Trump administration proposes rule to loosen curbs on short-term health plans

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Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Feb. 20 by the Trump administration that could further roil the marketplace.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

The proposed rule said short-term plans could add more choices to the market at lower cost and may offer broader provider networks than Affordable Care Act plans in rural areas.

But most short-term coverage requires answering a string of medical questions, and insurers can reject applicants with preexisting medical problems, which ACA plans cannot do. As a result, the proposed rule also noted that some people who switch to them from ACA coverage may see “reduced access to some services,” and “increased out of pocket costs, possibly leading to financial hardship.”

The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to 3 months. The rule comes on the heels of Congress’ approval of tax legislation that in 2019 will end the penalty for people who opt not to carry insurance coverage.

The administration also issued separate regulations Jan. 4 that would make it easier to form “association health plans,” which are offered to small businesses through membership organizations.

Together, the proposed regulations and the elimination of the so-called individual mandate by Congress could further undermine the Affordable Care Act marketplace, critics say.

Seema Verma, who now heads the Centers for Medicare & Medicaid Services, which oversees the marketplaces, told reporters Feb. 20 that federal officials believe that between 100,000 and 200,000 “healthy people” now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.

The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law – including plans that can reject people with preexisting medical conditions. Most short-term coverage excludes benefits for maternity care, preventive care, mental health services, or substance abuse treatment.

“It’s deeply concerning to me, considering the tragedy in Florida and national opioid crisis, that the administration would be encouraging the sale of policies that don’t have to cover mental health and substance abuse,” said Kevin Lucia, a research professor and project director at Georgetown University’s Health Policy Institute.

Over time, those remaining in ACA plans will increasingly be those who qualify for premium tax credit subsidies and the sick, who can’t get an alternative like a short-term plan, predict Mr. Lucia and other experts. That, in turn, would drive up ACA premiums further.

“If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans,” said industry consultant Robert Laszewski. “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

If 100,000-200,000 people shift from ACA-compliant plans in 2019, this would cause “average monthly individual market premiums … to increase,” the proposed rule states. That, in turn, would cause subsidies for eligible policyholders in the ACA market to rise, costing the government $96 million–$168 million.

Supporters said the rules are needed because the ACA plans have already become too costly for people who don’t receive a government subsidy to help them purchase the coverage. “The current system is failing too many,” said Ms. Verma.

And, many supporters don’t think the change is as significant as skeptics fear.

“It simply reverts back to where the short-term plan rules were prior to Obama limiting those plans,” said Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee. “While these plans might not be the best answer, people do need a choice, and this new proposal provides needed choice to a certain subsection of the population.”

But, in their call with reporters, CMS officials said the proposed rule seeks comment on whether there are ways to guarantee renewability of the plans, which currently cannot be renewed. Instead, policyholders must reapply and answer medical questions again. The proposal also seeks comments on whether the plans should be allowed for longer than 12-month periods.

The comment period for the proposed rule runs for 60 days. Ms. Verma said CMS hopes to get final rules out “as quickly as possible,” so insurers could start offering the longer duration plans.

Short-term plans had been designed as temporary coverage, lasting for a few months while, for instance, a worker is between jobs and employer-sponsored insurances. They provide some protection to those who enroll, generally paying a percentage of hospital and doctor bills after the policyholder meets a deductible.

They are generally less expensive than ACA plans, because they cover less. For example, they set annual and lifetime caps on benefits, and few cover prescription drugs.

Most require applicants to pass a medical questionnaire – and they can also exclude coverage for preexisting medical conditions.

The plans are appealing to consumers because they are cheaper than Obamacare plans. They are also attractive to brokers, because they often pay higher commissions than ACA plans. Insurers like them because their profit margins are relatively high – and are not held to the ACA requirement that they spend at least 80 percent of premium revenue on plan members’ medical care.

Extending short-term plans to a full year could be a benefit to consumers because they must pass the health questionnaire only once. Still, if a consumer develops a health condition during the contract’s term, that person would likely be rejected if he or she tried to renew.

Both supporters and critics of short-term plans say consumers who do develop health problems could then sign up for an ACA plan during the next open enrollment because the ACA bars insurers from rejecting people with preexisting conditions.

“We’re going to have two different markets, a Wild West frontier called short-term medical … and a high-risk pool called Obamacare,” said Laszewski.

KHN senior correspondent Phil Galewitz contributed to this article. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Feb. 20 by the Trump administration that could further roil the marketplace.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

The proposed rule said short-term plans could add more choices to the market at lower cost and may offer broader provider networks than Affordable Care Act plans in rural areas.

But most short-term coverage requires answering a string of medical questions, and insurers can reject applicants with preexisting medical problems, which ACA plans cannot do. As a result, the proposed rule also noted that some people who switch to them from ACA coverage may see “reduced access to some services,” and “increased out of pocket costs, possibly leading to financial hardship.”

The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to 3 months. The rule comes on the heels of Congress’ approval of tax legislation that in 2019 will end the penalty for people who opt not to carry insurance coverage.

The administration also issued separate regulations Jan. 4 that would make it easier to form “association health plans,” which are offered to small businesses through membership organizations.

Together, the proposed regulations and the elimination of the so-called individual mandate by Congress could further undermine the Affordable Care Act marketplace, critics say.

Seema Verma, who now heads the Centers for Medicare & Medicaid Services, which oversees the marketplaces, told reporters Feb. 20 that federal officials believe that between 100,000 and 200,000 “healthy people” now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.

The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law – including plans that can reject people with preexisting medical conditions. Most short-term coverage excludes benefits for maternity care, preventive care, mental health services, or substance abuse treatment.

“It’s deeply concerning to me, considering the tragedy in Florida and national opioid crisis, that the administration would be encouraging the sale of policies that don’t have to cover mental health and substance abuse,” said Kevin Lucia, a research professor and project director at Georgetown University’s Health Policy Institute.

Over time, those remaining in ACA plans will increasingly be those who qualify for premium tax credit subsidies and the sick, who can’t get an alternative like a short-term plan, predict Mr. Lucia and other experts. That, in turn, would drive up ACA premiums further.

“If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans,” said industry consultant Robert Laszewski. “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

If 100,000-200,000 people shift from ACA-compliant plans in 2019, this would cause “average monthly individual market premiums … to increase,” the proposed rule states. That, in turn, would cause subsidies for eligible policyholders in the ACA market to rise, costing the government $96 million–$168 million.

Supporters said the rules are needed because the ACA plans have already become too costly for people who don’t receive a government subsidy to help them purchase the coverage. “The current system is failing too many,” said Ms. Verma.

And, many supporters don’t think the change is as significant as skeptics fear.

“It simply reverts back to where the short-term plan rules were prior to Obama limiting those plans,” said Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee. “While these plans might not be the best answer, people do need a choice, and this new proposal provides needed choice to a certain subsection of the population.”

But, in their call with reporters, CMS officials said the proposed rule seeks comment on whether there are ways to guarantee renewability of the plans, which currently cannot be renewed. Instead, policyholders must reapply and answer medical questions again. The proposal also seeks comments on whether the plans should be allowed for longer than 12-month periods.

The comment period for the proposed rule runs for 60 days. Ms. Verma said CMS hopes to get final rules out “as quickly as possible,” so insurers could start offering the longer duration plans.

Short-term plans had been designed as temporary coverage, lasting for a few months while, for instance, a worker is between jobs and employer-sponsored insurances. They provide some protection to those who enroll, generally paying a percentage of hospital and doctor bills after the policyholder meets a deductible.

They are generally less expensive than ACA plans, because they cover less. For example, they set annual and lifetime caps on benefits, and few cover prescription drugs.

Most require applicants to pass a medical questionnaire – and they can also exclude coverage for preexisting medical conditions.

The plans are appealing to consumers because they are cheaper than Obamacare plans. They are also attractive to brokers, because they often pay higher commissions than ACA plans. Insurers like them because their profit margins are relatively high – and are not held to the ACA requirement that they spend at least 80 percent of premium revenue on plan members’ medical care.

Extending short-term plans to a full year could be a benefit to consumers because they must pass the health questionnaire only once. Still, if a consumer develops a health condition during the contract’s term, that person would likely be rejected if he or she tried to renew.

Both supporters and critics of short-term plans say consumers who do develop health problems could then sign up for an ACA plan during the next open enrollment because the ACA bars insurers from rejecting people with preexisting conditions.

“We’re going to have two different markets, a Wild West frontier called short-term medical … and a high-risk pool called Obamacare,” said Laszewski.

KHN senior correspondent Phil Galewitz contributed to this article. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

 

Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Feb. 20 by the Trump administration that could further roil the marketplace.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

The proposed rule said short-term plans could add more choices to the market at lower cost and may offer broader provider networks than Affordable Care Act plans in rural areas.

But most short-term coverage requires answering a string of medical questions, and insurers can reject applicants with preexisting medical problems, which ACA plans cannot do. As a result, the proposed rule also noted that some people who switch to them from ACA coverage may see “reduced access to some services,” and “increased out of pocket costs, possibly leading to financial hardship.”

The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to 3 months. The rule comes on the heels of Congress’ approval of tax legislation that in 2019 will end the penalty for people who opt not to carry insurance coverage.

The administration also issued separate regulations Jan. 4 that would make it easier to form “association health plans,” which are offered to small businesses through membership organizations.

Together, the proposed regulations and the elimination of the so-called individual mandate by Congress could further undermine the Affordable Care Act marketplace, critics say.

Seema Verma, who now heads the Centers for Medicare & Medicaid Services, which oversees the marketplaces, told reporters Feb. 20 that federal officials believe that between 100,000 and 200,000 “healthy people” now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.

The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law – including plans that can reject people with preexisting medical conditions. Most short-term coverage excludes benefits for maternity care, preventive care, mental health services, or substance abuse treatment.

“It’s deeply concerning to me, considering the tragedy in Florida and national opioid crisis, that the administration would be encouraging the sale of policies that don’t have to cover mental health and substance abuse,” said Kevin Lucia, a research professor and project director at Georgetown University’s Health Policy Institute.

Over time, those remaining in ACA plans will increasingly be those who qualify for premium tax credit subsidies and the sick, who can’t get an alternative like a short-term plan, predict Mr. Lucia and other experts. That, in turn, would drive up ACA premiums further.

“If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans,” said industry consultant Robert Laszewski. “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

If 100,000-200,000 people shift from ACA-compliant plans in 2019, this would cause “average monthly individual market premiums … to increase,” the proposed rule states. That, in turn, would cause subsidies for eligible policyholders in the ACA market to rise, costing the government $96 million–$168 million.

