expert review, said Dr. Jansen: “One of the reassuring points of our study was that we found that the best concordance was for nondysplastic Barrett’s, and high-grade dysplasia, which really replicates known glass slide characteristics. So we can really say that digital pathology is safe for this application – which is very relevant for pathologists that are taking in cases from outside for expert review.”
Concordance rates for nondysplastic Barrett’s esophagus and high-grade dysplasia were over 70%; for low-grade dysplasia, rates were intermediate at 42%.
Going forward, the study can inform the next iteration of guidelines for pathologist review of Barrett’s dysplasia, said Dr. Jansen. Rather than just recommending expert review, the guidelines can include a quantitative assessment of what’s needed. “You need to have to have at least 5 years of experience, and if you work in a [community hospital], to use a p53, and that is collectively what amounts to expertise in Barrett’s pathology.”
A follow-up study with a similar design is planned within the United Kingdom, the Netherlands, and the United States. This study, which Dr. Jansen said would enroll hundreds of pathologists, will include an intervention arm that administers a tutorial with the aim of improving concordance scoring.
Dr. Jansen reported no relevant conflicts of interest.
REPORTING FROM DDW 2019
When the parent is a psychiatrist: How are children affected?
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
REPORTING FROM APA 2019
Toolkit for providing mental health care to Muslim patients launched
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
REPORTING FROM APA 2019
Hip-hop offers lens into psyche of black boys, men
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
REPORTING FROM APA 2019
Ultrasound’s arrhythmia localization surpassed ECG’s accuracy
SAN FRANCISCO – A new type of echocardiography that uses a high frame rate to track tissue motion allowed researchers to noninvasively map the source of cardiac arrhythmias in patients with significantly more precision than did standard 12-lead ECG recordings in a pilot, single-center study with 55 patients.
Electromechanical wave imaging (EWI) correctly identified the arrhythmia source in 53 of 55 (96%) patients scheduled to undergo arrhythmia ablation, whereas only 39 of the same 55 patients (71%) were correctly mapped using recordings from a standard 12-lead ECG read by several trained electrophysiologists. The findings from this pilot study suggested that EWI performed with noninvasive ultrasound can provide useful, added information to 12-lead ECG tracings to localize cardiac arrhythmias of various types prior to invasive procedures, Elaine Y. Wan, MD, said at the annual scientific sessions of the Heart Rhythm Society.
She cautioned, however, that future studies must still establish that adding EWI to standard preprocedural assessment can benefit patients by, for example, reducing their radiation dosages or shortening their procedure times.
Patients at Columbia University Medical Center in New York scheduled to undergo ablation for a cardiac arrhythmia first had noninvasive assessment with EWI and 12-lead ECG. Patients averaged 56 years old; 45% had an atrial flutter, 22% had Wolff-Parkinson-White syndrome accessory pathways, 20% had premature ventricular complexes, and 13% had an atrial tachycardia. The researchers used 3D electroanatomic arrhythmia mapping performed during ablation as the arrhythmia-localization standard against which they compared both the EWI and ECG results.
EWI can map cardiac electromechanical activity in all four heart chambers by tracking, with high temporal and spatial resolution, transient tissue deformations that occur in response to local electrical activation of cardiac myocytes, the depolarizations in cardiac muscle that produce tissue movement. The technique captures 2,000 image frames per second, creating a “video of tissue movement that lets us see where the movement started,” explained Dr. Wan, a cardiac electrophysiologist at Columbia.
Dr. Wan and associates previously reported use of EWI to successfully map accessory pathways in all 14 children with Wolff-Parkinson-White syndrome they tested versus success in 11 of these 14 patients (79%) when using expert interpretation of 12-lead ECG recordings (JACC Clin Electrophysiol. 2019 Apr;5[4]:427-37).
