ORLANDO – The HeartMate 3 magnetically levitated left ventricular assist (LVAD) device provided far superior outcomes, compared with the widely used HeartMate II axial-flow pump at 2 years of follow-up in patients with advanced heart failure in the large multicenter MOMENTUM 3 trial, Mandeep R. Mehra, MD, reported at the annual meeting of the American College of Cardiology.

Bruce Jancin/Frontline Medical News

HeartMate 3 recipients had a 90% lower risk of undergoing reoperation to replace or remove their device because of malfunction, and a stroke rate half that in the HeartMate II group.

“This was the lowest rate of stroke ever seen in any LVAD trial,” according to Dr. Mehra, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, Boston, and professor of medicine at Harvard Medical School.

“We believe this is a practice-changing result in the field, and that the real implication of our findings is to reassure those who refer or treat patients with advanced heart failure that it is perhaps going to be ignorant not to refer patients for consideration for destination therapy,” he said at a press conference highlighting the MOMENTUM 3 results, also presented in a late-breaking clinical trials session.

The HeartMate 3 is a miniaturized centrifugal-flow device that fits entirely within the chest, whereas the HeartMate II requires creation of a pocket in the abdomen. The HeartMate 3 was designed to prevent pump thrombosis – a common limiting problem with the HeartMate II and other LVADs – by employing three innovations: use of wide blood-flow passages to reduce shear stress and minimize disruption of red blood cells as they pass through the pump; reliance on magnetic levitation technology to create a frictionless pump with no mechanical bearings, which are subject to wear and tear; and incorporation of an artificial fixed pulse that speeds up and slows every 2 seconds in order to minimize blood stasis, which promotes thrombosis, the cardiologist explained in a video interview.

Bruce Jancin/Frontline Medical News

Discussant James L. Janzuzzi Jr., called the MOMENTUM 3 results “a very-much-needed step forward.”

[email protected]

SOURCE: Mehra M et al. ACC 18.

ORLANDO – The HeartMate 3 magnetically levitated left ventricular assist (LVAD) device provided far superior outcomes, compared with the widely used HeartMate II axial-flow pump at 2 years of follow-up in patients with advanced heart failure in the large multicenter MOMENTUM 3 trial, Mandeep R. Mehra, MD, reported at the annual meeting of the American College of Cardiology.

Bruce Jancin/Frontline Medical News

HeartMate 3 recipients had a 90% lower risk of undergoing reoperation to replace or remove their device because of malfunction, and a stroke rate half that in the HeartMate II group.

“This was the lowest rate of stroke ever seen in any LVAD trial,” according to Dr. Mehra, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, Boston, and professor of medicine at Harvard Medical School.

“We believe this is a practice-changing result in the field, and that the real implication of our findings is to reassure those who refer or treat patients with advanced heart failure that it is perhaps going to be ignorant not to refer patients for consideration for destination therapy,” he said at a press conference highlighting the MOMENTUM 3 results, also presented in a late-breaking clinical trials session.

The HeartMate 3 is a miniaturized centrifugal-flow device that fits entirely within the chest, whereas the HeartMate II requires creation of a pocket in the abdomen. The HeartMate 3 was designed to prevent pump thrombosis – a common limiting problem with the HeartMate II and other LVADs – by employing three innovations: use of wide blood-flow passages to reduce shear stress and minimize disruption of red blood cells as they pass through the pump; reliance on magnetic levitation technology to create a frictionless pump with no mechanical bearings, which are subject to wear and tear; and incorporation of an artificial fixed pulse that speeds up and slows every 2 seconds in order to minimize blood stasis, which promotes thrombosis, the cardiologist explained in a video interview.

Bruce Jancin/Frontline Medical News

Discussant James L. Janzuzzi Jr., called the MOMENTUM 3 results “a very-much-needed step forward.”

[email protected]

SOURCE: Mehra M et al. ACC 18.

ORLANDO – The HeartMate 3 magnetically levitated left ventricular assist (LVAD) device provided far superior outcomes, compared with the widely used HeartMate II axial-flow pump at 2 years of follow-up in patients with advanced heart failure in the large multicenter MOMENTUM 3 trial, Mandeep R. Mehra, MD, reported at the annual meeting of the American College of Cardiology.

Bruce Jancin/Frontline Medical News

HeartMate 3 recipients had a 90% lower risk of undergoing reoperation to replace or remove their device because of malfunction, and a stroke rate half that in the HeartMate II group.

“This was the lowest rate of stroke ever seen in any LVAD trial,” according to Dr. Mehra, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, Boston, and professor of medicine at Harvard Medical School.

“We believe this is a practice-changing result in the field, and that the real implication of our findings is to reassure those who refer or treat patients with advanced heart failure that it is perhaps going to be ignorant not to refer patients for consideration for destination therapy,” he said at a press conference highlighting the MOMENTUM 3 results, also presented in a late-breaking clinical trials session.

The HeartMate 3 is a miniaturized centrifugal-flow device that fits entirely within the chest, whereas the HeartMate II requires creation of a pocket in the abdomen. The HeartMate 3 was designed to prevent pump thrombosis – a common limiting problem with the HeartMate II and other LVADs – by employing three innovations: use of wide blood-flow passages to reduce shear stress and minimize disruption of red blood cells as they pass through the pump; reliance on magnetic levitation technology to create a frictionless pump with no mechanical bearings, which are subject to wear and tear; and incorporation of an artificial fixed pulse that speeds up and slows every 2 seconds in order to minimize blood stasis, which promotes thrombosis, the cardiologist explained in a video interview.

Bruce Jancin/Frontline Medical News

Discussant James L. Janzuzzi Jr., called the MOMENTUM 3 results “a very-much-needed step forward.”

[email protected]

SOURCE: Mehra M et al. ACC 18.

The American Board of Surgery (ABS) has unveiled a shorter, more flexible assessment to take the place of the dreaded 10-year, pass-fail exam to maintain certification.

The new test, required every other year, consists of a 40-question, open-book assessment that surgeons can take on their own computers within the assessment time frame, according to a March 5 announcement. The previous 10-year exam consisted of nearly 250 questions and had to be completed at a highly secure testing center.

The assessment shift was made to address diplomates’ concerns that the prior exam was burdensome, stressful, and challenging to complete because of its rigid design and location requirements, ABS Chair Mary E. Klingensmith, MD, FACS, said in an interview.

“This new method, which allows a take-from-home or office format, is much less stressful, as both the setting, and the ability to choose the content area, give diplomates much more control,” Dr. Klingensmith said. “Additionally, the testing concepts and references will be provided in advance, should a diplomate desire to know these aspects.”

On March 11, the American College of Surgeons released a statement regarding the new assessment and suggested that, while the new approach is welcomed by the ACS, some details of the process are of concern to surgeons. “The American College of Surgeons (ACS) leadership has heard your concerns both through personal conversations with many of you and through your posts on ACS Communities. In fact, many in leadership share these concerns. We have been in discussions with ABS leadership and can tell you that they are also listening. They want to get this right.”

Of the 40 questions on the new exam, 20 questions will cover core surgical principles, while the other 20 will cover a practice-related area of the diplomate’s choosing. For 2018, diplomates can select from four practice-related areas: general surgery, abdomen, alimentary tract, or breast. More areas are planned based on future feedback from diplomates and surgical societies. Other aspects of the new exam include:

• Topics and references for the various areas will be published in advance on the ABS website.
• Diplomates will be provided with immediate feedback, and will have two opportunities to answer a question correctly.
• A final score of 80% correct will be required to pass.
• Once the assessment is started, diplomates will have 2 weeks to complete the test, with the ability to save and continue when convenient.

The purpose of the new assessment is to provide practicing surgeons with a timely, relevant, and accessible method to stay current with surgical practice knowledge,” Dr. Klingensmith said.

“By selecting a practice-specific area of their own choosing, surgeons will no longer have to study for and be tested upon the entire breadth of general surgery; instead they can focus on those areas that most reflect their practice,” she said. “By submitting to a learning exercise every 2 years, which is focused in the areas of an individual surgeon’s practice, I expect important aspects of knowledge will be transmitted and integrated into a surgeon’s practice. This new program will provide practicing surgeons with an accessible method for keeping up with the constantly changing landscape of surgical practice.”

The new exam is part of an ongoing effort by ABS to revamp its maintenance of certification requirements after widespread criticism that its past provisions were burdensome and irrelevant. In July, ABS announced that it was extending its continuing medical education reporting cycle from 3 to 5 years and reducing the number of required self-assessment by a third. Surgeons now have to report 150 credits over 5 years, 50 from self-assessment CMEs. Under the old system, it was 90 credits over 3 years, 60 of which had to include self-assessment.

After the July announcement, ABS sent surveys to all diplomates to gather feedback about alternatives to the 10-year exam. Nearly 10,000 surgeons responded, according to an ABS summary. The majority of respondents said they wanted more frequent, lower-stakes, open-book assessments that would be required no frequently than every 2 years. Most surgeons were also in favor of being tested on both surgery concepts and practice-specific content.

For 2019 and beyond, the ABS’ Component Boards – Vascular, Pediatric Surgery, Surgical, and Critical Care – will develop their continuous certification processes, Dr. Klingensmith said. Additional areas for the surgery exam also will be developed in collaboration with specialty societies.