Supporters said the rules are needed because the ACA plans have already become too costly for people who don’t receive a government subsidy to help them purchase the coverage. “The current system is failing too many,” said Ms. Verma.

And, many supporters don’t think the change is as significant as skeptics fear.

“It simply reverts back to where the short-term plan rules were prior to Obama limiting those plans,” said Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee. “While these plans might not be the best answer, people do need a choice, and this new proposal provides needed choice to a certain subsection of the population.”

But, in their call with reporters, CMS officials said the proposed rule seeks comment on whether there are ways to guarantee renewability of the plans, which currently cannot be renewed. Instead, policyholders must reapply and answer medical questions again. The proposal also seeks comments on whether the plans should be allowed for longer than 12-month periods.

The comment period for the proposed rule runs for 60 days. Ms. Verma said CMS hopes to get final rules out “as quickly as possible,” so insurers could start offering the longer duration plans.

Short-term plans had been designed as temporary coverage, lasting for a few months while, for instance, a worker is between jobs and employer-sponsored insurances. They provide some protection to those who enroll, generally paying a percentage of hospital and doctor bills after the policyholder meets a deductible.

They are generally less expensive than ACA plans, because they cover less. For example, they set annual and lifetime caps on benefits, and few cover prescription drugs.

Most require applicants to pass a medical questionnaire – and they can also exclude coverage for preexisting medical conditions.

The plans are appealing to consumers because they are cheaper than Obamacare plans. They are also attractive to brokers, because they often pay higher commissions than ACA plans. Insurers like them because their profit margins are relatively high – and are not held to the ACA requirement that they spend at least 80 percent of premium revenue on plan members’ medical care.

Extending short-term plans to a full year could be a benefit to consumers because they must pass the health questionnaire only once. Still, if a consumer develops a health condition during the contract’s term, that person would likely be rejected if he or she tried to renew.

Both supporters and critics of short-term plans say consumers who do develop health problems could then sign up for an ACA plan during the next open enrollment because the ACA bars insurers from rejecting people with preexisting conditions.

“We’re going to have two different markets, a Wild West frontier called short-term medical … and a high-risk pool called Obamacare,” said Laszewski.

KHN senior correspondent Phil Galewitz contributed to this article. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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Gut-homing protein predicts HIV-acquisition, disease progression in women

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Fri, 01/18/2019 - 17:25

 

Higher frequency of alpha4beta7 expression in the CD4 T cells in the gut was associated with increased HIV acquisition and severity, according to the results of a retrospective comparative analysis of blood samples from patients in the CAPRISA 004 study.

Courtesy Dr. Tom Folks, NIAID/National Institutes of Health

Researchers compared samples from patients who eventually developed HIV with samples from those who did not; they also assessed human study cohorts from Kenya and the RV254/Search 010 cohort in Thailand, according to an online report in Science Translational Medicine. In addition, they obtained data from nonhuman primates (NHPs) challenged with simian immunodeficiency virus (SIV) to compare results between primate species.

They found that alpha4beta7+ CD4+ T cells were depleted very early in HIV infection, particularly in the gut, and the initiation of antiretroviral therapy (ART) was unable to restore the normal levels of those cells even when provided at the earliest time point. Citing the literature, the researchers speculated that interactions between alpha4beta7 and the HIV env protein may assist the virus in locating its ideal target cells, and that high levels of alpha4beta7+ CD4+ T cells were associated with preferential infection by HIV-1 types containing motifs associated with higher alpha4beta7 binding, which are overrepresented in the region where the CAPRISA004 study was conducted.

“Although the association of alpha4beta7 and HIV expression was relatively modest, results were consistent in independent cohorts in two different countries and in NHPs,” according to Aida Sivro, PhD, of the Centre for the AIDS Programme of Research and her colleagues on behalf of the CAPRISA004 and RS254 study groups.

NHP studies showed some promise in this regard because, while ART alone did not lead to immune restoration of these T cells, “ART in combination with anti-alpha4beta7 did so in NHPs,” the researchers concluded, suggesting the possibility of additional therapeutic interventions in humans.

The authors reported having no disclosures. The CAPRISA 004 study was funded by the U.S. National Institutes of Health, U.S. Agency for International Development, and the South African Department of Science and Technology.

SOURCE: Sivro A et al. Sci Transl Med. 2018 Jan 24;10(425):eaam6354.

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Higher frequency of alpha4beta7 expression in the CD4 T cells in the gut was associated with increased HIV acquisition and severity, according to the results of a retrospective comparative analysis of blood samples from patients in the CAPRISA 004 study.

Courtesy Dr. Tom Folks, NIAID/National Institutes of Health

Researchers compared samples from patients who eventually developed HIV with samples from those who did not; they also assessed human study cohorts from Kenya and the RV254/Search 010 cohort in Thailand, according to an online report in Science Translational Medicine. In addition, they obtained data from nonhuman primates (NHPs) challenged with simian immunodeficiency virus (SIV) to compare results between primate species.

They found that alpha4beta7+ CD4+ T cells were depleted very early in HIV infection, particularly in the gut, and the initiation of antiretroviral therapy (ART) was unable to restore the normal levels of those cells even when provided at the earliest time point. Citing the literature, the researchers speculated that interactions between alpha4beta7 and the HIV env protein may assist the virus in locating its ideal target cells, and that high levels of alpha4beta7+ CD4+ T cells were associated with preferential infection by HIV-1 types containing motifs associated with higher alpha4beta7 binding, which are overrepresented in the region where the CAPRISA004 study was conducted.

“Although the association of alpha4beta7 and HIV expression was relatively modest, results were consistent in independent cohorts in two different countries and in NHPs,” according to Aida Sivro, PhD, of the Centre for the AIDS Programme of Research and her colleagues on behalf of the CAPRISA004 and RS254 study groups.

NHP studies showed some promise in this regard because, while ART alone did not lead to immune restoration of these T cells, “ART in combination with anti-alpha4beta7 did so in NHPs,” the researchers concluded, suggesting the possibility of additional therapeutic interventions in humans.

The authors reported having no disclosures. The CAPRISA 004 study was funded by the U.S. National Institutes of Health, U.S. Agency for International Development, and the South African Department of Science and Technology.

SOURCE: Sivro A et al. Sci Transl Med. 2018 Jan 24;10(425):eaam6354.

 

Higher frequency of alpha4beta7 expression in the CD4 T cells in the gut was associated with increased HIV acquisition and severity, according to the results of a retrospective comparative analysis of blood samples from patients in the CAPRISA 004 study.

Courtesy Dr. Tom Folks, NIAID/National Institutes of Health

Researchers compared samples from patients who eventually developed HIV with samples from those who did not; they also assessed human study cohorts from Kenya and the RV254/Search 010 cohort in Thailand, according to an online report in Science Translational Medicine. In addition, they obtained data from nonhuman primates (NHPs) challenged with simian immunodeficiency virus (SIV) to compare results between primate species.

They found that alpha4beta7+ CD4+ T cells were depleted very early in HIV infection, particularly in the gut, and the initiation of antiretroviral therapy (ART) was unable to restore the normal levels of those cells even when provided at the earliest time point. Citing the literature, the researchers speculated that interactions between alpha4beta7 and the HIV env protein may assist the virus in locating its ideal target cells, and that high levels of alpha4beta7+ CD4+ T cells were associated with preferential infection by HIV-1 types containing motifs associated with higher alpha4beta7 binding, which are overrepresented in the region where the CAPRISA004 study was conducted.

“Although the association of alpha4beta7 and HIV expression was relatively modest, results were consistent in independent cohorts in two different countries and in NHPs,” according to Aida Sivro, PhD, of the Centre for the AIDS Programme of Research and her colleagues on behalf of the CAPRISA004 and RS254 study groups.

NHP studies showed some promise in this regard because, while ART alone did not lead to immune restoration of these T cells, “ART in combination with anti-alpha4beta7 did so in NHPs,” the researchers concluded, suggesting the possibility of additional therapeutic interventions in humans.

The authors reported having no disclosures. The CAPRISA 004 study was funded by the U.S. National Institutes of Health, U.S. Agency for International Development, and the South African Department of Science and Technology.

SOURCE: Sivro A et al. Sci Transl Med. 2018 Jan 24;10(425):eaam6354.

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Key clinical point: CD4+ T cells expressing the protein were rapidly depleted very early in HIV infection.

Major finding: HIV outcomes and alpha4beta7 expression appear linked.

Study details: Blood samples analyzed from the CAPRISA 004 study comparing HIV-infected patients and controls.

Disclosures: The CAPRISA 004 study was funded by the U.S. National Institutes of Health, U.S. Agency for International Development, and the South African Department of Science and Technology.

Source: Sivro A et al. Sci Transl Med. 2018 Jan 24;10(425):eaam6354.

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Making social media work for your practice

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Thu, 03/28/2019 - 14:41

 

Social media use is ubiquitous and, in the digital age, it is the ascendant form of communication. Individuals and organizations, digital immigrants (those born before the widespread adoption of digital technology), and digital natives alike are leveraging social media platforms, such as blogs, Facebook, Twitter, YouTube, and LinkedIn, to curate, consume, and share information across the spectrum of demographics and target audiences. In the United States, 7 in 10 Americans are using social media and, although young adults were early adopters, use among older adults is increasing rapidly.1

Furthermore, social media has cultivated remarkable opportunities in the dissemination of health information and disrupted traditional methods of patient–provider communication. The days when medically trained health professionals were the gatekeepers of health information are long gone. Approximately 50% of Americans seek health information online before seeing a physician.2 Patients and other consumers regularly access social media to search for information about diseases and treatments, engage with other patients, identify providers, and to express or rate their satisfaction with providers, clinics, and health systems.3-5 In addition, they trust online health information from doctors more than that from hospitals, health insurers, and drug companies.6 Not surprisingly, this has led to tremendous growth in use of social media by health care providers, hospitals, and health centers. More than 90% of US hospitals have a Facebook page and 50% have a Twitter account.7

Dr. Darrell M. Gray II
Gastroenterology (GI) and hepatology practitioners, their clinical and research practices, and their patients are no exception. Although adoption of social media has been slow among gastroenterologists and hepatologists, it is growing. In a study published in 2015, Davis et al.8 found that only 48% of GI providers reported never using social media. More recently, in March 2017, we conducted a survey of American Gastroenterological Association (AGA) members subscribed to the AGA eDigest. Of the 69 participants, one-third reported using at least one social media platform multiple times per day and 56% expressed interest in expanding their social media presence. Chiang et al.9 even developed GI hashtag ontology (hashtag refers to a phrase that is preceded by # and is used to identify and collate topics of interest, ie, #coloncancer) as a means to allow lay and health professional social media users to curate medical information more easily. These data are particularly interesting in light of studies suggesting that patients with inflammatory bowel disease and chronic viral hepatitis, chronic diseases that commonly are managed by GI and hepatology providers, are highly motivated to use social media in the management of their disease. Patients with these conditions also value interaction with health care professionals on social media.10,11

There is ample opportunity to close the gap between patient and health care provider engagement in Social media, equip providers with the tools they need to be competent consumers and sharers of information in this digital exchange, and increase the pool of evidence-based information on GI and liver diseases on social media.12 However, there is limited published literature tailored to gastroenterologists and hepatologists. The goal of this article, therefore, is to provide a broad overview of best practices in the professional use of social media and highlight examples of novel applications in clinical practice.
 

