LAS VEGAS – One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

LAS VEGAS – One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

LAS VEGAS – One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

Clinical question: What factors contribute to increased mortality in weekend hospital admissions?

Background: The “weekend effect” is a commonly known phenomenon, where patients admitted to the hospital on weekends have higher mortality risk than those admitted on weekdays. However, little is known about the factors contributing to the excess mortality associated with weekend admissions.

Dr. Xu is assistant professor and hospitalist, Icahn School of Medicine of the Mount Sinai Health System, New York.

Clinical question: What factors contribute to increased mortality in weekend hospital admissions?

Background: The “weekend effect” is a commonly known phenomenon, where patients admitted to the hospital on weekends have higher mortality risk than those admitted on weekdays. However, little is known about the factors contributing to the excess mortality associated with weekend admissions.

Dr. Xu is assistant professor and hospitalist, Icahn School of Medicine of the Mount Sinai Health System, New York.

Clinical question: What factors contribute to increased mortality in weekend hospital admissions?

Background: The “weekend effect” is a commonly known phenomenon, where patients admitted to the hospital on weekends have higher mortality risk than those admitted on weekdays. However, little is known about the factors contributing to the excess mortality associated with weekend admissions.

Dr. Xu is assistant professor and hospitalist, Icahn School of Medicine of the Mount Sinai Health System, New York.

Good nutritional status can extend the lives of patients with acute myeloid leukemia going into induction chemotherapy, according to a retrospective study of 95 adult AML patients.

Those with good nutritional status had significantly shorter hospital stays than did undernourished patients. Furthermore, they had greater 12-month survival, compared with undernourished patients.

“Assessment of nutritional status is essential because undernutrition in this population is common,” Elise Deluche, MD, and her coinvestigators wrote (Nutrition. 2017 Sep;41:120-5). They assessed the nutritional status of 95 consecutive adult AML patients admitted to Limoges (France) University Hospital during 2009-2014 and followed their nutritional status for 12 months.Patients were considered undernourished if they had lost more than 5% of their weight, and had a body mass index (BMI) of under 18.5 kg/m² if less than 70 years of age, or under 21 kg/m² if aged at least 70 years.

Fourteen patients (15%) were undernourished at admission. That proportion grew after chemotherapy induction to 17 patients (18%), but there were no significant differences from admission in BMI, weight, or albumin.

The adequately nourished patients had significantly worse nutritional status at discharge than admission, with a significantly lower median weight (P =.02), BMI (P = .04), and albumin levels (P = .0002), compared with their admission values.

Importantly, the well nourished patients had shorter hospital stays than their undernourished counterparts, at 31 days, compared with 39 days (P = .03). Furthermore, their 12-month survival was greater, at 89.9%, than that of the undernourished patient, at 58.3% (P = .002).

After chemotherapy induction, 64 patients (67%) were in complete remission: 57 (70%) in the adequately nourished and 7 (50%) in the undernourished group, a nonsignificant difference.

This is the first study to look solely at patients with AML, Dr. DeLuche and her coinvestigators said, as previous nutritional studies have also included patients with acute lymphoblastic leukemia, and it “confirmed that the length of hospitalization was shorter for patients without undernutrition.” They added that their study included a more accurate representation of AML patients with a median patient age of 58 years, much older than the range of 28-41 found in other studies. A quarter of the patients in Dr. DeLuche’s study were over age 65.

“[Existing] screening tools should be improved and adapted to the specific situation of induction chemotherapy for monitoring nutritional status during hospitalization,” they concluded.

The study received no outside funding, and the investigators had no conflicts of interest.

[email protected]

Good nutritional status can extend the lives of patients with acute myeloid leukemia going into induction chemotherapy, according to a retrospective study of 95 adult AML patients.

Those with good nutritional status had significantly shorter hospital stays than did undernourished patients. Furthermore, they had greater 12-month survival, compared with undernourished patients.

