The Food and Drug Administration has approved Ixifi (infliximab-qbtx), a biosimilar of Remicade, the original infliximab product. Ixifi is the third infliximab biosimilar to be approved by the FDA, and it is approved for all the same indications as Remicade, according to an announcement from its manufacturer, Pfizer.

Ixifi and Remicade are approved for the treatment of rheumatoid arthritis in combination with methotrexate, Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

[email protected]

The Food and Drug Administration has approved Ixifi (infliximab-qbtx), a biosimilar of Remicade, the original infliximab product. Ixifi is the third infliximab biosimilar to be approved by the FDA, and it is approved for all the same indications as Remicade, according to an announcement from its manufacturer, Pfizer.

Ixifi and Remicade are approved for the treatment of rheumatoid arthritis in combination with methotrexate, Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

[email protected]

The Food and Drug Administration has approved Ixifi (infliximab-qbtx), a biosimilar of Remicade, the original infliximab product. Ixifi is the third infliximab biosimilar to be approved by the FDA, and it is approved for all the same indications as Remicade, according to an announcement from its manufacturer, Pfizer.

Ixifi and Remicade are approved for the treatment of rheumatoid arthritis in combination with methotrexate, Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

[email protected]

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also provides us with needed support in furthering basic digestive disease research.

•  Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
•  Telling your friends and family members to donate to the AGA Research Foundation in YOUR honor.

Your next step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also provides us with needed support in furthering basic digestive disease research.

•  Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
•  Telling your friends and family members to donate to the AGA Research Foundation in YOUR honor.

Your next step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also provides us with needed support in furthering basic digestive disease research.

•  Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
•  Telling your friends and family members to donate to the AGA Research Foundation in YOUR honor.

Your next step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Beginning in February 2018, The New Gastroenterologist (TNG) – a supplement to GI & Hepatology News that addresses issues pertinent to trainees and early-career GIs – will switch to a primarily digital format. We are excited about this change and confident that it will allow for a more effective and widespread dissemination of content that is valuable to both AGA members and our readership more broadly.

AGA Institute

[email protected]

Beginning in February 2018, The New Gastroenterologist (TNG) – a supplement to GI & Hepatology News that addresses issues pertinent to trainees and early-career GIs – will switch to a primarily digital format. We are excited about this change and confident that it will allow for a more effective and widespread dissemination of content that is valuable to both AGA members and our readership more broadly.

AGA Institute

[email protected]

Beginning in February 2018, The New Gastroenterologist (TNG) – a supplement to GI & Hepatology News that addresses issues pertinent to trainees and early-career GIs – will switch to a primarily digital format. We are excited about this change and confident that it will allow for a more effective and widespread dissemination of content that is valuable to both AGA members and our readership more broadly.

AGA Institute

[email protected]

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.

“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.

Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).

In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.

“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”

“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”

Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).

The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”

The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.

SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.

“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.

Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).

In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.

“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”

“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”

Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).

The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”

The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.

SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.

“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.

Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).

In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.

“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”

“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”

Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).

The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”

The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.

The diagnosis

Answer: Posttraumatic splenosis

Pathologic examination of the specimen revealed a splenosis showing regular red and white pulp (Figure E). Splenosis is the heterotopic autotransplantation of splenic tissue within the abdominal or pelvic cavity and occurs in 16%–67% of patients with a history of splenic trauma or splenic surgery.1 Nevertheless, hepatic splenosis is rare.2 The literature documents only 16 case reports of hepatic splenosis, although the difficulty of diagnosis could have contributed to underreporting. Although usually harmless, splenosis is a rare cause of bowel obstruction or abdominal pain.

AGA Institute

References

1. Fleming, C.R., Dickson, E.R., Harrison, E.G. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976;61:414-9.
2. D’Angelica, M., Fong, Y., Blumgart, L.H. Isolated hepatic splenosis: first reported case. HPB Surg. 1998;11:39-42.
3. Ohmoto, K., Mimura, N., Iguchi, Y. et al. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma on the surface of the liver. Hepatogastroenterology. 2003;50:1547-51.