The new study is the first report on using EWI in adults, Dr. Wan noted. Advantages of EWI over 12-lead ECG include its lack of dependence on correct lead placement, and EWI does not share the inherent limitation of 12-lead ECG for localizing arrhythmias on the heart’s posterior wall, she said in a video interview.
SOURCE: Wan EY et al. Heart Rhythm 2019, Abstract S-LCT04-03.
SAN FRANCISCO – A new type of echocardiography that uses a high frame rate to track tissue motion allowed researchers to noninvasively map the source of cardiac arrhythmias in patients with significantly more precision than did standard 12-lead ECG recordings in a pilot, single-center study with 55 patients.
Electromechanical wave imaging (EWI) correctly identified the arrhythmia source in 53 of 55 (96%) patients scheduled to undergo arrhythmia ablation, whereas only 39 of the same 55 patients (71%) were correctly mapped using recordings from a standard 12-lead ECG read by several trained electrophysiologists. The findings from this pilot study suggested that EWI performed with noninvasive ultrasound can provide useful, added information to 12-lead ECG tracings to localize cardiac arrhythmias of various types prior to invasive procedures, Elaine Y. Wan, MD, said at the annual scientific sessions of the Heart Rhythm Society.
She cautioned, however, that future studies must still establish that adding EWI to standard preprocedural assessment can benefit patients by, for example, reducing their radiation dosages or shortening their procedure times.
Patients at Columbia University Medical Center in New York scheduled to undergo ablation for a cardiac arrhythmia first had noninvasive assessment with EWI and 12-lead ECG. Patients averaged 56 years old; 45% had an atrial flutter, 22% had Wolff-Parkinson-White syndrome accessory pathways, 20% had premature ventricular complexes, and 13% had an atrial tachycardia. The researchers used 3D electroanatomic arrhythmia mapping performed during ablation as the arrhythmia-localization standard against which they compared both the EWI and ECG results.
EWI can map cardiac electromechanical activity in all four heart chambers by tracking, with high temporal and spatial resolution, transient tissue deformations that occur in response to local electrical activation of cardiac myocytes, the depolarizations in cardiac muscle that produce tissue movement. The technique captures 2,000 image frames per second, creating a “video of tissue movement that lets us see where the movement started,” explained Dr. Wan, a cardiac electrophysiologist at Columbia.
Dr. Wan and associates previously reported use of EWI to successfully map accessory pathways in all 14 children with Wolff-Parkinson-White syndrome they tested versus success in 11 of these 14 patients (79%) when using expert interpretation of 12-lead ECG recordings (JACC Clin Electrophysiol. 2019 Apr;5[4]:427-37).
The new study is the first report on using EWI in adults, Dr. Wan noted. Advantages of EWI over 12-lead ECG include its lack of dependence on correct lead placement, and EWI does not share the inherent limitation of 12-lead ECG for localizing arrhythmias on the heart’s posterior wall, she said in a video interview.
SOURCE: Wan EY et al. Heart Rhythm 2019, Abstract S-LCT04-03.
SAN FRANCISCO – A new type of echocardiography that uses a high frame rate to track tissue motion allowed researchers to noninvasively map the source of cardiac arrhythmias in patients with significantly more precision than did standard 12-lead ECG recordings in a pilot, single-center study with 55 patients.
Electromechanical wave imaging (EWI) correctly identified the arrhythmia source in 53 of 55 (96%) patients scheduled to undergo arrhythmia ablation, whereas only 39 of the same 55 patients (71%) were correctly mapped using recordings from a standard 12-lead ECG read by several trained electrophysiologists. The findings from this pilot study suggested that EWI performed with noninvasive ultrasound can provide useful, added information to 12-lead ECG tracings to localize cardiac arrhythmias of various types prior to invasive procedures, Elaine Y. Wan, MD, said at the annual scientific sessions of the Heart Rhythm Society.
She cautioned, however, that future studies must still establish that adding EWI to standard preprocedural assessment can benefit patients by, for example, reducing their radiation dosages or shortening their procedure times.
