Purpose: This literature review was performed to better understand how to facilitate the integration of palliative care and oncology care at the onset of treatment for patients at a VAMC facility.

Background: Palliative care is defined by the World Health Organization (WHO) as an approach to care aimed at improving the quality of life of patients and their families who are facing obstacles associated with a serious or terminal illness (WHO). The intention of palliative care is not curative; it does however address the prevention, early identification and treatment of pain, and problems which may be physical, psychosocial and spiritual. Palliative care should be integrated early in the course of the disease and in conjunction with life-saving treatments (Greer et al, 2013).

Methods: A search of databases included Google Scholar, PubMed, Ovid, and CINAHL identified randomized clinical trials, systematic reviews and expert reviews regarding the integration of palliative care at the initial diagnosis and when cancer treatment begins.

Results: Several interventions for integration of palliative care with standard cancer were identified as well as increase patient outcomes. The National Comprehensive Care Network,(NCCN), the American Society of Clinical Oncology, (ASCO), and the Institute of Medicine (IOM), all advocate for the initiation of palliative care at the onset of treatment. Guidelines for screening, assessments, and interventions are available to begin the process of integration. There are several barriers, however, affecting the integration of palliative care with comprehensive oncology care. These barriers include inadequate staffing, inadequate training, standardized assessment and screening tools. The process also requires the cooperation and support of facility leadership and administration.

Implications: There is strong evidence for the integration of palliative and oncology care for Veterans receiving cancer care at VAMC facilities. Oncology would continue to focus on the treatment of disease with the primary assessment of pain, other symptom management, and goals of care. Palliative care would be able to assist the patient with the more complicated symptomatology, psychosocial support, advance care planning and easier transitions into hospice care. Each discipline has a role in the improved outcomes and improved quality of life for patients.

Purpose: This literature review was performed to better understand how to facilitate the integration of palliative care and oncology care at the onset of treatment for patients at a VAMC facility.

Background: Palliative care is defined by the World Health Organization (WHO) as an approach to care aimed at improving the quality of life of patients and their families who are facing obstacles associated with a serious or terminal illness (WHO). The intention of palliative care is not curative; it does however address the prevention, early identification and treatment of pain, and problems which may be physical, psychosocial and spiritual. Palliative care should be integrated early in the course of the disease and in conjunction with life-saving treatments (Greer et al, 2013).

Methods: A search of databases included Google Scholar, PubMed, Ovid, and CINAHL identified randomized clinical trials, systematic reviews and expert reviews regarding the integration of palliative care at the initial diagnosis and when cancer treatment begins.

Results: Several interventions for integration of palliative care with standard cancer were identified as well as increase patient outcomes. The National Comprehensive Care Network,(NCCN), the American Society of Clinical Oncology, (ASCO), and the Institute of Medicine (IOM), all advocate for the initiation of palliative care at the onset of treatment. Guidelines for screening, assessments, and interventions are available to begin the process of integration. There are several barriers, however, affecting the integration of palliative care with comprehensive oncology care. These barriers include inadequate staffing, inadequate training, standardized assessment and screening tools. The process also requires the cooperation and support of facility leadership and administration.

Implications: There is strong evidence for the integration of palliative and oncology care for Veterans receiving cancer care at VAMC facilities. Oncology would continue to focus on the treatment of disease with the primary assessment of pain, other symptom management, and goals of care. Palliative care would be able to assist the patient with the more complicated symptomatology, psychosocial support, advance care planning and easier transitions into hospice care. Each discipline has a role in the improved outcomes and improved quality of life for patients.

Purpose: This literature review was performed to better understand how to facilitate the integration of palliative care and oncology care at the onset of treatment for patients at a VAMC facility.

Background: Palliative care is defined by the World Health Organization (WHO) as an approach to care aimed at improving the quality of life of patients and their families who are facing obstacles associated with a serious or terminal illness (WHO). The intention of palliative care is not curative; it does however address the prevention, early identification and treatment of pain, and problems which may be physical, psychosocial and spiritual. Palliative care should be integrated early in the course of the disease and in conjunction with life-saving treatments (Greer et al, 2013).

Methods: A search of databases included Google Scholar, PubMed, Ovid, and CINAHL identified randomized clinical trials, systematic reviews and expert reviews regarding the integration of palliative care at the initial diagnosis and when cancer treatment begins.

Results: Several interventions for integration of palliative care with standard cancer were identified as well as increase patient outcomes. The National Comprehensive Care Network,(NCCN), the American Society of Clinical Oncology, (ASCO), and the Institute of Medicine (IOM), all advocate for the initiation of palliative care at the onset of treatment. Guidelines for screening, assessments, and interventions are available to begin the process of integration. There are several barriers, however, affecting the integration of palliative care with comprehensive oncology care. These barriers include inadequate staffing, inadequate training, standardized assessment and screening tools. The process also requires the cooperation and support of facility leadership and administration.

Implications: There is strong evidence for the integration of palliative and oncology care for Veterans receiving cancer care at VAMC facilities. Oncology would continue to focus on the treatment of disease with the primary assessment of pain, other symptom management, and goals of care. Palliative care would be able to assist the patient with the more complicated symptomatology, psychosocial support, advance care planning and easier transitions into hospice care. Each discipline has a role in the improved outcomes and improved quality of life for patients.

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

[email protected]

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

[email protected]

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

[email protected]

Accountable care organizations participating in the Medicare Shared Savings Program generated $466 million in savings in 2015, up from $411 million in 2014, the Centers for Medicare & Medicaid Services announced.

Despite the growth in savings, there was little growth in the number of ACOs that qualified for bonus payments based on the savings they were able to generate.

©sndr/istockphoto.com

Of 392 participants in Medicare Shared Savings Programand 12 Pioneer ACO Model participants, 31% (125) received bonus payments in 2015, as compared with 27% (97 organizations from a pool of 20 Pioneer ACOs and 333 ACO shared savings program participants) in 2014, according to a CMS report.

The agency noted that another 83 ACOs in the Shared Savings Program and two Pioneer ACOs generated savings in 2015 but did not qualify for bonus payments. Of the four Pioneer ACOs that recorded losses, only one incurred losses great enough to require payment to CMS.

On the quality side, the mean quality score among Pioneer ACOs increased to 92% in 2015, the fourth year of the program, up from 87% in 2014. Quality scores have risen each year, with a growth of 21% from the first year.

Participants in the Shared Savings Program that reported quality measures in both 2014 and 2015 improved on 84% of the quality measures that were reported in both years. In four measures – screening risk for future falls, depression screening and follow-up, blood pressure screening and follow-up, and administering pneumonia vaccine – the average quality performance improvement was more than 15% year-over-year.

The National Association of ACOs said it was “disappointed” in the small bump in financial bonuses.

“The results are not as strong as we, and many of our ACO members, had hoped for,” NAACOS President and CEO Clif Gaus, ScD, said in a statement. “But overall, we are pleased to see the results show a positive trend for the program,” noting that despite being only a few years old, the the participating ACOs “have accomplished a lot to reduce cost and improve quality.”