Best practices: Getting started and maintaining a presence on social media

Social media can magnify your professional image, amplify your voice, and extend your reach and influence much faster than other methods. It also can be damaging if not used responsibly. Thus, we recommend the following approaches to responsible use of social media and cultivating your social media presence based on current evidence, professional organizations’ policy statements, and our combined experience. We initially presented these strategies during a Meet-the-Professor Luncheon at Digestive Disease Week® in Chicago (http://www.ddw.org/education/session-recordings).

Dr. Deborah A. Fisher
First, establish personal objectives and/or goals for using social media. It is with these in mind that you select social media platforms on which to create a digital profile and footprint. They also can serve as an internal censor and guiding principles for the content that you share and individuals or groups with whom you engage. For example, if your goals include disseminating evidence-based content on liver diseases to a broad audience and connecting with a network of key opinion leaders and patient-oriented groups who share this interest and/or expertise, Twitter may be an ideal option for you given its vast user base and flexibility in both posting multimedia content such as pictures, videos, and links to publications, and tailoring the content you receive to specific individuals and groups.

Second, as with other aspects of medical training and practice, find a mentor to provide hands-on advice. This is particularly true if your general familiarity with the social media platforms is limited. If this is not available through your network of colleagues or workplace, we recommend exploring opportunities offered through your professional organization(s) such as the aforementioned Meet-the-Professor Luncheon at Digestive Diseases Week.

Third, know the privacy setting options on your social media platform(s) of choice and use them to your advantage. For example, on Facebook and Twitter, you can select an option that requests your permission before a friend or follower is added to your network. You also can tailor who (such as friends or followers only) can access your posted content directly. However, know that your content still may be made public if it is shared by one of your friends or followers.

Fourth, nurture your social media presence by sharing credible content deliberately, regularly, and, when appropriate, with attribution.

Fifth, diversify your content within the realm of your predefined objectives and/or goals and avoid a singular focus of self-promotion or the appearance of self-promotion. Top social media users suggest, and the authors agree, that your content should be only 25%-33% of your posts.

Sixth, thoroughly vet all content that you share. Avoid automatically sharing articles or posts because of a catchy headline. Read them before you post them. There may be details buried in them that are not credible or with which you do not agree.

Seventh, build community by connecting and engaging with other users on your social media platform(s) of choice.

Eighth, integrate multiple media (i.e., photos, videos, infographics) and/or social media platforms (i.e., embed link to YouTube or a website) to increase engagement.

Ninth, adhere to the code of ethics, governance, and privacy of the profession and of your employer.
 

 

 

Best practices: Privacy and governance in patient-oriented communication on social media

Two factors that have been of pivotal concern with the adoption of social media in the health care arena and led to many health care professionals being laggards as opposed to early adopters are privacy and governance. Will it violate the patient–provider relationship? What about the Health Insurance Portability and Accountability Act? How do I maintain boundaries between myself and the public at large? These are just a few of the questions that commonly are asked by those who are unfamiliar with social media etiquette for health care professionals. We highly recommend reviewing the position paper regarding online medical professionalism issued by the American College of Physicians and the Federation of State Medical Boards as a starting point.13 We believe the following to be contemporary guiding principles for GI health providers for maintaining a digital footprint on social media that reflects the ethical and professional standards of the field.

First, avoid sharing information that could be construed as a patient identifier without documented consent. This includes, but is not limited to, an identifiable specimen or photograph, and stories of care, rare conditions, and complications. Note that dates and location of care can lead to identification of a patient or care episode.

Second, recognize that personal and professional online profiles/pages are discoverable. Many advocate for separating the two as a means of shielding the public from elements of a private persona (i.e., family pictures and controversial opinions). However, the capacity to share and find comments and images on social media is much more powerful than the privacy settings on the various social media platforms. If you establish distinct personal and professional profiles, exercise caution before accepting friend or follow requests from patients on your personal profile. In addition, be cautious with your posts on private social media accounts because they rarely truly are private.

Third, avoid providing specific medical recommendations to individuals. This creates a patient–provider relationship and legal duty. Instead, recommend consultation with a health care provider and consider providing a link to general information on the topic (e.g., AGA information for patients at www.gastro.org/patientinfo).

Fourth, declare conflicts of interest, if applicable, when sharing information involving your clinical, research, and/or business practice.

Fifth, routinely monitor your online presence for accuracy and appropriateness of content posted by you and by others in reference to you. Know that our profession’s ethical standards for behavior extend to social media and we can be held accountable to colleagues and our employer if we violate them.

Many employers have become savvy to issues of governance in use of social media and institute policy recommendations to which employees are expected to adhere. If you are an employee, we recommend checking with your marketing and/or human resources department(s) in regards to this. If you are an employer and do not have such a policy on online professionalism, it is our hope that this article serves as a launching pad.
 

Novel applications for social media in clinical practice

Social media has been shown to be an effective medium for medical education through virtual journal clubs, moderated discussions or chats, and video sharing for teaching procedures, to name a few applications. Social media is used to collect data via polls or surveys, and to disseminate and track the views and downloads of published works. It is also a source for unsolicited, real-time feedback on patient experience and engagement through data-mining techniques, such as natural language processing and, more simply, for solicited feedback for patient satisfaction ratings. However, its role in academic promotion is less clear and is an area for which we see a great opportunity for growth.

Academic institutions increasingly are recognizing social media scholarly activities and their broad-reaching influence on the tripartite mission of education, research, and patient care, but have been slow to acknowledge them as academic currency. The Mayo Clinic is a forerunner in developing a framework for the incorporation of social media scholarship into promotion and tenure criteria.14 They also have established a Social Media Network through which they develop best practices and train physicians and staff.15 However, there are examples of physicians who do not work in environments that have included social media engagement in promotion and tenure criteria, but who individually established metrics of their social media influence and impact, included them as a complement to the traditional requirements that were also in their dossier, and leveraged them to a promotion from assistant to associate professors.16,17 Examples are provided in Table 1.
 

 

 

Summary

We have outlined a high-level overview for why you should consider establishing and maintaining a professional presence on social media and how to accomplish this. These reasons include sharing information with colleagues, patients, and the public; amplifying the voice of physicians, a view that has diminished in the often-volatile health care environment; and promotion of the value of your work, be it patient care, advocacy, research, or education. You will have a smoother experience if you learn your local rules and policies and abide by our suggestions to avoid adverse outcomes. You will be most effective if you establish goals for your social media participation and revisit these goals over time for continued relevance and success and if you have consistent and valuable output that will support attainment of these goals. Welcome to the GI social media community! Be sure to follow Clinical Gastroenterology and Hepatology and the American Gastroenterological Association on Facebook (facebook.com/cghjournal and facebook.com/amergastroassn) and Twitter (@AGA_CGH and @AmerGastroAssn), and the coauthors (@DMGrayMD and @DrDeborahFisher) on Twitter.

References

1. Social Media Fact Sheet. Pew Research Center [updated January 12, 2017]. Available from http://www.pewinternet.org/fact-sheet/social-media/. Accessed: June 20, 2017.

2. Hesse B.W., Nelson D.E., Kreps G.L., et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165:2618-24.

3. Moorhead S.A., Hazlett D.E., Harrison L., et al. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res. 2013;15:e85.

4. Chou W.Y., Hunt Y.M., Beckjord E.B. et al. Social media use in the United States: implications for health communication. J Med Internet Res. 2009;11:e48.

5. Chretien K.C., Kind T. Social media and clinical care: ethical, professional, and social implications. Circulation. 2013;27:1413-21.

6. Social Media ‘likes’ Healthcare. PwC Health Research Institute; 2012. Available from https://www.pwc.com/us/en/health-industries/health-research-institute/publications/pdf/health-care-social-media-report.pdf. Accessed: June 20, 2017.

7. Griffis H.M., Kilaru A.S., Werner R.M., et al. Use of social media across US hospitals: descriptive analysis of adoption and utilization. J Med Internet Res. 2014;16:e264.

8. Davis E.D., Tang S.J., Glover P.H., et al. Impact of social media on gastroenterologists in the United States. Dig Liver Dis. 2015;47:258-9.

9. Chiang A.L., Vartabedian B., Spiegel B. Harnessing the hashtag: a standard approach to GI dialogue on social media. Am J Gastroenterol. 2016;111:1082-4.

10. Reich J., Guo L., Hall J., et al. A survey of social media use and preferences in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:2678-87.

11. Timms C., Forton D.M., Poullis A. Social media use in patients with inflammatory bowel disease and chronic viral hepatitis. Clin Med. 2014;14:215.

12. Prasad B. Social media, health care, and social networking. Gastrointest Endosc. 2013;77:492-5.

13. Farnan J.M., Snyder Sulmasy L., Worster B.K., et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013;158:620-7.

14. Cabrera D., Vartabedian B.S., Spinner R.J., et al. More than likes and tweets: creating social media portfolios for academic promotion and tenure. J Grad Med Educ. 2017;9:421-5.

15. Cabrera D. Mayo Clinic includes social media scholarship activities in academic advancement. Available from https://socialmedia.mayoclinic.org/2016/05/25/mayo-clinic-includes-social-media-scholarship-activities-in-academic-advancement/

Date: May 26, 2016. (Accessed: July 1, 2017).

16. Freitag C.E., Arnold M.A., Gardner J.M., et al. If you are not on social media, here’s what you’re missing! #DoTheThing. Arch Pathol Lab Med. 2017; (Epub ahead of print).

17. Stukus D.R. How I used twitter to get promoted in academic medicine. Available from http://www.kevinmd.com/blog/2016/10/used-twitter-get-promoted-academic-medicine.html. Date: October 9, 2016. (Accessed: July 1, 2017).

Dr. Gray is in the division of gastroenterology, hepatology, and nutrition, department of medicine, The Ohio State University College of Medicine, Columbus; Dr. Fisher is in the division of gastroenterology, department of medicine, Duke University, Durham, N.C. The authors disclose no conflicts of interest.

