Heidi Splete

The fluid, evolving nature of perioperative medicine lends itself to a lively literature review and research update, according to Steven L. Cohn, MD, SFHM, a presenter of “ ‘A Whole New World’ of Perioperative Medicine: The 2018 Update” on Monday, April 9, at HM18.

The perioperative medicine update has been a fixture at the SHM annual conference for several years and provides an opportunity to highlight articles that may affect practice, said Dr. Cohn of the University of Miami in an interview. “Our goals are to familiarize the attendees with this new data so they are aware, so they can review the key articles in detail on their own, and so they can then apply the new information in their clinical practices,” he said.

The agenda for the session involves a presentation of 10-15 articles published since HM17. Dr. Cohn and presenter Paul J. Grant, MD, SFHM, the director of the consultative and perioperative medicine program and an associate chief medical information officer at Michigan Medicine, Ann Arbor, will briefly review the objectives and methods of each study before moving on to focus primarily on the result and conclusions.

“The top take-home message is to try to keep up with the perioperative literature, particularly in cardiology, because the evidence base keeps expanding and changing,” said Dr. Cohn. “This session is designed to deliver new information and also to stimulate the attendees to periodically review the literature on their own during the year,” he said.

This year’s collection of articles will address a range of topics, Dr. Cohn said, but he highlighted several articles “that will be thought provoking and potentially impact clinical practice regarding perioperative surveillance with the new fifth generation high sensitivity troponin assay and management of myocardial injury after noncardiac surgery. In particular, results from the MANAGE trial that was presented as a late-breaking trial at the American College of Cardiology meeting in March will be of interest to anyone involved in perioperative medicine,” he noted.

Dr. Cohn and Dr. Grant had no relevant financial conflicts to disclose.

“A Whole New World” of Perioperative Medicine: The 2018 Update
Monday, April 9, 2:00-2:40 p.m.
Crystal Ballroom G2/C-F

The fluid, evolving nature of perioperative medicine lends itself to a lively literature review and research update, according to Steven L. Cohn, MD, SFHM, a presenter of “ ‘A Whole New World’ of Perioperative Medicine: The 2018 Update” on Monday, April 9, at HM18.

The perioperative medicine update has been a fixture at the SHM annual conference for several years and provides an opportunity to highlight articles that may affect practice, said Dr. Cohn of the University of Miami in an interview. “Our goals are to familiarize the attendees with this new data so they are aware, so they can review the key articles in detail on their own, and so they can then apply the new information in their clinical practices,” he said.

The agenda for the session involves a presentation of 10-15 articles published since HM17. Dr. Cohn and presenter Paul J. Grant, MD, SFHM, the director of the consultative and perioperative medicine program and an associate chief medical information officer at Michigan Medicine, Ann Arbor, will briefly review the objectives and methods of each study before moving on to focus primarily on the result and conclusions.

“The top take-home message is to try to keep up with the perioperative literature, particularly in cardiology, because the evidence base keeps expanding and changing,” said Dr. Cohn. “This session is designed to deliver new information and also to stimulate the attendees to periodically review the literature on their own during the year,” he said.

This year’s collection of articles will address a range of topics, Dr. Cohn said, but he highlighted several articles “that will be thought provoking and potentially impact clinical practice regarding perioperative surveillance with the new fifth generation high sensitivity troponin assay and management of myocardial injury after noncardiac surgery. In particular, results from the MANAGE trial that was presented as a late-breaking trial at the American College of Cardiology meeting in March will be of interest to anyone involved in perioperative medicine,” he noted.

Dr. Cohn and Dr. Grant had no relevant financial conflicts to disclose.

“A Whole New World” of Perioperative Medicine: The 2018 Update
Monday, April 9, 2:00-2:40 p.m.
Crystal Ballroom G2/C-F

The fluid, evolving nature of perioperative medicine lends itself to a lively literature review and research update, according to Steven L. Cohn, MD, SFHM, a presenter of “ ‘A Whole New World’ of Perioperative Medicine: The 2018 Update” on Monday, April 9, at HM18.

The perioperative medicine update has been a fixture at the SHM annual conference for several years and provides an opportunity to highlight articles that may affect practice, said Dr. Cohn of the University of Miami in an interview. “Our goals are to familiarize the attendees with this new data so they are aware, so they can review the key articles in detail on their own, and so they can then apply the new information in their clinical practices,” he said.

The agenda for the session involves a presentation of 10-15 articles published since HM17. Dr. Cohn and presenter Paul J. Grant, MD, SFHM, the director of the consultative and perioperative medicine program and an associate chief medical information officer at Michigan Medicine, Ann Arbor, will briefly review the objectives and methods of each study before moving on to focus primarily on the result and conclusions.

“The top take-home message is to try to keep up with the perioperative literature, particularly in cardiology, because the evidence base keeps expanding and changing,” said Dr. Cohn. “This session is designed to deliver new information and also to stimulate the attendees to periodically review the literature on their own during the year,” he said.

This year’s collection of articles will address a range of topics, Dr. Cohn said, but he highlighted several articles “that will be thought provoking and potentially impact clinical practice regarding perioperative surveillance with the new fifth generation high sensitivity troponin assay and management of myocardial injury after noncardiac surgery. In particular, results from the MANAGE trial that was presented as a late-breaking trial at the American College of Cardiology meeting in March will be of interest to anyone involved in perioperative medicine,” he noted.

Dr. Cohn and Dr. Grant had no relevant financial conflicts to disclose.