In the meantime, registration for the new general surgery assessment opens Aug. 1. The assessment will be available from Sept. 7 to Nov. 5, during which time diplomates can take the assessment at their convenience.

For more information, go to the continuous certification section on the ABS website.

[email protected]

The American Board of Surgery (ABS) has unveiled a shorter, more flexible assessment to take the place of the dreaded 10-year, pass-fail exam to maintain certification.

The new test, required every other year, consists of a 40-question, open-book assessment that surgeons can take on their own computers within the assessment time frame, according to a March 5 announcement. The previous 10-year exam consisted of nearly 250 questions and had to be completed at a highly secure testing center.

The assessment shift was made to address diplomates’ concerns that the prior exam was burdensome, stressful, and challenging to complete because of its rigid design and location requirements, ABS Chair Mary E. Klingensmith, MD, FACS, said in an interview.

“This new method, which allows a take-from-home or office format, is much less stressful, as both the setting, and the ability to choose the content area, give diplomates much more control,” Dr. Klingensmith said. “Additionally, the testing concepts and references will be provided in advance, should a diplomate desire to know these aspects.”

On March 11, the American College of Surgeons released a statement regarding the new assessment and suggested that, while the new approach is welcomed by the ACS, some details of the process are of concern to surgeons. “The American College of Surgeons (ACS) leadership has heard your concerns both through personal conversations with many of you and through your posts on ACS Communities. In fact, many in leadership share these concerns. We have been in discussions with ABS leadership and can tell you that they are also listening. They want to get this right.”

Of the 40 questions on the new exam, 20 questions will cover core surgical principles, while the other 20 will cover a practice-related area of the diplomate’s choosing. For 2018, diplomates can select from four practice-related areas: general surgery, abdomen, alimentary tract, or breast. More areas are planned based on future feedback from diplomates and surgical societies. Other aspects of the new exam include:

• Topics and references for the various areas will be published in advance on the ABS website.
• Diplomates will be provided with immediate feedback, and will have two opportunities to answer a question correctly.
• A final score of 80% correct will be required to pass.
• Once the assessment is started, diplomates will have 2 weeks to complete the test, with the ability to save and continue when convenient.

The purpose of the new assessment is to provide practicing surgeons with a timely, relevant, and accessible method to stay current with surgical practice knowledge,” Dr. Klingensmith said.

“By selecting a practice-specific area of their own choosing, surgeons will no longer have to study for and be tested upon the entire breadth of general surgery; instead they can focus on those areas that most reflect their practice,” she said. “By submitting to a learning exercise every 2 years, which is focused in the areas of an individual surgeon’s practice, I expect important aspects of knowledge will be transmitted and integrated into a surgeon’s practice. This new program will provide practicing surgeons with an accessible method for keeping up with the constantly changing landscape of surgical practice.”

The new exam is part of an ongoing effort by ABS to revamp its maintenance of certification requirements after widespread criticism that its past provisions were burdensome and irrelevant. In July, ABS announced that it was extending its continuing medical education reporting cycle from 3 to 5 years and reducing the number of required self-assessment by a third. Surgeons now have to report 150 credits over 5 years, 50 from self-assessment CMEs. Under the old system, it was 90 credits over 3 years, 60 of which had to include self-assessment.

After the July announcement, ABS sent surveys to all diplomates to gather feedback about alternatives to the 10-year exam. Nearly 10,000 surgeons responded, according to an ABS summary. The majority of respondents said they wanted more frequent, lower-stakes, open-book assessments that would be required no frequently than every 2 years. Most surgeons were also in favor of being tested on both surgery concepts and practice-specific content.

For 2019 and beyond, the ABS’ Component Boards – Vascular, Pediatric Surgery, Surgical, and Critical Care – will develop their continuous certification processes, Dr. Klingensmith said. Additional areas for the surgery exam also will be developed in collaboration with specialty societies.

In the meantime, registration for the new general surgery assessment opens Aug. 1. The assessment will be available from Sept. 7 to Nov. 5, during which time diplomates can take the assessment at their convenience.

For more information, go to the continuous certification section on the ABS website.

[email protected]

The American Board of Surgery (ABS) has unveiled a shorter, more flexible assessment to take the place of the dreaded 10-year, pass-fail exam to maintain certification.

The new test, required every other year, consists of a 40-question, open-book assessment that surgeons can take on their own computers within the assessment time frame, according to a March 5 announcement. The previous 10-year exam consisted of nearly 250 questions and had to be completed at a highly secure testing center.

The assessment shift was made to address diplomates’ concerns that the prior exam was burdensome, stressful, and challenging to complete because of its rigid design and location requirements, ABS Chair Mary E. Klingensmith, MD, FACS, said in an interview.

“This new method, which allows a take-from-home or office format, is much less stressful, as both the setting, and the ability to choose the content area, give diplomates much more control,” Dr. Klingensmith said. “Additionally, the testing concepts and references will be provided in advance, should a diplomate desire to know these aspects.”

On March 11, the American College of Surgeons released a statement regarding the new assessment and suggested that, while the new approach is welcomed by the ACS, some details of the process are of concern to surgeons. “The American College of Surgeons (ACS) leadership has heard your concerns both through personal conversations with many of you and through your posts on ACS Communities. In fact, many in leadership share these concerns. We have been in discussions with ABS leadership and can tell you that they are also listening. They want to get this right.”

Of the 40 questions on the new exam, 20 questions will cover core surgical principles, while the other 20 will cover a practice-related area of the diplomate’s choosing. For 2018, diplomates can select from four practice-related areas: general surgery, abdomen, alimentary tract, or breast. More areas are planned based on future feedback from diplomates and surgical societies. Other aspects of the new exam include:

• Topics and references for the various areas will be published in advance on the ABS website.
• Diplomates will be provided with immediate feedback, and will have two opportunities to answer a question correctly.
• A final score of 80% correct will be required to pass.
• Once the assessment is started, diplomates will have 2 weeks to complete the test, with the ability to save and continue when convenient.

The purpose of the new assessment is to provide practicing surgeons with a timely, relevant, and accessible method to stay current with surgical practice knowledge,” Dr. Klingensmith said.

“By selecting a practice-specific area of their own choosing, surgeons will no longer have to study for and be tested upon the entire breadth of general surgery; instead they can focus on those areas that most reflect their practice,” she said. “By submitting to a learning exercise every 2 years, which is focused in the areas of an individual surgeon’s practice, I expect important aspects of knowledge will be transmitted and integrated into a surgeon’s practice. This new program will provide practicing surgeons with an accessible method for keeping up with the constantly changing landscape of surgical practice.”

The new exam is part of an ongoing effort by ABS to revamp its maintenance of certification requirements after widespread criticism that its past provisions were burdensome and irrelevant. In July, ABS announced that it was extending its continuing medical education reporting cycle from 3 to 5 years and reducing the number of required self-assessment by a third. Surgeons now have to report 150 credits over 5 years, 50 from self-assessment CMEs. Under the old system, it was 90 credits over 3 years, 60 of which had to include self-assessment.

After the July announcement, ABS sent surveys to all diplomates to gather feedback about alternatives to the 10-year exam. Nearly 10,000 surgeons responded, according to an ABS summary. The majority of respondents said they wanted more frequent, lower-stakes, open-book assessments that would be required no frequently than every 2 years. Most surgeons were also in favor of being tested on both surgery concepts and practice-specific content.

For 2019 and beyond, the ABS’ Component Boards – Vascular, Pediatric Surgery, Surgical, and Critical Care – will develop their continuous certification processes, Dr. Klingensmith said. Additional areas for the surgery exam also will be developed in collaboration with specialty societies.

In the meantime, registration for the new general surgery assessment opens Aug. 1. The assessment will be available from Sept. 7 to Nov. 5, during which time diplomates can take the assessment at their convenience.

For more information, go to the continuous certification section on the ABS website.

[email protected]

More than one-quarter of initial emergency department (ED) visits for migraine are followed by headache revisits in fewer than six months, according to a retrospective study of New York City hospitals. Reporting in the March issue of Headache, Mia T. Minen, MD, MPH, and colleagues found that among patients discharged from the ED with a diagnosis of migraine, 12.5% revisit the same ED for headache more than once within six months. “Targeted interventions might … decrease the frequency of headache revisits,” said Dr. Minen and colleagues. Dr. Minen is Director of Headache Services at NYU Langone Headache Center in New York City.

Migraine causes more than 1.2 million visits to US EDs annually. Many of these visits are revisits among patients who have already been treated in an ED for migraine. Dr. Minen and colleagues sought to determine the frequency of these headache revisits and the sociodemographic factors associated with them.

A Study of New York City EDs

Using the New York City Department of Health and Mental Hygiene Syndromic Surveillance database, Dr. Minen and colleagues conducted a retrospective nested cohort study. They analyzed visits from 18 New York City EDs with discharge diagnoses in the first six months of 2015. They then conducted descriptive analyses to determine the frequency of headache revisits within six months of an index ED visit for migraine and the elapsed time to revisit. Using multivariable logistic regression, the researchers assessed associations between age, sex, poverty, and revisit.