[email protected]

Accountable care organizations participating in the Medicare Shared Savings Program generated $466 million in savings in 2015, up from $411 million in 2014, the Centers for Medicare & Medicaid Services announced.

Despite the growth in savings, there was little growth in the number of ACOs that qualified for bonus payments based on the savings they were able to generate.

©sndr/istockphoto.com

Of 392 participants in Medicare Shared Savings Programand 12 Pioneer ACO Model participants, 31% (125) received bonus payments in 2015, as compared with 27% (97 organizations from a pool of 20 Pioneer ACOs and 333 ACO shared savings program participants) in 2014, according to a CMS report.

The agency noted that another 83 ACOs in the Shared Savings Program and two Pioneer ACOs generated savings in 2015 but did not qualify for bonus payments. Of the four Pioneer ACOs that recorded losses, only one incurred losses great enough to require payment to CMS.

On the quality side, the mean quality score among Pioneer ACOs increased to 92% in 2015, the fourth year of the program, up from 87% in 2014. Quality scores have risen each year, with a growth of 21% from the first year.

Participants in the Shared Savings Program that reported quality measures in both 2014 and 2015 improved on 84% of the quality measures that were reported in both years. In four measures – screening risk for future falls, depression screening and follow-up, blood pressure screening and follow-up, and administering pneumonia vaccine – the average quality performance improvement was more than 15% year-over-year.

The National Association of ACOs said it was “disappointed” in the small bump in financial bonuses.

“The results are not as strong as we, and many of our ACO members, had hoped for,” NAACOS President and CEO Clif Gaus, ScD, said in a statement. “But overall, we are pleased to see the results show a positive trend for the program,” noting that despite being only a few years old, the the participating ACOs “have accomplished a lot to reduce cost and improve quality.”

[email protected]

Accountable care organizations participating in the Medicare Shared Savings Program generated $466 million in savings in 2015, up from $411 million in 2014, the Centers for Medicare & Medicaid Services announced.

Despite the growth in savings, there was little growth in the number of ACOs that qualified for bonus payments based on the savings they were able to generate.

©sndr/istockphoto.com

Of 392 participants in Medicare Shared Savings Programand 12 Pioneer ACO Model participants, 31% (125) received bonus payments in 2015, as compared with 27% (97 organizations from a pool of 20 Pioneer ACOs and 333 ACO shared savings program participants) in 2014, according to a CMS report.

The agency noted that another 83 ACOs in the Shared Savings Program and two Pioneer ACOs generated savings in 2015 but did not qualify for bonus payments. Of the four Pioneer ACOs that recorded losses, only one incurred losses great enough to require payment to CMS.

On the quality side, the mean quality score among Pioneer ACOs increased to 92% in 2015, the fourth year of the program, up from 87% in 2014. Quality scores have risen each year, with a growth of 21% from the first year.

Participants in the Shared Savings Program that reported quality measures in both 2014 and 2015 improved on 84% of the quality measures that were reported in both years. In four measures – screening risk for future falls, depression screening and follow-up, blood pressure screening and follow-up, and administering pneumonia vaccine – the average quality performance improvement was more than 15% year-over-year.

The National Association of ACOs said it was “disappointed” in the small bump in financial bonuses.

“The results are not as strong as we, and many of our ACO members, had hoped for,” NAACOS President and CEO Clif Gaus, ScD, said in a statement. “But overall, we are pleased to see the results show a positive trend for the program,” noting that despite being only a few years old, the the participating ACOs “have accomplished a lot to reduce cost and improve quality.”

[email protected]

If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.

As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.

Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.

Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:

Question: Why did you choose a career in medicine?

Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.

Q: How/when did you decide to become a hospitalist?

A: I decided to become a hospitalist as soon as I graduated residency.

Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?

A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.

Q: What do you like most about working as a hospitalist?

A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.

Q: What do you dislike most?

A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.

Q: What’s the best advice you ever received?

A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.

Q: What’s the worst advice you ever received?

A: Always practice defensive medicine because, if you don’t, you will get sued.

Q: Have you tried to mentor others? Why or why not?

A: I have mentored several medical students because I feel it is important to give back to the next generation.

Q: What’s the biggest change you’ve seen in HM in your career?

A: More paperwork.

Q: What’s the biggest change you would like to see in HM?

A: Decreasing paperwork.

Q: What aspect of patient care is most rewarding?

A: Connecting with patients.

Q: What is your biggest professional challenge?

A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.

Q: What is your biggest professional reward?

A: Being able to work with and learn from other hospitalists.

Q: Outside of patient care, tell us about your career interests.

A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.

Q: Where do you see yourself in 10 years?

A: Retired.

Q: What’s next professionally?

A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.

Q: What’s the best book you’ve read recently? Why?

A: Fortify Your Life, a book about supplements.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: iPhone and MacBook on a daily basis.

Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?

A: I use them for electronic health records.

Q: What’s your favorite social network? Do you use it at all for work or professional development?

A: Instagram, but not for work.

Richard Quinn is a freelance writer in New Jersey.

If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.

As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.

Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.

Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:

Question: Why did you choose a career in medicine?

Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.

Q: How/when did you decide to become a hospitalist?

A: I decided to become a hospitalist as soon as I graduated residency.

Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?

A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.

Q: What do you like most about working as a hospitalist?

A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.

Q: What do you dislike most?

A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.

Q: What’s the best advice you ever received?

A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.

Q: What’s the worst advice you ever received?

A: Always practice defensive medicine because, if you don’t, you will get sued.

Q: Have you tried to mentor others? Why or why not?

A: I have mentored several medical students because I feel it is important to give back to the next generation.

Q: What’s the biggest change you’ve seen in HM in your career?

A: More paperwork.

Q: What’s the biggest change you would like to see in HM?

A: Decreasing paperwork.

Q: What aspect of patient care is most rewarding?

A: Connecting with patients.

Q: What is your biggest professional challenge?

A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.

Q: What is your biggest professional reward?

A: Being able to work with and learn from other hospitalists.

Q: Outside of patient care, tell us about your career interests.

A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.

Q: Where do you see yourself in 10 years?

A: Retired.

Q: What’s next professionally?

A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.

Q: What’s the best book you’ve read recently? Why?

A: Fortify Your Life, a book about supplements.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: iPhone and MacBook on a daily basis.

Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?

A: I use them for electronic health records.

Q: What’s your favorite social network? Do you use it at all for work or professional development?

A: Instagram, but not for work.

Richard Quinn is a freelance writer in New Jersey.

If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.

As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.

Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.

Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:

Question: Why did you choose a career in medicine?

Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.

Q: How/when did you decide to become a hospitalist?

A: I decided to become a hospitalist as soon as I graduated residency.

Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?

A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.

Q: What do you like most about working as a hospitalist?

A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.

Q: What do you dislike most?

A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.

Q: What’s the best advice you ever received?

A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.