[email protected]

The diagnosis

Answer: Posttraumatic splenosis

Pathologic examination of the specimen revealed a splenosis showing regular red and white pulp (Figure E). Splenosis is the heterotopic autotransplantation of splenic tissue within the abdominal or pelvic cavity and occurs in 16%–67% of patients with a history of splenic trauma or splenic surgery.1 Nevertheless, hepatic splenosis is rare.2 The literature documents only 16 case reports of hepatic splenosis, although the difficulty of diagnosis could have contributed to underreporting. Although usually harmless, splenosis is a rare cause of bowel obstruction or abdominal pain.

AGA Institute

References

1. Fleming, C.R., Dickson, E.R., Harrison, E.G. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976;61:414-9.
2. D’Angelica, M., Fong, Y., Blumgart, L.H. Isolated hepatic splenosis: first reported case. HPB Surg. 1998;11:39-42.
3. Ohmoto, K., Mimura, N., Iguchi, Y. et al. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma on the surface of the liver. Hepatogastroenterology. 2003;50:1547-51.

[email protected]

The diagnosis

Answer: Posttraumatic splenosis

Pathologic examination of the specimen revealed a splenosis showing regular red and white pulp (Figure E). Splenosis is the heterotopic autotransplantation of splenic tissue within the abdominal or pelvic cavity and occurs in 16%–67% of patients with a history of splenic trauma or splenic surgery.1 Nevertheless, hepatic splenosis is rare.2 The literature documents only 16 case reports of hepatic splenosis, although the difficulty of diagnosis could have contributed to underreporting. Although usually harmless, splenosis is a rare cause of bowel obstruction or abdominal pain.

AGA Institute

References

1. Fleming, C.R., Dickson, E.R., Harrison, E.G. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976;61:414-9.
2. D’Angelica, M., Fong, Y., Blumgart, L.H. Isolated hepatic splenosis: first reported case. HPB Surg. 1998;11:39-42.
3. Ohmoto, K., Mimura, N., Iguchi, Y. et al. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma on the surface of the liver. Hepatogastroenterology. 2003;50:1547-51.

[email protected]

Q1. CORRECT ANSWER: A

RATIONALE
In patients with a good response to anti-reflux surgery who develop new dysphagia, an upper endoscopy is the test of choice. This will evaluate the structural integrity of the fundoplication, and evaluate for disruption and paraesophageal herniation. The esophagus can be inspected for esophagitis, and dilation of the fundoplication site can be performed. In the absence of heartburn or the original reflux symptoms, empiric acid suppression is not expected to improve the dysphagia. If the endoscopy is negative, esophageal manometry and barium swallow are the next studies of value. A pH study off PPI therapy is performed if recurrent reflux is suspected that does not respond to anti-reflux medications.

REFERENCE
1. Johnson D.A., Younes Z., Hogan W.J. Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000;52(5):650-9.

Q1. CORRECT ANSWER: A

RATIONALE
In patients with a good response to anti-reflux surgery who develop new dysphagia, an upper endoscopy is the test of choice. This will evaluate the structural integrity of the fundoplication, and evaluate for disruption and paraesophageal herniation. The esophagus can be inspected for esophagitis, and dilation of the fundoplication site can be performed. In the absence of heartburn or the original reflux symptoms, empiric acid suppression is not expected to improve the dysphagia. If the endoscopy is negative, esophageal manometry and barium swallow are the next studies of value. A pH study off PPI therapy is performed if recurrent reflux is suspected that does not respond to anti-reflux medications.

REFERENCE
1. Johnson D.A., Younes Z., Hogan W.J. Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000;52(5):650-9.

Q1. CORRECT ANSWER: A

RATIONALE
In patients with a good response to anti-reflux surgery who develop new dysphagia, an upper endoscopy is the test of choice. This will evaluate the structural integrity of the fundoplication, and evaluate for disruption and paraesophageal herniation. The esophagus can be inspected for esophagitis, and dilation of the fundoplication site can be performed. In the absence of heartburn or the original reflux symptoms, empiric acid suppression is not expected to improve the dysphagia. If the endoscopy is negative, esophageal manometry and barium swallow are the next studies of value. A pH study off PPI therapy is performed if recurrent reflux is suspected that does not respond to anti-reflux medications.

REFERENCE
1. Johnson D.A., Younes Z., Hogan W.J. Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000;52(5):650-9.

