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Texting reminders improved pediatric asthma control
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
Evidence-Based Apps: Texting reminders improved pediatric asthma control
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
More ways to make the most of lasers in clinical practice
PHOENIX – What’s the latest in lasers? The most stubborn tattoos – those with blue or green ink – are now the easiest to remove with new laser technology and techniques. Microwave treatment for armpit hair is a real option, even on difficult-to-remove blond hair. Cutaneous laser expert Dr. Roy Geronemus, director of the Laser and Skin Surgery Center of New York, describes what dermatologists need to know about these and other innovative cosmetic treatments in an interview at the annual meeting of the American Society for Laser Medicine and Surgery.
But that’s not all. More data support the use of lasers for common medical conditions, says Dr. Geronemus. Hear his description of how the same new laser used for tattoo removal can be a noninvasive treatment to reduce either hypertrophic or atrophic scarring in any skin type, with practically no downtime. He also explains several new approaches that show promise as acne therapy.
On Twitter @sherryboschert
PHOENIX – What’s the latest in lasers? The most stubborn tattoos – those with blue or green ink – are now the easiest to remove with new laser technology and techniques. Microwave treatment for armpit hair is a real option, even on difficult-to-remove blond hair. Cutaneous laser expert Dr. Roy Geronemus, director of the Laser and Skin Surgery Center of New York, describes what dermatologists need to know about these and other innovative cosmetic treatments in an interview at the annual meeting of the American Society for Laser Medicine and Surgery.
But that’s not all. More data support the use of lasers for common medical conditions, says Dr. Geronemus. Hear his description of how the same new laser used for tattoo removal can be a noninvasive treatment to reduce either hypertrophic or atrophic scarring in any skin type, with practically no downtime. He also explains several new approaches that show promise as acne therapy.
On Twitter @sherryboschert
PHOENIX – What’s the latest in lasers? The most stubborn tattoos – those with blue or green ink – are now the easiest to remove with new laser technology and techniques. Microwave treatment for armpit hair is a real option, even on difficult-to-remove blond hair. Cutaneous laser expert Dr. Roy Geronemus, director of the Laser and Skin Surgery Center of New York, describes what dermatologists need to know about these and other innovative cosmetic treatments in an interview at the annual meeting of the American Society for Laser Medicine and Surgery.
But that’s not all. More data support the use of lasers for common medical conditions, says Dr. Geronemus. Hear his description of how the same new laser used for tattoo removal can be a noninvasive treatment to reduce either hypertrophic or atrophic scarring in any skin type, with practically no downtime. He also explains several new approaches that show promise as acne therapy.
On Twitter @sherryboschert
AT LASER 2014
Acne scar improvements maintained after laser treatment
PHOENIX – Improvements in acne scarring were maintained 3 months after six laser treatments with a diffractive lens array and a picosecond 755-nm alexandrite laser. Changes seen on histology suggest the improvements stem from more than collagen remodeling alone.
Twenty adults with facial acne scars and Fitzpatrick skin types I-V underwent six laser treatments performed every 4-8 weeks at a single center using a 755-nm wavelength, diffractive lens array, pulse duration of 750-850 picoseconds, and repetition rate of 5 Hz, with a fixed spot size of 6 mm and fluence of 0.71 J/cm2.
Three physicians who were blinded to the results evaluated two- and three-dimensional images taken at baseline and at follow-up visits. Analysis of two-dimensional photos produced acne scar improvement scores averaging 1.5 at the 1-month follow-up visit and 1.4 at the 3-month visit on a 4-point scale (with 0 indicating 0-25% improvement and 3 indicating greater than 75% improvement), Dr. Jeremy Brauer and his associates reported.
Scar volume decreased by an average of 24% by 1 month post treatment and 27% by 3 months post treatment, according to analyses of the three-dimensional images, Dr. Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.
Histology of biopsy specimens taken at baseline and at 3 months after the last treatment showed elongation and increased density of elastic fibers, increased dermal collagen, and increased dermal mucin after treatment. These findings suggest that the improvements in scarring are caused by dermal changes beyond remodeling of collagen alone, said Dr. Brauer of the Laser & Skin Surgery Center in New York.
Dr. Brauer and his associates previously reported that the picosecond laser and diffractive lens array can improve acne scarring with minimal preparation and down time, "in many cases with no anesthesia at all," he said. The investigators offered topical anesthesia and antiviral prophylaxis to patients, but most declined.
The diffractive lens array delivers varying levels of heat at a fixed spot size and fluence. High-energy pulses that are 500 mcm apart deliver 70% of the fluence, with a lower level of heating surrounding these higher-level pulses. In total, approximately 10% of the tissue is exposed to the high-fluence regions.
The 15 women and 5 men in the study ranged in age from 27 to 62 years.
Previous methods of treating acne scarring with lasers, intense pulsed light, or other energy devices typically cause thermal injury that produces collagen synthesis and remodeling. Those procedures usually require anesthesia and can cause collateral damage that may take a long time to heal, he said.