“Assessment of nutritional status is essential because undernutrition in this population is common,” Elise Deluche, MD, and her coinvestigators wrote (Nutrition. 2017 Sep;41:120-5). They assessed the nutritional status of 95 consecutive adult AML patients admitted to Limoges (France) University Hospital during 2009-2014 and followed their nutritional status for 12 months.Patients were considered undernourished if they had lost more than 5% of their weight, and had a body mass index (BMI) of under 18.5 kg/m² if less than 70 years of age, or under 21 kg/m² if aged at least 70 years.

Fourteen patients (15%) were undernourished at admission. That proportion grew after chemotherapy induction to 17 patients (18%), but there were no significant differences from admission in BMI, weight, or albumin.

The adequately nourished patients had significantly worse nutritional status at discharge than admission, with a significantly lower median weight (P =.02), BMI (P = .04), and albumin levels (P = .0002), compared with their admission values.

Importantly, the well nourished patients had shorter hospital stays than their undernourished counterparts, at 31 days, compared with 39 days (P = .03). Furthermore, their 12-month survival was greater, at 89.9%, than that of the undernourished patient, at 58.3% (P = .002).

After chemotherapy induction, 64 patients (67%) were in complete remission: 57 (70%) in the adequately nourished and 7 (50%) in the undernourished group, a nonsignificant difference.

This is the first study to look solely at patients with AML, Dr. DeLuche and her coinvestigators said, as previous nutritional studies have also included patients with acute lymphoblastic leukemia, and it “confirmed that the length of hospitalization was shorter for patients without undernutrition.” They added that their study included a more accurate representation of AML patients with a median patient age of 58 years, much older than the range of 28-41 found in other studies. A quarter of the patients in Dr. DeLuche’s study were over age 65.

“[Existing] screening tools should be improved and adapted to the specific situation of induction chemotherapy for monitoring nutritional status during hospitalization,” they concluded.

The study received no outside funding, and the investigators had no conflicts of interest.

[email protected]

Good nutritional status can extend the lives of patients with acute myeloid leukemia going into induction chemotherapy, according to a retrospective study of 95 adult AML patients.

Those with good nutritional status had significantly shorter hospital stays than did undernourished patients. Furthermore, they had greater 12-month survival, compared with undernourished patients.

“Assessment of nutritional status is essential because undernutrition in this population is common,” Elise Deluche, MD, and her coinvestigators wrote (Nutrition. 2017 Sep;41:120-5). They assessed the nutritional status of 95 consecutive adult AML patients admitted to Limoges (France) University Hospital during 2009-2014 and followed their nutritional status for 12 months.Patients were considered undernourished if they had lost more than 5% of their weight, and had a body mass index (BMI) of under 18.5 kg/m² if less than 70 years of age, or under 21 kg/m² if aged at least 70 years.

Fourteen patients (15%) were undernourished at admission. That proportion grew after chemotherapy induction to 17 patients (18%), but there were no significant differences from admission in BMI, weight, or albumin.

The adequately nourished patients had significantly worse nutritional status at discharge than admission, with a significantly lower median weight (P =.02), BMI (P = .04), and albumin levels (P = .0002), compared with their admission values.

Importantly, the well nourished patients had shorter hospital stays than their undernourished counterparts, at 31 days, compared with 39 days (P = .03). Furthermore, their 12-month survival was greater, at 89.9%, than that of the undernourished patient, at 58.3% (P = .002).

After chemotherapy induction, 64 patients (67%) were in complete remission: 57 (70%) in the adequately nourished and 7 (50%) in the undernourished group, a nonsignificant difference.

This is the first study to look solely at patients with AML, Dr. DeLuche and her coinvestigators said, as previous nutritional studies have also included patients with acute lymphoblastic leukemia, and it “confirmed that the length of hospitalization was shorter for patients without undernutrition.” They added that their study included a more accurate representation of AML patients with a median patient age of 58 years, much older than the range of 28-41 found in other studies. A quarter of the patients in Dr. DeLuche’s study were over age 65.