“A Whole New World” of Perioperative Medicine: The 2018 Update
Monday, April 9, 2:00-2:40 p.m.
Crystal Ballroom G2/C-F

Chris Harrington knows that not all the benefits of attending the Society of Hospital Medicine’s annual meetings come from the lectures and courses; there is the formation of friendships that endure.

“I am very grateful to SHM for allowing me the opportunity to accompany Bob to their annual conferences and leadership academies over the years,” said Mrs. Harrington, spouse of former SHM president Robert Harrington Jr., MD, SFHM in an interview.

“It truly has been a rewarding experience for me both as a spouse to travel with my husband and spend time with our friends, and as a health care professional to witness the tremendous growth of SHM membership and the educational and networking opportunities it provides to its members. Watching SHM become even more innovative in universally improving patient care has been an amazing experience as well.

Chris Harrington knows that not all the benefits of attending the Society of Hospital Medicine’s annual meetings come from the lectures and courses; there is the formation of friendships that endure.

“I am very grateful to SHM for allowing me the opportunity to accompany Bob to their annual conferences and leadership academies over the years,” said Mrs. Harrington, spouse of former SHM president Robert Harrington Jr., MD, SFHM in an interview.

“It truly has been a rewarding experience for me both as a spouse to travel with my husband and spend time with our friends, and as a health care professional to witness the tremendous growth of SHM membership and the educational and networking opportunities it provides to its members. Watching SHM become even more innovative in universally improving patient care has been an amazing experience as well.

Chris Harrington knows that not all the benefits of attending the Society of Hospital Medicine’s annual meetings come from the lectures and courses; there is the formation of friendships that endure.

“I am very grateful to SHM for allowing me the opportunity to accompany Bob to their annual conferences and leadership academies over the years,” said Mrs. Harrington, spouse of former SHM president Robert Harrington Jr., MD, SFHM in an interview.

“It truly has been a rewarding experience for me both as a spouse to travel with my husband and spend time with our friends, and as a health care professional to witness the tremendous growth of SHM membership and the educational and networking opportunities it provides to its members. Watching SHM become even more innovative in universally improving patient care has been an amazing experience as well.

ORLANDO – Hospitals in the first quartile of short-term performance in treating heart failure patients had higher long-term survival rates for those patients, based on data from 317 hospitals that participated in a voluntary quality improvement program.

The burden of heart failure remains substantial in the United States, and health policies are increasingly focused on improving care for heart failure patients, said Ambarish Pandey, MD, of the University of Texas, Dallas, in a presentation at the annual meeting of the American College of Cardiology.

Heidi Splete/Frontline Medical News

SOURCE: Pandy A. ACC 2018.

ORLANDO – Hospitals in the first quartile of short-term performance in treating heart failure patients had higher long-term survival rates for those patients, based on data from 317 hospitals that participated in a voluntary quality improvement program.

The burden of heart failure remains substantial in the United States, and health policies are increasingly focused on improving care for heart failure patients, said Ambarish Pandey, MD, of the University of Texas, Dallas, in a presentation at the annual meeting of the American College of Cardiology.

Heidi Splete/Frontline Medical News

SOURCE: Pandy A. ACC 2018.

ORLANDO – Hospitals in the first quartile of short-term performance in treating heart failure patients had higher long-term survival rates for those patients, based on data from 317 hospitals that participated in a voluntary quality improvement program.

The burden of heart failure remains substantial in the United States, and health policies are increasingly focused on improving care for heart failure patients, said Ambarish Pandey, MD, of the University of Texas, Dallas, in a presentation at the annual meeting of the American College of Cardiology.

Heidi Splete/Frontline Medical News

SOURCE: Pandy A. ACC 2018.

ORLANDO – Closing a patent foramen ovale reduced the incidence of stroke and other adverse events in patients at increased risk the DEFENSE-PRO trial.

“The potential association between patent foramen ovale [PFO] and cryptogenic stroke has been a controversial issue for decades,” Jae Kwan Song, MD, of Asan Medical Center in Seoul, South Korea, said in an interview at the annual meeting of the American College of Cardiology.

In this study, 60 patients with high-risk PFOs (at least 2 mm) were randomized to receive anticoagulant or antiplatelet medications alone, and 60 were randomized to medication plus implantation of the Amplatzer PFO closure device.

The device implantation was successful for all patients in the device group. The primary endpoint was a combination of stroke, vascular death, and major bleeding within 2 years of follow-up after the procedure.

After an average follow-up of 2.8 years, none of the patients in the device group and six (10%) of patients in the medication-only group experienced a primary endpoint event. The events in the medication-only group included five cases of ischemic stroke, two cases of TIMI-defined major bleeding, one cerebral hemorrhage, and one transient ischemic attack.

Nonfatal procedural complications included two cases of atrial fibrillation, one case of pericardial effusion, and one pseudoaneurysm.

The average age of the patients was 54 years in the medication-only group and 49 years in the device group, and roughly one-third of the patients in each group were male. The baseline clinical characteristics, including the presence of hypertension, diabetes, smoking, and high cholesterol, were similar between the groups.

“We should consider two things before clinical decision of device closure,” Dr. Song said. First, exclude other causes of cryptogenic stroke; and second, conduct a comprehensive evaluation of the PFO to determine which patients are at highest risk and would be most likely to benefit from the procedure, he said.

To better determine which patients would benefit from the device implantation, Dr. Song and his colleagues used imaging to review data on the size and features of the PFO; patients with evidence of an atrial septal aneurysm or hypermobility (defined as a septal excursion 10 mm or larger) were deemed at especially high risk.

Dr. Song said that the next steps for research on management of PFOs include determining which medications are most effective in patients treated with medication alone, as well as clarifying the process of patient selection for device use based on PFO morphology.