The investigators chose the picosecond 755-nm alexandrite laser because it has been used successfully to remove tattoos or treat pigmented lesions while causing fewer side effects and coupled it with the specialized diffractive lens array.
The study excluded patients with hypersensitivity to light; localized or systemic infection, prior laser treatment in the past 3 months; and a history of skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Also excluded were patients who used isotretinoin in the past year and women who were pregnant, breastfeeding, or contemplating pregnancy.
Dr. Brauer and a coinvestigator reported financial associations with Cynosure, which also loaned equipment for the study.
On Twitter @sherryboschert
PHOENIX – Improvements in acne scarring were maintained 3 months after six laser treatments with a diffractive lens array and a picosecond 755-nm alexandrite laser. Changes seen on histology suggest the improvements stem from more than collagen remodeling alone.
Twenty adults with facial acne scars and Fitzpatrick skin types I-V underwent six laser treatments performed every 4-8 weeks at a single center using a 755-nm wavelength, diffractive lens array, pulse duration of 750-850 picoseconds, and repetition rate of 5 Hz, with a fixed spot size of 6 mm and fluence of 0.71 J/cm2.
Three physicians who were blinded to the results evaluated two- and three-dimensional images taken at baseline and at follow-up visits. Analysis of two-dimensional photos produced acne scar improvement scores averaging 1.5 at the 1-month follow-up visit and 1.4 at the 3-month visit on a 4-point scale (with 0 indicating 0-25% improvement and 3 indicating greater than 75% improvement), Dr. Jeremy Brauer and his associates reported.
Scar volume decreased by an average of 24% by 1 month post treatment and 27% by 3 months post treatment, according to analyses of the three-dimensional images, Dr. Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.
Histology of biopsy specimens taken at baseline and at 3 months after the last treatment showed elongation and increased density of elastic fibers, increased dermal collagen, and increased dermal mucin after treatment. These findings suggest that the improvements in scarring are caused by dermal changes beyond remodeling of collagen alone, said Dr. Brauer of the Laser & Skin Surgery Center in New York.
Dr. Brauer and his associates previously reported that the picosecond laser and diffractive lens array can improve acne scarring with minimal preparation and down time, "in many cases with no anesthesia at all," he said. The investigators offered topical anesthesia and antiviral prophylaxis to patients, but most declined.
The diffractive lens array delivers varying levels of heat at a fixed spot size and fluence. High-energy pulses that are 500 mcm apart deliver 70% of the fluence, with a lower level of heating surrounding these higher-level pulses. In total, approximately 10% of the tissue is exposed to the high-fluence regions.
The 15 women and 5 men in the study ranged in age from 27 to 62 years.
Previous methods of treating acne scarring with lasers, intense pulsed light, or other energy devices typically cause thermal injury that produces collagen synthesis and remodeling. Those procedures usually require anesthesia and can cause collateral damage that may take a long time to heal, he said.
The investigators chose the picosecond 755-nm alexandrite laser because it has been used successfully to remove tattoos or treat pigmented lesions while causing fewer side effects and coupled it with the specialized diffractive lens array.
The study excluded patients with hypersensitivity to light; localized or systemic infection, prior laser treatment in the past 3 months; and a history of skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Also excluded were patients who used isotretinoin in the past year and women who were pregnant, breastfeeding, or contemplating pregnancy.
Dr. Brauer and a coinvestigator reported financial associations with Cynosure, which also loaned equipment for the study.
On Twitter @sherryboschert
PHOENIX – Improvements in acne scarring were maintained 3 months after six laser treatments with a diffractive lens array and a picosecond 755-nm alexandrite laser. Changes seen on histology suggest the improvements stem from more than collagen remodeling alone.
Twenty adults with facial acne scars and Fitzpatrick skin types I-V underwent six laser treatments performed every 4-8 weeks at a single center using a 755-nm wavelength, diffractive lens array, pulse duration of 750-850 picoseconds, and repetition rate of 5 Hz, with a fixed spot size of 6 mm and fluence of 0.71 J/cm2.
Three physicians who were blinded to the results evaluated two- and three-dimensional images taken at baseline and at follow-up visits. Analysis of two-dimensional photos produced acne scar improvement scores averaging 1.5 at the 1-month follow-up visit and 1.4 at the 3-month visit on a 4-point scale (with 0 indicating 0-25% improvement and 3 indicating greater than 75% improvement), Dr. Jeremy Brauer and his associates reported.
Scar volume decreased by an average of 24% by 1 month post treatment and 27% by 3 months post treatment, according to analyses of the three-dimensional images, Dr. Brauer said at the annual meeting of the American Society for Laser Medicine and Surgery.
Histology of biopsy specimens taken at baseline and at 3 months after the last treatment showed elongation and increased density of elastic fibers, increased dermal collagen, and increased dermal mucin after treatment. These findings suggest that the improvements in scarring are caused by dermal changes beyond remodeling of collagen alone, said Dr. Brauer of the Laser & Skin Surgery Center in New York.