ATLANTA – 2017 was a banner year for the approval of new drugs to treat hematologic disorders.

At a special interest session at the annual meeting of American Society of Hematology, representatives from the Food and Drug Administration joined forces with clinicians to discuss the use of the newly approved treatments in the real-world setting.

In this video interview, Helen Heslop, MD, provided her perspective on the current use and future directions of three of these treatments: axicabtagene ciloleucel (Yescarta), acalabrutinib (Calquence), and copanlisib (Aliqopa).

“This is extremely exciting,” she said regarding the pace of new approvals for hematologic malignancies.

Axicabtagene ciloleucel, a CAR T-cell product approved in October for the treatment of relapsed/refractory large B-cell lymphoma in adults, is particularly interesting, she said.

“The data shows that if you look at a population of diffuse large B-cell lymphoma patients, that historically have a very poor outcome, there is definitely an impressive response rate and improved survival, compared to the natural history cohort,” said Dr. Heslop of Baylor College of Medicine, Houston.

However, while the findings are encouraging, only 30%-40% are having a durable response, she added.

“So I think there’ll be lots of efforts to try and improve the response rate by combination with other agents such as checkpoint inhibitors or other immunomodulators,” she said.

With respect to the second-generation Bruton’s tyrosine kinase inhibitor acalabrutinib, which was approved in October for adults with mantle cell lymphoma who have been treated with at least one prior therapy, she discussed the potential for improved outcomes and the importance of looking further into its use in patients who have failed ibrutinib therapy, as well as its use in combination with other agents, such as bendamustine and rituximab early in the course of disease.

Copanlisib, a PI3 kinase inhibitor approved in September, is an addition to the armamentarium for adult patients with relapsed follicular lymphoma after two lines of previous therapy.

“It still does have some side effects, as do other drugs in this class, so I think it’s place will still need to be defined,” Dr. Heslop said.

She reported having no relevant financial disclosures.

[email protected]

ATLANTA – 2017 was a banner year for the approval of new drugs to treat hematologic disorders.

At a special interest session at the annual meeting of American Society of Hematology, representatives from the Food and Drug Administration joined forces with clinicians to discuss the use of the newly approved treatments in the real-world setting.

In this video interview, Helen Heslop, MD, provided her perspective on the current use and future directions of three of these treatments: axicabtagene ciloleucel (Yescarta), acalabrutinib (Calquence), and copanlisib (Aliqopa).

“This is extremely exciting,” she said regarding the pace of new approvals for hematologic malignancies.

Axicabtagene ciloleucel, a CAR T-cell product approved in October for the treatment of relapsed/refractory large B-cell lymphoma in adults, is particularly interesting, she said.

“The data shows that if you look at a population of diffuse large B-cell lymphoma patients, that historically have a very poor outcome, there is definitely an impressive response rate and improved survival, compared to the natural history cohort,” said Dr. Heslop of Baylor College of Medicine, Houston.

However, while the findings are encouraging, only 30%-40% are having a durable response, she added.

“So I think there’ll be lots of efforts to try and improve the response rate by combination with other agents such as checkpoint inhibitors or other immunomodulators,” she said.

With respect to the second-generation Bruton’s tyrosine kinase inhibitor acalabrutinib, which was approved in October for adults with mantle cell lymphoma who have been treated with at least one prior therapy, she discussed the potential for improved outcomes and the importance of looking further into its use in patients who have failed ibrutinib therapy, as well as its use in combination with other agents, such as bendamustine and rituximab early in the course of disease.

Copanlisib, a PI3 kinase inhibitor approved in September, is an addition to the armamentarium for adult patients with relapsed follicular lymphoma after two lines of previous therapy.

“It still does have some side effects, as do other drugs in this class, so I think it’s place will still need to be defined,” Dr. Heslop said.

She reported having no relevant financial disclosures.

[email protected]

ATLANTA – 2017 was a banner year for the approval of new drugs to treat hematologic disorders.

At a special interest session at the annual meeting of American Society of Hematology, representatives from the Food and Drug Administration joined forces with clinicians to discuss the use of the newly approved treatments in the real-world setting.

In this video interview, Helen Heslop, MD, provided her perspective on the current use and future directions of three of these treatments: axicabtagene ciloleucel (Yescarta), acalabrutinib (Calquence), and copanlisib (Aliqopa).

