Heidi Splete

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.

“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.

In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.

The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”

After 9 months, the social recovery group averaged 8 more hours of structured activity compared with the control group in an intent-to-treat analysis. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.

“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.

The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.

The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.

The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.

SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.

The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).

In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.

The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.

A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.

The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.

SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.

In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.

Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).

Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.

The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”

The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.

The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.

SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.

The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.

The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.

Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.

The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.

Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.

“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.

The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.

The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.

SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.

A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.

The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.

The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.

Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.

The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.

Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.

“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.

The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.

The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.

SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.

A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.

The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.

The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.

Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.

The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.

Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.

“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.

The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.

The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.

SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.

The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.

In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.

In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.

After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.

“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.

The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).

After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.

Similarly, no significant differences appeared between the two groups at 26 weeks. “A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.

On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).

“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.

The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”

Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.

[email protected]

SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.

The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.

In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.

In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.

After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.

“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.

The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).

After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.

Similarly, no significant differences appeared between the two groups at 26 weeks. “A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.

On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).

“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.

The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”

Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.

[email protected]

SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.

The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.

In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.

In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.

After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.

“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.

The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).

After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.

Similarly, no significant differences appeared between the two groups at 26 weeks. “A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.

On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).

“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.

The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”

Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.

[email protected]

SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.

Stay attentive to cardiovascular disease risk in patients with psoriasis because effective treatment of psoriasis could improve their vascular risk as well, said Jeffrey M. Sobell, MD, of Tufts University in Boston.

Shared risk factors between psoriasis and cardiovascular disease may put psoriasis patients at particular risk for a major cardiac event, he said at the Caribbean Dermatology Symposium.

The metabolic syndrome and its associated cardiovascular risk of myocardial infarction and stroke is significantly more prevalent in psoriasis patients, compared with controls, Dr. Sobell said at the meeting, provided by Global Academy for Medical Education.

ricky_68fr/fotolia

[email protected]

Stay attentive to cardiovascular disease risk in patients with psoriasis because effective treatment of psoriasis could improve their vascular risk as well, said Jeffrey M. Sobell, MD, of Tufts University in Boston.

Shared risk factors between psoriasis and cardiovascular disease may put psoriasis patients at particular risk for a major cardiac event, he said at the Caribbean Dermatology Symposium.

The metabolic syndrome and its associated cardiovascular risk of myocardial infarction and stroke is significantly more prevalent in psoriasis patients, compared with controls, Dr. Sobell said at the meeting, provided by Global Academy for Medical Education.

ricky_68fr/fotolia

[email protected]

Stay attentive to cardiovascular disease risk in patients with psoriasis because effective treatment of psoriasis could improve their vascular risk as well, said Jeffrey M. Sobell, MD, of Tufts University in Boston.

Shared risk factors between psoriasis and cardiovascular disease may put psoriasis patients at particular risk for a major cardiac event, he said at the Caribbean Dermatology Symposium.

The metabolic syndrome and its associated cardiovascular risk of myocardial infarction and stroke is significantly more prevalent in psoriasis patients, compared with controls, Dr. Sobell said at the meeting, provided by Global Academy for Medical Education.

ricky_68fr/fotolia

[email protected]

Nearly 10% of children with systemic lupus erythematosus (SLE) developed macrophage activation syndrome (MAS) at some point during a mean follow-up time of more than 3 years at one center, and most were concomitantly diagnosed with the syndrome.

Although the investigators from the University of Toronto reported significantly higher mortality among patients with MAS, most cases were successfully treated with corticosteroids, and no relapses were observed during follow-up.

MAS was first identified in patients with juvenile idiopathic arthritis and is most well known as a complication of that broadly named disease, but data on outcomes and disease course in SLE patients are limited, first author Roberto Ezequiel Borgia, MD, and his colleagues wrote in their report in Arthritis & Rheumatology.

The researchers identified 403 children with SLE seen at the Hospital for Sick Children in Toronto during 2002-2012. Overall, 38 patients (9%) had MAS; of those patients, 68% received a MAS diagnosis within 7 days of the SLE diagnosis – termed “concomitant” diagnosis – while another 29% received a MAS diagnosis within 180 days of their SLE diagnosis.

The researchers explained that “since there are no validated nor universally accepted diagnostic criteria for MAS in SLE, the definition of MAS was based on the treating pediatric rheumatologist’s expert opinion at the time of the initial presentation.” The most common presenting feature of MAS was fever (100%), followed by generalized lymphadenopathy (24%), hepatomegaly (18%), CNS dysfunction secondary to MAS (18%), hemorrhage (13%), and splenomegaly (10%).