Q: What’s the worst advice you ever received?

A: Always practice defensive medicine because, if you don’t, you will get sued.

Q: Have you tried to mentor others? Why or why not?

A: I have mentored several medical students because I feel it is important to give back to the next generation.

Q: What’s the biggest change you’ve seen in HM in your career?

A: More paperwork.

Q: What’s the biggest change you would like to see in HM?

A: Decreasing paperwork.

Q: What aspect of patient care is most rewarding?

A: Connecting with patients.

Q: What is your biggest professional challenge?

A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.

Q: What is your biggest professional reward?

A: Being able to work with and learn from other hospitalists.

Q: Outside of patient care, tell us about your career interests.

A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.

Q: Where do you see yourself in 10 years?

A: Retired.

Q: What’s next professionally?

A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.

Q: What’s the best book you’ve read recently? Why?

A: Fortify Your Life, a book about supplements.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: iPhone and MacBook on a daily basis.

Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?

A: I use them for electronic health records.

Q: What’s your favorite social network? Do you use it at all for work or professional development?

A: Instagram, but not for work.

Richard Quinn is a freelance writer in New Jersey.

A hand spraying a mist

of nasal spray

Bevacizumab nasal spray is no more effective than a placebo for reducing epistaxis caused by hereditary hemorrhagic telangiectasia (HHT), according to a study published in JAMA.

Researchers compared 3 different doses of bevacizumab to a sodium chloride placebo and found no significant difference between the treatment groups in the frequency or duration of epistaxis, the need for transfusion, or hemoglobin/ferritin levels.

Sophie Dupuis-Girod, MD, PhD, of the Hopital Femme-Mere-Enfants in Bron, France, and her colleagues conducted this trial, enrolling 80 patients with HHT and a history of epistaxis.

The patients were randomized to receive placebo (0.9% sodium chloride, n=21) or 1 of 3 doses of bevacizumab nasal spray.

Patients in the bevacizumab groups received 25 mg (n=20), 50 mg (n=20), or 75 mg (n=19) in 3 doses, 14 days apart, for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, or 225 mg.

Epistaxis duration

The researchers measured the mean monthly epistaxis duration at 3 months and found no significant difference between the placebo group and the bevacizumab groups (P=0.57). Likewise, there were no significant differences between the bevacizumab groups.

However, most of the groups experienced improvements in epistaxis duration after treatment.

The mean monthly epistaxis duration (in minutes) before treatment (from day −90 to day −1) and after treatment (from day 29 to day 118), respectively, was:

• 262.8 and 200.4 in the placebo group
• 285.5 and 259.2 in the 25 mg group
• 229.0 and 244.0 in the 50 mg group
• 272.9 and 215.0 in the 75 mg group.

Epistaxis frequency

There was no significant difference between the bevacizumab groups and the placebo group when it came to the number of epistaxis episodes (P=0.55). However, patients in all of the groups saw a reduction in episodes after treatment.

The mean number of epistaxis episodes before treatment (from day −90 to day −1) and after (from day 29 to day 118), respectively, were:

• 31.37 and 24.27 in the placebo group
• 30.99 and 23.13 in the 25 mg bevacizumab group
• 25.06 and 20.01 in the 50 mg bevacizumab group
• 27.84 and 24.35 in the 75 mg bevacizumab group.

Other outcomes

There was no significant difference between the bevacizumab groups and the placebo group regarding the number of red blood cell transfusions at 3 months (P=0.35) and 6 months (P=0.39), mean hemoglobin levels (P=0.66), and mean ferritin levels (P=0.86).

There were no adverse events (AEs) thought to be treatment-related. There were 161 AEs overall and no significant differences between the groups—47 AEs in the 25 mg bevacizumab group, 33 in the 50 mg bevacizumab group, 38 in the 75 mg bevacizumab group, and 43 in the placebo group.

After an interim analysis, an independent data monitoring committee recommended terminating this study early due to treatment futility. So the study was stopped before entering phase 3.

A hand spraying a mist

of nasal spray

Bevacizumab nasal spray is no more effective than a placebo for reducing epistaxis caused by hereditary hemorrhagic telangiectasia (HHT), according to a study published in JAMA.

Researchers compared 3 different doses of bevacizumab to a sodium chloride placebo and found no significant difference between the treatment groups in the frequency or duration of epistaxis, the need for transfusion, or hemoglobin/ferritin levels.

Sophie Dupuis-Girod, MD, PhD, of the Hopital Femme-Mere-Enfants in Bron, France, and her colleagues conducted this trial, enrolling 80 patients with HHT and a history of epistaxis.

The patients were randomized to receive placebo (0.9% sodium chloride, n=21) or 1 of 3 doses of bevacizumab nasal spray.

Patients in the bevacizumab groups received 25 mg (n=20), 50 mg (n=20), or 75 mg (n=19) in 3 doses, 14 days apart, for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, or 225 mg.

Epistaxis duration

The researchers measured the mean monthly epistaxis duration at 3 months and found no significant difference between the placebo group and the bevacizumab groups (P=0.57). Likewise, there were no significant differences between the bevacizumab groups.

However, most of the groups experienced improvements in epistaxis duration after treatment.

The mean monthly epistaxis duration (in minutes) before treatment (from day −90 to day −1) and after treatment (from day 29 to day 118), respectively, was:

• 262.8 and 200.4 in the placebo group
• 285.5 and 259.2 in the 25 mg group
• 229.0 and 244.0 in the 50 mg group
• 272.9 and 215.0 in the 75 mg group.

Epistaxis frequency

There was no significant difference between the bevacizumab groups and the placebo group when it came to the number of epistaxis episodes (P=0.55). However, patients in all of the groups saw a reduction in episodes after treatment.

The mean number of epistaxis episodes before treatment (from day −90 to day −1) and after (from day 29 to day 118), respectively, were:

• 31.37 and 24.27 in the placebo group
• 30.99 and 23.13 in the 25 mg bevacizumab group
• 25.06 and 20.01 in the 50 mg bevacizumab group
• 27.84 and 24.35 in the 75 mg bevacizumab group.

Other outcomes

There was no significant difference between the bevacizumab groups and the placebo group regarding the number of red blood cell transfusions at 3 months (P=0.35) and 6 months (P=0.39), mean hemoglobin levels (P=0.66), and mean ferritin levels (P=0.86).

There were no adverse events (AEs) thought to be treatment-related. There were 161 AEs overall and no significant differences between the groups—47 AEs in the 25 mg bevacizumab group, 33 in the 50 mg bevacizumab group, 38 in the 75 mg bevacizumab group, and 43 in the placebo group.

After an interim analysis, an independent data monitoring committee recommended terminating this study early due to treatment futility. So the study was stopped before entering phase 3.

A hand spraying a mist

of nasal spray

Bevacizumab nasal spray is no more effective than a placebo for reducing epistaxis caused by hereditary hemorrhagic telangiectasia (HHT), according to a study published in JAMA.