“This is extremely exciting,” she said regarding the pace of new approvals for hematologic malignancies.

Axicabtagene ciloleucel, a CAR T-cell product approved in October for the treatment of relapsed/refractory large B-cell lymphoma in adults, is particularly interesting, she said.

“The data shows that if you look at a population of diffuse large B-cell lymphoma patients, that historically have a very poor outcome, there is definitely an impressive response rate and improved survival, compared to the natural history cohort,” said Dr. Heslop of Baylor College of Medicine, Houston.

However, while the findings are encouraging, only 30%-40% are having a durable response, she added.

“So I think there’ll be lots of efforts to try and improve the response rate by combination with other agents such as checkpoint inhibitors or other immunomodulators,” she said.

With respect to the second-generation Bruton’s tyrosine kinase inhibitor acalabrutinib, which was approved in October for adults with mantle cell lymphoma who have been treated with at least one prior therapy, she discussed the potential for improved outcomes and the importance of looking further into its use in patients who have failed ibrutinib therapy, as well as its use in combination with other agents, such as bendamustine and rituximab early in the course of disease.

Copanlisib, a PI3 kinase inhibitor approved in September, is an addition to the armamentarium for adult patients with relapsed follicular lymphoma after two lines of previous therapy.

“It still does have some side effects, as do other drugs in this class, so I think it’s place will still need to be defined,” Dr. Heslop said.

She reported having no relevant financial disclosures.

[email protected]

Take-Home Points

• PQ is easily mistaken for a PB tear.
• PQ is best identified on MRI, but commonly missed.
• For symptomatic cases, excision is the best treatment.
• Consider PQ in patients with chronic ankle pain, swelling, and/or instability.

The peroneus quartus (PQ) is an accessory muscle arising from the leg’s lateral compartment, which typically contains the peroneus longus (PL) and the peroneus brevis (PB). The many cadaveric studies that have been conducted indicate a general population prevalence ranging from 6.6% to 23%.¹ Radiographic studies, including magnetic resonance imaging (MRI) and ultrasonography, have shown a similar prevalence.² Although the PQ is asymptomatic in most cases, it may compromise the space of the superior peroneal tunnel and cause problems, including ankle pain, PB tear, subluxation of peroneal tendons, tendinous calcification, painful hypertrophy of retrotrochlear eminence, and recurrent hematomas.^1,3-5 Given its differing anatomy, the PQ variously has been referred to as peroneocalcaneus externum, peroneocuboideus, long peroneal tendon, and peroneoperoneolongus.¹ 

Although the PQ’s origin and insertion differ between subjects, the most common origin is the muscle fibers of the PB, and the most common insertion is the retrotrochlear eminence of the calcaneum.³

We report a case of peroneal tendon pathology that was initially thought to be caused primarily by impingement of a large osteochondroma on the tendons, but was later thought to be caused in part by a PQ and a split PB tendon seen only at the time of the second operation. The patient provided written informed consent for print and electronic publication of this case report.

Case Report

A 16-year-old boy with an osteochondroma of the right distal fibula presented to clinic with the chief complaint of lateral right ankle pain. A “sharp” pain accompanied by audible “popping” occurred with ankle motion. Medical history was significant only for non-Hodgkin lymphoma treated with bone marrow transplantation and whole body radiation at a young age. Physical examination revealed a palpable exostosis of the distal right fibula and associated ankle swelling.

One year after surgery, the patient returned with recurring right ankle pain and audible popping during ankle movement. There was no appreciable peroneal tendon subluxation on physical examination. Repeat imaging of the ankle showed no recurrence of the osteochondroma (Figure 2).