Of 1,052 ED visits with a discharge diagnosis of migraine during the first six months of 2015, 277 (26.3%) had a headache revisit within six months of their initial migraine visit, and 131 (12.5%) had two or more revisits at the same hospital. Of the revisits for headache, 9% occurred within 72 hours, and 46% occurred within 90 days of the initial migraine visit. Sex, age, and poverty were not associated with an ED revisit.

Noting that the revisit rate in New York City EDs was similar to the 30.3% revisit rate in a prior study in Maine EDs, the researchers said that frequent revisits for headache are not surprising. “Migraine is a recurrent headache disorder, and 80% of headache patients in the ED do not visit a clinic, primary care physician, or specialist before visiting the ED. In one urban ED, nearly 60% of ED patients were not instructed to follow-up with a physician, and approximately 40% were not prescribed medications.”

Potentially Preventable

Several approaches could decrease headache revisits, the researchers said. “Within the ED, the use of evidence-based algorithms can aid in the standardization of headache diagnosis and treatment. These should include the use of dexamethasone, an evidence-based intervention to decrease the frequency of moderate or severe headache within 48 hours of ED discharge.” On discharge from the ED, patients should be advised about local headache treatment facilities. “Because ED patients with migraine and psychiatric comorbidities have higher health care utilization rates than migraine patients without psychiatric comorbidities, migraine patients with comorbid psychiatric disorders could be referred to an ED case manager to ensure further intervention.” Finally, “ED revisits for headache could be mitigated by increasing the availability and access to urgent care appointments or walk-in outpatient appointments, especially during off-hour nights and weekends,” they said.

—Glenn S. Williams

Suggested Reading

Minen MT, Boubour A, Wahnich A, et al. A retrospective nested cohort study of emergency department revisits for migraine in New York City. Headache. 2018;58(3):399-406.

More than one-quarter of initial emergency department (ED) visits for migraine are followed by headache revisits in fewer than six months, according to a retrospective study of New York City hospitals. Reporting in the March issue of Headache, Mia T. Minen, MD, MPH, and colleagues found that among patients discharged from the ED with a diagnosis of migraine, 12.5% revisit the same ED for headache more than once within six months. “Targeted interventions might … decrease the frequency of headache revisits,” said Dr. Minen and colleagues. Dr. Minen is Director of Headache Services at NYU Langone Headache Center in New York City.

Migraine causes more than 1.2 million visits to US EDs annually. Many of these visits are revisits among patients who have already been treated in an ED for migraine. Dr. Minen and colleagues sought to determine the frequency of these headache revisits and the sociodemographic factors associated with them.

A Study of New York City EDs

Using the New York City Department of Health and Mental Hygiene Syndromic Surveillance database, Dr. Minen and colleagues conducted a retrospective nested cohort study. They analyzed visits from 18 New York City EDs with discharge diagnoses in the first six months of 2015. They then conducted descriptive analyses to determine the frequency of headache revisits within six months of an index ED visit for migraine and the elapsed time to revisit. Using multivariable logistic regression, the researchers assessed associations between age, sex, poverty, and revisit.

Of 1,052 ED visits with a discharge diagnosis of migraine during the first six months of 2015, 277 (26.3%) had a headache revisit within six months of their initial migraine visit, and 131 (12.5%) had two or more revisits at the same hospital. Of the revisits for headache, 9% occurred within 72 hours, and 46% occurred within 90 days of the initial migraine visit. Sex, age, and poverty were not associated with an ED revisit.

Noting that the revisit rate in New York City EDs was similar to the 30.3% revisit rate in a prior study in Maine EDs, the researchers said that frequent revisits for headache are not surprising. “Migraine is a recurrent headache disorder, and 80% of headache patients in the ED do not visit a clinic, primary care physician, or specialist before visiting the ED. In one urban ED, nearly 60% of ED patients were not instructed to follow-up with a physician, and approximately 40% were not prescribed medications.”

Potentially Preventable

Several approaches could decrease headache revisits, the researchers said. “Within the ED, the use of evidence-based algorithms can aid in the standardization of headache diagnosis and treatment. These should include the use of dexamethasone, an evidence-based intervention to decrease the frequency of moderate or severe headache within 48 hours of ED discharge.” On discharge from the ED, patients should be advised about local headache treatment facilities. “Because ED patients with migraine and psychiatric comorbidities have higher health care utilization rates than migraine patients without psychiatric comorbidities, migraine patients with comorbid psychiatric disorders could be referred to an ED case manager to ensure further intervention.” Finally, “ED revisits for headache could be mitigated by increasing the availability and access to urgent care appointments or walk-in outpatient appointments, especially during off-hour nights and weekends,” they said.

—Glenn S. Williams

Suggested Reading

Minen MT, Boubour A, Wahnich A, et al. A retrospective nested cohort study of emergency department revisits for migraine in New York City. Headache. 2018;58(3):399-406.

More than one-quarter of initial emergency department (ED) visits for migraine are followed by headache revisits in fewer than six months, according to a retrospective study of New York City hospitals. Reporting in the March issue of Headache, Mia T. Minen, MD, MPH, and colleagues found that among patients discharged from the ED with a diagnosis of migraine, 12.5% revisit the same ED for headache more than once within six months. “Targeted interventions might … decrease the frequency of headache revisits,” said Dr. Minen and colleagues. Dr. Minen is Director of Headache Services at NYU Langone Headache Center in New York City.

Migraine causes more than 1.2 million visits to US EDs annually. Many of these visits are revisits among patients who have already been treated in an ED for migraine. Dr. Minen and colleagues sought to determine the frequency of these headache revisits and the sociodemographic factors associated with them.

A Study of New York City EDs

Using the New York City Department of Health and Mental Hygiene Syndromic Surveillance database, Dr. Minen and colleagues conducted a retrospective nested cohort study. They analyzed visits from 18 New York City EDs with discharge diagnoses in the first six months of 2015. They then conducted descriptive analyses to determine the frequency of headache revisits within six months of an index ED visit for migraine and the elapsed time to revisit. Using multivariable logistic regression, the researchers assessed associations between age, sex, poverty, and revisit.

Of 1,052 ED visits with a discharge diagnosis of migraine during the first six months of 2015, 277 (26.3%) had a headache revisit within six months of their initial migraine visit, and 131 (12.5%) had two or more revisits at the same hospital. Of the revisits for headache, 9% occurred within 72 hours, and 46% occurred within 90 days of the initial migraine visit. Sex, age, and poverty were not associated with an ED revisit.

Noting that the revisit rate in New York City EDs was similar to the 30.3% revisit rate in a prior study in Maine EDs, the researchers said that frequent revisits for headache are not surprising. “Migraine is a recurrent headache disorder, and 80% of headache patients in the ED do not visit a clinic, primary care physician, or specialist before visiting the ED. In one urban ED, nearly 60% of ED patients were not instructed to follow-up with a physician, and approximately 40% were not prescribed medications.”

Potentially Preventable

Several approaches could decrease headache revisits, the researchers said. “Within the ED, the use of evidence-based algorithms can aid in the standardization of headache diagnosis and treatment. These should include the use of dexamethasone, an evidence-based intervention to decrease the frequency of moderate or severe headache within 48 hours of ED discharge.” On discharge from the ED, patients should be advised about local headache treatment facilities. “Because ED patients with migraine and psychiatric comorbidities have higher health care utilization rates than migraine patients without psychiatric comorbidities, migraine patients with comorbid psychiatric disorders could be referred to an ED case manager to ensure further intervention.” Finally, “ED revisits for headache could be mitigated by increasing the availability and access to urgent care appointments or walk-in outpatient appointments, especially during off-hour nights and weekends,” they said.

—Glenn S. Williams

Suggested Reading

Minen MT, Boubour A, Wahnich A, et al. A retrospective nested cohort study of emergency department revisits for migraine in New York City. Headache. 2018;58(3):399-406.

Americans spent more money on insulin glargine in 2015 than any other drug, and more than half of the 20 biggest-selling drugs for the year are regularly prescribed to patients with diabetes, according to the Agency for Healthcare Research and Quality.

The drugs in the MEPS top 10 for 2015 – the most recent year for which data are available – that are not commonly prescribed for diabetes were the asthma/chronic obstructive pulmonary drug fluticasone-salmeterol (third at $6.7 billion), the gastroesophageal reflux disease drug esomeprazole (fifth at $5.3 billion), and aripiprazole (sixth at $5.2 billion), which is used to treat schizophrenia and bipolar disorder.

[email protected]

Americans spent more money on insulin glargine in 2015 than any other drug, and more than half of the 20 biggest-selling drugs for the year are regularly prescribed to patients with diabetes, according to the Agency for Healthcare Research and Quality.

The drugs in the MEPS top 10 for 2015 – the most recent year for which data are available – that are not commonly prescribed for diabetes were the asthma/chronic obstructive pulmonary drug fluticasone-salmeterol (third at $6.7 billion), the gastroesophageal reflux disease drug esomeprazole (fifth at $5.3 billion), and aripiprazole (sixth at $5.2 billion), which is used to treat schizophrenia and bipolar disorder.

[email protected]

Americans spent more money on insulin glargine in 2015 than any other drug, and more than half of the 20 biggest-selling drugs for the year are regularly prescribed to patients with diabetes, according to the Agency for Healthcare Research and Quality.