“[Existing] screening tools should be improved and adapted to the specific situation of induction chemotherapy for monitoring nutritional status during hospitalization,” they concluded.

The study received no outside funding, and the investigators had no conflicts of interest.

[email protected]

One Drop announced on Oct. 31 a multipart collaboration with Fitbit to bring enhanced data-driven care management tools to the diabetes community.

One Drop users will now be able to sync Fitbit intraday data to their One Drop accounts. The first initiative will be to help users better understand the impact of physical activity on blood glucose management. The app software also will analyze user-generated health data points with the goal of gaining deeper insights and improving health outcomes for all people with diabetes worldwide. It can potentially allow users to see how their physical activity impacts blood glucose levels. Users can review these data with their very own Certified Diabetes Educator as they work together to meet personalized health goals.

In a study published in JMIR Diabetes in August 2017, results showed a 1.1%-1.3% absolute reduction in hemoglobin A_1C in just 4 months in patients using One Drop. It is noted that this was a more significant reduction than other published research suggested was possible using a mobile care management app.

“By integrating Fitbit data and creating an app for Fitbit Ionic, we will be able to provide our users and their health care providers with more data and deeper insights to better manage their diabetes,” said Jeff Dachis, CEO and founder of One Drop, in a press release.

Read the full press release here.
 

[email protected]

One Drop announced on Oct. 31 a multipart collaboration with Fitbit to bring enhanced data-driven care management tools to the diabetes community.

One Drop users will now be able to sync Fitbit intraday data to their One Drop accounts. The first initiative will be to help users better understand the impact of physical activity on blood glucose management. The app software also will analyze user-generated health data points with the goal of gaining deeper insights and improving health outcomes for all people with diabetes worldwide. It can potentially allow users to see how their physical activity impacts blood glucose levels. Users can review these data with their very own Certified Diabetes Educator as they work together to meet personalized health goals.

In a study published in JMIR Diabetes in August 2017, results showed a 1.1%-1.3% absolute reduction in hemoglobin A_1C in just 4 months in patients using One Drop. It is noted that this was a more significant reduction than other published research suggested was possible using a mobile care management app.

“By integrating Fitbit data and creating an app for Fitbit Ionic, we will be able to provide our users and their health care providers with more data and deeper insights to better manage their diabetes,” said Jeff Dachis, CEO and founder of One Drop, in a press release.

Read the full press release here.
 

[email protected]

One Drop announced on Oct. 31 a multipart collaboration with Fitbit to bring enhanced data-driven care management tools to the diabetes community.

One Drop users will now be able to sync Fitbit intraday data to their One Drop accounts. The first initiative will be to help users better understand the impact of physical activity on blood glucose management. The app software also will analyze user-generated health data points with the goal of gaining deeper insights and improving health outcomes for all people with diabetes worldwide. It can potentially allow users to see how their physical activity impacts blood glucose levels. Users can review these data with their very own Certified Diabetes Educator as they work together to meet personalized health goals.

In a study published in JMIR Diabetes in August 2017, results showed a 1.1%-1.3% absolute reduction in hemoglobin A_1C in just 4 months in patients using One Drop. It is noted that this was a more significant reduction than other published research suggested was possible using a mobile care management app.

“By integrating Fitbit data and creating an app for Fitbit Ionic, we will be able to provide our users and their health care providers with more data and deeper insights to better manage their diabetes,” said Jeff Dachis, CEO and founder of One Drop, in a press release.

Read the full press release here.
 

[email protected]

LAS VEGAS – Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

LAS VEGAS – Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

LAS VEGAS – Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

Use of the MenACWY-CRM vaccine as part of routine clinical care of children aged 2-10 years does not appear to raise any safety concerns, reported Sara Yee Tartof, PhD, of Kaiser Permanente Southern California, Pasadena, and her associates.