Dr. Brauer and his associates previously reported that the picosecond laser and diffractive lens array can improve acne scarring with minimal preparation and down time, "in many cases with no anesthesia at all," he said. The investigators offered topical anesthesia and antiviral prophylaxis to patients, but most declined.
The diffractive lens array delivers varying levels of heat at a fixed spot size and fluence. High-energy pulses that are 500 mcm apart deliver 70% of the fluence, with a lower level of heating surrounding these higher-level pulses. In total, approximately 10% of the tissue is exposed to the high-fluence regions.
The 15 women and 5 men in the study ranged in age from 27 to 62 years.
Previous methods of treating acne scarring with lasers, intense pulsed light, or other energy devices typically cause thermal injury that produces collagen synthesis and remodeling. Those procedures usually require anesthesia and can cause collateral damage that may take a long time to heal, he said.
The investigators chose the picosecond 755-nm alexandrite laser because it has been used successfully to remove tattoos or treat pigmented lesions while causing fewer side effects and coupled it with the specialized diffractive lens array.
The study excluded patients with hypersensitivity to light; localized or systemic infection, prior laser treatment in the past 3 months; and a history of skin cancer, keloidal scarring, immunosuppression, or immune deficiency disorder. Also excluded were patients who used isotretinoin in the past year and women who were pregnant, breastfeeding, or contemplating pregnancy.
Dr. Brauer and a coinvestigator reported financial associations with Cynosure, which also loaned equipment for the study.
On Twitter @sherryboschert
AT LASER 2014
Major finding: Acne scar volume decreased 24% by 1 month after treatment ended and 27% by 3 months post treatment, compared with baseline.
Key clinical point: Histologic data suggest that using a diffractive lens array and a picosecond 755-nm laser to treat acne scars caused dermal changes beyond skin remodeling alone.
Data source: Single-center study of 20 adults and photographic assessments by three physicians who were blinded to the results.
Disclosures: Dr. Brauer and a coinvestigator reported financial associations with Cynosure, which also loaned equipment for the study.
VIDEO: Laser innovations target tattoos, acne, body fat
PHOENIX – Advances in laser technology allow dermatologists to remove tattoos in half the time but at twice the cost. Cold therapy for sebaceous glands theoretically could cure acne. Nonsurgical body sculpting and contouring techniques are making it easier to take away love handles and other unwanted body fat.
These are some of the highlights from the annual meeting of the American Society for Laser Medicine and Surgery. Dr. Jeffrey S. Dover, immediate past president of the ASLMS, explains the details of these developments and how to make the most of them in practice. Dr. Dover is a dermatologist practicing in Chestnut Hill, Mass.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
PHOENIX – Advances in laser technology allow dermatologists to remove tattoos in half the time but at twice the cost. Cold therapy for sebaceous glands theoretically could cure acne. Nonsurgical body sculpting and contouring techniques are making it easier to take away love handles and other unwanted body fat.
These are some of the highlights from the annual meeting of the American Society for Laser Medicine and Surgery. Dr. Jeffrey S. Dover, immediate past president of the ASLMS, explains the details of these developments and how to make the most of them in practice. Dr. Dover is a dermatologist practicing in Chestnut Hill, Mass.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
PHOENIX – Advances in laser technology allow dermatologists to remove tattoos in half the time but at twice the cost. Cold therapy for sebaceous glands theoretically could cure acne. Nonsurgical body sculpting and contouring techniques are making it easier to take away love handles and other unwanted body fat.
These are some of the highlights from the annual meeting of the American Society for Laser Medicine and Surgery. Dr. Jeffrey S. Dover, immediate past president of the ASLMS, explains the details of these developments and how to make the most of them in practice. Dr. Dover is a dermatologist practicing in Chestnut Hill, Mass.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
AT LASER 2014
Minority correctly use EpiPen or metered dose inhaler
SAN DIEGO – Only 12% of 91 patients in Texas allergy/immunology clinics knew how to use an epinephrine autoinjector correctly, and only 7% of 41 patients could demonstrate correct use of their metered dose inhaler with a spacer, a small prospective study showed.
That’s not good enough, Dr. Rana S. Bonds said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Her team has begun studying interventions to improve correct use of those devices and "will be sharing that data in the near future," she said.
They asked patients to demonstrate the use of an EpiPen or a metered dose inhaler (MDI) and spacer and scored the patients’ adherence to the EpiPen manufacturer’s instructions or published standards for MDI/spacers.
For the EpiPen, 25% of patients missed one of the five steps for correct use, 18% missed two steps, and 19% missed three steps. "It was fairly alarming" to find that 31% got four steps wrong and 8% missed all five steps, said Dr. Bonds of the University of Texas Medical Branch, Galveston. (Percentages total more than 100% because they were rounded.)
The most common mistake with the EpiPen involved the final step. "Once they deployed the epinephrine injection, they didn’t hold it down long enough. They were bouncing it off the thigh or whatever body part they thought they should inject it into," she said.