Discussion

Absence of a PQ muscle in simian and prosimian species suggests that the PQ represents an evolutionary adaptation to evert the lateral foot and improve bipedal gait. Although the 3 peroneal (PL, PB, peroneus tertius [PT]) muscles evert the middle part of the lateral border of the foot, the PQ inserts on the retrotrochlear eminence, which everts the posterior part of the lateral border of the foot.^1,6 The PQ has often been described as a variation of the PB. The PQ may also stabilize the ankle and reduce the energy required for walking. A similar functional adaptation has been proposed for the PT, which dorsiflexes at the ankle. Although presence of a PT also varies in the population, its occurrence does not correlate with presence of a PQ. In people with PQ muscles, there is an 83% to 95% incidence of also having PT muscles.⁷

PQ prevalence has ranged from 6.6% to 23% in cadaver studies² and from 7% to 17% in radiologic studies.¹ To better evaluate prevalence, Yammine² performed a meta-analysis of data from 46 studies (cadaveric dissection, MRI, ultrasonography) and 3928 legs and found an overall incidence of 10.2% and a higher incidence in the Indian population than in other races. Another study found no correlation between PQ presence and sex.⁷

MRI is the best imaging modality for assessing for PQ but must be performed specifically for this anatomical variation. Axial images may show a fat pad separating the PQ muscle from the PB muscle.⁸ On imaging, a PQ muscle can be mistaken for a peroneal tendon tear. A feature that helps in distinguishing the 2 is location; the PQ typically is found posterior and medial to the PL and PB tendons, whereas PB tears are anterior to the retromalleolar groove.² Presence of a PQ muscle may be missed on initial MRI, as occurred in our patient’s case. Zammit and Singh³ reviewed 80 leg MRIs and found 6 PQs. Only 1 of the 6 reports described the PQ as an “atypical appearance of peroneus brevis [that] appears to be made up of more than one tendon.”

Surgical excision is often adequate treatment for a symptomatic PQ. If the PQ muscle is small and symptomatic from pressure to the muscle mass, a short fasciotomy may be performed.⁹ More commonly, complete excision of the accessory muscle is required. Although the PQ muscle is usually asymptomatic, it should be considered in cases of chronic ankle pain, swelling, or instability; recurrent hematomas; and peroneal tendon subluxation or tears.^5,7

Our patient’s diagnosis was initially overlooked because of an osteochondroma in the region of interest. It remains unclear whether his pain was caused by the PQ itself or, more likely, from the PB tear. It is thought that the accessory muscle adds bulk to the peroneal tunnel, predisposing to peroneal pathology, such as muscle tears and tendon subluxation. Regardless, advanced imaging performed before the index procedure, along with a general understanding of the PQ and its classic MRI findings, may have prevented the repeat operation in this case.

The PQ muscle is a rare but sometimes missed potential etiology of ankle pain and tendon subluxation. In our patient’s case, the most obvious abnormality, an osteochondroma, may have masked the true cause.

Take-Home Points

• PQ is easily mistaken for a PB tear.
• PQ is best identified on MRI, but commonly missed.
• For symptomatic cases, excision is the best treatment.
• Consider PQ in patients with chronic ankle pain, swelling, and/or instability.

The peroneus quartus (PQ) is an accessory muscle arising from the leg’s lateral compartment, which typically contains the peroneus longus (PL) and the peroneus brevis (PB). The many cadaveric studies that have been conducted indicate a general population prevalence ranging from 6.6% to 23%.¹ Radiographic studies, including magnetic resonance imaging (MRI) and ultrasonography, have shown a similar prevalence.² Although the PQ is asymptomatic in most cases, it may compromise the space of the superior peroneal tunnel and cause problems, including ankle pain, PB tear, subluxation of peroneal tendons, tendinous calcification, painful hypertrophy of retrotrochlear eminence, and recurrent hematomas.^1,3-5 Given its differing anatomy, the PQ variously has been referred to as peroneocalcaneus externum, peroneocuboideus, long peroneal tendon, and peroneoperoneolongus.¹ 

Although the PQ’s origin and insertion differ between subjects, the most common origin is the muscle fibers of the PB, and the most common insertion is the retrotrochlear eminence of the calcaneum.³

We report a case of peroneal tendon pathology that was initially thought to be caused primarily by impingement of a large osteochondroma on the tendons, but was later thought to be caused in part by a PQ and a split PB tendon seen only at the time of the second operation. The patient provided written informed consent for print and electronic publication of this case report.

Case Report

A 16-year-old boy with an osteochondroma of the right distal fibula presented to clinic with the chief complaint of lateral right ankle pain. A “sharp” pain accompanied by audible “popping” occurred with ankle motion. Medical history was significant only for non-Hodgkin lymphoma treated with bone marrow transplantation and whole body radiation at a young age. Physical examination revealed a palpable exostosis of the distal right fibula and associated ankle swelling.