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Social media use is ubiquitous and, in the digital age, it is the ascendant form of communication. Individuals and organizations, digital immigrants (those born before the widespread adoption of digital technology), and digital natives alike are leveraging social media platforms, such as blogs, Facebook, Twitter, YouTube, and LinkedIn, to curate, consume, and share information across the spectrum of demographics and target audiences. In the United States, 7 in 10 Americans are using social media and, although young adults were early adopters, use among older adults is increasing rapidly.1

Furthermore, social media has cultivated remarkable opportunities in the dissemination of health information and disrupted traditional methods of patient–provider communication. The days when medically trained health professionals were the gatekeepers of health information are long gone. Approximately 50% of Americans seek health information online before seeing a physician.2 Patients and other consumers regularly access social media to search for information about diseases and treatments, engage with other patients, identify providers, and to express or rate their satisfaction with providers, clinics, and health systems.3-5 In addition, they trust online health information from doctors more than that from hospitals, health insurers, and drug companies.6 Not surprisingly, this has led to tremendous growth in use of social media by health care providers, hospitals, and health centers. More than 90% of US hospitals have a Facebook page and 50% have a Twitter account.7

Dr. Darrell M. Gray II
Gastroenterology (GI) and hepatology practitioners, their clinical and research practices, and their patients are no exception. Although adoption of social media has been slow among gastroenterologists and hepatologists, it is growing. In a study published in 2015, Davis et al.8 found that only 48% of GI providers reported never using social media. More recently, in March 2017, we conducted a survey of American Gastroenterological Association (AGA) members subscribed to the AGA eDigest. Of the 69 participants, one-third reported using at least one social media platform multiple times per day and 56% expressed interest in expanding their social media presence. Chiang et al.9 even developed GI hashtag ontology (hashtag refers to a phrase that is preceded by # and is used to identify and collate topics of interest, ie, #coloncancer) as a means to allow lay and health professional social media users to curate medical information more easily. These data are particularly interesting in light of studies suggesting that patients with inflammatory bowel disease and chronic viral hepatitis, chronic diseases that commonly are managed by GI and hepatology providers, are highly motivated to use social media in the management of their disease. Patients with these conditions also value interaction with health care professionals on social media.10,11

There is ample opportunity to close the gap between patient and health care provider engagement in Social media, equip providers with the tools they need to be competent consumers and sharers of information in this digital exchange, and increase the pool of evidence-based information on GI and liver diseases on social media.12 However, there is limited published literature tailored to gastroenterologists and hepatologists. The goal of this article, therefore, is to provide a broad overview of best practices in the professional use of social media and highlight examples of novel applications in clinical practice.
 

Best practices: Getting started and maintaining a presence on social media

Social media can magnify your professional image, amplify your voice, and extend your reach and influence much faster than other methods. It also can be damaging if not used responsibly. Thus, we recommend the following approaches to responsible use of social media and cultivating your social media presence based on current evidence, professional organizations’ policy statements, and our combined experience. We initially presented these strategies during a Meet-the-Professor Luncheon at Digestive Disease Week® in Chicago (http://www.ddw.org/education/session-recordings).

Dr. Deborah A. Fisher
First, establish personal objectives and/or goals for using social media. It is with these in mind that you select social media platforms on which to create a digital profile and footprint. They also can serve as an internal censor and guiding principles for the content that you share and individuals or groups with whom you engage. For example, if your goals include disseminating evidence-based content on liver diseases to a broad audience and connecting with a network of key opinion leaders and patient-oriented groups who share this interest and/or expertise, Twitter may be an ideal option for you given its vast user base and flexibility in both posting multimedia content such as pictures, videos, and links to publications, and tailoring the content you receive to specific individuals and groups.

Second, as with other aspects of medical training and practice, find a mentor to provide hands-on advice. This is particularly true if your general familiarity with the social media platforms is limited. If this is not available through your network of colleagues or workplace, we recommend exploring opportunities offered through your professional organization(s) such as the aforementioned Meet-the-Professor Luncheon at Digestive Diseases Week.

Third, know the privacy setting options on your social media platform(s) of choice and use them to your advantage. For example, on Facebook and Twitter, you can select an option that requests your permission before a friend or follower is added to your network. You also can tailor who (such as friends or followers only) can access your posted content directly. However, know that your content still may be made public if it is shared by one of your friends or followers.

Fourth, nurture your social media presence by sharing credible content deliberately, regularly, and, when appropriate, with attribution.

Fifth, diversify your content within the realm of your predefined objectives and/or goals and avoid a singular focus of self-promotion or the appearance of self-promotion. Top social media users suggest, and the authors agree, that your content should be only 25%-33% of your posts.

Sixth, thoroughly vet all content that you share. Avoid automatically sharing articles or posts because of a catchy headline. Read them before you post them. There may be details buried in them that are not credible or with which you do not agree.

Seventh, build community by connecting and engaging with other users on your social media platform(s) of choice.

Eighth, integrate multiple media (i.e., photos, videos, infographics) and/or social media platforms (i.e., embed link to YouTube or a website) to increase engagement.

Ninth, adhere to the code of ethics, governance, and privacy of the profession and of your employer.
 

 

 

Best practices: Privacy and governance in patient-oriented communication on social media

Two factors that have been of pivotal concern with the adoption of social media in the health care arena and led to many health care professionals being laggards as opposed to early adopters are privacy and governance. Will it violate the patient–provider relationship? What about the Health Insurance Portability and Accountability Act? How do I maintain boundaries between myself and the public at large? These are just a few of the questions that commonly are asked by those who are unfamiliar with social media etiquette for health care professionals. We highly recommend reviewing the position paper regarding online medical professionalism issued by the American College of Physicians and the Federation of State Medical Boards as a starting point.13 We believe the following to be contemporary guiding principles for GI health providers for maintaining a digital footprint on social media that reflects the ethical and professional standards of the field.

First, avoid sharing information that could be construed as a patient identifier without documented consent. This includes, but is not limited to, an identifiable specimen or photograph, and stories of care, rare conditions, and complications. Note that dates and location of care can lead to identification of a patient or care episode.

Second, recognize that personal and professional online profiles/pages are discoverable. Many advocate for separating the two as a means of shielding the public from elements of a private persona (i.e., family pictures and controversial opinions). However, the capacity to share and find comments and images on social media is much more powerful than the privacy settings on the various social media platforms. If you establish distinct personal and professional profiles, exercise caution before accepting friend or follow requests from patients on your personal profile. In addition, be cautious with your posts on private social media accounts because they rarely truly are private.

Third, avoid providing specific medical recommendations to individuals. This creates a patient–provider relationship and legal duty. Instead, recommend consultation with a health care provider and consider providing a link to general information on the topic (e.g., AGA information for patients at www.gastro.org/patientinfo).

Fourth, declare conflicts of interest, if applicable, when sharing information involving your clinical, research, and/or business practice.

Fifth, routinely monitor your online presence for accuracy and appropriateness of content posted by you and by others in reference to you. Know that our profession’s ethical standards for behavior extend to social media and we can be held accountable to colleagues and our employer if we violate them.

Many employers have become savvy to issues of governance in use of social media and institute policy recommendations to which employees are expected to adhere. If you are an employee, we recommend checking with your marketing and/or human resources department(s) in regards to this. If you are an employer and do not have such a policy on online professionalism, it is our hope that this article serves as a launching pad.
 

Novel applications for social media in clinical practice

Social media has been shown to be an effective medium for medical education through virtual journal clubs, moderated discussions or chats, and video sharing for teaching procedures, to name a few applications. Social media is used to collect data via polls or surveys, and to disseminate and track the views and downloads of published works. It is also a source for unsolicited, real-time feedback on patient experience and engagement through data-mining techniques, such as natural language processing and, more simply, for solicited feedback for patient satisfaction ratings. However, its role in academic promotion is less clear and is an area for which we see a great opportunity for growth.

Academic institutions increasingly are recognizing social media scholarly activities and their broad-reaching influence on the tripartite mission of education, research, and patient care, but have been slow to acknowledge them as academic currency. The Mayo Clinic is a forerunner in developing a framework for the incorporation of social media scholarship into promotion and tenure criteria.14 They also have established a Social Media Network through which they develop best practices and train physicians and staff.15 However, there are examples of physicians who do not work in environments that have included social media engagement in promotion and tenure criteria, but who individually established metrics of their social media influence and impact, included them as a complement to the traditional requirements that were also in their dossier, and leveraged them to a promotion from assistant to associate professors.16,17 Examples are provided in Table 1.
 

 

 

Summary

We have outlined a high-level overview for why you should consider establishing and maintaining a professional presence on social media and how to accomplish this. These reasons include sharing information with colleagues, patients, and the public; amplifying the voice of physicians, a view that has diminished in the often-volatile health care environment; and promotion of the value of your work, be it patient care, advocacy, research, or education. You will have a smoother experience if you learn your local rules and policies and abide by our suggestions to avoid adverse outcomes. You will be most effective if you establish goals for your social media participation and revisit these goals over time for continued relevance and success and if you have consistent and valuable output that will support attainment of these goals. Welcome to the GI social media community! Be sure to follow Clinical Gastroenterology and Hepatology and the American Gastroenterological Association on Facebook (facebook.com/cghjournal and facebook.com/amergastroassn) and Twitter (@AGA_CGH and @AmerGastroAssn), and the coauthors (@DMGrayMD and @DrDeborahFisher) on Twitter.

References

1. Social Media Fact Sheet. Pew Research Center [updated January 12, 2017]. Available from http://www.pewinternet.org/fact-sheet/social-media/. Accessed: June 20, 2017.

2. Hesse B.W., Nelson D.E., Kreps G.L., et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165:2618-24.

3. Moorhead S.A., Hazlett D.E., Harrison L., et al. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res. 2013;15:e85.

4. Chou W.Y., Hunt Y.M., Beckjord E.B. et al. Social media use in the United States: implications for health communication. J Med Internet Res. 2009;11:e48.

5. Chretien K.C., Kind T. Social media and clinical care: ethical, professional, and social implications. Circulation. 2013;27:1413-21.

6. Social Media ‘likes’ Healthcare. PwC Health Research Institute; 2012. Available from https://www.pwc.com/us/en/health-industries/health-research-institute/publications/pdf/health-care-social-media-report.pdf. Accessed: June 20, 2017.

7. Griffis H.M., Kilaru A.S., Werner R.M., et al. Use of social media across US hospitals: descriptive analysis of adoption and utilization. J Med Internet Res. 2014;16:e264.

8. Davis E.D., Tang S.J., Glover P.H., et al. Impact of social media on gastroenterologists in the United States. Dig Liver Dis. 2015;47:258-9.