For the MDI/spacer, 16% of patients performed 1 of 11 steps for use incorrectly, 16% missed 2 steps, 21% missed 3 steps, and 18% missed 4 steps. Another 11% missed 5 steps, 5% missed 6 steps, 11% missed 7 steps, and 3% got all 11 steps wrong, Dr. Bonds and her associates reported. The most common mistake was failing to exhale before triggering the inhaler for inhalation.
The study recruited patients from the university’s main allergy/immunology clinic and its satellite clinics. Trainers are available at each clinic, and patients are supposed to see them before leaving with one of the devices, but the findings raise the question of whether health care providers at the clinics consistently make sure that happens, she said.
Younger patients, males, and patients with a medical background were more likely to show that they could use the EpiPen correctly. Being African American or less educated was associated with a greater likelihood of incorrect use. Correct usage rates differed significantly between some of the clinic sites. Factors that didn’t correlate with correct or incorrect use of the EpiPen included whether a family member also used the device, being prescribed the EpiPen more or less than 1 year ago, and whether patients had ever used the EpiPen (most hadn’t).
The number of patients in the MDI/spacer group was too small to permit risk factors to be analyzed, Dr. Bonds said.
Previously published studies have reported that 22% of food-allergic adolescents could demonstrate correct use of epinephrine and that rates of incorrect inhaler use ranged from 50% to 94%, she said. Other studies have shown that incorrect use reduces the treatment’s clinical efficacy, and that repeated instruction increases the likelihood of correct use.
Dr. Bonds reported having no relevant financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – Only 12% of 91 patients in Texas allergy/immunology clinics knew how to use an epinephrine autoinjector correctly, and only 7% of 41 patients could demonstrate correct use of their metered dose inhaler with a spacer, a small prospective study showed.
That’s not good enough, Dr. Rana S. Bonds said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Her team has begun studying interventions to improve correct use of those devices and "will be sharing that data in the near future," she said.
They asked patients to demonstrate the use of an EpiPen or a metered dose inhaler (MDI) and spacer and scored the patients’ adherence to the EpiPen manufacturer’s instructions or published standards for MDI/spacers.
For the EpiPen, 25% of patients missed one of the five steps for correct use, 18% missed two steps, and 19% missed three steps. "It was fairly alarming" to find that 31% got four steps wrong and 8% missed all five steps, said Dr. Bonds of the University of Texas Medical Branch, Galveston. (Percentages total more than 100% because they were rounded.)
The most common mistake with the EpiPen involved the final step. "Once they deployed the epinephrine injection, they didn’t hold it down long enough. They were bouncing it off the thigh or whatever body part they thought they should inject it into," she said.
For the MDI/spacer, 16% of patients performed 1 of 11 steps for use incorrectly, 16% missed 2 steps, 21% missed 3 steps, and 18% missed 4 steps. Another 11% missed 5 steps, 5% missed 6 steps, 11% missed 7 steps, and 3% got all 11 steps wrong, Dr. Bonds and her associates reported. The most common mistake was failing to exhale before triggering the inhaler for inhalation.
The study recruited patients from the university’s main allergy/immunology clinic and its satellite clinics. Trainers are available at each clinic, and patients are supposed to see them before leaving with one of the devices, but the findings raise the question of whether health care providers at the clinics consistently make sure that happens, she said.
Younger patients, males, and patients with a medical background were more likely to show that they could use the EpiPen correctly. Being African American or less educated was associated with a greater likelihood of incorrect use. Correct usage rates differed significantly between some of the clinic sites. Factors that didn’t correlate with correct or incorrect use of the EpiPen included whether a family member also used the device, being prescribed the EpiPen more or less than 1 year ago, and whether patients had ever used the EpiPen (most hadn’t).
The number of patients in the MDI/spacer group was too small to permit risk factors to be analyzed, Dr. Bonds said.
Previously published studies have reported that 22% of food-allergic adolescents could demonstrate correct use of epinephrine and that rates of incorrect inhaler use ranged from 50% to 94%, she said. Other studies have shown that incorrect use reduces the treatment’s clinical efficacy, and that repeated instruction increases the likelihood of correct use.
Dr. Bonds reported having no relevant financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – Only 12% of 91 patients in Texas allergy/immunology clinics knew how to use an epinephrine autoinjector correctly, and only 7% of 41 patients could demonstrate correct use of their metered dose inhaler with a spacer, a small prospective study showed.
That’s not good enough, Dr. Rana S. Bonds said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Her team has begun studying interventions to improve correct use of those devices and "will be sharing that data in the near future," she said.
They asked patients to demonstrate the use of an EpiPen or a metered dose inhaler (MDI) and spacer and scored the patients’ adherence to the EpiPen manufacturer’s instructions or published standards for MDI/spacers.
For the EpiPen, 25% of patients missed one of the five steps for correct use, 18% missed two steps, and 19% missed three steps. "It was fairly alarming" to find that 31% got four steps wrong and 8% missed all five steps, said Dr. Bonds of the University of Texas Medical Branch, Galveston. (Percentages total more than 100% because they were rounded.)