One year after surgery, the patient returned with recurring right ankle pain and audible popping during ankle movement. There was no appreciable peroneal tendon subluxation on physical examination. Repeat imaging of the ankle showed no recurrence of the osteochondroma (Figure 2).

Discussion

Absence of a PQ muscle in simian and prosimian species suggests that the PQ represents an evolutionary adaptation to evert the lateral foot and improve bipedal gait. Although the 3 peroneal (PL, PB, peroneus tertius [PT]) muscles evert the middle part of the lateral border of the foot, the PQ inserts on the retrotrochlear eminence, which everts the posterior part of the lateral border of the foot.^1,6 The PQ has often been described as a variation of the PB. The PQ may also stabilize the ankle and reduce the energy required for walking. A similar functional adaptation has been proposed for the PT, which dorsiflexes at the ankle. Although presence of a PT also varies in the population, its occurrence does not correlate with presence of a PQ. In people with PQ muscles, there is an 83% to 95% incidence of also having PT muscles.⁷

PQ prevalence has ranged from 6.6% to 23% in cadaver studies² and from 7% to 17% in radiologic studies.¹ To better evaluate prevalence, Yammine² performed a meta-analysis of data from 46 studies (cadaveric dissection, MRI, ultrasonography) and 3928 legs and found an overall incidence of 10.2% and a higher incidence in the Indian population than in other races. Another study found no correlation between PQ presence and sex.⁷

MRI is the best imaging modality for assessing for PQ but must be performed specifically for this anatomical variation. Axial images may show a fat pad separating the PQ muscle from the PB muscle.⁸ On imaging, a PQ muscle can be mistaken for a peroneal tendon tear. A feature that helps in distinguishing the 2 is location; the PQ typically is found posterior and medial to the PL and PB tendons, whereas PB tears are anterior to the retromalleolar groove.² Presence of a PQ muscle may be missed on initial MRI, as occurred in our patient’s case. Zammit and Singh³ reviewed 80 leg MRIs and found 6 PQs. Only 1 of the 6 reports described the PQ as an “atypical appearance of peroneus brevis [that] appears to be made up of more than one tendon.”

Surgical excision is often adequate treatment for a symptomatic PQ. If the PQ muscle is small and symptomatic from pressure to the muscle mass, a short fasciotomy may be performed.⁹ More commonly, complete excision of the accessory muscle is required. Although the PQ muscle is usually asymptomatic, it should be considered in cases of chronic ankle pain, swelling, or instability; recurrent hematomas; and peroneal tendon subluxation or tears.^5,7

Our patient’s diagnosis was initially overlooked because of an osteochondroma in the region of interest. It remains unclear whether his pain was caused by the PQ itself or, more likely, from the PB tear. It is thought that the accessory muscle adds bulk to the peroneal tunnel, predisposing to peroneal pathology, such as muscle tears and tendon subluxation. Regardless, advanced imaging performed before the index procedure, along with a general understanding of the PQ and its classic MRI findings, may have prevented the repeat operation in this case.

The PQ muscle is a rare but sometimes missed potential etiology of ankle pain and tendon subluxation. In our patient’s case, the most obvious abnormality, an osteochondroma, may have masked the true cause.

Take-Home Points

• PQ is easily mistaken for a PB tear.
• PQ is best identified on MRI, but commonly missed.
• For symptomatic cases, excision is the best treatment.
• Consider PQ in patients with chronic ankle pain, swelling, and/or instability.

The peroneus quartus (PQ) is an accessory muscle arising from the leg’s lateral compartment, which typically contains the peroneus longus (PL) and the peroneus brevis (PB). The many cadaveric studies that have been conducted indicate a general population prevalence ranging from 6.6% to 23%.¹ Radiographic studies, including magnetic resonance imaging (MRI) and ultrasonography, have shown a similar prevalence.² Although the PQ is asymptomatic in most cases, it may compromise the space of the superior peroneal tunnel and cause problems, including ankle pain, PB tear, subluxation of peroneal tendons, tendinous calcification, painful hypertrophy of retrotrochlear eminence, and recurrent hematomas.^1,3-5 Given its differing anatomy, the PQ variously has been referred to as peroneocalcaneus externum, peroneocuboideus, long peroneal tendon, and peroneoperoneolongus.¹ 

Although the PQ’s origin and insertion differ between subjects, the most common origin is the muscle fibers of the PB, and the most common insertion is the retrotrochlear eminence of the calcaneum.³

We report a case of peroneal tendon pathology that was initially thought to be caused primarily by impingement of a large osteochondroma on the tendons, but was later thought to be caused in part by a PQ and a split PB tendon seen only at the time of the second operation. The patient provided written informed consent for print and electronic publication of this case report.