The study was terminated early because of several factors, including low patient recruitment and the decision not to deny patients the closure treatment because of its demonstrated effectiveness, Dr. Song noted.

The study was supported by the Cardiovascular Research Foundation in Seoul, South Korea. Dr. Song had no financial conflicts to disclose. The findings were published simultaneously in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2018.02.046).

SOURCE: Song J. ACC 2018.

ORLANDO – Closing a patent foramen ovale reduced the incidence of stroke and other adverse events in patients at increased risk the DEFENSE-PRO trial.

“The potential association between patent foramen ovale [PFO] and cryptogenic stroke has been a controversial issue for decades,” Jae Kwan Song, MD, of Asan Medical Center in Seoul, South Korea, said in an interview at the annual meeting of the American College of Cardiology.

In this study, 60 patients with high-risk PFOs (at least 2 mm) were randomized to receive anticoagulant or antiplatelet medications alone, and 60 were randomized to medication plus implantation of the Amplatzer PFO closure device.

The device implantation was successful for all patients in the device group. The primary endpoint was a combination of stroke, vascular death, and major bleeding within 2 years of follow-up after the procedure.

After an average follow-up of 2.8 years, none of the patients in the device group and six (10%) of patients in the medication-only group experienced a primary endpoint event. The events in the medication-only group included five cases of ischemic stroke, two cases of TIMI-defined major bleeding, one cerebral hemorrhage, and one transient ischemic attack.

Nonfatal procedural complications included two cases of atrial fibrillation, one case of pericardial effusion, and one pseudoaneurysm.

The average age of the patients was 54 years in the medication-only group and 49 years in the device group, and roughly one-third of the patients in each group were male. The baseline clinical characteristics, including the presence of hypertension, diabetes, smoking, and high cholesterol, were similar between the groups.

“We should consider two things before clinical decision of device closure,” Dr. Song said. First, exclude other causes of cryptogenic stroke; and second, conduct a comprehensive evaluation of the PFO to determine which patients are at highest risk and would be most likely to benefit from the procedure, he said.

To better determine which patients would benefit from the device implantation, Dr. Song and his colleagues used imaging to review data on the size and features of the PFO; patients with evidence of an atrial septal aneurysm or hypermobility (defined as a septal excursion 10 mm or larger) were deemed at especially high risk.

Dr. Song said that the next steps for research on management of PFOs include determining which medications are most effective in patients treated with medication alone, as well as clarifying the process of patient selection for device use based on PFO morphology.

The study was terminated early because of several factors, including low patient recruitment and the decision not to deny patients the closure treatment because of its demonstrated effectiveness, Dr. Song noted.

The study was supported by the Cardiovascular Research Foundation in Seoul, South Korea. Dr. Song had no financial conflicts to disclose. The findings were published simultaneously in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2018.02.046).

SOURCE: Song J. ACC 2018.

ORLANDO – Closing a patent foramen ovale reduced the incidence of stroke and other adverse events in patients at increased risk the DEFENSE-PRO trial.

“The potential association between patent foramen ovale [PFO] and cryptogenic stroke has been a controversial issue for decades,” Jae Kwan Song, MD, of Asan Medical Center in Seoul, South Korea, said in an interview at the annual meeting of the American College of Cardiology.

In this study, 60 patients with high-risk PFOs (at least 2 mm) were randomized to receive anticoagulant or antiplatelet medications alone, and 60 were randomized to medication plus implantation of the Amplatzer PFO closure device.

The device implantation was successful for all patients in the device group. The primary endpoint was a combination of stroke, vascular death, and major bleeding within 2 years of follow-up after the procedure.

After an average follow-up of 2.8 years, none of the patients in the device group and six (10%) of patients in the medication-only group experienced a primary endpoint event. The events in the medication-only group included five cases of ischemic stroke, two cases of TIMI-defined major bleeding, one cerebral hemorrhage, and one transient ischemic attack.

Nonfatal procedural complications included two cases of atrial fibrillation, one case of pericardial effusion, and one pseudoaneurysm.

The average age of the patients was 54 years in the medication-only group and 49 years in the device group, and roughly one-third of the patients in each group were male. The baseline clinical characteristics, including the presence of hypertension, diabetes, smoking, and high cholesterol, were similar between the groups.

“We should consider two things before clinical decision of device closure,” Dr. Song said. First, exclude other causes of cryptogenic stroke; and second, conduct a comprehensive evaluation of the PFO to determine which patients are at highest risk and would be most likely to benefit from the procedure, he said.

To better determine which patients would benefit from the device implantation, Dr. Song and his colleagues used imaging to review data on the size and features of the PFO; patients with evidence of an atrial septal aneurysm or hypermobility (defined as a septal excursion 10 mm or larger) were deemed at especially high risk.

Dr. Song said that the next steps for research on management of PFOs include determining which medications are most effective in patients treated with medication alone, as well as clarifying the process of patient selection for device use based on PFO morphology.

The study was terminated early because of several factors, including low patient recruitment and the decision not to deny patients the closure treatment because of its demonstrated effectiveness, Dr. Song noted.

The study was supported by the Cardiovascular Research Foundation in Seoul, South Korea. Dr. Song had no financial conflicts to disclose. The findings were published simultaneously in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2018.02.046).

SOURCE: Song J. ACC 2018.

A Pap test combined with assays for gene mutations showed an 81% and 33% sensitivity or identifying endometrial and ovarian cancer, respectively.