9. Chiang A.L., Vartabedian B., Spiegel B. Harnessing the hashtag: a standard approach to GI dialogue on social media. Am J Gastroenterol. 2016;111:1082-4.

10. Reich J., Guo L., Hall J., et al. A survey of social media use and preferences in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:2678-87.

11. Timms C., Forton D.M., Poullis A. Social media use in patients with inflammatory bowel disease and chronic viral hepatitis. Clin Med. 2014;14:215.

12. Prasad B. Social media, health care, and social networking. Gastrointest Endosc. 2013;77:492-5.

13. Farnan J.M., Snyder Sulmasy L., Worster B.K., et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013;158:620-7.

14. Cabrera D., Vartabedian B.S., Spinner R.J., et al. More than likes and tweets: creating social media portfolios for academic promotion and tenure. J Grad Med Educ. 2017;9:421-5.

15. Cabrera D. Mayo Clinic includes social media scholarship activities in academic advancement. Available from https://socialmedia.mayoclinic.org/2016/05/25/mayo-clinic-includes-social-media-scholarship-activities-in-academic-advancement/

Date: May 26, 2016. (Accessed: July 1, 2017).

16. Freitag C.E., Arnold M.A., Gardner J.M., et al. If you are not on social media, here’s what you’re missing! #DoTheThing. Arch Pathol Lab Med. 2017; (Epub ahead of print).

17. Stukus D.R. How I used twitter to get promoted in academic medicine. Available from http://www.kevinmd.com/blog/2016/10/used-twitter-get-promoted-academic-medicine.html. Date: October 9, 2016. (Accessed: July 1, 2017).

Dr. Gray is in the division of gastroenterology, hepatology, and nutrition, department of medicine, The Ohio State University College of Medicine, Columbus; Dr. Fisher is in the division of gastroenterology, department of medicine, Duke University, Durham, N.C. The authors disclose no conflicts of interest.

 

Social media use is ubiquitous and, in the digital age, it is the ascendant form of communication. Individuals and organizations, digital immigrants (those born before the widespread adoption of digital technology), and digital natives alike are leveraging social media platforms, such as blogs, Facebook, Twitter, YouTube, and LinkedIn, to curate, consume, and share information across the spectrum of demographics and target audiences. In the United States, 7 in 10 Americans are using social media and, although young adults were early adopters, use among older adults is increasing rapidly.1

Furthermore, social media has cultivated remarkable opportunities in the dissemination of health information and disrupted traditional methods of patient–provider communication. The days when medically trained health professionals were the gatekeepers of health information are long gone. Approximately 50% of Americans seek health information online before seeing a physician.2 Patients and other consumers regularly access social media to search for information about diseases and treatments, engage with other patients, identify providers, and to express or rate their satisfaction with providers, clinics, and health systems.3-5 In addition, they trust online health information from doctors more than that from hospitals, health insurers, and drug companies.6 Not surprisingly, this has led to tremendous growth in use of social media by health care providers, hospitals, and health centers. More than 90% of US hospitals have a Facebook page and 50% have a Twitter account.7

Dr. Darrell M. Gray II
Gastroenterology (GI) and hepatology practitioners, their clinical and research practices, and their patients are no exception. Although adoption of social media has been slow among gastroenterologists and hepatologists, it is growing. In a study published in 2015, Davis et al.8 found that only 48% of GI providers reported never using social media. More recently, in March 2017, we conducted a survey of American Gastroenterological Association (AGA) members subscribed to the AGA eDigest. Of the 69 participants, one-third reported using at least one social media platform multiple times per day and 56% expressed interest in expanding their social media presence. Chiang et al.9 even developed GI hashtag ontology (hashtag refers to a phrase that is preceded by # and is used to identify and collate topics of interest, ie, #coloncancer) as a means to allow lay and health professional social media users to curate medical information more easily. These data are particularly interesting in light of studies suggesting that patients with inflammatory bowel disease and chronic viral hepatitis, chronic diseases that commonly are managed by GI and hepatology providers, are highly motivated to use social media in the management of their disease. Patients with these conditions also value interaction with health care professionals on social media.10,11

There is ample opportunity to close the gap between patient and health care provider engagement in Social media, equip providers with the tools they need to be competent consumers and sharers of information in this digital exchange, and increase the pool of evidence-based information on GI and liver diseases on social media.12 However, there is limited published literature tailored to gastroenterologists and hepatologists. The goal of this article, therefore, is to provide a broad overview of best practices in the professional use of social media and highlight examples of novel applications in clinical practice.
 

Best practices: Getting started and maintaining a presence on social media

Social media can magnify your professional image, amplify your voice, and extend your reach and influence much faster than other methods. It also can be damaging if not used responsibly. Thus, we recommend the following approaches to responsible use of social media and cultivating your social media presence based on current evidence, professional organizations’ policy statements, and our combined experience. We initially presented these strategies during a Meet-the-Professor Luncheon at Digestive Disease Week® in Chicago (http://www.ddw.org/education/session-recordings).

Dr. Deborah A. Fisher
First, establish personal objectives and/or goals for using social media. It is with these in mind that you select social media platforms on which to create a digital profile and footprint. They also can serve as an internal censor and guiding principles for the content that you share and individuals or groups with whom you engage. For example, if your goals include disseminating evidence-based content on liver diseases to a broad audience and connecting with a network of key opinion leaders and patient-oriented groups who share this interest and/or expertise, Twitter may be an ideal option for you given its vast user base and flexibility in both posting multimedia content such as pictures, videos, and links to publications, and tailoring the content you receive to specific individuals and groups.

Second, as with other aspects of medical training and practice, find a mentor to provide hands-on advice. This is particularly true if your general familiarity with the social media platforms is limited. If this is not available through your network of colleagues or workplace, we recommend exploring opportunities offered through your professional organization(s) such as the aforementioned Meet-the-Professor Luncheon at Digestive Diseases Week.

Third, know the privacy setting options on your social media platform(s) of choice and use them to your advantage. For example, on Facebook and Twitter, you can select an option that requests your permission before a friend or follower is added to your network. You also can tailor who (such as friends or followers only) can access your posted content directly. However, know that your content still may be made public if it is shared by one of your friends or followers.

Fourth, nurture your social media presence by sharing credible content deliberately, regularly, and, when appropriate, with attribution.

Fifth, diversify your content within the realm of your predefined objectives and/or goals and avoid a singular focus of self-promotion or the appearance of self-promotion. Top social media users suggest, and the authors agree, that your content should be only 25%-33% of your posts.

Sixth, thoroughly vet all content that you share. Avoid automatically sharing articles or posts because of a catchy headline. Read them before you post them. There may be details buried in them that are not credible or with which you do not agree.

Seventh, build community by connecting and engaging with other users on your social media platform(s) of choice.

Eighth, integrate multiple media (i.e., photos, videos, infographics) and/or social media platforms (i.e., embed link to YouTube or a website) to increase engagement.

Ninth, adhere to the code of ethics, governance, and privacy of the profession and of your employer.
 

 

 

Best practices: Privacy and governance in patient-oriented communication on social media

Two factors that have been of pivotal concern with the adoption of social media in the health care arena and led to many health care professionals being laggards as opposed to early adopters are privacy and governance. Will it violate the patient–provider relationship? What about the Health Insurance Portability and Accountability Act? How do I maintain boundaries between myself and the public at large? These are just a few of the questions that commonly are asked by those who are unfamiliar with social media etiquette for health care professionals. We highly recommend reviewing the position paper regarding online medical professionalism issued by the American College of Physicians and the Federation of State Medical Boards as a starting point.13 We believe the following to be contemporary guiding principles for GI health providers for maintaining a digital footprint on social media that reflects the ethical and professional standards of the field.

First, avoid sharing information that could be construed as a patient identifier without documented consent. This includes, but is not limited to, an identifiable specimen or photograph, and stories of care, rare conditions, and complications. Note that dates and location of care can lead to identification of a patient or care episode.

Second, recognize that personal and professional online profiles/pages are discoverable. Many advocate for separating the two as a means of shielding the public from elements of a private persona (i.e., family pictures and controversial opinions). However, the capacity to share and find comments and images on social media is much more powerful than the privacy settings on the various social media platforms. If you establish distinct personal and professional profiles, exercise caution before accepting friend or follow requests from patients on your personal profile. In addition, be cautious with your posts on private social media accounts because they rarely truly are private.

Third, avoid providing specific medical recommendations to individuals. This creates a patient–provider relationship and legal duty. Instead, recommend consultation with a health care provider and consider providing a link to general information on the topic (e.g., AGA information for patients at www.gastro.org/patientinfo).

Fourth, declare conflicts of interest, if applicable, when sharing information involving your clinical, research, and/or business practice.

Fifth, routinely monitor your online presence for accuracy and appropriateness of content posted by you and by others in reference to you. Know that our profession’s ethical standards for behavior extend to social media and we can be held accountable to colleagues and our employer if we violate them.

Many employers have become savvy to issues of governance in use of social media and institute policy recommendations to which employees are expected to adhere. If you are an employee, we recommend checking with your marketing and/or human resources department(s) in regards to this. If you are an employer and do not have such a policy on online professionalism, it is our hope that this article serves as a launching pad.
 

Novel applications for social media in clinical practice

Social media has been shown to be an effective medium for medical education through virtual journal clubs, moderated discussions or chats, and video sharing for teaching procedures, to name a few applications. Social media is used to collect data via polls or surveys, and to disseminate and track the views and downloads of published works. It is also a source for unsolicited, real-time feedback on patient experience and engagement through data-mining techniques, such as natural language processing and, more simply, for solicited feedback for patient satisfaction ratings. However, its role in academic promotion is less clear and is an area for which we see a great opportunity for growth.

Academic institutions increasingly are recognizing social media scholarly activities and their broad-reaching influence on the tripartite mission of education, research, and patient care, but have been slow to acknowledge them as academic currency. The Mayo Clinic is a forerunner in developing a framework for the incorporation of social media scholarship into promotion and tenure criteria.14 They also have established a Social Media Network through which they develop best practices and train physicians and staff.15 However, there are examples of physicians who do not work in environments that have included social media engagement in promotion and tenure criteria, but who individually established metrics of their social media influence and impact, included them as a complement to the traditional requirements that were also in their dossier, and leveraged them to a promotion from assistant to associate professors.16,17 Examples are provided in Table 1.
 