Case Report

A 16-year-old boy with an osteochondroma of the right distal fibula presented to clinic with the chief complaint of lateral right ankle pain. A “sharp” pain accompanied by audible “popping” occurred with ankle motion. Medical history was significant only for non-Hodgkin lymphoma treated with bone marrow transplantation and whole body radiation at a young age. Physical examination revealed a palpable exostosis of the distal right fibula and associated ankle swelling.

One year after surgery, the patient returned with recurring right ankle pain and audible popping during ankle movement. There was no appreciable peroneal tendon subluxation on physical examination. Repeat imaging of the ankle showed no recurrence of the osteochondroma (Figure 2).

Discussion

Absence of a PQ muscle in simian and prosimian species suggests that the PQ represents an evolutionary adaptation to evert the lateral foot and improve bipedal gait. Although the 3 peroneal (PL, PB, peroneus tertius [PT]) muscles evert the middle part of the lateral border of the foot, the PQ inserts on the retrotrochlear eminence, which everts the posterior part of the lateral border of the foot.^1,6 The PQ has often been described as a variation of the PB. The PQ may also stabilize the ankle and reduce the energy required for walking. A similar functional adaptation has been proposed for the PT, which dorsiflexes at the ankle. Although presence of a PT also varies in the population, its occurrence does not correlate with presence of a PQ. In people with PQ muscles, there is an 83% to 95% incidence of also having PT muscles.⁷

PQ prevalence has ranged from 6.6% to 23% in cadaver studies² and from 7% to 17% in radiologic studies.¹ To better evaluate prevalence, Yammine² performed a meta-analysis of data from 46 studies (cadaveric dissection, MRI, ultrasonography) and 3928 legs and found an overall incidence of 10.2% and a higher incidence in the Indian population than in other races. Another study found no correlation between PQ presence and sex.⁷

MRI is the best imaging modality for assessing for PQ but must be performed specifically for this anatomical variation. Axial images may show a fat pad separating the PQ muscle from the PB muscle.⁸ On imaging, a PQ muscle can be mistaken for a peroneal tendon tear. A feature that helps in distinguishing the 2 is location; the PQ typically is found posterior and medial to the PL and PB tendons, whereas PB tears are anterior to the retromalleolar groove.² Presence of a PQ muscle may be missed on initial MRI, as occurred in our patient’s case. Zammit and Singh³ reviewed 80 leg MRIs and found 6 PQs. Only 1 of the 6 reports described the PQ as an “atypical appearance of peroneus brevis [that] appears to be made up of more than one tendon.”

Surgical excision is often adequate treatment for a symptomatic PQ. If the PQ muscle is small and symptomatic from pressure to the muscle mass, a short fasciotomy may be performed.⁹ More commonly, complete excision of the accessory muscle is required. Although the PQ muscle is usually asymptomatic, it should be considered in cases of chronic ankle pain, swelling, or instability; recurrent hematomas; and peroneal tendon subluxation or tears.^5,7

Our patient’s diagnosis was initially overlooked because of an osteochondroma in the region of interest. It remains unclear whether his pain was caused by the PQ itself or, more likely, from the PB tear. It is thought that the accessory muscle adds bulk to the peroneal tunnel, predisposing to peroneal pathology, such as muscle tears and tendon subluxation. Regardless, advanced imaging performed before the index procedure, along with a general understanding of the PQ and its classic MRI findings, may have prevented the repeat operation in this case.

The PQ muscle is a rare but sometimes missed potential etiology of ankle pain and tendon subluxation. In our patient’s case, the most obvious abnormality, an osteochondroma, may have masked the true cause.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.