In a study published in Science Translational Medicine, Yuxuan Wang, MD, of Johns Hopkins University, Baltimore, and her colleagues used a polymerase chain reaction–based test known as PapSEEK to examine Pap brush samples from 382 women with endometrial cancer, 245 women with ovarian cancer, and 714 women without cancer.

Overall, 81% of the endometrial cancer patients and 29% of the ovarian cancer patients had detectable mutations on Pap smears taken with a Pap brush. Among endometrial cancer patients, the genetic test identified mutations in 78% of patients with early-stage disease and 89% of those with late-stage disease. Among ovarian cancer patients, the genetic test identified 28% of patients with early-stage disease and 30% of those with late-stage disease.

The investigators also used the genetic test on Tao brush samples from the intrauterine cavity from a subset of 123 patients with endometrial cancer, 51 with ovarian cancer, and 125 controls and identified genetic mutations in 93% and 45% of endometrial and ovarian cancers, respectively.

The results demonstrate the potential of mutation-based diagnostic testing, and samples taken with the Tao brush may be especially helpful for ovarian cancers, especially in samples combining Pap and plasma sample data, the researchers said.

The study was limited by several factors including its retrospective design and having a study population confined to women with known cancers, the researchers noted. More research is needed, but results suggest the potential for DNA analysis to catch cancers early in a screening setting, they said. “Our study lays the foundation for evaluating PapSEEK in a large prospective study,” ideally including patients at high risk for gynecologic cancers, they added.

The study was funded by multiple sources including the Virginia and D.K. Ludwig Fund for Cancer Research, the National Institutes of Health, and the Stand Up to Cancer Colorectal Dream Team Translational Research Grant. Dr. Wang and several coauthors disclosed patent, equity, and royalty interest in technologies discussed in the paper. Four coauthors are cofounders of and stockholders in PapGene, which has licensed technologies related to the work described in the paper.

SOURCE: Wang Y et al. Sci Transl Med. 2018 Mar 21;10(433):eaap8793.

A Pap test combined with assays for gene mutations showed an 81% and 33% sensitivity or identifying endometrial and ovarian cancer, respectively.

In a study published in Science Translational Medicine, Yuxuan Wang, MD, of Johns Hopkins University, Baltimore, and her colleagues used a polymerase chain reaction–based test known as PapSEEK to examine Pap brush samples from 382 women with endometrial cancer, 245 women with ovarian cancer, and 714 women without cancer.

Overall, 81% of the endometrial cancer patients and 29% of the ovarian cancer patients had detectable mutations on Pap smears taken with a Pap brush. Among endometrial cancer patients, the genetic test identified mutations in 78% of patients with early-stage disease and 89% of those with late-stage disease. Among ovarian cancer patients, the genetic test identified 28% of patients with early-stage disease and 30% of those with late-stage disease.

The investigators also used the genetic test on Tao brush samples from the intrauterine cavity from a subset of 123 patients with endometrial cancer, 51 with ovarian cancer, and 125 controls and identified genetic mutations in 93% and 45% of endometrial and ovarian cancers, respectively.

The results demonstrate the potential of mutation-based diagnostic testing, and samples taken with the Tao brush may be especially helpful for ovarian cancers, especially in samples combining Pap and plasma sample data, the researchers said.

The study was limited by several factors including its retrospective design and having a study population confined to women with known cancers, the researchers noted. More research is needed, but results suggest the potential for DNA analysis to catch cancers early in a screening setting, they said. “Our study lays the foundation for evaluating PapSEEK in a large prospective study,” ideally including patients at high risk for gynecologic cancers, they added.

The study was funded by multiple sources including the Virginia and D.K. Ludwig Fund for Cancer Research, the National Institutes of Health, and the Stand Up to Cancer Colorectal Dream Team Translational Research Grant. Dr. Wang and several coauthors disclosed patent, equity, and royalty interest in technologies discussed in the paper. Four coauthors are cofounders of and stockholders in PapGene, which has licensed technologies related to the work described in the paper.

SOURCE: Wang Y et al. Sci Transl Med. 2018 Mar 21;10(433):eaap8793.

A Pap test combined with assays for gene mutations showed an 81% and 33% sensitivity or identifying endometrial and ovarian cancer, respectively.

In a study published in Science Translational Medicine, Yuxuan Wang, MD, of Johns Hopkins University, Baltimore, and her colleagues used a polymerase chain reaction–based test known as PapSEEK to examine Pap brush samples from 382 women with endometrial cancer, 245 women with ovarian cancer, and 714 women without cancer.

Overall, 81% of the endometrial cancer patients and 29% of the ovarian cancer patients had detectable mutations on Pap smears taken with a Pap brush. Among endometrial cancer patients, the genetic test identified mutations in 78% of patients with early-stage disease and 89% of those with late-stage disease. Among ovarian cancer patients, the genetic test identified 28% of patients with early-stage disease and 30% of those with late-stage disease.

The investigators also used the genetic test on Tao brush samples from the intrauterine cavity from a subset of 123 patients with endometrial cancer, 51 with ovarian cancer, and 125 controls and identified genetic mutations in 93% and 45% of endometrial and ovarian cancers, respectively.

The results demonstrate the potential of mutation-based diagnostic testing, and samples taken with the Tao brush may be especially helpful for ovarian cancers, especially in samples combining Pap and plasma sample data, the researchers said.

The study was limited by several factors including its retrospective design and having a study population confined to women with known cancers, the researchers noted. More research is needed, but results suggest the potential for DNA analysis to catch cancers early in a screening setting, they said. “Our study lays the foundation for evaluating PapSEEK in a large prospective study,” ideally including patients at high risk for gynecologic cancers, they added.