The most common mistake with the EpiPen involved the final step. "Once they deployed the epinephrine injection, they didn’t hold it down long enough. They were bouncing it off the thigh or whatever body part they thought they should inject it into," she said.
For the MDI/spacer, 16% of patients performed 1 of 11 steps for use incorrectly, 16% missed 2 steps, 21% missed 3 steps, and 18% missed 4 steps. Another 11% missed 5 steps, 5% missed 6 steps, 11% missed 7 steps, and 3% got all 11 steps wrong, Dr. Bonds and her associates reported. The most common mistake was failing to exhale before triggering the inhaler for inhalation.
The study recruited patients from the university’s main allergy/immunology clinic and its satellite clinics. Trainers are available at each clinic, and patients are supposed to see them before leaving with one of the devices, but the findings raise the question of whether health care providers at the clinics consistently make sure that happens, she said.
Younger patients, males, and patients with a medical background were more likely to show that they could use the EpiPen correctly. Being African American or less educated was associated with a greater likelihood of incorrect use. Correct usage rates differed significantly between some of the clinic sites. Factors that didn’t correlate with correct or incorrect use of the EpiPen included whether a family member also used the device, being prescribed the EpiPen more or less than 1 year ago, and whether patients had ever used the EpiPen (most hadn’t).
The number of patients in the MDI/spacer group was too small to permit risk factors to be analyzed, Dr. Bonds said.
Previously published studies have reported that 22% of food-allergic adolescents could demonstrate correct use of epinephrine and that rates of incorrect inhaler use ranged from 50% to 94%, she said. Other studies have shown that incorrect use reduces the treatment’s clinical efficacy, and that repeated instruction increases the likelihood of correct use.
Dr. Bonds reported having no relevant financial disclosures.
On Twitter @sherryboschert
AT 2014 AAAAI ANNUAL MEETING
Major finding: Twelve percent of patients showed they could use an EpiPen correctly, and 7% knew how to use a metered dose inhaler and spacer.
Data source: A prospective study of 91 patients using EpiPens and 41 using MDI/spacers in Texas allergy/immunology clinics.
Disclosures: Dr. Bonds reported having no relevant financial disclosures.
Sacral nerve stimulation reduced irritable bowel symptoms
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
FROM ANNALS OF SURGERY
Major finding: Median symptom scores worsened by 12 points between months when the stimulator was on and then off and improved by 18 points between months when the stimulator was off and then on, a significant difference.
Data source: A prospective, randomized, controlled crossover study of 21 patients with diarrhea-predominant or mixed irritable bowel syndrome at a single institution.
Disclosures: Medtronic provided the neurostimulators for the study free of charge and some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
Asthma medication nonadherence mainly unintentional
SAN DIEGO – When patients do not take their asthma medication, it’s usually because they forgot and not because they intentionally made a change in their treatment regimen, a retrospective study of data on 108 adults and 156 children found.
The role of forgetfulness in nonadherence emphasizes the importance of interventions such as text messages, smart inhalers with reminder systems, or Web-based reminder programs to reduce the risk of exacerbations, Dr. Joyce Xiang Wu Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Lee, a fellow in allergy and immunology at the Veterans Affairs Greater Los Angeles Medical Center, and her colleagues retrospectively analyzed a subset of data from a previous observational study of the correlation between the Medication Adherence Report ScaleAsthma (MARSA) and other asthma control metrics. They used answers to 10 questions in 283 MARSA surveys completed by the adults (aged 46-77 years) and in 190 MARSA surveys completed by children (aged 4-11 years) during multiple health care visits between June 2010 and May 2011.
The first of the 10 questions asked patients how often they forget to take their asthma medication, and answers were considered indicative of unintentional nonadherence. The other nine questions were used as proxies for intentional nonadherence, including asking how often patients "stop taking it for awhile," "decide to miss a dose," "try to avoid using it," "only use it when I feel breathless," "alter the dose," "use it for a reserve" if other treatments don’t work, "use it before doing something which might make me breathless," "take it less than instructed," or "use it when I need it."
The results suggest that both adult and pediatric patients are more likely to be unintentionally nonadherent to asthma therapy than intentionally adherent, according to statistical analyses using Cronbach’s alpha, nonparametric one-way analysis of variance, and a pairwise comparison using the Bonferroni approach to determine differences between answers to the questions, .
The current analysis excluded patients with chronic obstructive pulmonary disease, other confounding comorbidities, or an inability to perform spirometry or to complete the questionnaire.
Dr. Lee reported having no financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – When patients do not take their asthma medication, it’s usually because they forgot and not because they intentionally made a change in their treatment regimen, a retrospective study of data on 108 adults and 156 children found.
The role of forgetfulness in nonadherence emphasizes the importance of interventions such as text messages, smart inhalers with reminder systems, or Web-based reminder programs to reduce the risk of exacerbations, Dr. Joyce Xiang Wu Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Lee, a fellow in allergy and immunology at the Veterans Affairs Greater Los Angeles Medical Center, and her colleagues retrospectively analyzed a subset of data from a previous observational study of the correlation between the Medication Adherence Report ScaleAsthma (MARSA) and other asthma control metrics. They used answers to 10 questions in 283 MARSA surveys completed by the adults (aged 46-77 years) and in 190 MARSA surveys completed by children (aged 4-11 years) during multiple health care visits between June 2010 and May 2011.