Patients at Columbia University Medical Center in New York scheduled to undergo ablation for a cardiac arrhythmia first had noninvasive assessment with EWI and 12-lead ECG. Patients averaged 56 years old; 45% had an atrial flutter, 22% had Wolff-Parkinson-White syndrome accessory pathways, 20% had premature ventricular complexes, and 13% had an atrial tachycardia. The researchers used 3D electroanatomic arrhythmia mapping performed during ablation as the arrhythmia-localization standard against which they compared both the EWI and ECG results.
EWI can map cardiac electromechanical activity in all four heart chambers by tracking, with high temporal and spatial resolution, transient tissue deformations that occur in response to local electrical activation of cardiac myocytes, the depolarizations in cardiac muscle that produce tissue movement. The technique captures 2,000 image frames per second, creating a “video of tissue movement that lets us see where the movement started,” explained Dr. Wan, a cardiac electrophysiologist at Columbia.
Dr. Wan and associates previously reported use of EWI to successfully map accessory pathways in all 14 children with Wolff-Parkinson-White syndrome they tested versus success in 11 of these 14 patients (79%) when using expert interpretation of 12-lead ECG recordings (JACC Clin Electrophysiol. 2019 Apr;5[4]:427-37).
The new study is the first report on using EWI in adults, Dr. Wan noted. Advantages of EWI over 12-lead ECG include its lack of dependence on correct lead placement, and EWI does not share the inherent limitation of 12-lead ECG for localizing arrhythmias on the heart’s posterior wall, she said in a video interview.
SOURCE: Wan EY et al. Heart Rhythm 2019, Abstract S-LCT04-03.
REPORTING FROM HEART RHYTHM 2019
Ultrasound or biopsy for evaluation of endometrium? It depends
NASHVILLE, TENN. – Biopsy isn’t usually the first step in evaluating the endometrium of a reproductive-age woman who presents with abnormal uterine bleeding, but that’s not always the case, according to James M. Shwayder, MD.
“If we have young women come in, generally speaking, we don’t think much about doing biopsies, but there are those patients who really require a biopsy very early on: If they are obese and if they have long histories of oligomenorrhea ... they are at significantly greater risk for either endometrial hyperplasia or cancer, so in those patients I recommend biopsy very early on,” Dr. Shwayder said in this video interview about his presentation entitled “Modern Evaluation of the Endometrium: When to Use Ultrasound, When to Biopsy,” as presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Conversely, in some cases when biopsy is typically considered the first-line step in evaluation, ultrasound may actually be better, he argued.
“[ACOG] recommends that women over 45 ... should have a biopsy done as their first-line evaluation. I kind of take issue with that a little bit,” said Dr. Shwayder, a professor at the University of Mississippi Medical Center, Jackson, and president and chief executive officer of Shwayder Consulting in Venice, Fla.
Data suggest that a “blind biopsy” could miss up to 18% of cases involving either a submucous myoma or a polyp and that one-third to one-fourth of patients have a structural defect such as a polyp or fibroid that can’t be diagnosed with a biopsy, he explained, noting that sonohysterography is best for preoperative evaluation in such case.
Ultrasound also has utility for evaluating other abnormalities, and it can be a very simple way to evaluate the patient and decide whether they need further evaluation or further treatment, he said.
Dr. Shwayder also discussed evidence for making a choice between biopsy and ultrasound for initial evaluation in postmenopausal women and for assessing women with asymptomatic thickened endometrium.
Dr. Shwayder is a consultant for GE Ultrasound.
NASHVILLE, TENN. – Biopsy isn’t usually the first step in evaluating the endometrium of a reproductive-age woman who presents with abnormal uterine bleeding, but that’s not always the case, according to James M. Shwayder, MD.