The drugs in the MEPS top 10 for 2015 – the most recent year for which data are available – that are not commonly prescribed for diabetes were the asthma/chronic obstructive pulmonary drug fluticasone-salmeterol (third at $6.7 billion), the gastroesophageal reflux disease drug esomeprazole (fifth at $5.3 billion), and aripiprazole (sixth at $5.2 billion), which is used to treat schizophrenia and bipolar disorder.

[email protected]

Myth: Eczema has a minimal impact on patients’ daily activities

Although eczema may be considered a relatively mild skin condition, the effects of the disease can be debilitating for many patients. Low quality of life (QoL) due to eczema flares and trigger avoidance can lead to decreased productivity in this population, and patients often report interference of the disease with participation in daily life, including activities at work and school.

In a series of patient satisfaction surveys administered by the National Eczema Foundation, 75% of adults with eczema said their disease interferes with their job and household chores. A study of 380 adult atopic dermatitis (AD) patients assessing the impact of the disease on QoL showed similar results, as 39.0% of participants said AD impacted shopping, home, and garden activities a lot or very much and 36.8% said it impacted these activities a little. Additionally, reports from caregivers of children with AD indicated that nearly 50% of children miss at least 1 day of the school year due to their disease, and 17% miss 5 or more days. Over time, these limitations can have a serious psychological impact in eczema patients of any age.

In the National Eczema Foundation survey, 71% of respondents said their disease also gets in the way of participating in sports or hobbies. Eczema patients may miss out on the physical and mental health benefits of activities associated with increased body temperature or prolonged contact with sports equipment, which can exacerbate symptoms. In general, outdoor activities in all seasons can be particularly troublesome in this population, as eczema flares can be triggered by cold or hot temperatures, humidity, wind, dry air, sun exposure, pollution, and contact with allergens like pollen or mold.

The impact of eczema treatments on patients’ daily activities also should be considered when evaluating QoL in this population, as it frequently takes considerable time out of a patient’s day to manage his/her disease. Control of symptoms often requires a multistep daily regimen involving medication, bathing, moisturizing, applying wet compresses, ridding the house of allergens, and/or cleaning sheets and clothing. According to the National Eczema Foundation survey, 1 in 3 respondents said it takes 1 or more hours per day to treat their disease. To encourage adherence and ensure optimal outcomes, physicians should work with patients to develop an eczema treatment plan that is both effective and manageable in terms of their daily routines.

Ultimately, the disease burden in eczema patients is multidimensional, extending beyond only cutaneous symptoms; therefore, it is important for clinicians to consider the impact on QoL when choosing treatments for patients with eczema and to initiate appropriate therapy at the onset of disease presentation to mitigate the effects of the condition on patients’ daily lives. Eczema management strategies should include QoL screening to ensure the disease has a minimal impact on patients' daily lives and preferred activities.

Myth: Eczema has a minimal impact on patients’ daily activities

Although eczema may be considered a relatively mild skin condition, the effects of the disease can be debilitating for many patients. Low quality of life (QoL) due to eczema flares and trigger avoidance can lead to decreased productivity in this population, and patients often report interference of the disease with participation in daily life, including activities at work and school.

In a series of patient satisfaction surveys administered by the National Eczema Foundation, 75% of adults with eczema said their disease interferes with their job and household chores. A study of 380 adult atopic dermatitis (AD) patients assessing the impact of the disease on QoL showed similar results, as 39.0% of participants said AD impacted shopping, home, and garden activities a lot or very much and 36.8% said it impacted these activities a little. Additionally, reports from caregivers of children with AD indicated that nearly 50% of children miss at least 1 day of the school year due to their disease, and 17% miss 5 or more days. Over time, these limitations can have a serious psychological impact in eczema patients of any age.

In the National Eczema Foundation survey, 71% of respondents said their disease also gets in the way of participating in sports or hobbies. Eczema patients may miss out on the physical and mental health benefits of activities associated with increased body temperature or prolonged contact with sports equipment, which can exacerbate symptoms. In general, outdoor activities in all seasons can be particularly troublesome in this population, as eczema flares can be triggered by cold or hot temperatures, humidity, wind, dry air, sun exposure, pollution, and contact with allergens like pollen or mold.

The impact of eczema treatments on patients’ daily activities also should be considered when evaluating QoL in this population, as it frequently takes considerable time out of a patient’s day to manage his/her disease. Control of symptoms often requires a multistep daily regimen involving medication, bathing, moisturizing, applying wet compresses, ridding the house of allergens, and/or cleaning sheets and clothing. According to the National Eczema Foundation survey, 1 in 3 respondents said it takes 1 or more hours per day to treat their disease. To encourage adherence and ensure optimal outcomes, physicians should work with patients to develop an eczema treatment plan that is both effective and manageable in terms of their daily routines.

Ultimately, the disease burden in eczema patients is multidimensional, extending beyond only cutaneous symptoms; therefore, it is important for clinicians to consider the impact on QoL when choosing treatments for patients with eczema and to initiate appropriate therapy at the onset of disease presentation to mitigate the effects of the condition on patients’ daily lives. Eczema management strategies should include QoL screening to ensure the disease has a minimal impact on patients' daily lives and preferred activities.

Myth: Eczema has a minimal impact on patients’ daily activities

Although eczema may be considered a relatively mild skin condition, the effects of the disease can be debilitating for many patients. Low quality of life (QoL) due to eczema flares and trigger avoidance can lead to decreased productivity in this population, and patients often report interference of the disease with participation in daily life, including activities at work and school.

In a series of patient satisfaction surveys administered by the National Eczema Foundation, 75% of adults with eczema said their disease interferes with their job and household chores. A study of 380 adult atopic dermatitis (AD) patients assessing the impact of the disease on QoL showed similar results, as 39.0% of participants said AD impacted shopping, home, and garden activities a lot or very much and 36.8% said it impacted these activities a little. Additionally, reports from caregivers of children with AD indicated that nearly 50% of children miss at least 1 day of the school year due to their disease, and 17% miss 5 or more days. Over time, these limitations can have a serious psychological impact in eczema patients of any age.

In the National Eczema Foundation survey, 71% of respondents said their disease also gets in the way of participating in sports or hobbies. Eczema patients may miss out on the physical and mental health benefits of activities associated with increased body temperature or prolonged contact with sports equipment, which can exacerbate symptoms. In general, outdoor activities in all seasons can be particularly troublesome in this population, as eczema flares can be triggered by cold or hot temperatures, humidity, wind, dry air, sun exposure, pollution, and contact with allergens like pollen or mold.

The impact of eczema treatments on patients’ daily activities also should be considered when evaluating QoL in this population, as it frequently takes considerable time out of a patient’s day to manage his/her disease. Control of symptoms often requires a multistep daily regimen involving medication, bathing, moisturizing, applying wet compresses, ridding the house of allergens, and/or cleaning sheets and clothing. According to the National Eczema Foundation survey, 1 in 3 respondents said it takes 1 or more hours per day to treat their disease. To encourage adherence and ensure optimal outcomes, physicians should work with patients to develop an eczema treatment plan that is both effective and manageable in terms of their daily routines.

Ultimately, the disease burden in eczema patients is multidimensional, extending beyond only cutaneous symptoms; therefore, it is important for clinicians to consider the impact on QoL when choosing treatments for patients with eczema and to initiate appropriate therapy at the onset of disease presentation to mitigate the effects of the condition on patients’ daily lives. Eczema management strategies should include QoL screening to ensure the disease has a minimal impact on patients' daily lives and preferred activities.

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

This month, The Hospitalist spotlights Kathleen Finn, MD, M. Phil, FACP, FHM, the inpatient associate program director of the internal medicine residency program at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School, both in Boston. Dr. Finn has been a member of the Society of Hospital Medicine’s Annual Conference Committee for the past 8 years and is the course director for Hospital Medicine 2018 (HM18), to be held April 8-11 in Orlando.
 

When did you become a member of SHM, and how did you initially become involved with the Annual Conference Committee?

I became involved with the Annual Conference Committee 8 years ago because of my interest in education. Being a founding member of the SHM Boston Chapter, I gained experience planning the quarterly local chapter meetings. As a clinical educator and hospitalist, I was involved in planning conferences for faculty at my hospital. I found I really enjoyed developing educational conferences and curriculum, so when I heard about the Annual Conference Committee, I thought it would be a perfect fit.

It’s been a great experience getting to know committee members from all over the country and hearing their thoughts about the annual conference. It’s always exciting to brainstorm topic ideas and think about what would interest conference attendees.

Describe your role as course director.

My job as course director is to challenge committee members to be as creative as possible and help focus the discussion around the needs of SHM members while keeping to a schedule. I led a team of 23 amazing committee members through the planning stages for HM18 this past summer. With the help of Brittany Evans, SHM’s Education and Meetings Project Manager, and Dustin Smith, MD, FHM, the cocourse director, the committee reviewed prior conference agendas and feedback from attendees and from other SHM committees. Using that information, we discussed, brainstormed, voted on, and planned this year’s clinical content talks, workshops, and many of the specialty tracks.

What are you most looking forward to at HM18?