CDC/Amanda Mills

[email protected]

Use of the MenACWY-CRM vaccine as part of routine clinical care of children aged 2-10 years does not appear to raise any safety concerns, reported Sara Yee Tartof, PhD, of Kaiser Permanente Southern California, Pasadena, and her associates.

CDC/Amanda Mills

[email protected]

Use of the MenACWY-CRM vaccine as part of routine clinical care of children aged 2-10 years does not appear to raise any safety concerns, reported Sara Yee Tartof, PhD, of Kaiser Permanente Southern California, Pasadena, and her associates.

CDC/Amanda Mills

[email protected]

An early diagnosis of tuberous sclerosis complex (TSC) may be possible in many infants with an echocardiogram for cardiac rhabdomyomas and a skin examination for hypomelanotic macules, noninvasive tests that do not require sedation, said Peter E. Davis, MD, of Boston Children’s Hospital, and his associates on behalf of the Tuberous Sclerosis Complex Autism Center of Excellence Research Network.

“Early TSC diagnosis in infants opens a window of opportunity to treat before the onset of epilepsy or other neurodevelopmental disorders and allows for close surveillance for sequelae of TSC,” the researchers said. “However, this window may be as small as a few months.”

In two concurrent, prospective, longitudinal, observational studies at five medical centers of 130 infants meeting a genetic or clinical diagnosis of TSC, cardiac rhabdomyomas, and hypomelanotic macules were the most common initial presenting features, occurring in 59% and 39% of infants, respectively; 85% of infants had either or both. In terms of prevalence, hypomelanotic macules and tubers or other cortical dysplasias were the most prevalent TSC features both occurring at 94%, followed by subependymal nodules (SENs) at 90%, and cardiac rhabdomyomas at 82%. Every infant had at least one of these diagnostic criteria, and 61% had all four of them, the investigators reported.

Neuroimaging results were available in 115 infants, of whom 94% had tubers or cortical dysplasias, 90% had SENs, and 89% had both; 6% had subependymal giant cell astrocytomas. Seizure onset occurred in 15% of infants before or when other TSC criteria were recorded, “suggesting that seizure was an initial presenting symptom.” Seizure onset occurred within 3 months after initial presentation in 17% of infants, within 6 months in 39%, and within 12 months in 57%. Ultimately, 57% of the infants had infantile spasms, 55% had focal seizures, and 12% had another seizure type, Dr. Davis and his associates said.

“Early, prospective use of EEGs may enable risk stratification in studies of epilepsy prevention in infants with TSC. The antiepileptic medication vigabatrin is particularly effective in treating infantile spasms in TSC‍ and has mTOR [mechanistic target of the rapamycin]–inhibiting effects. Vigabatrin is currently in clinical trials to determine its efficacy at preventing epilepsy in patients with TSC,” they said, although the drug is not currently recommended for infants. “mTOR inhibitors have been successfully used to treat multiple TSC manifestations and have shown some efficacy as adjunctive treatment of refractory epilepsy,” they wrote, adding that studies are needed “to determine the safety and efficacy of mTOR inhibitors in this age group.”

Read more at Pediatrics. 2017;140(6):e20164040 (doi: 10.1542/peds.2016-4040).

An early diagnosis of tuberous sclerosis complex (TSC) may be possible in many infants with an echocardiogram for cardiac rhabdomyomas and a skin examination for hypomelanotic macules, noninvasive tests that do not require sedation, said Peter E. Davis, MD, of Boston Children’s Hospital, and his associates on behalf of the Tuberous Sclerosis Complex Autism Center of Excellence Research Network.

“Early TSC diagnosis in infants opens a window of opportunity to treat before the onset of epilepsy or other neurodevelopmental disorders and allows for close surveillance for sequelae of TSC,” the researchers said. “However, this window may be as small as a few months.”