The first of the 10 questions asked patients how often they forget to take their asthma medication, and answers were considered indicative of unintentional nonadherence. The other nine questions were used as proxies for intentional nonadherence, including asking how often patients "stop taking it for awhile," "decide to miss a dose," "try to avoid using it," "only use it when I feel breathless," "alter the dose," "use it for a reserve" if other treatments don’t work, "use it before doing something which might make me breathless," "take it less than instructed," or "use it when I need it."
The results suggest that both adult and pediatric patients are more likely to be unintentionally nonadherent to asthma therapy than intentionally adherent, according to statistical analyses using Cronbach’s alpha, nonparametric one-way analysis of variance, and a pairwise comparison using the Bonferroni approach to determine differences between answers to the questions, .
The current analysis excluded patients with chronic obstructive pulmonary disease, other confounding comorbidities, or an inability to perform spirometry or to complete the questionnaire.
Dr. Lee reported having no financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – When patients do not take their asthma medication, it’s usually because they forgot and not because they intentionally made a change in their treatment regimen, a retrospective study of data on 108 adults and 156 children found.
The role of forgetfulness in nonadherence emphasizes the importance of interventions such as text messages, smart inhalers with reminder systems, or Web-based reminder programs to reduce the risk of exacerbations, Dr. Joyce Xiang Wu Lee said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Lee, a fellow in allergy and immunology at the Veterans Affairs Greater Los Angeles Medical Center, and her colleagues retrospectively analyzed a subset of data from a previous observational study of the correlation between the Medication Adherence Report ScaleAsthma (MARSA) and other asthma control metrics. They used answers to 10 questions in 283 MARSA surveys completed by the adults (aged 46-77 years) and in 190 MARSA surveys completed by children (aged 4-11 years) during multiple health care visits between June 2010 and May 2011.
The first of the 10 questions asked patients how often they forget to take their asthma medication, and answers were considered indicative of unintentional nonadherence. The other nine questions were used as proxies for intentional nonadherence, including asking how often patients "stop taking it for awhile," "decide to miss a dose," "try to avoid using it," "only use it when I feel breathless," "alter the dose," "use it for a reserve" if other treatments don’t work, "use it before doing something which might make me breathless," "take it less than instructed," or "use it when I need it."
The results suggest that both adult and pediatric patients are more likely to be unintentionally nonadherent to asthma therapy than intentionally adherent, according to statistical analyses using Cronbach’s alpha, nonparametric one-way analysis of variance, and a pairwise comparison using the Bonferroni approach to determine differences between answers to the questions, .
The current analysis excluded patients with chronic obstructive pulmonary disease, other confounding comorbidities, or an inability to perform spirometry or to complete the questionnaire.
Dr. Lee reported having no financial disclosures.
On Twitter @sherryboschert
AT 2014 AAAAI ANNUAL MEETING
Major finding: Adults and children were more likely to report unintentional than intentional nonadherence to asthma therapy.
Data source: Retrospective statistical analysis of answers to 10 survey questions completed by 108 adults and 156 children with asthma during multiple health care visits.
Disclosures: Dr. Lee reported having no financial disclosures.
VIDEO: Study highlights progress, challenges in nosocomial infections
One in 25 hospitalized patients on any given day has an infection acquired from health care, and as many as 1 in 9 of those will die.
At a press briefing, Dr. Michael Bell discussed new data from a prevalence study conducted by the Centers for Disease Control and Prevention, where he is the deputy director for the division of health care quality promotion. Hospitals, doctors, and patients all have a role to play in decreasing the risks of these infections, he said.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
This article was updated 3/28/2014.
One in 25 hospitalized patients on any given day has an infection acquired from health care, and as many as 1 in 9 of those will die.
At a press briefing, Dr. Michael Bell discussed new data from a prevalence study conducted by the Centers for Disease Control and Prevention, where he is the deputy director for the division of health care quality promotion. Hospitals, doctors, and patients all have a role to play in decreasing the risks of these infections, he said.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
This article was updated 3/28/2014.
One in 25 hospitalized patients on any given day has an infection acquired from health care, and as many as 1 in 9 of those will die.
At a press briefing, Dr. Michael Bell discussed new data from a prevalence study conducted by the Centers for Disease Control and Prevention, where he is the deputy director for the division of health care quality promotion. Hospitals, doctors, and patients all have a role to play in decreasing the risks of these infections, he said.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
This article was updated 3/28/2014.
FROM THE CDC
Systolic variability after intracerebral hemorrhage raises odds of death, disability
SAN DIEGO – Patients with greater variability in systolic blood pressure in the first day or week after an acute intracerebral hemorrhage were more likely to die within 90 days or have a major disability, a secondary analysis of data on 2,839 patients found.