“If we have young women come in, generally speaking, we don’t think much about doing biopsies, but there are those patients who really require a biopsy very early on: If they are obese and if they have long histories of oligomenorrhea ... they are at significantly greater risk for either endometrial hyperplasia or cancer, so in those patients I recommend biopsy very early on,” Dr. Shwayder said in this video interview about his presentation entitled “Modern Evaluation of the Endometrium: When to Use Ultrasound, When to Biopsy,” as presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Conversely, in some cases when biopsy is typically considered the first-line step in evaluation, ultrasound may actually be better, he argued.
“[ACOG] recommends that women over 45 ... should have a biopsy done as their first-line evaluation. I kind of take issue with that a little bit,” said Dr. Shwayder, a professor at the University of Mississippi Medical Center, Jackson, and president and chief executive officer of Shwayder Consulting in Venice, Fla.
Data suggest that a “blind biopsy” could miss up to 18% of cases involving either a submucous myoma or a polyp and that one-third to one-fourth of patients have a structural defect such as a polyp or fibroid that can’t be diagnosed with a biopsy, he explained, noting that sonohysterography is best for preoperative evaluation in such case.
Ultrasound also has utility for evaluating other abnormalities, and it can be a very simple way to evaluate the patient and decide whether they need further evaluation or further treatment, he said.
Dr. Shwayder also discussed evidence for making a choice between biopsy and ultrasound for initial evaluation in postmenopausal women and for assessing women with asymptomatic thickened endometrium.
Dr. Shwayder is a consultant for GE Ultrasound.
NASHVILLE, TENN. – Biopsy isn’t usually the first step in evaluating the endometrium of a reproductive-age woman who presents with abnormal uterine bleeding, but that’s not always the case, according to James M. Shwayder, MD.
“If we have young women come in, generally speaking, we don’t think much about doing biopsies, but there are those patients who really require a biopsy very early on: If they are obese and if they have long histories of oligomenorrhea ... they are at significantly greater risk for either endometrial hyperplasia or cancer, so in those patients I recommend biopsy very early on,” Dr. Shwayder said in this video interview about his presentation entitled “Modern Evaluation of the Endometrium: When to Use Ultrasound, When to Biopsy,” as presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Conversely, in some cases when biopsy is typically considered the first-line step in evaluation, ultrasound may actually be better, he argued.
“[ACOG] recommends that women over 45 ... should have a biopsy done as their first-line evaluation. I kind of take issue with that a little bit,” said Dr. Shwayder, a professor at the University of Mississippi Medical Center, Jackson, and president and chief executive officer of Shwayder Consulting in Venice, Fla.
Data suggest that a “blind biopsy” could miss up to 18% of cases involving either a submucous myoma or a polyp and that one-third to one-fourth of patients have a structural defect such as a polyp or fibroid that can’t be diagnosed with a biopsy, he explained, noting that sonohysterography is best for preoperative evaluation in such case.
Ultrasound also has utility for evaluating other abnormalities, and it can be a very simple way to evaluate the patient and decide whether they need further evaluation or further treatment, he said.
Dr. Shwayder also discussed evidence for making a choice between biopsy and ultrasound for initial evaluation in postmenopausal women and for assessing women with asymptomatic thickened endometrium.
Dr. Shwayder is a consultant for GE Ultrasound.
EXPERT ANALYSIS FROM ACOG 2019
Immediate postpartum LARC: ‘Agony and ecstasy’
NASHVILLE, TENN. – according to Eve Espey, MD.
“I think [the rate] is going to settle out at around 15%-20%, but good cost-effectiveness studies show that, even if it were that high, it is still highly cost effective,” she said during an update on contraceptives at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Immediate postpartum long-acting reversible contraception (LARC), including an IUD or implant, may reduce rapid-repeat pregnancy, she added, noting, however, that while Medicaid is covering it in many states, “it turns out that payment models are very cumbersome; they actually don’t work very well.”
At the University of New Mexico (UNM) in Albuquerque, where Dr .Espey is a professor and chair of the department of obstetrics and gynecology and director of the family planning fellowship, immediate postpartum LARC is offered to women with Medicaid coverage, and payment is received in about 97% of cases.