Researchers compared 3 different doses of bevacizumab to a sodium chloride placebo and found no significant difference between the treatment groups in the frequency or duration of epistaxis, the need for transfusion, or hemoglobin/ferritin levels.

Sophie Dupuis-Girod, MD, PhD, of the Hopital Femme-Mere-Enfants in Bron, France, and her colleagues conducted this trial, enrolling 80 patients with HHT and a history of epistaxis.

The patients were randomized to receive placebo (0.9% sodium chloride, n=21) or 1 of 3 doses of bevacizumab nasal spray.

Patients in the bevacizumab groups received 25 mg (n=20), 50 mg (n=20), or 75 mg (n=19) in 3 doses, 14 days apart, for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, or 225 mg.

Epistaxis duration

The researchers measured the mean monthly epistaxis duration at 3 months and found no significant difference between the placebo group and the bevacizumab groups (P=0.57). Likewise, there were no significant differences between the bevacizumab groups.

However, most of the groups experienced improvements in epistaxis duration after treatment.

The mean monthly epistaxis duration (in minutes) before treatment (from day −90 to day −1) and after treatment (from day 29 to day 118), respectively, was:

• 262.8 and 200.4 in the placebo group
• 285.5 and 259.2 in the 25 mg group
• 229.0 and 244.0 in the 50 mg group
• 272.9 and 215.0 in the 75 mg group.

Epistaxis frequency

There was no significant difference between the bevacizumab groups and the placebo group when it came to the number of epistaxis episodes (P=0.55). However, patients in all of the groups saw a reduction in episodes after treatment.

The mean number of epistaxis episodes before treatment (from day −90 to day −1) and after (from day 29 to day 118), respectively, were:

• 31.37 and 24.27 in the placebo group
• 30.99 and 23.13 in the 25 mg bevacizumab group
• 25.06 and 20.01 in the 50 mg bevacizumab group
• 27.84 and 24.35 in the 75 mg bevacizumab group.

Other outcomes

There was no significant difference between the bevacizumab groups and the placebo group regarding the number of red blood cell transfusions at 3 months (P=0.35) and 6 months (P=0.39), mean hemoglobin levels (P=0.66), and mean ferritin levels (P=0.86).

There were no adverse events (AEs) thought to be treatment-related. There were 161 AEs overall and no significant differences between the groups—47 AEs in the 25 mg bevacizumab group, 33 in the 50 mg bevacizumab group, 38 in the 75 mg bevacizumab group, and 43 in the placebo group.

After an interim analysis, an independent data monitoring committee recommended terminating this study early due to treatment futility. So the study was stopped before entering phase 3.

Doctor examines SCD patient

Photo courtesy of St. Jude

Children’s Hospital

A new report suggests the current state of care for sickle cell disease (SCD) is inadequate, and improvements are needed.

The State of Sickle Cell Disease: 2016 Report outlines 4 main areas for improvement—SCD patients’ access to care, the training and education of healthcare professionals treating patients with SCD, research and clinical trials pertaining to SCD, and global health issues related to the disease.

The American Society of Hematology (ASH) published the report, with the endorsement of organizations in the SCD community.

The report includes statistics that highlight the need for improvements as well as future goals and recommended actions.

Access to care

The report states that more than 75% of adults with SCD who have frequent pain crises do not receive the recommended treatment, hydroxyurea.

One potential solution, according to the report, is to ensure that existing standard-of-care guidelines are being used. Another solution is to develop coordinated healthcare delivery models that ensure SCD patients can access quality care regardless of their age, location, and socioeconomic status.

“Not only are individuals with SCD burdened by the pain and disability that comes with a chronic condition, but they also have very few accessible treatment options due to our fragmented healthcare system,” said ASH President Charles S. Abrams, MD, of the University of Pennsylvania in Philadelphia.

Training and education

The report cites a national survey in which only 20.4% of family physicians said they felt comfortable treating SCD. And 69.4% of family physicians said clinical decision support tools would be useful for helping to guide their treatment decisions for SCD patients.

Therefore, the report recommends devising an “actionable plan” to educate healthcare providers about best practices in caring for SCD patients, developing clinical support tools, and encouraging medical trainees to pursue careers in SCD care, among other solutions.

“There are many unique challenges that people with SCD face,” said ASH Vice President Alexis Thompson, MD, of the Ann and Robert H. Lurie Children’s Hospital of Chicago in Illinois.

“For example, the transition from pediatric to adult care can be especially difficult, and many people struggle to find healthcare providers with comprehensive knowledge and expertise to provide proper care, especially in rural communities.”

Research and clinical trials

The report notes that hydroxyurea is the only drug approved by the US Food and Drug Administration to treat SCD. Therefore, research is needed to develop novel therapies, new drug delivery modes, and new agents that can be used in combination with hydroxyurea.

The report also highlights other areas where research is needed and recommends developing clinical trial networks to increase enrollment in trials.

Global issues

According to the report, roughly 1000 children in Africa are born with SCD every day, and more than half will die before they reach the age of 5. In addition, more than 90% of children with SCD who live in resource-poor countries do not survive to adulthood.

Therefore, the report recommends expanding newborn screening and early intervention programs, increasing SCD awareness and education, and improving access to quality care in developing regions.

Sickle Cell Disease Coalition

To address the aforementioned challenges, ASH and more than 20 other organizations launched the Sickle Cell Disease Coalition. The coalition is focused on promoting research, clinical care, education, training, and advocacy.

The aim of the coalition is to provide a platform to encourage stakeholders to work together to implement projects and activities that will ultimately help the SCD community and improve patient outcomes.

The coalition consists of leading patient advocacy groups, people with SCD and their families, researchers, clinicians, policymakers, industry stakeholders, and foundations with an interest in SCD.

Doctor examines SCD patient

Photo courtesy of St. Jude

Children’s Hospital

A new report suggests the current state of care for sickle cell disease (SCD) is inadequate, and improvements are needed.

The State of Sickle Cell Disease: 2016 Report outlines 4 main areas for improvement—SCD patients’ access to care, the training and education of healthcare professionals treating patients with SCD, research and clinical trials pertaining to SCD, and global health issues related to the disease.

The American Society of Hematology (ASH) published the report, with the endorsement of organizations in the SCD community.

The report includes statistics that highlight the need for improvements as well as future goals and recommended actions.

Access to care

The report states that more than 75% of adults with SCD who have frequent pain crises do not receive the recommended treatment, hydroxyurea.

One potential solution, according to the report, is to ensure that existing standard-of-care guidelines are being used. Another solution is to develop coordinated healthcare delivery models that ensure SCD patients can access quality care regardless of their age, location, and socioeconomic status.

“Not only are individuals with SCD burdened by the pain and disability that comes with a chronic condition, but they also have very few accessible treatment options due to our fragmented healthcare system,” said ASH President Charles S. Abrams, MD, of the University of Pennsylvania in Philadelphia.

