Many patients are sleep deprived but are either unaware of, or unwilling to acknowledge, their problem. Sleep deprivation occurs because of inadequate sleep duration (often caused by insomnia or simply not allowing enough time for sleep), or poor sleep quality (often caused by sleep-disordered breathing). These conditions can be diagnosed by obtaining a thorough sleep history that consists of 5 groups of questions. The specific questions that should be asked in order to make a more accurate diagnosis are included in this article from Current Psychiatry, available at http://www.currentpsychiatry.com/the-publication/issue-single-view/disordered-sleep-ask-the-right-questions-to-reveal-this-hidden-confounder/913369ef53768717303c9cd35a58e790.html.

Many patients are sleep deprived but are either unaware of, or unwilling to acknowledge, their problem. Sleep deprivation occurs because of inadequate sleep duration (often caused by insomnia or simply not allowing enough time for sleep), or poor sleep quality (often caused by sleep-disordered breathing). These conditions can be diagnosed by obtaining a thorough sleep history that consists of 5 groups of questions. The specific questions that should be asked in order to make a more accurate diagnosis are included in this article from Current Psychiatry, available at http://www.currentpsychiatry.com/the-publication/issue-single-view/disordered-sleep-ask-the-right-questions-to-reveal-this-hidden-confounder/913369ef53768717303c9cd35a58e790.html.

Many patients are sleep deprived but are either unaware of, or unwilling to acknowledge, their problem. Sleep deprivation occurs because of inadequate sleep duration (often caused by insomnia or simply not allowing enough time for sleep), or poor sleep quality (often caused by sleep-disordered breathing). These conditions can be diagnosed by obtaining a thorough sleep history that consists of 5 groups of questions. The specific questions that should be asked in order to make a more accurate diagnosis are included in this article from Current Psychiatry, available at http://www.currentpsychiatry.com/the-publication/issue-single-view/disordered-sleep-ask-the-right-questions-to-reveal-this-hidden-confounder/913369ef53768717303c9cd35a58e790.html.

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population. Estimates suggest that as many as 40% of the 14 million US adults living with cancer have chronic pain related to their malignancy. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, RN, PhD, in a press statement accompanying the release of the new guideline. To learn more about the key recommendations from the guideline, see this article from Family Practice News: http://www.familypracticenews.com/specialty-focus/pain/single-article-page/asco-always-screen-cancer-survivors-for-chronic-pain/5c182fdaacc6b573f00f001f3928749b.html.

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population. Estimates suggest that as many as 40% of the 14 million US adults living with cancer have chronic pain related to their malignancy. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, RN, PhD, in a press statement accompanying the release of the new guideline. To learn more about the key recommendations from the guideline, see this article from Family Practice News: http://www.familypracticenews.com/specialty-focus/pain/single-article-page/asco-always-screen-cancer-survivors-for-chronic-pain/5c182fdaacc6b573f00f001f3928749b.html.

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population. Estimates suggest that as many as 40% of the 14 million US adults living with cancer have chronic pain related to their malignancy. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, RN, PhD, in a press statement accompanying the release of the new guideline. To learn more about the key recommendations from the guideline, see this article from Family Practice News: http://www.familypracticenews.com/specialty-focus/pain/single-article-page/asco-always-screen-cancer-survivors-for-chronic-pain/5c182fdaacc6b573f00f001f3928749b.html.

A 54-year-old man with a history of cirrhosis secondary to hepatitis C virus (HCV) infection has had a progressive decline in kidney function. He was diagnosed with HCV 15 years ago; he tried interferon treatment, but this failed. He received a transjugular intrahepatic shunt 10 years ago after an episode of esophageal variceal bleeding. He has since been taking furosemide and spironolactone as maintenance treatment for ascites, and he has no other medical concerns, such as hypertension or diabetes. What is the cause of the patient’s renal failure? The answer can be found in this article from Cleveland Clinic Journal of Medicine: http://www.ccjm.org/current-issue/issue-single-view/renal-failure-in-hcv-cirrhosis/6336c91b99df7f186817921a5d5c08ab.html.

A 54-year-old man with a history of cirrhosis secondary to hepatitis C virus (HCV) infection has had a progressive decline in kidney function. He was diagnosed with HCV 15 years ago; he tried interferon treatment, but this failed. He received a transjugular intrahepatic shunt 10 years ago after an episode of esophageal variceal bleeding. He has since been taking furosemide and spironolactone as maintenance treatment for ascites, and he has no other medical concerns, such as hypertension or diabetes. What is the cause of the patient’s renal failure? The answer can be found in this article from Cleveland Clinic Journal of Medicine: http://www.ccjm.org/current-issue/issue-single-view/renal-failure-in-hcv-cirrhosis/6336c91b99df7f186817921a5d5c08ab.html.