The study was funded by multiple sources including the Virginia and D.K. Ludwig Fund for Cancer Research, the National Institutes of Health, and the Stand Up to Cancer Colorectal Dream Team Translational Research Grant. Dr. Wang and several coauthors disclosed patent, equity, and royalty interest in technologies discussed in the paper. Four coauthors are cofounders of and stockholders in PapGene, which has licensed technologies related to the work described in the paper.

SOURCE: Wang Y et al. Sci Transl Med. 2018 Mar 21;10(433):eaap8793.

No age is too young to be educated about skin cancer prevention, according to recommendations from the U.S. Preventive Services Task Force (USPSTF). The recommendations, published online March 20 in JAMA, advise clinicians to counsel young adults, children, and parents of young children who are aged 6 months to 24 years and have fair skin types about skin cancer prevention. Counseling for individuals aged 24 years and older should be based on a clinician’s assessment of patient risk.

The recommendations target asymptomatic individuals with no history of skin cancer who might be likely to sunburn easily, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, the corresponding author of the USPSTF recommendation statement, and his associates.

The task force found adequate (grade B) evidence to support behavioral counseling for children and young adults aged 6 months to 24 years with no notable risk of harm from this intervention. The task force gave a grade C recommendation for routine skin cancer counseling for adults older than 24 years, citing a small net benefit. In addition, the USPSTF found insufficient evidence (I statement) to evaluate the risks versus benefits of counseling adults about skin self-examination as a way to reduce skin cancer risk.

In the evidence report, lead author Nora B. Henrikson, PhD, of Kaiser Permanente Washington Health Research Institute, Seattle, and her colleagues addressed five topics: the effects of skin cancer prevention counseling on short- and long-term outcomes, the effects of primary care counseling interventions on skin cancer prevention behavior, the association between skin self-examination and skin cancer outcomes, the potential harms of counseling interventions, and the potential harms of skin self-examinations.

SOURCE: Grossman DC et al. JAMA. 2018;319(11):1134-42.

No age is too young to be educated about skin cancer prevention, according to recommendations from the U.S. Preventive Services Task Force (USPSTF). The recommendations, published online March 20 in JAMA, advise clinicians to counsel young adults, children, and parents of young children who are aged 6 months to 24 years and have fair skin types about skin cancer prevention. Counseling for individuals aged 24 years and older should be based on a clinician’s assessment of patient risk.

The recommendations target asymptomatic individuals with no history of skin cancer who might be likely to sunburn easily, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, the corresponding author of the USPSTF recommendation statement, and his associates.

The task force found adequate (grade B) evidence to support behavioral counseling for children and young adults aged 6 months to 24 years with no notable risk of harm from this intervention. The task force gave a grade C recommendation for routine skin cancer counseling for adults older than 24 years, citing a small net benefit. In addition, the USPSTF found insufficient evidence (I statement) to evaluate the risks versus benefits of counseling adults about skin self-examination as a way to reduce skin cancer risk.

In the evidence report, lead author Nora B. Henrikson, PhD, of Kaiser Permanente Washington Health Research Institute, Seattle, and her colleagues addressed five topics: the effects of skin cancer prevention counseling on short- and long-term outcomes, the effects of primary care counseling interventions on skin cancer prevention behavior, the association between skin self-examination and skin cancer outcomes, the potential harms of counseling interventions, and the potential harms of skin self-examinations.

SOURCE: Grossman DC et al. JAMA. 2018;319(11):1134-42.

No age is too young to be educated about skin cancer prevention, according to recommendations from the U.S. Preventive Services Task Force (USPSTF). The recommendations, published online March 20 in JAMA, advise clinicians to counsel young adults, children, and parents of young children who are aged 6 months to 24 years and have fair skin types about skin cancer prevention. Counseling for individuals aged 24 years and older should be based on a clinician’s assessment of patient risk.

The recommendations target asymptomatic individuals with no history of skin cancer who might be likely to sunburn easily, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, the corresponding author of the USPSTF recommendation statement, and his associates.

The task force found adequate (grade B) evidence to support behavioral counseling for children and young adults aged 6 months to 24 years with no notable risk of harm from this intervention. The task force gave a grade C recommendation for routine skin cancer counseling for adults older than 24 years, citing a small net benefit. In addition, the USPSTF found insufficient evidence (I statement) to evaluate the risks versus benefits of counseling adults about skin self-examination as a way to reduce skin cancer risk.

In the evidence report, lead author Nora B. Henrikson, PhD, of Kaiser Permanente Washington Health Research Institute, Seattle, and her colleagues addressed five topics: the effects of skin cancer prevention counseling on short- and long-term outcomes, the effects of primary care counseling interventions on skin cancer prevention behavior, the association between skin self-examination and skin cancer outcomes, the potential harms of counseling interventions, and the potential harms of skin self-examinations.

SOURCE: Grossman DC et al. JAMA. 2018;319(11):1134-42.

ORLANDO – Cardiovascular outcomes were significantly more favorable with sodium glucose cotransporter-2 inhibitors compared with other glucose-lowering drugs, according to data from more than 400,000 type 2 diabetes patients in the Middle East, Asia Pacific, and North America.

Data on cardiovascular outcomes from diabetes treatments in patients outside the United States and Europe are limited, said Mikhail Kosiborod, MD, of Saint Luke’s Mid-America Heart Institute and University of Missouri–Kansas City.

In fact, most patients with type 2 diabetes reside in the Asia-Pacific and the Middle East, he said in a presentation at the annual meeting of the American College of Cardiology.