Training and education

The report cites a national survey in which only 20.4% of family physicians said they felt comfortable treating SCD. And 69.4% of family physicians said clinical decision support tools would be useful for helping to guide their treatment decisions for SCD patients.

Therefore, the report recommends devising an “actionable plan” to educate healthcare providers about best practices in caring for SCD patients, developing clinical support tools, and encouraging medical trainees to pursue careers in SCD care, among other solutions.

“There are many unique challenges that people with SCD face,” said ASH Vice President Alexis Thompson, MD, of the Ann and Robert H. Lurie Children’s Hospital of Chicago in Illinois.

“For example, the transition from pediatric to adult care can be especially difficult, and many people struggle to find healthcare providers with comprehensive knowledge and expertise to provide proper care, especially in rural communities.”

Research and clinical trials

The report notes that hydroxyurea is the only drug approved by the US Food and Drug Administration to treat SCD. Therefore, research is needed to develop novel therapies, new drug delivery modes, and new agents that can be used in combination with hydroxyurea.

The report also highlights other areas where research is needed and recommends developing clinical trial networks to increase enrollment in trials.

Global issues

According to the report, roughly 1000 children in Africa are born with SCD every day, and more than half will die before they reach the age of 5. In addition, more than 90% of children with SCD who live in resource-poor countries do not survive to adulthood.

Therefore, the report recommends expanding newborn screening and early intervention programs, increasing SCD awareness and education, and improving access to quality care in developing regions.

Sickle Cell Disease Coalition

To address the aforementioned challenges, ASH and more than 20 other organizations launched the Sickle Cell Disease Coalition. The coalition is focused on promoting research, clinical care, education, training, and advocacy.

The aim of the coalition is to provide a platform to encourage stakeholders to work together to implement projects and activities that will ultimately help the SCD community and improve patient outcomes.

The coalition consists of leading patient advocacy groups, people with SCD and their families, researchers, clinicians, policymakers, industry stakeholders, and foundations with an interest in SCD.

Doctor examines SCD patient

Photo courtesy of St. Jude

Children’s Hospital

A new report suggests the current state of care for sickle cell disease (SCD) is inadequate, and improvements are needed.

The State of Sickle Cell Disease: 2016 Report outlines 4 main areas for improvement—SCD patients’ access to care, the training and education of healthcare professionals treating patients with SCD, research and clinical trials pertaining to SCD, and global health issues related to the disease.

The American Society of Hematology (ASH) published the report, with the endorsement of organizations in the SCD community.

The report includes statistics that highlight the need for improvements as well as future goals and recommended actions.

Access to care

The report states that more than 75% of adults with SCD who have frequent pain crises do not receive the recommended treatment, hydroxyurea.

One potential solution, according to the report, is to ensure that existing standard-of-care guidelines are being used. Another solution is to develop coordinated healthcare delivery models that ensure SCD patients can access quality care regardless of their age, location, and socioeconomic status.

“Not only are individuals with SCD burdened by the pain and disability that comes with a chronic condition, but they also have very few accessible treatment options due to our fragmented healthcare system,” said ASH President Charles S. Abrams, MD, of the University of Pennsylvania in Philadelphia.

Training and education

The report cites a national survey in which only 20.4% of family physicians said they felt comfortable treating SCD. And 69.4% of family physicians said clinical decision support tools would be useful for helping to guide their treatment decisions for SCD patients.

Therefore, the report recommends devising an “actionable plan” to educate healthcare providers about best practices in caring for SCD patients, developing clinical support tools, and encouraging medical trainees to pursue careers in SCD care, among other solutions.

“There are many unique challenges that people with SCD face,” said ASH Vice President Alexis Thompson, MD, of the Ann and Robert H. Lurie Children’s Hospital of Chicago in Illinois.

“For example, the transition from pediatric to adult care can be especially difficult, and many people struggle to find healthcare providers with comprehensive knowledge and expertise to provide proper care, especially in rural communities.”

Research and clinical trials

The report notes that hydroxyurea is the only drug approved by the US Food and Drug Administration to treat SCD. Therefore, research is needed to develop novel therapies, new drug delivery modes, and new agents that can be used in combination with hydroxyurea.

The report also highlights other areas where research is needed and recommends developing clinical trial networks to increase enrollment in trials.

Global issues

According to the report, roughly 1000 children in Africa are born with SCD every day, and more than half will die before they reach the age of 5. In addition, more than 90% of children with SCD who live in resource-poor countries do not survive to adulthood.

Therefore, the report recommends expanding newborn screening and early intervention programs, increasing SCD awareness and education, and improving access to quality care in developing regions.

Sickle Cell Disease Coalition

To address the aforementioned challenges, ASH and more than 20 other organizations launched the Sickle Cell Disease Coalition. The coalition is focused on promoting research, clinical care, education, training, and advocacy.

The aim of the coalition is to provide a platform to encourage stakeholders to work together to implement projects and activities that will ultimately help the SCD community and improve patient outcomes.

The coalition consists of leading patient advocacy groups, people with SCD and their families, researchers, clinicians, policymakers, industry stakeholders, and foundations with an interest in SCD.

Kevin Whitehead, MD

Photo courtesy of the

University of Utah

Health Sciences Center

Results of a phase 2 study suggest a saline nose spray may be as effective as 3 different medicated sprays for preventing epistaxis in patients with hemorrhagic telangiectasia (HHT).

The study was a comparison of bevacizumab, estriol, tranexamic acid, and saline.

The results showed no significant differences in the frequency or duration of epistaxis, and patients in all 4 groups reported improvements in Epistaxis Severity Scores (ESS).

“This research highlights that there could be a benefit even in the simplest of interventions,” said study author Kevin Whitehead, MD, of the University of Utah School of Medicine in Salt Lake City.

“No drug proved to be any better than the saline placebo, but the majority of patients improved over the course of treatment—even those using saline.”

Dr Whitehead and his colleagues reported these results in JAMA.

The study included 121 HHT patients who had experienced HHT-related epistaxis. They were randomized to twice-daily nose sprays with bevacizumab 1% (4 mg/day), estriol 0.1% (0.4 mg/day), tranexamic acid 10% (40 mg/day), or placebo (0.9% saline) for 12 weeks.

Safety

The investigators said nasal symptoms were the most common adverse events, and they occurred in all 4 treatment groups.

Gastrointestinal symptoms, including abdominal pain, nausea, and vomiting, were most common among patients receiving tranexamic acid.

There were no thrombotic complications, episodes of severe hypertension, serious drug-related adverse events, or deaths in any treatment group.

Efficacy

There was no significant difference in epistaxis frequency between the placebo group and the other treatment groups (P=0.97).

After 12 weeks of treatment, the median weekly number of bleeding episodes was 7.0 for patients in the bevacizumab group, 8.0 for the estriol group, 7.5 for the tranexamic acid group, and 8.0 for the placebo group. At baseline, the median weekly number of bleeding episodes was 10.0, 7.0, 7.8, and 7.0, respectively.