In two concurrent, prospective, longitudinal, observational studies at five medical centers of 130 infants meeting a genetic or clinical diagnosis of TSC, cardiac rhabdomyomas, and hypomelanotic macules were the most common initial presenting features, occurring in 59% and 39% of infants, respectively; 85% of infants had either or both. In terms of prevalence, hypomelanotic macules and tubers or other cortical dysplasias were the most prevalent TSC features both occurring at 94%, followed by subependymal nodules (SENs) at 90%, and cardiac rhabdomyomas at 82%. Every infant had at least one of these diagnostic criteria, and 61% had all four of them, the investigators reported.

Neuroimaging results were available in 115 infants, of whom 94% had tubers or cortical dysplasias, 90% had SENs, and 89% had both; 6% had subependymal giant cell astrocytomas. Seizure onset occurred in 15% of infants before or when other TSC criteria were recorded, “suggesting that seizure was an initial presenting symptom.” Seizure onset occurred within 3 months after initial presentation in 17% of infants, within 6 months in 39%, and within 12 months in 57%. Ultimately, 57% of the infants had infantile spasms, 55% had focal seizures, and 12% had another seizure type, Dr. Davis and his associates said.

“Early, prospective use of EEGs may enable risk stratification in studies of epilepsy prevention in infants with TSC. The antiepileptic medication vigabatrin is particularly effective in treating infantile spasms in TSC‍ and has mTOR [mechanistic target of the rapamycin]–inhibiting effects. Vigabatrin is currently in clinical trials to determine its efficacy at preventing epilepsy in patients with TSC,” they said, although the drug is not currently recommended for infants. “mTOR inhibitors have been successfully used to treat multiple TSC manifestations and have shown some efficacy as adjunctive treatment of refractory epilepsy,” they wrote, adding that studies are needed “to determine the safety and efficacy of mTOR inhibitors in this age group.”

Read more at Pediatrics. 2017;140(6):e20164040 (doi: 10.1542/peds.2016-4040).

An early diagnosis of tuberous sclerosis complex (TSC) may be possible in many infants with an echocardiogram for cardiac rhabdomyomas and a skin examination for hypomelanotic macules, noninvasive tests that do not require sedation, said Peter E. Davis, MD, of Boston Children’s Hospital, and his associates on behalf of the Tuberous Sclerosis Complex Autism Center of Excellence Research Network.

“Early TSC diagnosis in infants opens a window of opportunity to treat before the onset of epilepsy or other neurodevelopmental disorders and allows for close surveillance for sequelae of TSC,” the researchers said. “However, this window may be as small as a few months.”

In two concurrent, prospective, longitudinal, observational studies at five medical centers of 130 infants meeting a genetic or clinical diagnosis of TSC, cardiac rhabdomyomas, and hypomelanotic macules were the most common initial presenting features, occurring in 59% and 39% of infants, respectively; 85% of infants had either or both. In terms of prevalence, hypomelanotic macules and tubers or other cortical dysplasias were the most prevalent TSC features both occurring at 94%, followed by subependymal nodules (SENs) at 90%, and cardiac rhabdomyomas at 82%. Every infant had at least one of these diagnostic criteria, and 61% had all four of them, the investigators reported.

Neuroimaging results were available in 115 infants, of whom 94% had tubers or cortical dysplasias, 90% had SENs, and 89% had both; 6% had subependymal giant cell astrocytomas. Seizure onset occurred in 15% of infants before or when other TSC criteria were recorded, “suggesting that seizure was an initial presenting symptom.” Seizure onset occurred within 3 months after initial presentation in 17% of infants, within 6 months in 39%, and within 12 months in 57%. Ultimately, 57% of the infants had infantile spasms, 55% had focal seizures, and 12% had another seizure type, Dr. Davis and his associates said.