Dr. Kosiborod was involved in a previous large pharmaco-epidemiologic study known as the Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors (CVD-REAL), that showed SGLT2 inhibitor effects in a broad population of type 2 diabetes patients, but that study included only patients from Europe and North America, and focused on just two outcomes: all-cause mortality and hospitalization for heart failure.

[email protected]

SOURCE: Kosiborod M. ACC 2018.

ORLANDO – Cardiovascular outcomes were significantly more favorable with sodium glucose cotransporter-2 inhibitors compared with other glucose-lowering drugs, according to data from more than 400,000 type 2 diabetes patients in the Middle East, Asia Pacific, and North America.

Data on cardiovascular outcomes from diabetes treatments in patients outside the United States and Europe are limited, said Mikhail Kosiborod, MD, of Saint Luke’s Mid-America Heart Institute and University of Missouri–Kansas City.

In fact, most patients with type 2 diabetes reside in the Asia-Pacific and the Middle East, he said in a presentation at the annual meeting of the American College of Cardiology.

Dr. Kosiborod was involved in a previous large pharmaco-epidemiologic study known as the Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors (CVD-REAL), that showed SGLT2 inhibitor effects in a broad population of type 2 diabetes patients, but that study included only patients from Europe and North America, and focused on just two outcomes: all-cause mortality and hospitalization for heart failure.

[email protected]

SOURCE: Kosiborod M. ACC 2018.

ORLANDO – Cardiovascular outcomes were significantly more favorable with sodium glucose cotransporter-2 inhibitors compared with other glucose-lowering drugs, according to data from more than 400,000 type 2 diabetes patients in the Middle East, Asia Pacific, and North America.

Data on cardiovascular outcomes from diabetes treatments in patients outside the United States and Europe are limited, said Mikhail Kosiborod, MD, of Saint Luke’s Mid-America Heart Institute and University of Missouri–Kansas City.

In fact, most patients with type 2 diabetes reside in the Asia-Pacific and the Middle East, he said in a presentation at the annual meeting of the American College of Cardiology.

Dr. Kosiborod was involved in a previous large pharmaco-epidemiologic study known as the Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors (CVD-REAL), that showed SGLT2 inhibitor effects in a broad population of type 2 diabetes patients, but that study included only patients from Europe and North America, and focused on just two outcomes: all-cause mortality and hospitalization for heart failure.

[email protected]

SOURCE: Kosiborod M. ACC 2018.

Estrogen tablets and a popular vaginal gel failed to top placebo for relieving vulvovaginal symptoms in postmenopausal women, based on data from a randomized trial of more than 300 patients suffering from genitourinary syndrome of menopause (GSM), a constellation of symptoms including pain on vaginal penetration and vaginal dryness.

“Surveys of postmenopausal women demonstrate a preference for effective, nonhormonal therapies, often due to safety concerns,” wrote Caroline M. Mitchell, MD, of Massachusetts General Hospital, Boston, and her colleagues. The report was published in JAMA Internal Medicine. The researchers randomized 302 postmenopausal women with GSM 1:1:1 to a Vagifem 10-microgram estradiol tablet and placebo gel, a placebo tablet and Replens gel, or a placebo tablet and a placebo gel.

The average age of the women was 61 years, 88% were white, and 81% were sexually active.

The primary outcome was a decrease in the most bothersome symptoms reported by the women after 12 weeks of treatment. The most common of these were pain on penetration (60%) and vulvovaginal dryness (21%).

[email protected]

SOURCE: Mitchell C et al. JAMA Intern Med. 2018 Mar. doi: 10.1001/jamainternmed.2018.0116.

Estrogen tablets and a popular vaginal gel failed to top placebo for relieving vulvovaginal symptoms in postmenopausal women, based on data from a randomized trial of more than 300 patients suffering from genitourinary syndrome of menopause (GSM), a constellation of symptoms including pain on vaginal penetration and vaginal dryness.

“Surveys of postmenopausal women demonstrate a preference for effective, nonhormonal therapies, often due to safety concerns,” wrote Caroline M. Mitchell, MD, of Massachusetts General Hospital, Boston, and her colleagues. The report was published in JAMA Internal Medicine. The researchers randomized 302 postmenopausal women with GSM 1:1:1 to a Vagifem 10-microgram estradiol tablet and placebo gel, a placebo tablet and Replens gel, or a placebo tablet and a placebo gel.

The average age of the women was 61 years, 88% were white, and 81% were sexually active.

The primary outcome was a decrease in the most bothersome symptoms reported by the women after 12 weeks of treatment. The most common of these were pain on penetration (60%) and vulvovaginal dryness (21%).

[email protected]

SOURCE: Mitchell C et al. JAMA Intern Med. 2018 Mar. doi: 10.1001/jamainternmed.2018.0116.

Estrogen tablets and a popular vaginal gel failed to top placebo for relieving vulvovaginal symptoms in postmenopausal women, based on data from a randomized trial of more than 300 patients suffering from genitourinary syndrome of menopause (GSM), a constellation of symptoms including pain on vaginal penetration and vaginal dryness.

“Surveys of postmenopausal women demonstrate a preference for effective, nonhormonal therapies, often due to safety concerns,” wrote Caroline M. Mitchell, MD, of Massachusetts General Hospital, Boston, and her colleagues. The report was published in JAMA Internal Medicine. The researchers randomized 302 postmenopausal women with GSM 1:1:1 to a Vagifem 10-microgram estradiol tablet and placebo gel, a placebo tablet and Replens gel, or a placebo tablet and a placebo gel.

The average age of the women was 61 years, 88% were white, and 81% were sexually active.