 

 

Summary

We have outlined a high-level overview for why you should consider establishing and maintaining a professional presence on social media and how to accomplish this. These reasons include sharing information with colleagues, patients, and the public; amplifying the voice of physicians, a view that has diminished in the often-volatile health care environment; and promotion of the value of your work, be it patient care, advocacy, research, or education. You will have a smoother experience if you learn your local rules and policies and abide by our suggestions to avoid adverse outcomes. You will be most effective if you establish goals for your social media participation and revisit these goals over time for continued relevance and success and if you have consistent and valuable output that will support attainment of these goals. Welcome to the GI social media community! Be sure to follow Clinical Gastroenterology and Hepatology and the American Gastroenterological Association on Facebook (facebook.com/cghjournal and facebook.com/amergastroassn) and Twitter (@AGA_CGH and @AmerGastroAssn), and the coauthors (@DMGrayMD and @DrDeborahFisher) on Twitter.

References

1. Social Media Fact Sheet. Pew Research Center [updated January 12, 2017]. Available from http://www.pewinternet.org/fact-sheet/social-media/. Accessed: June 20, 2017.

2. Hesse B.W., Nelson D.E., Kreps G.L., et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165:2618-24.

3. Moorhead S.A., Hazlett D.E., Harrison L., et al. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res. 2013;15:e85.

4. Chou W.Y., Hunt Y.M., Beckjord E.B. et al. Social media use in the United States: implications for health communication. J Med Internet Res. 2009;11:e48.

5. Chretien K.C., Kind T. Social media and clinical care: ethical, professional, and social implications. Circulation. 2013;27:1413-21.

6. Social Media ‘likes’ Healthcare. PwC Health Research Institute; 2012. Available from https://www.pwc.com/us/en/health-industries/health-research-institute/publications/pdf/health-care-social-media-report.pdf. Accessed: June 20, 2017.

7. Griffis H.M., Kilaru A.S., Werner R.M., et al. Use of social media across US hospitals: descriptive analysis of adoption and utilization. J Med Internet Res. 2014;16:e264.

8. Davis E.D., Tang S.J., Glover P.H., et al. Impact of social media on gastroenterologists in the United States. Dig Liver Dis. 2015;47:258-9.

9. Chiang A.L., Vartabedian B., Spiegel B. Harnessing the hashtag: a standard approach to GI dialogue on social media. Am J Gastroenterol. 2016;111:1082-4.

10. Reich J., Guo L., Hall J., et al. A survey of social media use and preferences in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:2678-87.

11. Timms C., Forton D.M., Poullis A. Social media use in patients with inflammatory bowel disease and chronic viral hepatitis. Clin Med. 2014;14:215.

12. Prasad B. Social media, health care, and social networking. Gastrointest Endosc. 2013;77:492-5.

13. Farnan J.M., Snyder Sulmasy L., Worster B.K., et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013;158:620-7.

14. Cabrera D., Vartabedian B.S., Spinner R.J., et al. More than likes and tweets: creating social media portfolios for academic promotion and tenure. J Grad Med Educ. 2017;9:421-5.

15. Cabrera D. Mayo Clinic includes social media scholarship activities in academic advancement. Available from https://socialmedia.mayoclinic.org/2016/05/25/mayo-clinic-includes-social-media-scholarship-activities-in-academic-advancement/

Date: May 26, 2016. (Accessed: July 1, 2017).

16. Freitag C.E., Arnold M.A., Gardner J.M., et al. If you are not on social media, here’s what you’re missing! #DoTheThing. Arch Pathol Lab Med. 2017; (Epub ahead of print).

17. Stukus D.R. How I used twitter to get promoted in academic medicine. Available from http://www.kevinmd.com/blog/2016/10/used-twitter-get-promoted-academic-medicine.html. Date: October 9, 2016. (Accessed: July 1, 2017).

Dr. Gray is in the division of gastroenterology, hepatology, and nutrition, department of medicine, The Ohio State University College of Medicine, Columbus; Dr. Fisher is in the division of gastroenterology, department of medicine, Duke University, Durham, N.C. The authors disclose no conflicts of interest.

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RNS May Reduce the Risk of SUDEP

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Responsive neurostimulation (RNS) appears to reduce the risk of sudden unexpected death in epilepsy (SUDEP), according to research published online ahead of print January 16 in Epilepsia. The results provide evidence that treatments that reduce seizures decrease the risk of SUDEP, according to the authors. The data also indicate that not every SUDEP follows a seizure.

Orrin Devinsky, MD, Director of the Comprehensive Epilepsy Center at New York University Langone Medical Center, and colleagues examined data for all deaths in patients with epilepsy who received RNS in clinical trials or following FDA approval through May 5, 2016, and adjudicated them for SUDEP. In all, 256 patients received treatment during trials, and 451 received treatment after FDA approval.

Orrin Devinsky, MD


The investigators observed 14 deaths, including two possible, one probable, and four definite cases of SUDEP. The rate of probable or definite SUDEP was 2.0/1,000 over 2,036 patient stimulation years and 2.3/1,000 over 2,208 patient implant years. The age-adjusted standardized mortality ratio for definite and probable SUDEP was 0.75.

“The SUDEP rate of 2.0/1,000 patient stimulation years among patients undergoing treatment with RNS is favorable relative to patients [with treatment-resistant epilepsy] randomized to the placebo arm of add-on drug studies (SUDEP rate of 6.1/1,000 patient years), patients who were referred for epilepsy surgery but did not receive epilepsy surgery (SUDEP rate of 6.3/1,000 patient years), and patients with recurrent seizures after epilepsy surgery (SUDEP rate 6.3/1,000 patient years),” said the authors. “Future explorations can examine whether certain seizure patterns are particularly associated with SUDEP.”

Erik Greb

Suggested Reading

Devinsky O, Friedman D, Duckrow RB, et al. Sudden unexpected death in epilepsy in patients treated with brain-responsive neurostimulation. Epilepsia. 2018 Jan 16 [Epub ahead of print].

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Responsive neurostimulation (RNS) appears to reduce the risk of sudden unexpected death in epilepsy (SUDEP), according to research published online ahead of print January 16 in Epilepsia. The results provide evidence that treatments that reduce seizures decrease the risk of SUDEP, according to the authors. The data also indicate that not every SUDEP follows a seizure.

Orrin Devinsky, MD, Director of the Comprehensive Epilepsy Center at New York University Langone Medical Center, and colleagues examined data for all deaths in patients with epilepsy who received RNS in clinical trials or following FDA approval through May 5, 2016, and adjudicated them for SUDEP. In all, 256 patients received treatment during trials, and 451 received treatment after FDA approval.

Orrin Devinsky, MD


The investigators observed 14 deaths, including two possible, one probable, and four definite cases of SUDEP. The rate of probable or definite SUDEP was 2.0/1,000 over 2,036 patient stimulation years and 2.3/1,000 over 2,208 patient implant years. The age-adjusted standardized mortality ratio for definite and probable SUDEP was 0.75.

“The SUDEP rate of 2.0/1,000 patient stimulation years among patients undergoing treatment with RNS is favorable relative to patients [with treatment-resistant epilepsy] randomized to the placebo arm of add-on drug studies (SUDEP rate of 6.1/1,000 patient years), patients who were referred for epilepsy surgery but did not receive epilepsy surgery (SUDEP rate of 6.3/1,000 patient years), and patients with recurrent seizures after epilepsy surgery (SUDEP rate 6.3/1,000 patient years),” said the authors. “Future explorations can examine whether certain seizure patterns are particularly associated with SUDEP.”

Erik Greb

Suggested Reading

Devinsky O, Friedman D, Duckrow RB, et al. Sudden unexpected death in epilepsy in patients treated with brain-responsive neurostimulation. Epilepsia. 2018 Jan 16 [Epub ahead of print].

Responsive neurostimulation (RNS) appears to reduce the risk of sudden unexpected death in epilepsy (SUDEP), according to research published online ahead of print January 16 in Epilepsia. The results provide evidence that treatments that reduce seizures decrease the risk of SUDEP, according to the authors. The data also indicate that not every SUDEP follows a seizure.

Orrin Devinsky, MD, Director of the Comprehensive Epilepsy Center at New York University Langone Medical Center, and colleagues examined data for all deaths in patients with epilepsy who received RNS in clinical trials or following FDA approval through May 5, 2016, and adjudicated them for SUDEP. In all, 256 patients received treatment during trials, and 451 received treatment after FDA approval.

Orrin Devinsky, MD


The investigators observed 14 deaths, including two possible, one probable, and four definite cases of SUDEP. The rate of probable or definite SUDEP was 2.0/1,000 over 2,036 patient stimulation years and 2.3/1,000 over 2,208 patient implant years. The age-adjusted standardized mortality ratio for definite and probable SUDEP was 0.75.

“The SUDEP rate of 2.0/1,000 patient stimulation years among patients undergoing treatment with RNS is favorable relative to patients [with treatment-resistant epilepsy] randomized to the placebo arm of add-on drug studies (SUDEP rate of 6.1/1,000 patient years), patients who were referred for epilepsy surgery but did not receive epilepsy surgery (SUDEP rate of 6.3/1,000 patient years), and patients with recurrent seizures after epilepsy surgery (SUDEP rate 6.3/1,000 patient years),” said the authors. “Future explorations can examine whether certain seizure patterns are particularly associated with SUDEP.”

Erik Greb

Suggested Reading

Devinsky O, Friedman D, Duckrow RB, et al. Sudden unexpected death in epilepsy in patients treated with brain-responsive neurostimulation. Epilepsia. 2018 Jan 16 [Epub ahead of print].

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Diagnostic delays, morbidity, and epidural abscesses

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Fri, 09/14/2018 - 11:55

 

Clinical question: What is the frequency of diagnostic delays in epidural abscesses, and what factors may contribute to these delays?

Background: Diagnostic evaluation of back pain can be challenging. Missed diagnosis of serious conditions such as epidural abscesses can lead to significant morbidity.

Dr. Celeste Pizza
Study design: Retrospective chart review.

Setting: Veterans Affairs Electronic Medical Record database from more than 1,700 VA outpatient and inpatient facilities in the United States.

Synopsis: Of the 119 patients with a new diagnosis of spinal epidural abscess, 55.5% were felt to have experienced a diagnostic error, defined by the study authors as a missed opportunity to evaluate a red flag (e.g. weight loss, neurologic deficit, fever) in a timely or appropriate manner. There was a significant difference in the time to diagnosis between patients with and without a diagnostic error (4 versus 12 days, P less than .01). Of those cases involving diagnostic error, 60.6% were felt to have resulted in serious patient harm and 12.1% in patient death. The most commonly missed red flags were fever, focal neurological deficits, and signs of active infection.

Based on these findings, the authors suggest that future intervention focus on improving information gathering during patient-physician encounter and physician education about existing guidelines.