The average age of the children at diagnosis was nearly 14 years, and 79% were female. The average follow-up was 3.5 years. There were no significant differences in the demographic features of children with and without MAS nor were there any in variables used to assess lupus outcomes, which included immunosuppressive drug use, average daily corticosteroid dose (18.3 mg/day with MAS vs. 18.6 mg/day without MAS), and the number of pediatric ICU visits (incidence rate ratio for MAS vs. non-MAS, 1.60 [95% CI, 0.74-3.18]).

Mortality was significantly higher in children with MAS, compared with those without MAS (5.3% vs. 0.3%; P = .02), although the overall number of deaths in the cohort was small (n = 3). Apart from the “acute illness which was associated with 2 deaths secondary to MAS,” the investigators said that they “did not find any significant differences in the number of deaths or damage accrual between the cohorts, including overall SLICC [Systemic Lupus International Collaborating Clinics] damage score or any specific damage feature within the score.”

The study findings were limited by several factors including the lack of validated MAS criteria for children with SLE and a lack of follow-up data on the patients beyond 18 years of age, the researchers said.

The results suggest that MAS remains a life-threatening complication in children with SLE and should be considered an important cause of mortality for them, but “if the initial presentation does not result in death, the long-term outcome seem[s] to be comparable to those without MAS,” the investigators wrote.

The researchers had no financial conflicts to disclose.

[email protected]

SOURCE: Borgia R et al. Arthritis Rheumatol. 2018 Jan 17. doi: 10.1002/art.40417

Nearly 10% of children with systemic lupus erythematosus (SLE) developed macrophage activation syndrome (MAS) at some point during a mean follow-up time of more than 3 years at one center, and most were concomitantly diagnosed with the syndrome.

Although the investigators from the University of Toronto reported significantly higher mortality among patients with MAS, most cases were successfully treated with corticosteroids, and no relapses were observed during follow-up.

MAS was first identified in patients with juvenile idiopathic arthritis and is most well known as a complication of that broadly named disease, but data on outcomes and disease course in SLE patients are limited, first author Roberto Ezequiel Borgia, MD, and his colleagues wrote in their report in Arthritis & Rheumatology.

The researchers identified 403 children with SLE seen at the Hospital for Sick Children in Toronto during 2002-2012. Overall, 38 patients (9%) had MAS; of those patients, 68% received a MAS diagnosis within 7 days of the SLE diagnosis – termed “concomitant” diagnosis – while another 29% received a MAS diagnosis within 180 days of their SLE diagnosis.

The researchers explained that “since there are no validated nor universally accepted diagnostic criteria for MAS in SLE, the definition of MAS was based on the treating pediatric rheumatologist’s expert opinion at the time of the initial presentation.” The most common presenting feature of MAS was fever (100%), followed by generalized lymphadenopathy (24%), hepatomegaly (18%), CNS dysfunction secondary to MAS (18%), hemorrhage (13%), and splenomegaly (10%).

The average age of the children at diagnosis was nearly 14 years, and 79% were female. The average follow-up was 3.5 years. There were no significant differences in the demographic features of children with and without MAS nor were there any in variables used to assess lupus outcomes, which included immunosuppressive drug use, average daily corticosteroid dose (18.3 mg/day with MAS vs. 18.6 mg/day without MAS), and the number of pediatric ICU visits (incidence rate ratio for MAS vs. non-MAS, 1.60 [95% CI, 0.74-3.18]).

Mortality was significantly higher in children with MAS, compared with those without MAS (5.3% vs. 0.3%; P = .02), although the overall number of deaths in the cohort was small (n = 3). Apart from the “acute illness which was associated with 2 deaths secondary to MAS,” the investigators said that they “did not find any significant differences in the number of deaths or damage accrual between the cohorts, including overall SLICC [Systemic Lupus International Collaborating Clinics] damage score or any specific damage feature within the score.”

The study findings were limited by several factors including the lack of validated MAS criteria for children with SLE and a lack of follow-up data on the patients beyond 18 years of age, the researchers said.

The results suggest that MAS remains a life-threatening complication in children with SLE and should be considered an important cause of mortality for them, but “if the initial presentation does not result in death, the long-term outcome seem[s] to be comparable to those without MAS,” the investigators wrote.

The researchers had no financial conflicts to disclose.