The study compared patient outcomes with data from 5 blood pressure measurements taken within 24 hours of an acute intracerebral hemorrhage and 12 measurements taken in days 2-7 after the hemorrhage. The investigators described blood pressure variability as a standard deviation of systolic pressure, divided into quintiles.
They found a significant linear association between systolic pressure variability and death or major disability at 90 days that was independent of mean systolic blood pressure. The risk for death or disability was 41% higher in patients in the highest quintile of systolic variability within 24 hours of an acute intracerebral hemorrhage, compared with patients in the lowest quintile. The risk was 57% higher in the highest quintile of systolic variability in days 2-7 after the hemorrhage, compared with the lowest quintile, Dr. Lisa Manning reported at the International Stroke Conference.
The greatest predictors of death or major disability were maximum systolic blood pressure in the first 24 hours after a hemorrhage and standard deviation in systolic pressure in days 2-7, said Dr. Manning of the University of Leicester (England).
Similar significant associations were seen for the secondary outcome, which was an ordinal shift in modified Rankin Scale scores at 90 days. The likelihood of this shift was 43% higher in patients in the highest quintile of systolic variability in the first day after a hemorrhage and 46% higher in patients in the highest quintile of variability in days 2-7, compared with the lowest-quartile patients, she said at the meeting, sponsored by the American Heart Association.
The results were published online in Lancet Neurology (2014 Feb. 13 [doi:10.1016/S1474-4422(14)70018-3]).
Data for the analysis came from the INTERACT2 trial (The Second Intensive Blood Pressure in Acute Haemorrhage trial). The prospective, international multicenter study randomized patients with spontaneous intracerebral hemorrhage and high systolic blood pressure to early intensive lowering of blood pressure (within 1 hour of randomization) or to conventional treatment as recommended in guidelines. Results showed no significant reduction in the risk of death or disability with early intensive treatment (N. Engl. J. Med. 2013;368:2355-65).
For the current analysis, investigators studied data on 2,645 patients with blood pressure measurement in the first day after a hemorrhage (93% of the INTERACT2 cohort) and 2,347 patients with measurements in days 2-7 (83% of the total cohort).
The findings present several clinical implications, Dr. Manning suggested. Consistent, sustained efforts to control blood pressure in the first few days after an acute intracerebral hemorrhage may benefit patients, and clinicians may want to adjust the frequency and intensity of blood pressure monitoring to ensure that systolic blood pressure consistently falls and stabilizes throughout hospitalization in these patients.
The increased risk for death or disability with greater systolic variability was seen after investigators adjusted for the effects of other factors such as age, sex, the randomized treatment group, geographical region, hematoma volume at baseline, and high scores on the National Institutes of Health Stroke Scale.
The study was funded by the National Health and Medical Research Council of Australia. Two of Dr. Manning’s associates in the study reported financial associations with Osaka Pharmaceuticals, Novartis, Omron Healthcare, Pfizer, Takeda, A&D Pharma, and/or Servier.
On Twitter @sherryboschert
SAN DIEGO – Patients with greater variability in systolic blood pressure in the first day or week after an acute intracerebral hemorrhage were more likely to die within 90 days or have a major disability, a secondary analysis of data on 2,839 patients found.
The study compared patient outcomes with data from 5 blood pressure measurements taken within 24 hours of an acute intracerebral hemorrhage and 12 measurements taken in days 2-7 after the hemorrhage. The investigators described blood pressure variability as a standard deviation of systolic pressure, divided into quintiles.
They found a significant linear association between systolic pressure variability and death or major disability at 90 days that was independent of mean systolic blood pressure. The risk for death or disability was 41% higher in patients in the highest quintile of systolic variability within 24 hours of an acute intracerebral hemorrhage, compared with patients in the lowest quintile. The risk was 57% higher in the highest quintile of systolic variability in days 2-7 after the hemorrhage, compared with the lowest quintile, Dr. Lisa Manning reported at the International Stroke Conference.
The greatest predictors of death or major disability were maximum systolic blood pressure in the first 24 hours after a hemorrhage and standard deviation in systolic pressure in days 2-7, said Dr. Manning of the University of Leicester (England).
Similar significant associations were seen for the secondary outcome, which was an ordinal shift in modified Rankin Scale scores at 90 days. The likelihood of this shift was 43% higher in patients in the highest quintile of systolic variability in the first day after a hemorrhage and 46% higher in patients in the highest quintile of variability in days 2-7, compared with the lowest-quartile patients, she said at the meeting, sponsored by the American Heart Association.
The results were published online in Lancet Neurology (2014 Feb. 13 [doi:10.1016/S1474-4422(14)70018-3]).
Data for the analysis came from the INTERACT2 trial (The Second Intensive Blood Pressure in Acute Haemorrhage trial). The prospective, international multicenter study randomized patients with spontaneous intracerebral hemorrhage and high systolic blood pressure to early intensive lowering of blood pressure (within 1 hour of randomization) or to conventional treatment as recommended in guidelines. Results showed no significant reduction in the risk of death or disability with early intensive treatment (N. Engl. J. Med. 2013;368:2355-65).