The primary outcome was a decrease in the most bothersome symptoms reported by the women after 12 weeks of treatment. The most common of these were pain on penetration (60%) and vulvovaginal dryness (21%).

[email protected]

SOURCE: Mitchell C et al. JAMA Intern Med. 2018 Mar. doi: 10.1001/jamainternmed.2018.0116.

ORLANDO – Patients who received vouchers to cover copayments were more likely to receive prescriptions for more effective antiplatelet medication, according to data from a multicenter, randomized trial.

“We know that guidelines are very clear; we need to treat patients with antiplatelet therapy for 12 months,” and that the most potent drug, ticagrelor, should be used, Tracy Wang, MD, of Duke University, Durham, N.C., said in a video interview at the annual meeting of the American College of Cardiology. However, in the United States, clopidogrel, though less effective, is prescribed much more often, and many patients discontinue their P2Y₁₂ inhibitor therapy within the first year because of cost, she added.

“We hypothesized that, by reducing the out of pocket costs, treatment would be more evidence driven, rather than driven by what patients could afford,” she said.

The Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) included 11,001 MI patients at 301 hospitals across the United States. Patients in the treatment hospital group received a voucher to use at a pharmacy or through a mail-order pharmacy to reduce out of pocket costs. Randomization occurred at the hospital level, and hospital characteristics were similar between the groups.

Overall, patients in the treatment group were significantly more likely to receive a prescription for ticagrelor than clopidogrel (60% vs. 36%); 55% and 32% of patients in the usual care group were prescribed ticagrelor and clopidogrel, respectively. Nonpersistence, defined as a gap in P2Y₁₂-inhibitor use of at least 30 days within 1 year, was significantly lower in the treatment group than it was in the usual care group based on patient reported analysis (13% vs. 16%).

However, the incidence of major adverse cardiac events was roughly 10% in both groups. The similar outcomes may stem from the fact that 28% of patients with vouchers did not fill their prescriptions for reasons that the study did not explore, said Dr. Wang.

All patients had health insurance: 64% private, 42% Medicare, 9% Medicaid. The average age of the patients was 62 years, and 31% were women. Patient demographics and clinical characteristics were similar between the groups.

The vouchers affected choice of treatment but didn’t help clinical outcomes, which suggests that copayment reduction should be part of a broader strategy to help patients with adherence over time, said Dr. Wang.

Next steps for research include taking a subset of patients who are more likely to be nonadherent and at high risk for adverse events and targeting them for additional intervention, she noted.

Discussant Craig J. Beavers, PharmD, of the University of Kentucky College of Pharmacy, Lexington, agreed that a multipronged approach is needed to get patients to take their medicines. “We have to figure out what other barriers there are,” he said. “The real trick is, even if you lead a horse to water, how to get them to drink it,” he said.

The study was funded by AstraZeneca. Dr. Wang disclosed relationships with companies including Gilead Sciences, Merck, and Sanofi Pasteur. Dr. Beavers had no financial conflicts to disclose.

SOURCE: Wang T. ACC 18.

ORLANDO – Patients who received vouchers to cover copayments were more likely to receive prescriptions for more effective antiplatelet medication, according to data from a multicenter, randomized trial.

“We know that guidelines are very clear; we need to treat patients with antiplatelet therapy for 12 months,” and that the most potent drug, ticagrelor, should be used, Tracy Wang, MD, of Duke University, Durham, N.C., said in a video interview at the annual meeting of the American College of Cardiology. However, in the United States, clopidogrel, though less effective, is prescribed much more often, and many patients discontinue their P2Y₁₂ inhibitor therapy within the first year because of cost, she added.

“We hypothesized that, by reducing the out of pocket costs, treatment would be more evidence driven, rather than driven by what patients could afford,” she said.

The Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) included 11,001 MI patients at 301 hospitals across the United States. Patients in the treatment hospital group received a voucher to use at a pharmacy or through a mail-order pharmacy to reduce out of pocket costs. Randomization occurred at the hospital level, and hospital characteristics were similar between the groups.

Overall, patients in the treatment group were significantly more likely to receive a prescription for ticagrelor than clopidogrel (60% vs. 36%); 55% and 32% of patients in the usual care group were prescribed ticagrelor and clopidogrel, respectively. Nonpersistence, defined as a gap in P2Y₁₂-inhibitor use of at least 30 days within 1 year, was significantly lower in the treatment group than it was in the usual care group based on patient reported analysis (13% vs. 16%).

However, the incidence of major adverse cardiac events was roughly 10% in both groups. The similar outcomes may stem from the fact that 28% of patients with vouchers did not fill their prescriptions for reasons that the study did not explore, said Dr. Wang.

All patients had health insurance: 64% private, 42% Medicare, 9% Medicaid. The average age of the patients was 62 years, and 31% were women. Patient demographics and clinical characteristics were similar between the groups.

The vouchers affected choice of treatment but didn’t help clinical outcomes, which suggests that copayment reduction should be part of a broader strategy to help patients with adherence over time, said Dr. Wang.

Next steps for research include taking a subset of patients who are more likely to be nonadherent and at high risk for adverse events and targeting them for additional intervention, she noted.

Discussant Craig J. Beavers, PharmD, of the University of Kentucky College of Pharmacy, Lexington, agreed that a multipronged approach is needed to get patients to take their medicines. “We have to figure out what other barriers there are,” he said. “The real trick is, even if you lead a horse to water, how to get them to drink it,” he said.

The study was funded by AstraZeneca. Dr. Wang disclosed relationships with companies including Gilead Sciences, Merck, and Sanofi Pasteur. Dr. Beavers had no financial conflicts to disclose.