The limitations of this study include its use of data from a single health system, and the employment of chart reviews instead of a root cause analysis based on provider and patient interviews.

Bottom line: A delay in diagnosis resulting in patient harm or death may occur frequently in cases of epidural abscesses. Further work on targeted interventions to reduce error and prevent harm are needed.

Citation: Bhise V, Meyer A, Singh H, et al. Diagnosis of spinal epidural abscesses in the era of electronic health records. Am J Med. 2017;130(8):975-81.
 

Dr. Pizza is a hospitalist, Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, Boston.

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Clinical question: What is the frequency of diagnostic delays in epidural abscesses, and what factors may contribute to these delays?

Background: Diagnostic evaluation of back pain can be challenging. Missed diagnosis of serious conditions such as epidural abscesses can lead to significant morbidity.

Dr. Celeste Pizza
Study design: Retrospective chart review.

Setting: Veterans Affairs Electronic Medical Record database from more than 1,700 VA outpatient and inpatient facilities in the United States.

Synopsis: Of the 119 patients with a new diagnosis of spinal epidural abscess, 55.5% were felt to have experienced a diagnostic error, defined by the study authors as a missed opportunity to evaluate a red flag (e.g. weight loss, neurologic deficit, fever) in a timely or appropriate manner. There was a significant difference in the time to diagnosis between patients with and without a diagnostic error (4 versus 12 days, P less than .01). Of those cases involving diagnostic error, 60.6% were felt to have resulted in serious patient harm and 12.1% in patient death. The most commonly missed red flags were fever, focal neurological deficits, and signs of active infection.

Based on these findings, the authors suggest that future intervention focus on improving information gathering during patient-physician encounter and physician education about existing guidelines.

The limitations of this study include its use of data from a single health system, and the employment of chart reviews instead of a root cause analysis based on provider and patient interviews.

Bottom line: A delay in diagnosis resulting in patient harm or death may occur frequently in cases of epidural abscesses. Further work on targeted interventions to reduce error and prevent harm are needed.

Citation: Bhise V, Meyer A, Singh H, et al. Diagnosis of spinal epidural abscesses in the era of electronic health records. Am J Med. 2017;130(8):975-81.
 

Dr. Pizza is a hospitalist, Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, Boston.

 

Clinical question: What is the frequency of diagnostic delays in epidural abscesses, and what factors may contribute to these delays?

Background: Diagnostic evaluation of back pain can be challenging. Missed diagnosis of serious conditions such as epidural abscesses can lead to significant morbidity.

Dr. Celeste Pizza
Study design: Retrospective chart review.

Setting: Veterans Affairs Electronic Medical Record database from more than 1,700 VA outpatient and inpatient facilities in the United States.

Synopsis: Of the 119 patients with a new diagnosis of spinal epidural abscess, 55.5% were felt to have experienced a diagnostic error, defined by the study authors as a missed opportunity to evaluate a red flag (e.g. weight loss, neurologic deficit, fever) in a timely or appropriate manner. There was a significant difference in the time to diagnosis between patients with and without a diagnostic error (4 versus 12 days, P less than .01). Of those cases involving diagnostic error, 60.6% were felt to have resulted in serious patient harm and 12.1% in patient death. The most commonly missed red flags were fever, focal neurological deficits, and signs of active infection.

Based on these findings, the authors suggest that future intervention focus on improving information gathering during patient-physician encounter and physician education about existing guidelines.

The limitations of this study include its use of data from a single health system, and the employment of chart reviews instead of a root cause analysis based on provider and patient interviews.

Bottom line: A delay in diagnosis resulting in patient harm or death may occur frequently in cases of epidural abscesses. Further work on targeted interventions to reduce error and prevent harm are needed.

Citation: Bhise V, Meyer A, Singh H, et al. Diagnosis of spinal epidural abscesses in the era of electronic health records. Am J Med. 2017;130(8):975-81.
 

Dr. Pizza is a hospitalist, Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, Boston.

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Parental leave not available to all academic surgeons

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Wed, 04/03/2019 - 10:23

 

Paid parental leave policies have been unevenly adopted among academic medical centers, according to a study published in the Journal of Surgical Research. These policies, or their lack, may have important ramifications for recruiting and specialty selection by surgeons, and for women of child-rearing age in particular.

The ACS supports maternity leave of no less than 6 weeks (vaginal delivery)/8 weeks (cesarean section) and paternity leave of not less than 6 weeks. The American College of Obstetricians and Gynecologists endorses paid parental leave for all workers that includes maintenance of full benefits and 100% of pay for at least 6 weeks. The Association of Women Surgeons has issued a similar statement supporting paid parental leave.

Dina S. Itum, MD, a fifth-year resident in the department of surgery, University of Texas Southwestern Medical Center, Houston, and a research team looked into how widespread parental leave is for surgeons in US medical centers. Their sample was the 91 top-ranked academic medical centers identified by U.S. News & World Report in 2016. The method used by U.S. News & World Report for ranking medical centers is based on student selectivity, dean and residency directors’ peer assessment of national institutions, faculty to student ratio, and the dollar amount in NIH research grants received.

“Parental leave” was defined by the research team as any leave dedicated to new mothers, fathers and/or primary caregivers after childbirth or adoption. “Paid leave” was defined as some protected leave with salary without mandated use of sick leave or vacation leave.

The study found that among the top-ranked 91 institutions, 48 (53%) offered some form of paid parental leave to faculty surgeons. The higher the rating, the more likely the institution offered paid parental leave: 77% of those in the top third of rankings vs. 53% in the middle third and 29% in the bottom third. Private institutions were more likely to offer paid leave of 6 weeks or longer; 67% vs. 33% of public institutions.

The investigators posed a question: Did these institutions implement the policy to attract the top talent, or did the policy improve faculty morale and productivity leading to a higher ranking? The study does not answer the question, but the investigators consider it an important issue for further study.

The investigators also suggested that surgeons of child-rearing age use parental leave information their in their own employment negotiations. “As physicians, we are aware of the health care benefits associated with parental leave, and as leaders within our communities, we should be at the forefront of supporting further advancement of this benefit,” the investigators wrote.

The investigators reported having no financial disclosures.

SOURCE: Itum DS et al. J Surg Res. 2018 Feb 3. doi. org/10.1016/j.jss.2018.01.001.

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Paid parental leave policies have been unevenly adopted among academic medical centers, according to a study published in the Journal of Surgical Research. These policies, or their lack, may have important ramifications for recruiting and specialty selection by surgeons, and for women of child-rearing age in particular.

The ACS supports maternity leave of no less than 6 weeks (vaginal delivery)/8 weeks (cesarean section) and paternity leave of not less than 6 weeks. The American College of Obstetricians and Gynecologists endorses paid parental leave for all workers that includes maintenance of full benefits and 100% of pay for at least 6 weeks. The Association of Women Surgeons has issued a similar statement supporting paid parental leave.

Dina S. Itum, MD, a fifth-year resident in the department of surgery, University of Texas Southwestern Medical Center, Houston, and a research team looked into how widespread parental leave is for surgeons in US medical centers. Their sample was the 91 top-ranked academic medical centers identified by U.S. News & World Report in 2016. The method used by U.S. News & World Report for ranking medical centers is based on student selectivity, dean and residency directors’ peer assessment of national institutions, faculty to student ratio, and the dollar amount in NIH research grants received.

“Parental leave” was defined by the research team as any leave dedicated to new mothers, fathers and/or primary caregivers after childbirth or adoption. “Paid leave” was defined as some protected leave with salary without mandated use of sick leave or vacation leave.

The study found that among the top-ranked 91 institutions, 48 (53%) offered some form of paid parental leave to faculty surgeons. The higher the rating, the more likely the institution offered paid parental leave: 77% of those in the top third of rankings vs. 53% in the middle third and 29% in the bottom third. Private institutions were more likely to offer paid leave of 6 weeks or longer; 67% vs. 33% of public institutions.

The investigators posed a question: Did these institutions implement the policy to attract the top talent, or did the policy improve faculty morale and productivity leading to a higher ranking? The study does not answer the question, but the investigators consider it an important issue for further study.

The investigators also suggested that surgeons of child-rearing age use parental leave information their in their own employment negotiations. “As physicians, we are aware of the health care benefits associated with parental leave, and as leaders within our communities, we should be at the forefront of supporting further advancement of this benefit,” the investigators wrote.

The investigators reported having no financial disclosures.

SOURCE: Itum DS et al. J Surg Res. 2018 Feb 3. doi. org/10.1016/j.jss.2018.01.001.

 

Paid parental leave policies have been unevenly adopted among academic medical centers, according to a study published in the Journal of Surgical Research. These policies, or their lack, may have important ramifications for recruiting and specialty selection by surgeons, and for women of child-rearing age in particular.

The ACS supports maternity leave of no less than 6 weeks (vaginal delivery)/8 weeks (cesarean section) and paternity leave of not less than 6 weeks. The American College of Obstetricians and Gynecologists endorses paid parental leave for all workers that includes maintenance of full benefits and 100% of pay for at least 6 weeks. The Association of Women Surgeons has issued a similar statement supporting paid parental leave.

Dina S. Itum, MD, a fifth-year resident in the department of surgery, University of Texas Southwestern Medical Center, Houston, and a research team looked into how widespread parental leave is for surgeons in US medical centers. Their sample was the 91 top-ranked academic medical centers identified by U.S. News & World Report in 2016. The method used by U.S. News & World Report for ranking medical centers is based on student selectivity, dean and residency directors’ peer assessment of national institutions, faculty to student ratio, and the dollar amount in NIH research grants received.

“Parental leave” was defined by the research team as any leave dedicated to new mothers, fathers and/or primary caregivers after childbirth or adoption. “Paid leave” was defined as some protected leave with salary without mandated use of sick leave or vacation leave.

The study found that among the top-ranked 91 institutions, 48 (53%) offered some form of paid parental leave to faculty surgeons. The higher the rating, the more likely the institution offered paid parental leave: 77% of those in the top third of rankings vs. 53% in the middle third and 29% in the bottom third. Private institutions were more likely to offer paid leave of 6 weeks or longer; 67% vs. 33% of public institutions.

The investigators posed a question: Did these institutions implement the policy to attract the top talent, or did the policy improve faculty morale and productivity leading to a higher ranking? The study does not answer the question, but the investigators consider it an important issue for further study.

The investigators also suggested that surgeons of child-rearing age use parental leave information their in their own employment negotiations. “As physicians, we are aware of the health care benefits associated with parental leave, and as leaders within our communities, we should be at the forefront of supporting further advancement of this benefit,” the investigators wrote.

The investigators reported having no financial disclosures.