After 12 weeks of treatment, there was no significant difference in epistaxis duration between the placebo group and the other treatment groups (P=0.09).

The median duration of epistaxis per bleeding episode was 3.0 minutes for the bevacizumab group, 4.0 minutes for the estriol group, 6.2 minutes for the tranexamic acid group, and 5.0 minutes for the placebo group. (Bleeding duration was not recorded at baseline.)

After 12 weeks of treatment, there were no significant differences between the treatment groups when it came to hemoglobin levels (P=0.43), ferritin levels (P=0.10), treatment failure (P=0.08), the need for transfusion (P=0.42), or emergency department visits (P=0.72).

Patients in all 4 treatment groups experienced a significant decline in ESS from baseline to week 12 (P<0.001 for time effect).

The median ESS decreased from 5.71 to 3.74 in the placebo group, 5.16 to 3.54 in the bevacizumab group, 5.19 to 3.56 in the estriol group, and 5.43 to 4.06 in the tranexamic acid group. The investigators said the improvement in ESS was clinically significant.

However, the team also said they cannot completely rule out the possibility that symptoms may have improved because of a placebo effect.

What’s more, it could be that some of the drugs tested would work better if taken at a higher dose, or if applied as a gel or polymer that adheres better to the inside of the nasal cavity.

Nevertheless, the results from this trial were enough to convince Dr Whitehead and his colleagues to routinely recommend saline nasal spray to their patients with HHT.

“We stress the importance of hydration,” Dr Whitehead said. “We tell them that something as simple as a morning and night saline spray could offer them some benefit.”

Kevin Whitehead, MD

Photo courtesy of the

University of Utah

Health Sciences Center

Results of a phase 2 study suggest a saline nose spray may be as effective as 3 different medicated sprays for preventing epistaxis in patients with hemorrhagic telangiectasia (HHT).

The study was a comparison of bevacizumab, estriol, tranexamic acid, and saline.

The results showed no significant differences in the frequency or duration of epistaxis, and patients in all 4 groups reported improvements in Epistaxis Severity Scores (ESS).

“This research highlights that there could be a benefit even in the simplest of interventions,” said study author Kevin Whitehead, MD, of the University of Utah School of Medicine in Salt Lake City.

“No drug proved to be any better than the saline placebo, but the majority of patients improved over the course of treatment—even those using saline.”

Dr Whitehead and his colleagues reported these results in JAMA.

The study included 121 HHT patients who had experienced HHT-related epistaxis. They were randomized to twice-daily nose sprays with bevacizumab 1% (4 mg/day), estriol 0.1% (0.4 mg/day), tranexamic acid 10% (40 mg/day), or placebo (0.9% saline) for 12 weeks.

Safety

The investigators said nasal symptoms were the most common adverse events, and they occurred in all 4 treatment groups.

Gastrointestinal symptoms, including abdominal pain, nausea, and vomiting, were most common among patients receiving tranexamic acid.

There were no thrombotic complications, episodes of severe hypertension, serious drug-related adverse events, or deaths in any treatment group.

Efficacy

There was no significant difference in epistaxis frequency between the placebo group and the other treatment groups (P=0.97).

After 12 weeks of treatment, the median weekly number of bleeding episodes was 7.0 for patients in the bevacizumab group, 8.0 for the estriol group, 7.5 for the tranexamic acid group, and 8.0 for the placebo group. At baseline, the median weekly number of bleeding episodes was 10.0, 7.0, 7.8, and 7.0, respectively.

After 12 weeks of treatment, there was no significant difference in epistaxis duration between the placebo group and the other treatment groups (P=0.09).

The median duration of epistaxis per bleeding episode was 3.0 minutes for the bevacizumab group, 4.0 minutes for the estriol group, 6.2 minutes for the tranexamic acid group, and 5.0 minutes for the placebo group. (Bleeding duration was not recorded at baseline.)

After 12 weeks of treatment, there were no significant differences between the treatment groups when it came to hemoglobin levels (P=0.43), ferritin levels (P=0.10), treatment failure (P=0.08), the need for transfusion (P=0.42), or emergency department visits (P=0.72).

Patients in all 4 treatment groups experienced a significant decline in ESS from baseline to week 12 (P<0.001 for time effect).

The median ESS decreased from 5.71 to 3.74 in the placebo group, 5.16 to 3.54 in the bevacizumab group, 5.19 to 3.56 in the estriol group, and 5.43 to 4.06 in the tranexamic acid group. The investigators said the improvement in ESS was clinically significant.

However, the team also said they cannot completely rule out the possibility that symptoms may have improved because of a placebo effect.

What’s more, it could be that some of the drugs tested would work better if taken at a higher dose, or if applied as a gel or polymer that adheres better to the inside of the nasal cavity.

Nevertheless, the results from this trial were enough to convince Dr Whitehead and his colleagues to routinely recommend saline nasal spray to their patients with HHT.

“We stress the importance of hydration,” Dr Whitehead said. “We tell them that something as simple as a morning and night saline spray could offer them some benefit.”

Kevin Whitehead, MD

Photo courtesy of the

University of Utah

Health Sciences Center

Results of a phase 2 study suggest a saline nose spray may be as effective as 3 different medicated sprays for preventing epistaxis in patients with hemorrhagic telangiectasia (HHT).

The study was a comparison of bevacizumab, estriol, tranexamic acid, and saline.

The results showed no significant differences in the frequency or duration of epistaxis, and patients in all 4 groups reported improvements in Epistaxis Severity Scores (ESS).

“This research highlights that there could be a benefit even in the simplest of interventions,” said study author Kevin Whitehead, MD, of the University of Utah School of Medicine in Salt Lake City.

“No drug proved to be any better than the saline placebo, but the majority of patients improved over the course of treatment—even those using saline.”

Dr Whitehead and his colleagues reported these results in JAMA.

The study included 121 HHT patients who had experienced HHT-related epistaxis. They were randomized to twice-daily nose sprays with bevacizumab 1% (4 mg/day), estriol 0.1% (0.4 mg/day), tranexamic acid 10% (40 mg/day), or placebo (0.9% saline) for 12 weeks.

Safety

The investigators said nasal symptoms were the most common adverse events, and they occurred in all 4 treatment groups.

Gastrointestinal symptoms, including abdominal pain, nausea, and vomiting, were most common among patients receiving tranexamic acid.

There were no thrombotic complications, episodes of severe hypertension, serious drug-related adverse events, or deaths in any treatment group.

Efficacy

There was no significant difference in epistaxis frequency between the placebo group and the other treatment groups (P=0.97).

After 12 weeks of treatment, the median weekly number of bleeding episodes was 7.0 for patients in the bevacizumab group, 8.0 for the estriol group, 7.5 for the tranexamic acid group, and 8.0 for the placebo group. At baseline, the median weekly number of bleeding episodes was 10.0, 7.0, 7.8, and 7.0, respectively.

After 12 weeks of treatment, there was no significant difference in epistaxis duration between the placebo group and the other treatment groups (P=0.09).