I am looking forward to the entire meeting! First, the location is exciting since this is our first time in Orlando. I’m curious to see what the facility is like, and I am hoping attendees use the location as a reason to bring their families and visit the theme parks. In recognition of our Orlando location, the committee got creative with titles for the conference. For example, geriatrics became “The Tale as Old as Time.” I hope some of the titles put a smile on the attendees’ faces.

I am also eagerly anticipating the nationally recognized speakers. We invited the best speakers we know from both subspecialty backgrounds and fellow hospitalists, and given the Orlando location, we tried to feature the best speakers from the Southeast. Finally, I am looking forward to the diversity of topics. The committee really thought broadly about relevant topics to today’s practicing hospitalists.

What will be new and different for attendees at HM18 in comparison to previous annual conferences?

There are many new things this year. Given the field of hospital medicine is now more than 20 years old, the committee thought it was important to focus on career development – not just for new hospitalists, but midcareer hospitalists as well. How do you make hospital medicine a lifelong, enjoyable, and engaging career? To explore and answer these questions, the Annual Conference Committee created several new tracks for HM18.

We created a Seasoning Your Career track that offers ideas on how to change your role midcareer – how to advance to a leadership position, how to use emotional intelligence to achieve success, how to prevent burnout, and, best of all, how to consider and change your hospitalist group’s work schedule, which rules our lives and our families’ lives. We also added financial planning advice to help you prepare for retirement.

Another new track at HM18 is the Career Development Workshops track, which includes a diversity of workshops meant to help build leadership skills, develop presentation/communication skills, encourage peers to give each other feedback, promote women in hospital medicine, prevent burnout, and turn ideas into clinical research. The Medical Education track also has a session on how to break into educational roles, especially if you want to expand your career into a leadership position in medical education.

In addition to Seasoning Your Career and Career Development Workshops, we have three other new tracks: Palliative Care, NP/PA, and The Great Debate. The Great Debate track uses the popular format of the perioperative debate given every year at the annual conference to tackle topics in infectious disease and pulmonary medicine. We ask very talented, opinionated, and humorous speakers to debate with each other over clinical content; it will be a great “smack down!”

Other new things for HM18 include:

• An interventional radiologist will speak about the latest procedures and when to refer your patients.
• A few surgeons will talk about managing surgical patients on your service and about decubitus ulcers.
• An oncologist will discuss the complications of the latest advanced agents on the wards.
• A rheumatologist will discuss the complications of new biologic agents.
• A rehab specialist will discuss the benefits and limitations of physical/occupational therapists and physiatrists.
• A speaker will discussing vulnerable populations, focusing on the social determinants of health, which last year’s HM17 plenary speaker Karen DeSalvo, MD, MPH, MSc raised as an important issue.
• There will be an “Updates in Addiction Medicine” lecture.
• There will be a new cardiology precourse and an expanded infectious disease precourse, which will also focus on sepsis.

How has the committee worked to ensure the course content is refreshed and current?

The reason the Annual Conference Committee is large is to ensure that there is a diversity of voices and talents from all over the country. There are both academic and community hospitalists on the committee; its members represent internal medicine, family medicine, pediatrics, and subspecialists, as well as administrators and hospitalist leaders. The annual meetings are planned over 3-4 months via weekly calls. In between calls, committee members are encouraged to discuss topics with their colleagues at home for opinions and advice.

The best ideas from the committee come from the group discussion and brainstorming. Someone mentions a topic, which leads someone else to add to it, and so on. Within the hour, we have some fantastic suggestions that the committee can run with. We also rely on input from SHM members: For example, many of the workshops’ topics are chosen from hundreds of submissions from members; speaker and content suggestions are submitted by hospitalist leaders from around the country and thereby provide insight into current topics. Combined, these offer a richness of ideas, which allows the committee to stay up to date and refresh old ideas.
 

What advice can you offer to early career hospitalists looking to get involved with the Annual Conference Committee or other conference planning roles?

My advice for early career hospitalists is to start locally. Join your local SHM chapter, or start one. In trying to plan local conferences, you begin to figure out which content areas interest hospitalists and how they can best be delivered. You might offer to give a talk at your local chapter or at your hospital and develop presentation skills. Developing a network of fellow hospitalists through your local chapter is important. The more local hospitalists you connect with, the more likely it is that they will think of you when they are planning a conference. At the national level, consider submitting a workshop or submitting an idea for content. Workshops are a great way to get recognized at the national level.

The Annual Conference Committee takes applications every year. Once you have some experience planning conferences or coordinating speakers, it would definitely be worth applying. You may not be selected your first year, but do not let that discourage you! Demonstrating interest and perseverance goes a long way. There are also many other national SHM committees to join and other ways to get involved. Your willingness to provide some of your time makes the society – and the specialty – what it is.
 

Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.

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

This month, The Hospitalist spotlights Kathleen Finn, MD, M. Phil, FACP, FHM, the inpatient associate program director of the internal medicine residency program at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School, both in Boston. Dr. Finn has been a member of the Society of Hospital Medicine’s Annual Conference Committee for the past 8 years and is the course director for Hospital Medicine 2018 (HM18), to be held April 8-11 in Orlando.
 

When did you become a member of SHM, and how did you initially become involved with the Annual Conference Committee?

I became involved with the Annual Conference Committee 8 years ago because of my interest in education. Being a founding member of the SHM Boston Chapter, I gained experience planning the quarterly local chapter meetings. As a clinical educator and hospitalist, I was involved in planning conferences for faculty at my hospital. I found I really enjoyed developing educational conferences and curriculum, so when I heard about the Annual Conference Committee, I thought it would be a perfect fit.

It’s been a great experience getting to know committee members from all over the country and hearing their thoughts about the annual conference. It’s always exciting to brainstorm topic ideas and think about what would interest conference attendees.

Describe your role as course director.

My job as course director is to challenge committee members to be as creative as possible and help focus the discussion around the needs of SHM members while keeping to a schedule. I led a team of 23 amazing committee members through the planning stages for HM18 this past summer. With the help of Brittany Evans, SHM’s Education and Meetings Project Manager, and Dustin Smith, MD, FHM, the cocourse director, the committee reviewed prior conference agendas and feedback from attendees and from other SHM committees. Using that information, we discussed, brainstormed, voted on, and planned this year’s clinical content talks, workshops, and many of the specialty tracks.

What are you most looking forward to at HM18?

I am looking forward to the entire meeting! First, the location is exciting since this is our first time in Orlando. I’m curious to see what the facility is like, and I am hoping attendees use the location as a reason to bring their families and visit the theme parks. In recognition of our Orlando location, the committee got creative with titles for the conference. For example, geriatrics became “The Tale as Old as Time.” I hope some of the titles put a smile on the attendees’ faces.

I am also eagerly anticipating the nationally recognized speakers. We invited the best speakers we know from both subspecialty backgrounds and fellow hospitalists, and given the Orlando location, we tried to feature the best speakers from the Southeast. Finally, I am looking forward to the diversity of topics. The committee really thought broadly about relevant topics to today’s practicing hospitalists.

What will be new and different for attendees at HM18 in comparison to previous annual conferences?

There are many new things this year. Given the field of hospital medicine is now more than 20 years old, the committee thought it was important to focus on career development – not just for new hospitalists, but midcareer hospitalists as well. How do you make hospital medicine a lifelong, enjoyable, and engaging career? To explore and answer these questions, the Annual Conference Committee created several new tracks for HM18.

We created a Seasoning Your Career track that offers ideas on how to change your role midcareer – how to advance to a leadership position, how to use emotional intelligence to achieve success, how to prevent burnout, and, best of all, how to consider and change your hospitalist group’s work schedule, which rules our lives and our families’ lives. We also added financial planning advice to help you prepare for retirement.

Another new track at HM18 is the Career Development Workshops track, which includes a diversity of workshops meant to help build leadership skills, develop presentation/communication skills, encourage peers to give each other feedback, promote women in hospital medicine, prevent burnout, and turn ideas into clinical research. The Medical Education track also has a session on how to break into educational roles, especially if you want to expand your career into a leadership position in medical education.

In addition to Seasoning Your Career and Career Development Workshops, we have three other new tracks: Palliative Care, NP/PA, and The Great Debate. The Great Debate track uses the popular format of the perioperative debate given every year at the annual conference to tackle topics in infectious disease and pulmonary medicine. We ask very talented, opinionated, and humorous speakers to debate with each other over clinical content; it will be a great “smack down!”

Other new things for HM18 include:

• An interventional radiologist will speak about the latest procedures and when to refer your patients.
• A few surgeons will talk about managing surgical patients on your service and about decubitus ulcers.
• An oncologist will discuss the complications of the latest advanced agents on the wards.
• A rheumatologist will discuss the complications of new biologic agents.
• A rehab specialist will discuss the benefits and limitations of physical/occupational therapists and physiatrists.
• A speaker will discussing vulnerable populations, focusing on the social determinants of health, which last year’s HM17 plenary speaker Karen DeSalvo, MD, MPH, MSc raised as an important issue.
• There will be an “Updates in Addiction Medicine” lecture.
• There will be a new cardiology precourse and an expanded infectious disease precourse, which will also focus on sepsis.

How has the committee worked to ensure the course content is refreshed and current?