SOURCE: Itum DS et al. J Surg Res. 2018 Feb 3. doi. org/10.1016/j.jss.2018.01.001.

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FROM THE JOURNAL OF SURGICAL RESEARCH

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Key clinical point: Parental leave policies have been unevenly adopted by U.S. medical schools.

Major finding: Among the top 91 ranked medical schools, 53% offer paid parental leave.

Data source: Survey of 91 top academic medical centers identified in U.S. News & World Report 2016 listing.

Disclosures: The investigators reported having no financial disclosures.

SOURCE: Itum DS et al. J Surg Res. 2018 Feb 3. doi. org/10.1016/j.jss.2018.01.001.

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FDA grants priority review for AML drug

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Fri, 01/04/2019 - 10:18

 

The Food and Drug Administration has granted priority review status to ivosidenib for the treatment of patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase 1 mutation.

The drug, marketed by Agios Pharmaceuticals, was given a Prescription Drug User Free Act action date of Aug. 21, 2018.


Ivosidenib is a first-in-class oral inhibitor of mutant IDH1. Results from a phase 1 dose-escalation and expansion study (AG120-C-001) presented at the annual meeting of the American Society of Hematology showed a complete response and complete response with partial hematologic recovery rate of 30.4% in 125 patients with relapsed/refractory AML who received the drug, according to Agios.

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The Food and Drug Administration has granted priority review status to ivosidenib for the treatment of patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase 1 mutation.

The drug, marketed by Agios Pharmaceuticals, was given a Prescription Drug User Free Act action date of Aug. 21, 2018.


Ivosidenib is a first-in-class oral inhibitor of mutant IDH1. Results from a phase 1 dose-escalation and expansion study (AG120-C-001) presented at the annual meeting of the American Society of Hematology showed a complete response and complete response with partial hematologic recovery rate of 30.4% in 125 patients with relapsed/refractory AML who received the drug, according to Agios.

 

The Food and Drug Administration has granted priority review status to ivosidenib for the treatment of patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase 1 mutation.

The drug, marketed by Agios Pharmaceuticals, was given a Prescription Drug User Free Act action date of Aug. 21, 2018.


Ivosidenib is a first-in-class oral inhibitor of mutant IDH1. Results from a phase 1 dose-escalation and expansion study (AG120-C-001) presented at the annual meeting of the American Society of Hematology showed a complete response and complete response with partial hematologic recovery rate of 30.4% in 125 patients with relapsed/refractory AML who received the drug, according to Agios.

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Mortality estimates put pancreatic cancer on the map

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The alphabet may put Vermont right after Utah, but pancreatic cancer mortality has them on opposite sides of the country. Utah’s estimated pancreatic cancer rate of 8.7 per 100,000 population for 2018 is the lowest in the United States, and Vermont’s rate of 17.7 per 100,000 is the highest.

Approximately 44,330 deaths from pancreatic cancer are predicted for this year by the American Cancer Society (ACS) in its Cancer Facts & Figures 2018, which is based on analysis of 2001-2015 data from the National Center for Health Statistics. That estimate is up from the 43,090 projected for 2017; the death rate has been rising 0.2% a year since 2006 in whites but decreasing in blacks by 0.5% per year.

The expected number of deaths for 2018 and the current U.S. population estimate of nearly 326 million produce an expected death rate of 13.6 per 100,000 population. The Census Bureau estimates for the state populations, the deaths projected by the ACS, and a little math result in expected death rates of 8.7 per 100,000 for Utah and 17.7 for Vermont.

The incidence of pancreatic cancer increased by about 1% per year in whites and was stable in blacks from 2005 to 2014, although the rate of new cases in blacks is still about 25% higher than it is for whites. An estimated 55,440 new cases are expected in the United States in 2018, the ACS reported.

Although the survival rate for cancer of the pancreas has tripled since the mid-1970s, it is still much lower than for any other cancer. Five-year relative survival went from 3% in 1975-1977 to 9% in 2007-2013 for pancreatic cancer, while liver and intrahepatic bile duct cancer, which had the next-lowest survival rate, went from 3% to 19%, the ACS said.

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The alphabet may put Vermont right after Utah, but pancreatic cancer mortality has them on opposite sides of the country. Utah’s estimated pancreatic cancer rate of 8.7 per 100,000 population for 2018 is the lowest in the United States, and Vermont’s rate of 17.7 per 100,000 is the highest.

Approximately 44,330 deaths from pancreatic cancer are predicted for this year by the American Cancer Society (ACS) in its Cancer Facts & Figures 2018, which is based on analysis of 2001-2015 data from the National Center for Health Statistics. That estimate is up from the 43,090 projected for 2017; the death rate has been rising 0.2% a year since 2006 in whites but decreasing in blacks by 0.5% per year.

The expected number of deaths for 2018 and the current U.S. population estimate of nearly 326 million produce an expected death rate of 13.6 per 100,000 population. The Census Bureau estimates for the state populations, the deaths projected by the ACS, and a little math result in expected death rates of 8.7 per 100,000 for Utah and 17.7 for Vermont.

The incidence of pancreatic cancer increased by about 1% per year in whites and was stable in blacks from 2005 to 2014, although the rate of new cases in blacks is still about 25% higher than it is for whites. An estimated 55,440 new cases are expected in the United States in 2018, the ACS reported.

Although the survival rate for cancer of the pancreas has tripled since the mid-1970s, it is still much lower than for any other cancer. Five-year relative survival went from 3% in 1975-1977 to 9% in 2007-2013 for pancreatic cancer, while liver and intrahepatic bile duct cancer, which had the next-lowest survival rate, went from 3% to 19%, the ACS said.

 

The alphabet may put Vermont right after Utah, but pancreatic cancer mortality has them on opposite sides of the country. Utah’s estimated pancreatic cancer rate of 8.7 per 100,000 population for 2018 is the lowest in the United States, and Vermont’s rate of 17.7 per 100,000 is the highest.

Approximately 44,330 deaths from pancreatic cancer are predicted for this year by the American Cancer Society (ACS) in its Cancer Facts & Figures 2018, which is based on analysis of 2001-2015 data from the National Center for Health Statistics. That estimate is up from the 43,090 projected for 2017; the death rate has been rising 0.2% a year since 2006 in whites but decreasing in blacks by 0.5% per year.

The expected number of deaths for 2018 and the current U.S. population estimate of nearly 326 million produce an expected death rate of 13.6 per 100,000 population. The Census Bureau estimates for the state populations, the deaths projected by the ACS, and a little math result in expected death rates of 8.7 per 100,000 for Utah and 17.7 for Vermont.

The incidence of pancreatic cancer increased by about 1% per year in whites and was stable in blacks from 2005 to 2014, although the rate of new cases in blacks is still about 25% higher than it is for whites. An estimated 55,440 new cases are expected in the United States in 2018, the ACS reported.

Although the survival rate for cancer of the pancreas has tripled since the mid-1970s, it is still much lower than for any other cancer. Five-year relative survival went from 3% in 1975-1977 to 9% in 2007-2013 for pancreatic cancer, while liver and intrahepatic bile duct cancer, which had the next-lowest survival rate, went from 3% to 19%, the ACS said.

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Legacy Society members sustain research

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Tue, 02/20/2018 - 15:17

 

AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.


The AGA Research Foundation’s mission is to raise funds to support young researchers in gastroenterology and hepatology. Gifts to the foundation support researchers working towards developing new treatments and diagnostics for patients with GI conditions.

“I am extremely grateful to be selected for this award. I would like to thank the foundation donors for their generous support. This award will me build a research program to better understand mechanisms that promote growth of cholangiocarcinoma,” remarks Silvia Affe, PhD, Columbia University, 2017 AGA Research Scholar recipient.

Donors who make gifts at the Legacy Society level before DDW will receive an invitation to the annual Benefactors’ Dinner at the Folger Shakespeare Library in Washington, DC. Individuals interested in learning more about Legacy Society membership may contact Stacey Hinton Tuneski, Senior Director of Development at [email protected] or via phone (301) 222-4005. More information on the AGA Legacy Society including the current roster and acceptance form is available on the foundation’s website at www.gastro.org/legacysociety.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

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AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.


The AGA Research Foundation’s mission is to raise funds to support young researchers in gastroenterology and hepatology. Gifts to the foundation support researchers working towards developing new treatments and diagnostics for patients with GI conditions.

“I am extremely grateful to be selected for this award. I would like to thank the foundation donors for their generous support. This award will me build a research program to better understand mechanisms that promote growth of cholangiocarcinoma,” remarks Silvia Affe, PhD, Columbia University, 2017 AGA Research Scholar recipient.

Donors who make gifts at the Legacy Society level before DDW will receive an invitation to the annual Benefactors’ Dinner at the Folger Shakespeare Library in Washington, DC. Individuals interested in learning more about Legacy Society membership may contact Stacey Hinton Tuneski, Senior Director of Development at [email protected] or via phone (301) 222-4005. More information on the AGA Legacy Society including the current roster and acceptance form is available on the foundation’s website at www.gastro.org/legacysociety.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

 

AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.


The AGA Research Foundation’s mission is to raise funds to support young researchers in gastroenterology and hepatology. Gifts to the foundation support researchers working towards developing new treatments and diagnostics for patients with GI conditions.

“I am extremely grateful to be selected for this award. I would like to thank the foundation donors for their generous support. This award will me build a research program to better understand mechanisms that promote growth of cholangiocarcinoma,” remarks Silvia Affe, PhD, Columbia University, 2017 AGA Research Scholar recipient.

Donors who make gifts at the Legacy Society level before DDW will receive an invitation to the annual Benefactors’ Dinner at the Folger Shakespeare Library in Washington, DC. Individuals interested in learning more about Legacy Society membership may contact Stacey Hinton Tuneski, Senior Director of Development at [email protected] or via phone (301) 222-4005. More information on the AGA Legacy Society including the current roster and acceptance form is available on the foundation’s website at www.gastro.org/legacysociety.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

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MDedge Daily News: The Nonallergen of the Year

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Parabens are named “nonallergen” of the year, a gene test guides need for sentinel node biopsy in elderly melanoma patients, select atopic dermatitis patients need patch testing, and try these real solutions for delusional parasitosis.

 

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

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The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

Parabens are named “nonallergen” of the year, a gene test guides need for sentinel node biopsy in elderly melanoma patients, select atopic dermatitis patients need patch testing, and try these real solutions for delusional parasitosis.

 

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

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

Parabens are named “nonallergen” of the year, a gene test guides need for sentinel node biopsy in elderly melanoma patients, select atopic dermatitis patients need patch testing, and try these real solutions for delusional parasitosis.

 

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

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