[email protected]

SOURCE: Borgia R et al. Arthritis Rheumatol. 2018 Jan 17. doi: 10.1002/art.40417

Nearly 10% of children with systemic lupus erythematosus (SLE) developed macrophage activation syndrome (MAS) at some point during a mean follow-up time of more than 3 years at one center, and most were concomitantly diagnosed with the syndrome.

Although the investigators from the University of Toronto reported significantly higher mortality among patients with MAS, most cases were successfully treated with corticosteroids, and no relapses were observed during follow-up.

MAS was first identified in patients with juvenile idiopathic arthritis and is most well known as a complication of that broadly named disease, but data on outcomes and disease course in SLE patients are limited, first author Roberto Ezequiel Borgia, MD, and his colleagues wrote in their report in Arthritis & Rheumatology.

The researchers identified 403 children with SLE seen at the Hospital for Sick Children in Toronto during 2002-2012. Overall, 38 patients (9%) had MAS; of those patients, 68% received a MAS diagnosis within 7 days of the SLE diagnosis – termed “concomitant” diagnosis – while another 29% received a MAS diagnosis within 180 days of their SLE diagnosis.

The researchers explained that “since there are no validated nor universally accepted diagnostic criteria for MAS in SLE, the definition of MAS was based on the treating pediatric rheumatologist’s expert opinion at the time of the initial presentation.” The most common presenting feature of MAS was fever (100%), followed by generalized lymphadenopathy (24%), hepatomegaly (18%), CNS dysfunction secondary to MAS (18%), hemorrhage (13%), and splenomegaly (10%).

The average age of the children at diagnosis was nearly 14 years, and 79% were female. The average follow-up was 3.5 years. There were no significant differences in the demographic features of children with and without MAS nor were there any in variables used to assess lupus outcomes, which included immunosuppressive drug use, average daily corticosteroid dose (18.3 mg/day with MAS vs. 18.6 mg/day without MAS), and the number of pediatric ICU visits (incidence rate ratio for MAS vs. non-MAS, 1.60 [95% CI, 0.74-3.18]).

Mortality was significantly higher in children with MAS, compared with those without MAS (5.3% vs. 0.3%; P = .02), although the overall number of deaths in the cohort was small (n = 3). Apart from the “acute illness which was associated with 2 deaths secondary to MAS,” the investigators said that they “did not find any significant differences in the number of deaths or damage accrual between the cohorts, including overall SLICC [Systemic Lupus International Collaborating Clinics] damage score or any specific damage feature within the score.”

The study findings were limited by several factors including the lack of validated MAS criteria for children with SLE and a lack of follow-up data on the patients beyond 18 years of age, the researchers said.

The results suggest that MAS remains a life-threatening complication in children with SLE and should be considered an important cause of mortality for them, but “if the initial presentation does not result in death, the long-term outcome seem[s] to be comparable to those without MAS,” the investigators wrote.

The researchers had no financial conflicts to disclose.

[email protected]

SOURCE: Borgia R et al. Arthritis Rheumatol. 2018 Jan 17. doi: 10.1002/art.40417

Despite the increased risk for invasive pneumococcal disease, prophylactic antibiotics are underused in children with sickle cell anemia, according to data from more than 2,000 children in six states.

Less than one-fifth (18%) of young children (aged 3 months to 5 years) with sickle cell anemia (SCA) receive at least 300 days of prophylactic antibiotics to reduce their risk of pneumococcal infections, the analysis found.

“Although the effectiveness of daily penicillin prophylaxis has been known for decades, limited evidence indicates low rates of compliance among children,” wrote Sarah L. Reeves, PhD, of the University of Michigan, Ann Arbor, and her colleagues. The report was published in Pediatrics.

The researchers reviewed Medicaid claims for 2,821 children with SCA from the period of 2005-2012 for a total of 5,014 person-years. The data were taken from six states: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Antibiotic prophylaxis was defined as four different treatment protocols: oral penicillin; oral penicillin or erythromycin; oral penicillin, erythromycin, or amoxicillin; or any antibiotic that could protect against Streptococcus pneumoniae.

Overall, the children in the study averaged 1.7 sickle cell disease–related inpatient hospitalizations annually, as well as 13.2 sickle cell disease–related outpatient visits and 3.8 emergency department visits per year.

The proportion of children who received 300 days or more of prophylactic antibiotics varied by state, by year, and by type of treatment. “In this multistate analysis, receipt of antibiotic prophylaxis among children with SCA was persistently low, irrespective of year or state,” the researchers noted.