The median duration of epistaxis per bleeding episode was 3.0 minutes for the bevacizumab group, 4.0 minutes for the estriol group, 6.2 minutes for the tranexamic acid group, and 5.0 minutes for the placebo group. (Bleeding duration was not recorded at baseline.)

After 12 weeks of treatment, there were no significant differences between the treatment groups when it came to hemoglobin levels (P=0.43), ferritin levels (P=0.10), treatment failure (P=0.08), the need for transfusion (P=0.42), or emergency department visits (P=0.72).

Patients in all 4 treatment groups experienced a significant decline in ESS from baseline to week 12 (P<0.001 for time effect).

The median ESS decreased from 5.71 to 3.74 in the placebo group, 5.16 to 3.54 in the bevacizumab group, 5.19 to 3.56 in the estriol group, and 5.43 to 4.06 in the tranexamic acid group. The investigators said the improvement in ESS was clinically significant.

However, the team also said they cannot completely rule out the possibility that symptoms may have improved because of a placebo effect.

What’s more, it could be that some of the drugs tested would work better if taken at a higher dose, or if applied as a gel or polymer that adheres better to the inside of the nasal cavity.

Nevertheless, the results from this trial were enough to convince Dr Whitehead and his colleagues to routinely recommend saline nasal spray to their patients with HHT.

“We stress the importance of hydration,” Dr Whitehead said. “We tell them that something as simple as a morning and night saline spray could offer them some benefit.”

DNA helix

Image by Spencer Phillips

The US Food and Drug Administration (FDA) has granted orphan drug designation to SB-FIX, a zinc finger nuclease (ZFN)-mediated genome-editing product candidate for the treatment of hemophilia B.

SB-FIX is designed to be used as a one-time treatment that will provide stable, continuous production of factor IX (FIX) for the lifetime of the patient.

The ZFN-mediated in vivo genome-editing approach makes use of the albumin gene locus, a highly expressing and liver-specific genomic “safe-harbor site,” that can be edited with ZFNs to accept and express therapeutic genes.

The approach is designed is to enable the patient’s liver to permanently produce circulating therapeutic levels of a corrective protein product.

This differs from conventional adeno-associated virus complementary DNA gene therapy approaches, which are non-integrating and may “wash out” of the liver as cells divide and turn over.

Sangamo BioSciences, Inc., the company developing SB-FIX, expects to initiate a phase 1/2 trial of SB-FIX in adults with hemophilia B this year.

“We will enroll adult hemophilia patients into our first clinical trial. However, our goal is to move into pediatric patients, a population we believe could particularly benefit from a treatment that has the potential to provide life-long expression of therapeutic levels of factor IX protein,” said Geoff Nichol, MBChB, Sangamo’s executive vice president of research and development.

About orphan designation

The FDA grants orphan designation to drugs and biologics intended to treat, diagnose, or prevent diseases/disorders that affect fewer than 200,000 people in the US.

The designation provides incentives for sponsors to develop products for rare diseases. This may include tax credits toward the cost of clinical trials, prescription drug user fee waivers, and 7 years of market exclusivity if the product is approved.

DNA helix

Image by Spencer Phillips

The US Food and Drug Administration (FDA) has granted orphan drug designation to SB-FIX, a zinc finger nuclease (ZFN)-mediated genome-editing product candidate for the treatment of hemophilia B.

SB-FIX is designed to be used as a one-time treatment that will provide stable, continuous production of factor IX (FIX) for the lifetime of the patient.

The ZFN-mediated in vivo genome-editing approach makes use of the albumin gene locus, a highly expressing and liver-specific genomic “safe-harbor site,” that can be edited with ZFNs to accept and express therapeutic genes.

The approach is designed is to enable the patient’s liver to permanently produce circulating therapeutic levels of a corrective protein product.

This differs from conventional adeno-associated virus complementary DNA gene therapy approaches, which are non-integrating and may “wash out” of the liver as cells divide and turn over.

Sangamo BioSciences, Inc., the company developing SB-FIX, expects to initiate a phase 1/2 trial of SB-FIX in adults with hemophilia B this year.

“We will enroll adult hemophilia patients into our first clinical trial. However, our goal is to move into pediatric patients, a population we believe could particularly benefit from a treatment that has the potential to provide life-long expression of therapeutic levels of factor IX protein,” said Geoff Nichol, MBChB, Sangamo’s executive vice president of research and development.

About orphan designation

The FDA grants orphan designation to drugs and biologics intended to treat, diagnose, or prevent diseases/disorders that affect fewer than 200,000 people in the US.

The designation provides incentives for sponsors to develop products for rare diseases. This may include tax credits toward the cost of clinical trials, prescription drug user fee waivers, and 7 years of market exclusivity if the product is approved.

DNA helix

Image by Spencer Phillips

The US Food and Drug Administration (FDA) has granted orphan drug designation to SB-FIX, a zinc finger nuclease (ZFN)-mediated genome-editing product candidate for the treatment of hemophilia B.

SB-FIX is designed to be used as a one-time treatment that will provide stable, continuous production of factor IX (FIX) for the lifetime of the patient.

The ZFN-mediated in vivo genome-editing approach makes use of the albumin gene locus, a highly expressing and liver-specific genomic “safe-harbor site,” that can be edited with ZFNs to accept and express therapeutic genes.

The approach is designed is to enable the patient’s liver to permanently produce circulating therapeutic levels of a corrective protein product.

This differs from conventional adeno-associated virus complementary DNA gene therapy approaches, which are non-integrating and may “wash out” of the liver as cells divide and turn over.

Sangamo BioSciences, Inc., the company developing SB-FIX, expects to initiate a phase 1/2 trial of SB-FIX in adults with hemophilia B this year.

“We will enroll adult hemophilia patients into our first clinical trial. However, our goal is to move into pediatric patients, a population we believe could particularly benefit from a treatment that has the potential to provide life-long expression of therapeutic levels of factor IX protein,” said Geoff Nichol, MBChB, Sangamo’s executive vice president of research and development.

About orphan designation

The FDA grants orphan designation to drugs and biologics intended to treat, diagnose, or prevent diseases/disorders that affect fewer than 200,000 people in the US.

The designation provides incentives for sponsors to develop products for rare diseases. This may include tax credits toward the cost of clinical trials, prescription drug user fee waivers, and 7 years of market exclusivity if the product is approved.

Delaying single-sport specialization until late adolescence not only minimizes the risks of overuse injuries and burnout, but it increases the likelihood of athletic success, according to a new clinical report from the American Academy of Pediatrics.

The new report gives pediatricians a current knowledge base to draw upon in well checks and sports injury visits, author Joel S. Brenner, MD, MPH, of the AAP’s Council on Sports Medicine and Fitness, said in an interview.

©Ablestock.com/Thinkstock

Specializing in a single sport at younger ages – and playing intensively year-round – has become increasingly common, and is often driven by aspirations for college scholarships or elite athletic status. Yet evidence suggests that early specialization may actually work against such goals.