“Early, prospective use of EEGs may enable risk stratification in studies of epilepsy prevention in infants with TSC. The antiepileptic medication vigabatrin is particularly effective in treating infantile spasms in TSC‍ and has mTOR [mechanistic target of the rapamycin]–inhibiting effects. Vigabatrin is currently in clinical trials to determine its efficacy at preventing epilepsy in patients with TSC,” they said, although the drug is not currently recommended for infants. “mTOR inhibitors have been successfully used to treat multiple TSC manifestations and have shown some efficacy as adjunctive treatment of refractory epilepsy,” they wrote, adding that studies are needed “to determine the safety and efficacy of mTOR inhibitors in this age group.”

Read more at Pediatrics. 2017;140(6):e20164040 (doi: 10.1542/peds.2016-4040).

The Choosing Wisely recommendations for hospitalists have launched numerous research projects. One dealing with telemetry and catheter use was published in September’s American Journal of Medicine.

After reviewing the literature on how people were implementing these recommendations, the researchers noticed most projects “1) narrowly focused on only one of the recommendations; 2) often used intrusive interventions that appeared to be burdensome and not adaptable to physician workflow; and 3) were expensive to implement,” said lead author Charlie M. Wray, DO, MS, of the Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, and the University of California, San Francisco. “We set out to design a project that could minimize these aspects while hopefully decreasing the use of telemetry and Foley catheters.”

The researchers created a “silent” reminder that was posted on a widely used screen within their EHR and was only activated when the user clicked on it. “Additionally, we wanted to make sure that this intervention made its way to teaching rounds and the patients’ bedsides,” Dr. Wray said. “So, when the attendings and residents would print out their daily census, it would contain the reminders, which allowed the team to quickly review which patients were actively using telemetry or had a Foley and discuss, at a team-level, whose telemetry or Foley could be stopped.”

The project demonstrated a trend toward less telemetry use, less time spent on telemetry, fewer catheters ordered, and more selective utilization of catheters in sicker patients.

“We believe that our project shows that the bundling of interventions has the potential to impart an effect on a greater proportion of the population than those that focus on a single issue,” Dr. Wray said. “Second, future interventions that look to utilize EHR-based clinical reminders should consider utilizing a ‘silent’ design that is prominent but doesn’t intrude upon practitioners workflow.”

You don’t need to be at a large academic institution to implement this idea, he added. “A few hours with your IT expert and a champion who is willing to take the lead could easily implement this project and hopefully see similar outcomes.”
 

Reference

Wray, Charlie M. et al. Improving value by reducing unnecessary telemetry and urinary catheter utilization in hospitalized patients. Am J Med. 2017 Sep;130(9):1037-41.

The Choosing Wisely recommendations for hospitalists have launched numerous research projects. One dealing with telemetry and catheter use was published in September’s American Journal of Medicine.

After reviewing the literature on how people were implementing these recommendations, the researchers noticed most projects “1) narrowly focused on only one of the recommendations; 2) often used intrusive interventions that appeared to be burdensome and not adaptable to physician workflow; and 3) were expensive to implement,” said lead author Charlie M. Wray, DO, MS, of the Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, and the University of California, San Francisco. “We set out to design a project that could minimize these aspects while hopefully decreasing the use of telemetry and Foley catheters.”

The researchers created a “silent” reminder that was posted on a widely used screen within their EHR and was only activated when the user clicked on it. “Additionally, we wanted to make sure that this intervention made its way to teaching rounds and the patients’ bedsides,” Dr. Wray said. “So, when the attendings and residents would print out their daily census, it would contain the reminders, which allowed the team to quickly review which patients were actively using telemetry or had a Foley and discuss, at a team-level, whose telemetry or Foley could be stopped.”

The project demonstrated a trend toward less telemetry use, less time spent on telemetry, fewer catheters ordered, and more selective utilization of catheters in sicker patients.

“We believe that our project shows that the bundling of interventions has the potential to impart an effect on a greater proportion of the population than those that focus on a single issue,” Dr. Wray said. “Second, future interventions that look to utilize EHR-based clinical reminders should consider utilizing a ‘silent’ design that is prominent but doesn’t intrude upon practitioners workflow.”