The odds that a child received 300 days or more of prophylactic antibiotics increased with each outpatient visit, including well child visits and sickle cell disease–related visits (odds ratios 1.08 and 1.01, respectively).

A child in the third quartile of sickle cell disease–related outpatient visits (defined as 17 annual visits) was 15% more likely than was a child in the first quartile (defined as six annual visits) to receive at least 300 days of antibiotics.

The study findings were limited by several factors including potential overestimation of how many children received medication, the researchers said. However, the results suggest the need for practical and effective intervention that targets barriers to treatment adherence, they said.

“Provider-focused strategies to increase adherence could capitalize on the numerous annual outpatient encounters with the health care system that children with SCA are already experiencing,” they wrote.

The study was supported by a grant from the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services. The researchers reported having no financial disclosures.

SOURCE: Reeves S et al. Pediatrics. 2018;141(3):e20172182. doi: 10.1542/peds.2017-2182.

Despite the increased risk for invasive pneumococcal disease, prophylactic antibiotics are underused in children with sickle cell anemia, according to data from more than 2,000 children in six states.

Less than one-fifth (18%) of young children (aged 3 months to 5 years) with sickle cell anemia (SCA) receive at least 300 days of prophylactic antibiotics to reduce their risk of pneumococcal infections, the analysis found.

“Although the effectiveness of daily penicillin prophylaxis has been known for decades, limited evidence indicates low rates of compliance among children,” wrote Sarah L. Reeves, PhD, of the University of Michigan, Ann Arbor, and her colleagues. The report was published in Pediatrics.

The researchers reviewed Medicaid claims for 2,821 children with SCA from the period of 2005-2012 for a total of 5,014 person-years. The data were taken from six states: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Antibiotic prophylaxis was defined as four different treatment protocols: oral penicillin; oral penicillin or erythromycin; oral penicillin, erythromycin, or amoxicillin; or any antibiotic that could protect against Streptococcus pneumoniae.

Overall, the children in the study averaged 1.7 sickle cell disease–related inpatient hospitalizations annually, as well as 13.2 sickle cell disease–related outpatient visits and 3.8 emergency department visits per year.

The proportion of children who received 300 days or more of prophylactic antibiotics varied by state, by year, and by type of treatment. “In this multistate analysis, receipt of antibiotic prophylaxis among children with SCA was persistently low, irrespective of year or state,” the researchers noted.

The odds that a child received 300 days or more of prophylactic antibiotics increased with each outpatient visit, including well child visits and sickle cell disease–related visits (odds ratios 1.08 and 1.01, respectively).

A child in the third quartile of sickle cell disease–related outpatient visits (defined as 17 annual visits) was 15% more likely than was a child in the first quartile (defined as six annual visits) to receive at least 300 days of antibiotics.

The study findings were limited by several factors including potential overestimation of how many children received medication, the researchers said. However, the results suggest the need for practical and effective intervention that targets barriers to treatment adherence, they said.

“Provider-focused strategies to increase adherence could capitalize on the numerous annual outpatient encounters with the health care system that children with SCA are already experiencing,” they wrote.

The study was supported by a grant from the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services. The researchers reported having no financial disclosures.

SOURCE: Reeves S et al. Pediatrics. 2018;141(3):e20172182. doi: 10.1542/peds.2017-2182.

Despite the increased risk for invasive pneumococcal disease, prophylactic antibiotics are underused in children with sickle cell anemia, according to data from more than 2,000 children in six states.

Less than one-fifth (18%) of young children (aged 3 months to 5 years) with sickle cell anemia (SCA) receive at least 300 days of prophylactic antibiotics to reduce their risk of pneumococcal infections, the analysis found.

“Although the effectiveness of daily penicillin prophylaxis has been known for decades, limited evidence indicates low rates of compliance among children,” wrote Sarah L. Reeves, PhD, of the University of Michigan, Ann Arbor, and her colleagues. The report was published in Pediatrics.

The researchers reviewed Medicaid claims for 2,821 children with SCA from the period of 2005-2012 for a total of 5,014 person-years. The data were taken from six states: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Antibiotic prophylaxis was defined as four different treatment protocols: oral penicillin; oral penicillin or erythromycin; oral penicillin, erythromycin, or amoxicillin; or any antibiotic that could protect against Streptococcus pneumoniae.

Overall, the children in the study averaged 1.7 sickle cell disease–related inpatient hospitalizations annually, as well as 13.2 sickle cell disease–related outpatient visits and 3.8 emergency department visits per year.