The reason the Annual Conference Committee is large is to ensure that there is a diversity of voices and talents from all over the country. There are both academic and community hospitalists on the committee; its members represent internal medicine, family medicine, pediatrics, and subspecialists, as well as administrators and hospitalist leaders. The annual meetings are planned over 3-4 months via weekly calls. In between calls, committee members are encouraged to discuss topics with their colleagues at home for opinions and advice.

The best ideas from the committee come from the group discussion and brainstorming. Someone mentions a topic, which leads someone else to add to it, and so on. Within the hour, we have some fantastic suggestions that the committee can run with. We also rely on input from SHM members: For example, many of the workshops’ topics are chosen from hundreds of submissions from members; speaker and content suggestions are submitted by hospitalist leaders from around the country and thereby provide insight into current topics. Combined, these offer a richness of ideas, which allows the committee to stay up to date and refresh old ideas.
 

What advice can you offer to early career hospitalists looking to get involved with the Annual Conference Committee or other conference planning roles?

My advice for early career hospitalists is to start locally. Join your local SHM chapter, or start one. In trying to plan local conferences, you begin to figure out which content areas interest hospitalists and how they can best be delivered. You might offer to give a talk at your local chapter or at your hospital and develop presentation skills. Developing a network of fellow hospitalists through your local chapter is important. The more local hospitalists you connect with, the more likely it is that they will think of you when they are planning a conference. At the national level, consider submitting a workshop or submitting an idea for content. Workshops are a great way to get recognized at the national level.

The Annual Conference Committee takes applications every year. Once you have some experience planning conferences or coordinating speakers, it would definitely be worth applying. You may not be selected your first year, but do not let that discourage you! Demonstrating interest and perseverance goes a long way. There are also many other national SHM committees to join and other ways to get involved. Your willingness to provide some of your time makes the society – and the specialty – what it is.
 

Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.

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

This month, The Hospitalist spotlights Kathleen Finn, MD, M. Phil, FACP, FHM, the inpatient associate program director of the internal medicine residency program at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School, both in Boston. Dr. Finn has been a member of the Society of Hospital Medicine’s Annual Conference Committee for the past 8 years and is the course director for Hospital Medicine 2018 (HM18), to be held April 8-11 in Orlando.
 

When did you become a member of SHM, and how did you initially become involved with the Annual Conference Committee?

I became involved with the Annual Conference Committee 8 years ago because of my interest in education. Being a founding member of the SHM Boston Chapter, I gained experience planning the quarterly local chapter meetings. As a clinical educator and hospitalist, I was involved in planning conferences for faculty at my hospital. I found I really enjoyed developing educational conferences and curriculum, so when I heard about the Annual Conference Committee, I thought it would be a perfect fit.

It’s been a great experience getting to know committee members from all over the country and hearing their thoughts about the annual conference. It’s always exciting to brainstorm topic ideas and think about what would interest conference attendees.

Describe your role as course director.

My job as course director is to challenge committee members to be as creative as possible and help focus the discussion around the needs of SHM members while keeping to a schedule. I led a team of 23 amazing committee members through the planning stages for HM18 this past summer. With the help of Brittany Evans, SHM’s Education and Meetings Project Manager, and Dustin Smith, MD, FHM, the cocourse director, the committee reviewed prior conference agendas and feedback from attendees and from other SHM committees. Using that information, we discussed, brainstormed, voted on, and planned this year’s clinical content talks, workshops, and many of the specialty tracks.

What are you most looking forward to at HM18?

I am looking forward to the entire meeting! First, the location is exciting since this is our first time in Orlando. I’m curious to see what the facility is like, and I am hoping attendees use the location as a reason to bring their families and visit the theme parks. In recognition of our Orlando location, the committee got creative with titles for the conference. For example, geriatrics became “The Tale as Old as Time.” I hope some of the titles put a smile on the attendees’ faces.

I am also eagerly anticipating the nationally recognized speakers. We invited the best speakers we know from both subspecialty backgrounds and fellow hospitalists, and given the Orlando location, we tried to feature the best speakers from the Southeast. Finally, I am looking forward to the diversity of topics. The committee really thought broadly about relevant topics to today’s practicing hospitalists.

What will be new and different for attendees at HM18 in comparison to previous annual conferences?

There are many new things this year. Given the field of hospital medicine is now more than 20 years old, the committee thought it was important to focus on career development – not just for new hospitalists, but midcareer hospitalists as well. How do you make hospital medicine a lifelong, enjoyable, and engaging career? To explore and answer these questions, the Annual Conference Committee created several new tracks for HM18.

We created a Seasoning Your Career track that offers ideas on how to change your role midcareer – how to advance to a leadership position, how to use emotional intelligence to achieve success, how to prevent burnout, and, best of all, how to consider and change your hospitalist group’s work schedule, which rules our lives and our families’ lives. We also added financial planning advice to help you prepare for retirement.

Another new track at HM18 is the Career Development Workshops track, which includes a diversity of workshops meant to help build leadership skills, develop presentation/communication skills, encourage peers to give each other feedback, promote women in hospital medicine, prevent burnout, and turn ideas into clinical research. The Medical Education track also has a session on how to break into educational roles, especially if you want to expand your career into a leadership position in medical education.

In addition to Seasoning Your Career and Career Development Workshops, we have three other new tracks: Palliative Care, NP/PA, and The Great Debate. The Great Debate track uses the popular format of the perioperative debate given every year at the annual conference to tackle topics in infectious disease and pulmonary medicine. We ask very talented, opinionated, and humorous speakers to debate with each other over clinical content; it will be a great “smack down!”

Other new things for HM18 include:

• An interventional radiologist will speak about the latest procedures and when to refer your patients.
• A few surgeons will talk about managing surgical patients on your service and about decubitus ulcers.
• An oncologist will discuss the complications of the latest advanced agents on the wards.
• A rheumatologist will discuss the complications of new biologic agents.
• A rehab specialist will discuss the benefits and limitations of physical/occupational therapists and physiatrists.
• A speaker will discussing vulnerable populations, focusing on the social determinants of health, which last year’s HM17 plenary speaker Karen DeSalvo, MD, MPH, MSc raised as an important issue.
• There will be an “Updates in Addiction Medicine” lecture.
• There will be a new cardiology precourse and an expanded infectious disease precourse, which will also focus on sepsis.

How has the committee worked to ensure the course content is refreshed and current?

The reason the Annual Conference Committee is large is to ensure that there is a diversity of voices and talents from all over the country. There are both academic and community hospitalists on the committee; its members represent internal medicine, family medicine, pediatrics, and subspecialists, as well as administrators and hospitalist leaders. The annual meetings are planned over 3-4 months via weekly calls. In between calls, committee members are encouraged to discuss topics with their colleagues at home for opinions and advice.

The best ideas from the committee come from the group discussion and brainstorming. Someone mentions a topic, which leads someone else to add to it, and so on. Within the hour, we have some fantastic suggestions that the committee can run with. We also rely on input from SHM members: For example, many of the workshops’ topics are chosen from hundreds of submissions from members; speaker and content suggestions are submitted by hospitalist leaders from around the country and thereby provide insight into current topics. Combined, these offer a richness of ideas, which allows the committee to stay up to date and refresh old ideas.
 

What advice can you offer to early career hospitalists looking to get involved with the Annual Conference Committee or other conference planning roles?

My advice for early career hospitalists is to start locally. Join your local SHM chapter, or start one. In trying to plan local conferences, you begin to figure out which content areas interest hospitalists and how they can best be delivered. You might offer to give a talk at your local chapter or at your hospital and develop presentation skills. Developing a network of fellow hospitalists through your local chapter is important. The more local hospitalists you connect with, the more likely it is that they will think of you when they are planning a conference. At the national level, consider submitting a workshop or submitting an idea for content. Workshops are a great way to get recognized at the national level.

The Annual Conference Committee takes applications every year. Once you have some experience planning conferences or coordinating speakers, it would definitely be worth applying. You may not be selected your first year, but do not let that discourage you! Demonstrating interest and perseverance goes a long way. There are also many other national SHM committees to join and other ways to get involved. Your willingness to provide some of your time makes the society – and the specialty – what it is.
 

Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.

The presence of obstructive sleep apnea (OSA) may have a protective effect in patients with acute coronary syndromes, according to researchers.

In a study of 127 patients presenting with acute coronary syndromes (ACS), median peak cardiac troponin-I (cTn-I) values were significantly higher in patients without obstructive sleep apnea, compared with OSA patients (10.7; interquartile range: 1.78-40.1, vs. 3.79; IQR: 0.37-24.3, respectively; P = .04 ). The findings were published Feb. 5 in the journal CHEST®.

The study comprised 89 OSA patients and 38 non-OSA patients who were admitted to a hospital for acute coronary syndromes. The OSA group had a median apnea-hypopnea index (AHI) of 32, while the non-OSA group had a median AHI of 4.8. There was no significant difference between the two groups in gender, age, or cardiovascular risk factors such as hypertension, diabetes mellitus, body mass index, dyslipidemia, and smoking.

The cohort was part of the Continuous Positive Airway Pressure (CPAP) in Patients With Acute Coronary Syndrome and Obstructive Sleep Apnea (ISAACC) study, a prior randomized, controlled trial that evaluated the effect of CPAP treatment on new cardiovascular events in patients with an episode of ACS and OSA, reported Alicia Sánchez-de-la-Torre, PhD, of the respiratory department at Hospital Universitari Arnau de Vilanova and Santa Maria in Catalonia, Spain, and her coauthors.