Studies of top college athletes and reviews of other elite athletes and their specialization history show that “for the majority of sports, late specialization with early diversification [playing multiple sports early] is most likely to lead to elite status,” the report states (Pediatrics. 2016;138[3]:e20162148).

Youth who participate in a variety of sports until late adolescence (about 15-16 years of age) also have fewer injuries and a higher chance of remaining engaged in sports for the long term than do children who specialize early, according to the guideline. “Unfortunately, 70% of children drop out of organized sports by 13 years of age.”

If a young athlete has decided to specialize in a single sport, you should discuss his or her goals to determine if they are appropriate and realistic. A mere 1% of high school athletes receive athletic scholarships and only 3%-11% go on to compete at college level; of high school athletes, only 0.03%-0.5% proceed to the professional sports level, the report notes.

Having at least 1-2 days off per week from the focal sport can decrease the chance of injury, and taking 1 month off at least 3 times a year “will allow for athletes’ physical and psychological recovery.”

An estimated 50% of athletic injuries are related to overuse. The physiologic and psychological effects of intensive training in young athletes are detailed in other articles by the AAP (Pediatrics. 2007;119[6]:1242-5) and the American Medical Society for Sports Medicine (Clin J Sport Med. 2014;24[1]:3-20).

According to a 2008 report from the National Council of Youth Sports, 27% of the youth active in adult-led organized sports participated in only 1 sport. “There is increased pressure to participate at a high level, to specialize in one sport early, and to play year-round, often on multiple teams,” the guideline notes.

This clinical report replaces the academy’s 2000 policy statement on sports specialization and intensive training and provides “concrete guidance” for pediatricians, said Dr. Brenner, who is medical director of Children’s Hospital of the King’s Daughters’ sports medicine and adolescent medicine programs and the director of CHKD’s sports concussion program, in Norfolk, Va.

There was no external funding for this report and the authors had no relevant financial disclosures.

Delaying single-sport specialization until late adolescence not only minimizes the risks of overuse injuries and burnout, but it increases the likelihood of athletic success, according to a new clinical report from the American Academy of Pediatrics.

The new report gives pediatricians a current knowledge base to draw upon in well checks and sports injury visits, author Joel S. Brenner, MD, MPH, of the AAP’s Council on Sports Medicine and Fitness, said in an interview.

©Ablestock.com/Thinkstock

Specializing in a single sport at younger ages – and playing intensively year-round – has become increasingly common, and is often driven by aspirations for college scholarships or elite athletic status. Yet evidence suggests that early specialization may actually work against such goals.

Studies of top college athletes and reviews of other elite athletes and their specialization history show that “for the majority of sports, late specialization with early diversification [playing multiple sports early] is most likely to lead to elite status,” the report states (Pediatrics. 2016;138[3]:e20162148).

Youth who participate in a variety of sports until late adolescence (about 15-16 years of age) also have fewer injuries and a higher chance of remaining engaged in sports for the long term than do children who specialize early, according to the guideline. “Unfortunately, 70% of children drop out of organized sports by 13 years of age.”

If a young athlete has decided to specialize in a single sport, you should discuss his or her goals to determine if they are appropriate and realistic. A mere 1% of high school athletes receive athletic scholarships and only 3%-11% go on to compete at college level; of high school athletes, only 0.03%-0.5% proceed to the professional sports level, the report notes.

Having at least 1-2 days off per week from the focal sport can decrease the chance of injury, and taking 1 month off at least 3 times a year “will allow for athletes’ physical and psychological recovery.”

An estimated 50% of athletic injuries are related to overuse. The physiologic and psychological effects of intensive training in young athletes are detailed in other articles by the AAP (Pediatrics. 2007;119[6]:1242-5) and the American Medical Society for Sports Medicine (Clin J Sport Med. 2014;24[1]:3-20).

According to a 2008 report from the National Council of Youth Sports, 27% of the youth active in adult-led organized sports participated in only 1 sport. “There is increased pressure to participate at a high level, to specialize in one sport early, and to play year-round, often on multiple teams,” the guideline notes.

This clinical report replaces the academy’s 2000 policy statement on sports specialization and intensive training and provides “concrete guidance” for pediatricians, said Dr. Brenner, who is medical director of Children’s Hospital of the King’s Daughters’ sports medicine and adolescent medicine programs and the director of CHKD’s sports concussion program, in Norfolk, Va.

There was no external funding for this report and the authors had no relevant financial disclosures.

Delaying single-sport specialization until late adolescence not only minimizes the risks of overuse injuries and burnout, but it increases the likelihood of athletic success, according to a new clinical report from the American Academy of Pediatrics.

The new report gives pediatricians a current knowledge base to draw upon in well checks and sports injury visits, author Joel S. Brenner, MD, MPH, of the AAP’s Council on Sports Medicine and Fitness, said in an interview.

©Ablestock.com/Thinkstock

Specializing in a single sport at younger ages – and playing intensively year-round – has become increasingly common, and is often driven by aspirations for college scholarships or elite athletic status. Yet evidence suggests that early specialization may actually work against such goals.

Studies of top college athletes and reviews of other elite athletes and their specialization history show that “for the majority of sports, late specialization with early diversification [playing multiple sports early] is most likely to lead to elite status,” the report states (Pediatrics. 2016;138[3]:e20162148).

Youth who participate in a variety of sports until late adolescence (about 15-16 years of age) also have fewer injuries and a higher chance of remaining engaged in sports for the long term than do children who specialize early, according to the guideline. “Unfortunately, 70% of children drop out of organized sports by 13 years of age.”

If a young athlete has decided to specialize in a single sport, you should discuss his or her goals to determine if they are appropriate and realistic. A mere 1% of high school athletes receive athletic scholarships and only 3%-11% go on to compete at college level; of high school athletes, only 0.03%-0.5% proceed to the professional sports level, the report notes.

Having at least 1-2 days off per week from the focal sport can decrease the chance of injury, and taking 1 month off at least 3 times a year “will allow for athletes’ physical and psychological recovery.”

An estimated 50% of athletic injuries are related to overuse. The physiologic and psychological effects of intensive training in young athletes are detailed in other articles by the AAP (Pediatrics. 2007;119[6]:1242-5) and the American Medical Society for Sports Medicine (Clin J Sport Med. 2014;24[1]:3-20).

According to a 2008 report from the National Council of Youth Sports, 27% of the youth active in adult-led organized sports participated in only 1 sport. “There is increased pressure to participate at a high level, to specialize in one sport early, and to play year-round, often on multiple teams,” the guideline notes.

This clinical report replaces the academy’s 2000 policy statement on sports specialization and intensive training and provides “concrete guidance” for pediatricians, said Dr. Brenner, who is medical director of Children’s Hospital of the King’s Daughters’ sports medicine and adolescent medicine programs and the director of CHKD’s sports concussion program, in Norfolk, Va.

There was no external funding for this report and the authors had no relevant financial disclosures.