The proportion of children who received 300 days or more of prophylactic antibiotics varied by state, by year, and by type of treatment. “In this multistate analysis, receipt of antibiotic prophylaxis among children with SCA was persistently low, irrespective of year or state,” the researchers noted.

The odds that a child received 300 days or more of prophylactic antibiotics increased with each outpatient visit, including well child visits and sickle cell disease–related visits (odds ratios 1.08 and 1.01, respectively).

A child in the third quartile of sickle cell disease–related outpatient visits (defined as 17 annual visits) was 15% more likely than was a child in the first quartile (defined as six annual visits) to receive at least 300 days of antibiotics.

The study findings were limited by several factors including potential overestimation of how many children received medication, the researchers said. However, the results suggest the need for practical and effective intervention that targets barriers to treatment adherence, they said.

“Provider-focused strategies to increase adherence could capitalize on the numerous annual outpatient encounters with the health care system that children with SCA are already experiencing,” they wrote.

The study was supported by a grant from the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services. The researchers reported having no financial disclosures.

SOURCE: Reeves S et al. Pediatrics. 2018;141(3):e20172182. doi: 10.1542/peds.2017-2182.

The number of colorectal cancers diagnosed after a colonoscopy remained consistent at approximately 8% over a 15-year period despite the introduction of quality improvement measures, according to data from a population-based cohort study of more than 1 million individuals in Canada.

“It is believed that the majority of PCCRCs [postcolonoscopy colorectal cancers] arise due to cancers or near cancers that were either missed or incompletely treated during colonoscopy,” wrote Sanjay K. Murthy, MD, of the University of Ottawa, and colleagues.

Established quality improvement measures included adenoma detection rate, cecal intubation rate, colonoscopy withdrawal time, and endoscopy training standards, but how well the measures have been implemented remains uncertain, the researchers said. In a study published in Gastrointestinal Endoscopy (2018 Jan 6. doi: 10.1016/j.gie.2017.12.027), the researchers assessed data from 1,093,658 eligible adults aged 50-74 years over a 15-year period. The time period was divided into three sections: July 1, 1996, to June 30, 2001; July 1, 2001, to June 30, 2006; and July 1, 2006, to Dec. 31, 2010.

Overall, the number of colonoscopy procedures increased during the study period, from 305 per 10,000 people in 1996-1997 to 870 per 10,000 people in 2010-2011, and the percentage of individuals who underwent complete colonoscopies increased from 67% in the 1996-2001 period to 88% in the 2006-2010 period. “There was a considerable increase in the proportion of colonoscopies performed in younger age groups and community clinics in successive study periods,” the researchers noted.

Comparing the 2006-2010 and 1996-2001 time periods yielded adjusted odds of PCCRC, distal PCCRC, and proximal PCCRC of 1.14, 1.11, and 1.14, respectively; the trends were not affected by endoscopist specialty or institutional setting.

“Our findings are concerning for lack of improvement in colonoscopy practice quality in Ontario, particularly in the wake of greater emphasis having been placed on colonoscopy quality metrics during the study period,” the researchers said. The findings contrast with the decline in PCCRC rates in the United Kingdom reported in a previous study of a similar time period, they noted.

The study findings were limited by several factors, including possible patient and outcome misclassification, an unvalidated definition for PCCRC, and unmeasured confounders such as changes in practice or changes in the definition of PCCRC. Although more research is needed in other jurisdictions to confirm, the results “call for increased population-based practice audit as well as endoscopy educational programs and certification requirements.”

The study was supported by a research grant to Dr. Murthy from the University of Ottawa. The researchers had no financial conflicts to disclose.

SOURCE: Murthy S et al. Gastrointest Endosc. 2018 Jan 6. doi: 10.1016/j.gie.2017.12.027

The number of colorectal cancers diagnosed after a colonoscopy remained consistent at approximately 8% over a 15-year period despite the introduction of quality improvement measures, according to data from a population-based cohort study of more than 1 million individuals in Canada.

“It is believed that the majority of PCCRCs [postcolonoscopy colorectal cancers] arise due to cancers or near cancers that were either missed or incompletely treated during colonoscopy,” wrote Sanjay K. Murthy, MD, of the University of Ottawa, and colleagues.