Respiratory polygraphy was performed in the first 24-72 hours after hospital admission, and patients with an AHI of at least 15 events per hour were considered to have OSA. Those with an AHI less than 15 events per hour were included in the non-OSA group.

 

The OSA patients were randomized to conservative or CPAP treatment. An obstructive apnea “episode” was defined as a complete cessation of airflow for 10 seconds or longer, and an episode of hypopnea was defined as a reduction in airflow for at least 10 seconds associated with a greater than 4% decrease in arterial oxygen saturation.

[email protected]

SOURCE: Chest. 2018 Feb 5;153[2]:329-38. doi: 10.1016/j.chest.2017.06.046.

The presence of obstructive sleep apnea (OSA) may have a protective effect in patients with acute coronary syndromes, according to researchers.

In a study of 127 patients presenting with acute coronary syndromes (ACS), median peak cardiac troponin-I (cTn-I) values were significantly higher in patients without obstructive sleep apnea, compared with OSA patients (10.7; interquartile range: 1.78-40.1, vs. 3.79; IQR: 0.37-24.3, respectively; P = .04 ). The findings were published Feb. 5 in the journal CHEST®.

The study comprised 89 OSA patients and 38 non-OSA patients who were admitted to a hospital for acute coronary syndromes. The OSA group had a median apnea-hypopnea index (AHI) of 32, while the non-OSA group had a median AHI of 4.8. There was no significant difference between the two groups in gender, age, or cardiovascular risk factors such as hypertension, diabetes mellitus, body mass index, dyslipidemia, and smoking.

The cohort was part of the Continuous Positive Airway Pressure (CPAP) in Patients With Acute Coronary Syndrome and Obstructive Sleep Apnea (ISAACC) study, a prior randomized, controlled trial that evaluated the effect of CPAP treatment on new cardiovascular events in patients with an episode of ACS and OSA, reported Alicia Sánchez-de-la-Torre, PhD, of the respiratory department at Hospital Universitari Arnau de Vilanova and Santa Maria in Catalonia, Spain, and her coauthors.

Respiratory polygraphy was performed in the first 24-72 hours after hospital admission, and patients with an AHI of at least 15 events per hour were considered to have OSA. Those with an AHI less than 15 events per hour were included in the non-OSA group.

 

The OSA patients were randomized to conservative or CPAP treatment. An obstructive apnea “episode” was defined as a complete cessation of airflow for 10 seconds or longer, and an episode of hypopnea was defined as a reduction in airflow for at least 10 seconds associated with a greater than 4% decrease in arterial oxygen saturation.

[email protected]

SOURCE: Chest. 2018 Feb 5;153[2]:329-38. doi: 10.1016/j.chest.2017.06.046.

The presence of obstructive sleep apnea (OSA) may have a protective effect in patients with acute coronary syndromes, according to researchers.

In a study of 127 patients presenting with acute coronary syndromes (ACS), median peak cardiac troponin-I (cTn-I) values were significantly higher in patients without obstructive sleep apnea, compared with OSA patients (10.7; interquartile range: 1.78-40.1, vs. 3.79; IQR: 0.37-24.3, respectively; P = .04 ). The findings were published Feb. 5 in the journal CHEST®.

The study comprised 89 OSA patients and 38 non-OSA patients who were admitted to a hospital for acute coronary syndromes. The OSA group had a median apnea-hypopnea index (AHI) of 32, while the non-OSA group had a median AHI of 4.8. There was no significant difference between the two groups in gender, age, or cardiovascular risk factors such as hypertension, diabetes mellitus, body mass index, dyslipidemia, and smoking.

The cohort was part of the Continuous Positive Airway Pressure (CPAP) in Patients With Acute Coronary Syndrome and Obstructive Sleep Apnea (ISAACC) study, a prior randomized, controlled trial that evaluated the effect of CPAP treatment on new cardiovascular events in patients with an episode of ACS and OSA, reported Alicia Sánchez-de-la-Torre, PhD, of the respiratory department at Hospital Universitari Arnau de Vilanova and Santa Maria in Catalonia, Spain, and her coauthors.

Respiratory polygraphy was performed in the first 24-72 hours after hospital admission, and patients with an AHI of at least 15 events per hour were considered to have OSA. Those with an AHI less than 15 events per hour were included in the non-OSA group.

 

The OSA patients were randomized to conservative or CPAP treatment. An obstructive apnea “episode” was defined as a complete cessation of airflow for 10 seconds or longer, and an episode of hypopnea was defined as a reduction in airflow for at least 10 seconds associated with a greater than 4% decrease in arterial oxygen saturation.

[email protected]

SOURCE: Chest. 2018 Feb 5;153[2]:329-38. doi: 10.1016/j.chest.2017.06.046.

SALT LAKE CITY – A CD19-directed 4-1BB chimeric antigen receptor (CAR) T cell product showed efficacy and a low rate of cytokine release syndrome and neurotoxicity in patients with aggressive lymphomas and poor prognoses, raising the possibility of outpatient administration and fewer hospitalization days in this high-risk group.

A total of 86 patients who received inpatient infusions of lisocabtagene maraleucel (liso-cel, also known as JCAR017) had a mean 15.6 days of hospitalization, compared with 9.3 days for 8 outpatient recipients, said Jeremy Abramson, MD, speaking at a top abstracts session of the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation.

Kari Oakes/Frontline Medical News

Although all but one required hospital admission, at a median of 5 days postinfusion (range, 4-22 days), there had been no intensive care unit admissions, and no outpatient recipients had experienced severe cytokine release syndrome (CRS) or neurotoxicity. All admitted patients presented with fever.

Among the study population, “Cytokine release syndrome was only seen in 35% of our entire dataset,” with neurologic toxicity seen in 19% of participants, Dr. Abramson said. “The majority of subjects had no CRS and no toxicity,” he said. Severe CRS occurred in 1% of the study population, and severe neurotoxicity in 12%. There were no deaths related to either complication.

Dr. Abramson reported these results from the TRANSCEND NHL 001 trial, a seamless design phase 1 pivotal trial of liso-cel enrolling patients with relapsed and refractory aggressive B cell non-Hodgkin lymphoma (NHL). Liso-cel delivers CD19-directed CD4 and CD8 CAR T cells in a 1:1 ratio, said Dr. Abramson, director of the lymphoma program at the Massachusetts General Hospital Cancer Center, Boston.

A total of 91 patients were randomized to one of the three dose-finding cohorts of the multicenter trial of liso-cel. One cohort received 5 x 10⁷ cells in a single dose; a second cohort received the same number of cells but in two doses administered 14 days apart; the third cohort received a single dose of 1 x 10⁸ cells.

The seamless trial design then moved to dose expansion, using the two single doses established in the dose-finding phase of the study. Ultimately, Dr. Abramson said, the third and pivotal diffuse large B-cell lymphoma (DLBCL) cohort received the higher single dose, since a dose-response relationship was seen in the earlier cohorts. No increase in cytokine release syndrome or neurotoxicity has been seen with the higher dose in patients evaluated to date.

Patients (median age, 61 years) were eligible to participate in the trial if they had relapsed or refractory DLBCL, primary mediastinal B-cell lymphoma, grade 3B follicular lymphoma, or mantle cell lymphoma. Patients with a failed prior allogeneic stem cell transplant or secondary central nervous system involvement were eligible, but all patients had to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

As the trial moved to the core pivotal phase, eligibility requirements shifted slightly to include patients with ECOG status 0 or 1, and lymphoma diagnoses narrowed to include only DLBCL not otherwise specified (NOS), transformed follicular lymphoma, and high-grade B-cell lymphoma with double- and triple-hit cytogenetics. The core group was nearing completion of accrual at the time of the presentation, which presented preliminary results from this phase of the trial.

Among the 88 evaluable patients in the initial population with DLBCL receiving any of three dose levels, the best overall response rate (ORR) was 74% (95% confidence interval, 63%-83%); 52% of these patients achieved complete response (CR; 95% CI, 41%-63%).

For patients receiving the higher dose of liso-cel, the ORR was 81% (95% CI, 62%-94%), with a 63% CR rate (95% CI, 42%-81%), bearing out the dose-response rate that had been seen earlier in the trial, Dr. Abramson said.

The median duration of response in all TRANSCEND patients was 9.2 months; the median duration of remission has not been reached, he said. “We see evidence of durable response at 3 months in all our high-risk subsets, and that includes double- and triple-hit lymphomas, double-expresser lymphomas, patients who’ve never achieved prior complete remission, and patients with refractory disease.”

“The overall results are similarly encouraging,” Dr. Abramson said, with 86% of all patients alive at 6 months. Among the complete responders, 94% are alive at the 6-month mark. “The median duration of complete responders has not been reached in this cohort,” he said.

These results are notable, Dr. Abramson said, since about 90% of study participants have at least one disease risk factor that would predict median overall survival of 3-6 months.

[email protected]

SOURCE: Abramson J et al. Abstract 5.

SALT LAKE CITY – A CD19-directed 4-1BB chimeric antigen receptor (CAR) T cell product showed efficacy and a low rate of cytokine release syndrome and neurotoxicity in patients with aggressive lymphomas and poor prognoses, raising the possibility of outpatient administration and fewer hospitalization days in this high-risk group.