SOURCE: Wang T. ACC 18.

ORLANDO – Patients who received vouchers to cover copayments were more likely to receive prescriptions for more effective antiplatelet medication, according to data from a multicenter, randomized trial.

“We know that guidelines are very clear; we need to treat patients with antiplatelet therapy for 12 months,” and that the most potent drug, ticagrelor, should be used, Tracy Wang, MD, of Duke University, Durham, N.C., said in a video interview at the annual meeting of the American College of Cardiology. However, in the United States, clopidogrel, though less effective, is prescribed much more often, and many patients discontinue their P2Y₁₂ inhibitor therapy within the first year because of cost, she added.

“We hypothesized that, by reducing the out of pocket costs, treatment would be more evidence driven, rather than driven by what patients could afford,” she said.

The Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) included 11,001 MI patients at 301 hospitals across the United States. Patients in the treatment hospital group received a voucher to use at a pharmacy or through a mail-order pharmacy to reduce out of pocket costs. Randomization occurred at the hospital level, and hospital characteristics were similar between the groups.

Overall, patients in the treatment group were significantly more likely to receive a prescription for ticagrelor than clopidogrel (60% vs. 36%); 55% and 32% of patients in the usual care group were prescribed ticagrelor and clopidogrel, respectively. Nonpersistence, defined as a gap in P2Y₁₂-inhibitor use of at least 30 days within 1 year, was significantly lower in the treatment group than it was in the usual care group based on patient reported analysis (13% vs. 16%).

However, the incidence of major adverse cardiac events was roughly 10% in both groups. The similar outcomes may stem from the fact that 28% of patients with vouchers did not fill their prescriptions for reasons that the study did not explore, said Dr. Wang.

All patients had health insurance: 64% private, 42% Medicare, 9% Medicaid. The average age of the patients was 62 years, and 31% were women. Patient demographics and clinical characteristics were similar between the groups.

The vouchers affected choice of treatment but didn’t help clinical outcomes, which suggests that copayment reduction should be part of a broader strategy to help patients with adherence over time, said Dr. Wang.

Next steps for research include taking a subset of patients who are more likely to be nonadherent and at high risk for adverse events and targeting them for additional intervention, she noted.

Discussant Craig J. Beavers, PharmD, of the University of Kentucky College of Pharmacy, Lexington, agreed that a multipronged approach is needed to get patients to take their medicines. “We have to figure out what other barriers there are,” he said. “The real trick is, even if you lead a horse to water, how to get them to drink it,” he said.

The study was funded by AstraZeneca. Dr. Wang disclosed relationships with companies including Gilead Sciences, Merck, and Sanofi Pasteur. Dr. Beavers had no financial conflicts to disclose.

SOURCE: Wang T. ACC 18.

ORLANDO – Black men who received a pharmacist-led intervention in their local barbershops showed significantly improved blood pressure after 6 months, compared with controls, in a randomized trial of 319 individuals.

“Non-Hispanic black men still have the highest hypertension death rate of any group in the country. Something like 60% of black men have blood pressure of 140/90 or higher,” but they have relatively low rates of physician interaction for blood pressure management, compared with other groups, Ronald G. Victor, MD, of Cedars-Sinai Medical Center, Los Angeles, said in a video interview at the annual meeting of the American College of Cardiology.

“Health outreach to barbershops has been well established in the lay press, but they only scratch the surface in terms of a scientific evaluation, and that’s what we did,” he noted.

The primary outcome was a change in systolic blood pressure at 6 months. The average decrease was 27.0 mm Hg in the intervention group, compared with 9.3 mm Hg in the control group.

[email protected]

SOURCE: Victor R et al. ACC 2018.

ORLANDO – Black men who received a pharmacist-led intervention in their local barbershops showed significantly improved blood pressure after 6 months, compared with controls, in a randomized trial of 319 individuals.

“Non-Hispanic black men still have the highest hypertension death rate of any group in the country. Something like 60% of black men have blood pressure of 140/90 or higher,” but they have relatively low rates of physician interaction for blood pressure management, compared with other groups, Ronald G. Victor, MD, of Cedars-Sinai Medical Center, Los Angeles, said in a video interview at the annual meeting of the American College of Cardiology.

“Health outreach to barbershops has been well established in the lay press, but they only scratch the surface in terms of a scientific evaluation, and that’s what we did,” he noted.

The primary outcome was a change in systolic blood pressure at 6 months. The average decrease was 27.0 mm Hg in the intervention group, compared with 9.3 mm Hg in the control group.

[email protected]

SOURCE: Victor R et al. ACC 2018.

ORLANDO – Black men who received a pharmacist-led intervention in their local barbershops showed significantly improved blood pressure after 6 months, compared with controls, in a randomized trial of 319 individuals.

“Non-Hispanic black men still have the highest hypertension death rate of any group in the country. Something like 60% of black men have blood pressure of 140/90 or higher,” but they have relatively low rates of physician interaction for blood pressure management, compared with other groups, Ronald G. Victor, MD, of Cedars-Sinai Medical Center, Los Angeles, said in a video interview at the annual meeting of the American College of Cardiology.

“Health outreach to barbershops has been well established in the lay press, but they only scratch the surface in terms of a scientific evaluation, and that’s what we did,” he noted.

The primary outcome was a change in systolic blood pressure at 6 months. The average decrease was 27.0 mm Hg in the intervention group, compared with 9.3 mm Hg in the control group.

[email protected]

SOURCE: Victor R et al. ACC 2018.