It took about 4 years of persistent effort to make that happen, she said, adding that the UNM Hospital still is the only one in the state offering the service, although efforts are underway to help other hospitals “troubleshoot the issues.”
Another challenge is the lack of private insurance coverage for immediate postpartum LARC, she said.
“I was super enthusiastic about this a few years ago, and I remain super enthusiastic about it, but I think it’s going to take another 5 years or so [for better coverage], and honestly I think what we really need is an inpatient LARC CPT code to make this happen.”
In this video interview, Dr. Espey discusses the “agony and ecstasy” of immediate postpartum LARC, summarizing the main points regarding its benefits and challenges as presented during an “EdTalk” she gave at the meeting.
Dr. Espey reported having no relevant financial disclosures.
NASHVILLE, TENN. – according to Eve Espey, MD.
“I think [the rate] is going to settle out at around 15%-20%, but good cost-effectiveness studies show that, even if it were that high, it is still highly cost effective,” she said during an update on contraceptives at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Immediate postpartum long-acting reversible contraception (LARC), including an IUD or implant, may reduce rapid-repeat pregnancy, she added, noting, however, that while Medicaid is covering it in many states, “it turns out that payment models are very cumbersome; they actually don’t work very well.”
At the University of New Mexico (UNM) in Albuquerque, where Dr .Espey is a professor and chair of the department of obstetrics and gynecology and director of the family planning fellowship, immediate postpartum LARC is offered to women with Medicaid coverage, and payment is received in about 97% of cases.
It took about 4 years of persistent effort to make that happen, she said, adding that the UNM Hospital still is the only one in the state offering the service, although efforts are underway to help other hospitals “troubleshoot the issues.”
Another challenge is the lack of private insurance coverage for immediate postpartum LARC, she said.
“I was super enthusiastic about this a few years ago, and I remain super enthusiastic about it, but I think it’s going to take another 5 years or so [for better coverage], and honestly I think what we really need is an inpatient LARC CPT code to make this happen.”
In this video interview, Dr. Espey discusses the “agony and ecstasy” of immediate postpartum LARC, summarizing the main points regarding its benefits and challenges as presented during an “EdTalk” she gave at the meeting.
Dr. Espey reported having no relevant financial disclosures.
NASHVILLE, TENN. – according to Eve Espey, MD.
“I think [the rate] is going to settle out at around 15%-20%, but good cost-effectiveness studies show that, even if it were that high, it is still highly cost effective,” she said during an update on contraceptives at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Immediate postpartum long-acting reversible contraception (LARC), including an IUD or implant, may reduce rapid-repeat pregnancy, she added, noting, however, that while Medicaid is covering it in many states, “it turns out that payment models are very cumbersome; they actually don’t work very well.”
At the University of New Mexico (UNM) in Albuquerque, where Dr .Espey is a professor and chair of the department of obstetrics and gynecology and director of the family planning fellowship, immediate postpartum LARC is offered to women with Medicaid coverage, and payment is received in about 97% of cases.
It took about 4 years of persistent effort to make that happen, she said, adding that the UNM Hospital still is the only one in the state offering the service, although efforts are underway to help other hospitals “troubleshoot the issues.”
Another challenge is the lack of private insurance coverage for immediate postpartum LARC, she said.
“I was super enthusiastic about this a few years ago, and I remain super enthusiastic about it, but I think it’s going to take another 5 years or so [for better coverage], and honestly I think what we really need is an inpatient LARC CPT code to make this happen.”
In this video interview, Dr. Espey discusses the “agony and ecstasy” of immediate postpartum LARC, summarizing the main points regarding its benefits and challenges as presented during an “EdTalk” she gave at the meeting.
Dr. Espey reported having no relevant financial disclosures.
EXPERT ANALYSIS FROM ACOG 2019