A total of 86 patients who received inpatient infusions of lisocabtagene maraleucel (liso-cel, also known as JCAR017) had a mean 15.6 days of hospitalization, compared with 9.3 days for 8 outpatient recipients, said Jeremy Abramson, MD, speaking at a top abstracts session of the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation.

Kari Oakes/Frontline Medical News

Although all but one required hospital admission, at a median of 5 days postinfusion (range, 4-22 days), there had been no intensive care unit admissions, and no outpatient recipients had experienced severe cytokine release syndrome (CRS) or neurotoxicity. All admitted patients presented with fever.

Among the study population, “Cytokine release syndrome was only seen in 35% of our entire dataset,” with neurologic toxicity seen in 19% of participants, Dr. Abramson said. “The majority of subjects had no CRS and no toxicity,” he said. Severe CRS occurred in 1% of the study population, and severe neurotoxicity in 12%. There were no deaths related to either complication.

Dr. Abramson reported these results from the TRANSCEND NHL 001 trial, a seamless design phase 1 pivotal trial of liso-cel enrolling patients with relapsed and refractory aggressive B cell non-Hodgkin lymphoma (NHL). Liso-cel delivers CD19-directed CD4 and CD8 CAR T cells in a 1:1 ratio, said Dr. Abramson, director of the lymphoma program at the Massachusetts General Hospital Cancer Center, Boston.

A total of 91 patients were randomized to one of the three dose-finding cohorts of the multicenter trial of liso-cel. One cohort received 5 x 10⁷ cells in a single dose; a second cohort received the same number of cells but in two doses administered 14 days apart; the third cohort received a single dose of 1 x 10⁸ cells.

The seamless trial design then moved to dose expansion, using the two single doses established in the dose-finding phase of the study. Ultimately, Dr. Abramson said, the third and pivotal diffuse large B-cell lymphoma (DLBCL) cohort received the higher single dose, since a dose-response relationship was seen in the earlier cohorts. No increase in cytokine release syndrome or neurotoxicity has been seen with the higher dose in patients evaluated to date.

Patients (median age, 61 years) were eligible to participate in the trial if they had relapsed or refractory DLBCL, primary mediastinal B-cell lymphoma, grade 3B follicular lymphoma, or mantle cell lymphoma. Patients with a failed prior allogeneic stem cell transplant or secondary central nervous system involvement were eligible, but all patients had to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

As the trial moved to the core pivotal phase, eligibility requirements shifted slightly to include patients with ECOG status 0 or 1, and lymphoma diagnoses narrowed to include only DLBCL not otherwise specified (NOS), transformed follicular lymphoma, and high-grade B-cell lymphoma with double- and triple-hit cytogenetics. The core group was nearing completion of accrual at the time of the presentation, which presented preliminary results from this phase of the trial.

Among the 88 evaluable patients in the initial population with DLBCL receiving any of three dose levels, the best overall response rate (ORR) was 74% (95% confidence interval, 63%-83%); 52% of these patients achieved complete response (CR; 95% CI, 41%-63%).

For patients receiving the higher dose of liso-cel, the ORR was 81% (95% CI, 62%-94%), with a 63% CR rate (95% CI, 42%-81%), bearing out the dose-response rate that had been seen earlier in the trial, Dr. Abramson said.

The median duration of response in all TRANSCEND patients was 9.2 months; the median duration of remission has not been reached, he said. “We see evidence of durable response at 3 months in all our high-risk subsets, and that includes double- and triple-hit lymphomas, double-expresser lymphomas, patients who’ve never achieved prior complete remission, and patients with refractory disease.”

“The overall results are similarly encouraging,” Dr. Abramson said, with 86% of all patients alive at 6 months. Among the complete responders, 94% are alive at the 6-month mark. “The median duration of complete responders has not been reached in this cohort,” he said.

These results are notable, Dr. Abramson said, since about 90% of study participants have at least one disease risk factor that would predict median overall survival of 3-6 months.

[email protected]

SOURCE: Abramson J et al. Abstract 5.

SALT LAKE CITY – A CD19-directed 4-1BB chimeric antigen receptor (CAR) T cell product showed efficacy and a low rate of cytokine release syndrome and neurotoxicity in patients with aggressive lymphomas and poor prognoses, raising the possibility of outpatient administration and fewer hospitalization days in this high-risk group.

A total of 86 patients who received inpatient infusions of lisocabtagene maraleucel (liso-cel, also known as JCAR017) had a mean 15.6 days of hospitalization, compared with 9.3 days for 8 outpatient recipients, said Jeremy Abramson, MD, speaking at a top abstracts session of the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation.

Kari Oakes/Frontline Medical News

Although all but one required hospital admission, at a median of 5 days postinfusion (range, 4-22 days), there had been no intensive care unit admissions, and no outpatient recipients had experienced severe cytokine release syndrome (CRS) or neurotoxicity. All admitted patients presented with fever.

Among the study population, “Cytokine release syndrome was only seen in 35% of our entire dataset,” with neurologic toxicity seen in 19% of participants, Dr. Abramson said. “The majority of subjects had no CRS and no toxicity,” he said. Severe CRS occurred in 1% of the study population, and severe neurotoxicity in 12%. There were no deaths related to either complication.

Dr. Abramson reported these results from the TRANSCEND NHL 001 trial, a seamless design phase 1 pivotal trial of liso-cel enrolling patients with relapsed and refractory aggressive B cell non-Hodgkin lymphoma (NHL). Liso-cel delivers CD19-directed CD4 and CD8 CAR T cells in a 1:1 ratio, said Dr. Abramson, director of the lymphoma program at the Massachusetts General Hospital Cancer Center, Boston.

A total of 91 patients were randomized to one of the three dose-finding cohorts of the multicenter trial of liso-cel. One cohort received 5 x 10⁷ cells in a single dose; a second cohort received the same number of cells but in two doses administered 14 days apart; the third cohort received a single dose of 1 x 10⁸ cells.

The seamless trial design then moved to dose expansion, using the two single doses established in the dose-finding phase of the study. Ultimately, Dr. Abramson said, the third and pivotal diffuse large B-cell lymphoma (DLBCL) cohort received the higher single dose, since a dose-response relationship was seen in the earlier cohorts. No increase in cytokine release syndrome or neurotoxicity has been seen with the higher dose in patients evaluated to date.

Patients (median age, 61 years) were eligible to participate in the trial if they had relapsed or refractory DLBCL, primary mediastinal B-cell lymphoma, grade 3B follicular lymphoma, or mantle cell lymphoma. Patients with a failed prior allogeneic stem cell transplant or secondary central nervous system involvement were eligible, but all patients had to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

As the trial moved to the core pivotal phase, eligibility requirements shifted slightly to include patients with ECOG status 0 or 1, and lymphoma diagnoses narrowed to include only DLBCL not otherwise specified (NOS), transformed follicular lymphoma, and high-grade B-cell lymphoma with double- and triple-hit cytogenetics. The core group was nearing completion of accrual at the time of the presentation, which presented preliminary results from this phase of the trial.

Among the 88 evaluable patients in the initial population with DLBCL receiving any of three dose levels, the best overall response rate (ORR) was 74% (95% confidence interval, 63%-83%); 52% of these patients achieved complete response (CR; 95% CI, 41%-63%).

For patients receiving the higher dose of liso-cel, the ORR was 81% (95% CI, 62%-94%), with a 63% CR rate (95% CI, 42%-81%), bearing out the dose-response rate that had been seen earlier in the trial, Dr. Abramson said.

The median duration of response in all TRANSCEND patients was 9.2 months; the median duration of remission has not been reached, he said. “We see evidence of durable response at 3 months in all our high-risk subsets, and that includes double- and triple-hit lymphomas, double-expresser lymphomas, patients who’ve never achieved prior complete remission, and patients with refractory disease.”

“The overall results are similarly encouraging,” Dr. Abramson said, with 86% of all patients alive at 6 months. Among the complete responders, 94% are alive at the 6-month mark. “The median duration of complete responders has not been reached in this cohort,” he said.

These results are notable, Dr. Abramson said, since about 90% of study participants have at least one disease risk factor that would predict median overall survival of 3-6 months.

[email protected]

SOURCE: Abramson J et al. Abstract 5.

Closer tailoring might boost wearable cardioverter defibrillators’ benefit, alirocumab cuts deaths in post–acute coronary syndrome patients, the ODYSSEY Outcomes trial redefines secondary cardiovascular prevention, and how walking cuts postmenopausal women’s heart failure risk.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Closer tailoring might boost wearable cardioverter defibrillators’ benefit, alirocumab cuts deaths in post–acute coronary syndrome patients, the ODYSSEY Outcomes trial redefines secondary cardiovascular prevention, and how walking cuts postmenopausal women’s heart failure risk.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Closer tailoring might boost wearable cardioverter defibrillators’ benefit, alirocumab cuts deaths in post–acute coronary syndrome patients, the ODYSSEY Outcomes trial redefines secondary cardiovascular prevention, and how walking cuts postmenopausal women’s heart failure risk.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Click here to view the articles published in March 2018.

Click here to view the articles published in March 2018.

Click here to view the articles published in March 2018.