Established quality improvement measures included adenoma detection rate, cecal intubation rate, colonoscopy withdrawal time, and endoscopy training standards, but how well the measures have been implemented remains uncertain, the researchers said. In a study published in Gastrointestinal Endoscopy (2018 Jan 6. doi: 10.1016/j.gie.2017.12.027), the researchers assessed data from 1,093,658 eligible adults aged 50-74 years over a 15-year period. The time period was divided into three sections: July 1, 1996, to June 30, 2001; July 1, 2001, to June 30, 2006; and July 1, 2006, to Dec. 31, 2010.

Overall, the number of colonoscopy procedures increased during the study period, from 305 per 10,000 people in 1996-1997 to 870 per 10,000 people in 2010-2011, and the percentage of individuals who underwent complete colonoscopies increased from 67% in the 1996-2001 period to 88% in the 2006-2010 period. “There was a considerable increase in the proportion of colonoscopies performed in younger age groups and community clinics in successive study periods,” the researchers noted.

Comparing the 2006-2010 and 1996-2001 time periods yielded adjusted odds of PCCRC, distal PCCRC, and proximal PCCRC of 1.14, 1.11, and 1.14, respectively; the trends were not affected by endoscopist specialty or institutional setting.

“Our findings are concerning for lack of improvement in colonoscopy practice quality in Ontario, particularly in the wake of greater emphasis having been placed on colonoscopy quality metrics during the study period,” the researchers said. The findings contrast with the decline in PCCRC rates in the United Kingdom reported in a previous study of a similar time period, they noted.

The study findings were limited by several factors, including possible patient and outcome misclassification, an unvalidated definition for PCCRC, and unmeasured confounders such as changes in practice or changes in the definition of PCCRC. Although more research is needed in other jurisdictions to confirm, the results “call for increased population-based practice audit as well as endoscopy educational programs and certification requirements.”

The study was supported by a research grant to Dr. Murthy from the University of Ottawa. The researchers had no financial conflicts to disclose.

SOURCE: Murthy S et al. Gastrointest Endosc. 2018 Jan 6. doi: 10.1016/j.gie.2017.12.027

The number of colorectal cancers diagnosed after a colonoscopy remained consistent at approximately 8% over a 15-year period despite the introduction of quality improvement measures, according to data from a population-based cohort study of more than 1 million individuals in Canada.

“It is believed that the majority of PCCRCs [postcolonoscopy colorectal cancers] arise due to cancers or near cancers that were either missed or incompletely treated during colonoscopy,” wrote Sanjay K. Murthy, MD, of the University of Ottawa, and colleagues.

Established quality improvement measures included adenoma detection rate, cecal intubation rate, colonoscopy withdrawal time, and endoscopy training standards, but how well the measures have been implemented remains uncertain, the researchers said. In a study published in Gastrointestinal Endoscopy (2018 Jan 6. doi: 10.1016/j.gie.2017.12.027), the researchers assessed data from 1,093,658 eligible adults aged 50-74 years over a 15-year period. The time period was divided into three sections: July 1, 1996, to June 30, 2001; July 1, 2001, to June 30, 2006; and July 1, 2006, to Dec. 31, 2010.

Overall, the number of colonoscopy procedures increased during the study period, from 305 per 10,000 people in 1996-1997 to 870 per 10,000 people in 2010-2011, and the percentage of individuals who underwent complete colonoscopies increased from 67% in the 1996-2001 period to 88% in the 2006-2010 period. “There was a considerable increase in the proportion of colonoscopies performed in younger age groups and community clinics in successive study periods,” the researchers noted.

Comparing the 2006-2010 and 1996-2001 time periods yielded adjusted odds of PCCRC, distal PCCRC, and proximal PCCRC of 1.14, 1.11, and 1.14, respectively; the trends were not affected by endoscopist specialty or institutional setting.

“Our findings are concerning for lack of improvement in colonoscopy practice quality in Ontario, particularly in the wake of greater emphasis having been placed on colonoscopy quality metrics during the study period,” the researchers said. The findings contrast with the decline in PCCRC rates in the United Kingdom reported in a previous study of a similar time period, they noted.

The study findings were limited by several factors, including possible patient and outcome misclassification, an unvalidated definition for PCCRC, and unmeasured confounders such as changes in practice or changes in the definition of PCCRC. Although more research is needed in other jurisdictions to confirm, the results “call for increased population-based practice audit as well as endoscopy educational programs and certification requirements.”

The study was supported by a research grant to Dr. Murthy from the University of Ottawa. The researchers had no financial conflicts to disclose.

SOURCE: Murthy S et al. Gastrointest Endosc. 2018 Jan 6. doi: 10.1016/j.gie.2017.12.027