For the current analysis, investigators studied data on 2,645 patients with blood pressure measurement in the first day after a hemorrhage (93% of the INTERACT2 cohort) and 2,347 patients with measurements in days 2-7 (83% of the total cohort).
The findings present several clinical implications, Dr. Manning suggested. Consistent, sustained efforts to control blood pressure in the first few days after an acute intracerebral hemorrhage may benefit patients, and clinicians may want to adjust the frequency and intensity of blood pressure monitoring to ensure that systolic blood pressure consistently falls and stabilizes throughout hospitalization in these patients.
The increased risk for death or disability with greater systolic variability was seen after investigators adjusted for the effects of other factors such as age, sex, the randomized treatment group, geographical region, hematoma volume at baseline, and high scores on the National Institutes of Health Stroke Scale.
The study was funded by the National Health and Medical Research Council of Australia. Two of Dr. Manning’s associates in the study reported financial associations with Osaka Pharmaceuticals, Novartis, Omron Healthcare, Pfizer, Takeda, A&D Pharma, and/or Servier.
On Twitter @sherryboschert
SAN DIEGO – Patients with greater variability in systolic blood pressure in the first day or week after an acute intracerebral hemorrhage were more likely to die within 90 days or have a major disability, a secondary analysis of data on 2,839 patients found.
The study compared patient outcomes with data from 5 blood pressure measurements taken within 24 hours of an acute intracerebral hemorrhage and 12 measurements taken in days 2-7 after the hemorrhage. The investigators described blood pressure variability as a standard deviation of systolic pressure, divided into quintiles.
They found a significant linear association between systolic pressure variability and death or major disability at 90 days that was independent of mean systolic blood pressure. The risk for death or disability was 41% higher in patients in the highest quintile of systolic variability within 24 hours of an acute intracerebral hemorrhage, compared with patients in the lowest quintile. The risk was 57% higher in the highest quintile of systolic variability in days 2-7 after the hemorrhage, compared with the lowest quintile, Dr. Lisa Manning reported at the International Stroke Conference.
The greatest predictors of death or major disability were maximum systolic blood pressure in the first 24 hours after a hemorrhage and standard deviation in systolic pressure in days 2-7, said Dr. Manning of the University of Leicester (England).
Similar significant associations were seen for the secondary outcome, which was an ordinal shift in modified Rankin Scale scores at 90 days. The likelihood of this shift was 43% higher in patients in the highest quintile of systolic variability in the first day after a hemorrhage and 46% higher in patients in the highest quintile of variability in days 2-7, compared with the lowest-quartile patients, she said at the meeting, sponsored by the American Heart Association.
The results were published online in Lancet Neurology (2014 Feb. 13 [doi:10.1016/S1474-4422(14)70018-3]).
Data for the analysis came from the INTERACT2 trial (The Second Intensive Blood Pressure in Acute Haemorrhage trial). The prospective, international multicenter study randomized patients with spontaneous intracerebral hemorrhage and high systolic blood pressure to early intensive lowering of blood pressure (within 1 hour of randomization) or to conventional treatment as recommended in guidelines. Results showed no significant reduction in the risk of death or disability with early intensive treatment (N. Engl. J. Med. 2013;368:2355-65).
For the current analysis, investigators studied data on 2,645 patients with blood pressure measurement in the first day after a hemorrhage (93% of the INTERACT2 cohort) and 2,347 patients with measurements in days 2-7 (83% of the total cohort).
The findings present several clinical implications, Dr. Manning suggested. Consistent, sustained efforts to control blood pressure in the first few days after an acute intracerebral hemorrhage may benefit patients, and clinicians may want to adjust the frequency and intensity of blood pressure monitoring to ensure that systolic blood pressure consistently falls and stabilizes throughout hospitalization in these patients.
The increased risk for death or disability with greater systolic variability was seen after investigators adjusted for the effects of other factors such as age, sex, the randomized treatment group, geographical region, hematoma volume at baseline, and high scores on the National Institutes of Health Stroke Scale.
The study was funded by the National Health and Medical Research Council of Australia. Two of Dr. Manning’s associates in the study reported financial associations with Osaka Pharmaceuticals, Novartis, Omron Healthcare, Pfizer, Takeda, A&D Pharma, and/or Servier.
On Twitter @sherryboschert
AT THE INTERNATIONAL STROKE CONFERENCE
Major finding: Death or major disability were 41% more likely in patients in the highest quintile of systolic variability 1 day after acute intracerebral hemorrhage and 57% higher in those in the highest quintile 2-7 days after hemorrhage, compared with the lowest quintile.
Data source: A secondary analysis of data on 2,839 patients in the prospective, randomized INTERACT2 trial of early intensive blood pressure treatment after acute intracerebral hemorrhage.
Disclosures: The study was funded by the National Health and Medical Research Council of Australia. Two of Dr. Manning’s associates in the study reported financial associations with Osaka Pharmaceuticals, Novartis, Omron Healthcare, Pfizer, Takeda, A&D Pharma, and/or Servier.