You don’t need to be at a large academic institution to implement this idea, he added. “A few hours with your IT expert and a champion who is willing to take the lead could easily implement this project and hopefully see similar outcomes.”
 

Reference

Wray, Charlie M. et al. Improving value by reducing unnecessary telemetry and urinary catheter utilization in hospitalized patients. Am J Med. 2017 Sep;130(9):1037-41.

The Choosing Wisely recommendations for hospitalists have launched numerous research projects. One dealing with telemetry and catheter use was published in September’s American Journal of Medicine.

After reviewing the literature on how people were implementing these recommendations, the researchers noticed most projects “1) narrowly focused on only one of the recommendations; 2) often used intrusive interventions that appeared to be burdensome and not adaptable to physician workflow; and 3) were expensive to implement,” said lead author Charlie M. Wray, DO, MS, of the Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, and the University of California, San Francisco. “We set out to design a project that could minimize these aspects while hopefully decreasing the use of telemetry and Foley catheters.”

The researchers created a “silent” reminder that was posted on a widely used screen within their EHR and was only activated when the user clicked on it. “Additionally, we wanted to make sure that this intervention made its way to teaching rounds and the patients’ bedsides,” Dr. Wray said. “So, when the attendings and residents would print out their daily census, it would contain the reminders, which allowed the team to quickly review which patients were actively using telemetry or had a Foley and discuss, at a team-level, whose telemetry or Foley could be stopped.”

The project demonstrated a trend toward less telemetry use, less time spent on telemetry, fewer catheters ordered, and more selective utilization of catheters in sicker patients.

“We believe that our project shows that the bundling of interventions has the potential to impart an effect on a greater proportion of the population than those that focus on a single issue,” Dr. Wray said. “Second, future interventions that look to utilize EHR-based clinical reminders should consider utilizing a ‘silent’ design that is prominent but doesn’t intrude upon practitioners workflow.”

You don’t need to be at a large academic institution to implement this idea, he added. “A few hours with your IT expert and a champion who is willing to take the lead could easily implement this project and hopefully see similar outcomes.”
 

Reference

Wray, Charlie M. et al. Improving value by reducing unnecessary telemetry and urinary catheter utilization in hospitalized patients. Am J Med. 2017 Sep;130(9):1037-41.

SAN ANTONIO – The results of a prospective study showed that, in patients without a surgical endometriosis diagnosis, a serum test of microRNA (miRNA) levels yielded a very high predictive value when endometriosis was later surgically confirmed.

“This is the first prospective study performed within a diverse population that identifies miRNAs can reliably be used to differentiate between endometriosis and other gynecologic pathologies,” Sarah Moustafa, MD, said at the annual meeting of the American Society for Reproductive Medicine.

[email protected]

On Twitter @karioakes

SAN ANTONIO – The results of a prospective study showed that, in patients without a surgical endometriosis diagnosis, a serum test of microRNA (miRNA) levels yielded a very high predictive value when endometriosis was later surgically confirmed.

“This is the first prospective study performed within a diverse population that identifies miRNAs can reliably be used to differentiate between endometriosis and other gynecologic pathologies,” Sarah Moustafa, MD, said at the annual meeting of the American Society for Reproductive Medicine.

[email protected]

On Twitter @karioakes

SAN ANTONIO – The results of a prospective study showed that, in patients without a surgical endometriosis diagnosis, a serum test of microRNA (miRNA) levels yielded a very high predictive value when endometriosis was later surgically confirmed.

“This is the first prospective study performed within a diverse population that identifies miRNAs can reliably be used to differentiate between endometriosis and other gynecologic pathologies,” Sarah Moustafa, MD, said at the annual meeting of the American Society for Reproductive Medicine.

[email protected]

On Twitter @karioakes