A 54-year-old man with a history of cirrhosis secondary to hepatitis C virus (HCV) infection has had a progressive decline in kidney function. He was diagnosed with HCV 15 years ago; he tried interferon treatment, but this failed. He received a transjugular intrahepatic shunt 10 years ago after an episode of esophageal variceal bleeding. He has since been taking furosemide and spironolactone as maintenance treatment for ascites, and he has no other medical concerns, such as hypertension or diabetes. What is the cause of the patient’s renal failure? The answer can be found in this article from Cleveland Clinic Journal of Medicine: http://www.ccjm.org/current-issue/issue-single-view/renal-failure-in-hcv-cirrhosis/6336c91b99df7f186817921a5d5c08ab.html.

Implantable cardioverter-defibrillators (ICDs) significantly cut the rate of sudden cardiac death in patients with non-ischemic systolic heart failure, and reduced all-cause mortality in patients younger than 68 years. Results from the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) also highlighted the importance of targeting implantable ICD treatment to the patients with non-ischemic systolic heart failure who are most likely to benefit from it. The DANISH results “tell us ICDs can benefit patients if we can be a little better in selecting the right patients,” said Lars Køber, MD, professor of cardiology at the University of Copenhagen. Read more on which patients would benefit most from ICDs in this article from Cardiology News, available at: http://www.ecardiologynews.com/specialty-focus/heart-failure/single-article-page/video-icds-cut-mortality-in-younger-healthier-heart-failure-patients/8b26c497ed439d4bac87c4086f0f74f1.html#mytake

Implantable cardioverter-defibrillators (ICDs) significantly cut the rate of sudden cardiac death in patients with non-ischemic systolic heart failure, and reduced all-cause mortality in patients younger than 68 years. Results from the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) also highlighted the importance of targeting implantable ICD treatment to the patients with non-ischemic systolic heart failure who are most likely to benefit from it. The DANISH results “tell us ICDs can benefit patients if we can be a little better in selecting the right patients,” said Lars Køber, MD, professor of cardiology at the University of Copenhagen. Read more on which patients would benefit most from ICDs in this article from Cardiology News, available at: http://www.ecardiologynews.com/specialty-focus/heart-failure/single-article-page/video-icds-cut-mortality-in-younger-healthier-heart-failure-patients/8b26c497ed439d4bac87c4086f0f74f1.html#mytake

Implantable cardioverter-defibrillators (ICDs) significantly cut the rate of sudden cardiac death in patients with non-ischemic systolic heart failure, and reduced all-cause mortality in patients younger than 68 years. Results from the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) also highlighted the importance of targeting implantable ICD treatment to the patients with non-ischemic systolic heart failure who are most likely to benefit from it. The DANISH results “tell us ICDs can benefit patients if we can be a little better in selecting the right patients,” said Lars Køber, MD, professor of cardiology at the University of Copenhagen. Read more on which patients would benefit most from ICDs in this article from Cardiology News, available at: http://www.ecardiologynews.com/specialty-focus/heart-failure/single-article-page/video-icds-cut-mortality-in-younger-healthier-heart-failure-patients/8b26c497ed439d4bac87c4086f0f74f1.html#mytake

Higher levels of LDL cholesterol, HDL cholesterol, and triglycerides over a lifetime are protective against type 2 diabetes, a Mendelian randomization study has shown. Jon White, PhD, of University College London and his co-investigators sought to shed light on the role of the most commonly measured lipid fractions—LDL cholesterol, HDL cholesterol, and triglycerides—in the development of coronary artery disease and diabetes, particularly the observed link between statin therapy and an increased risk of diabetes. More on the study, and how the results can help to identify the potential effects of lipid-modifying drugs, is available at Family Practice News: http://www.familypracticenews.com/specialty-focus/cardiology/single-article-page/rises-in-ldl-and-hdl-cholesterol-triglycerides-tied-to-lower-diabetes-risk/1c99fd4b400f60185df3f4de7d895f5f.html.

Higher levels of LDL cholesterol, HDL cholesterol, and triglycerides over a lifetime are protective against type 2 diabetes, a Mendelian randomization study has shown. Jon White, PhD, of University College London and his co-investigators sought to shed light on the role of the most commonly measured lipid fractions—LDL cholesterol, HDL cholesterol, and triglycerides—in the development of coronary artery disease and diabetes, particularly the observed link between statin therapy and an increased risk of diabetes. More on the study, and how the results can help to identify the potential effects of lipid-modifying drugs, is available at Family Practice News: http://www.familypracticenews.com/specialty-focus/cardiology/single-article-page/rises-in-ldl-and-hdl-cholesterol-triglycerides-tied-to-lower-diabetes-risk/1c99fd4b400f60185df3f4de7d895f5f.html.

Higher levels of LDL cholesterol, HDL cholesterol, and triglycerides over a lifetime are protective against type 2 diabetes, a Mendelian randomization study has shown. Jon White, PhD, of University College London and his co-investigators sought to shed light on the role of the most commonly measured lipid fractions—LDL cholesterol, HDL cholesterol, and triglycerides—in the development of coronary artery disease and diabetes, particularly the observed link between statin therapy and an increased risk of diabetes. More on the study, and how the results can help to identify the potential effects of lipid-modifying drugs, is available at Family Practice News: http://www.familypracticenews.com/specialty-focus/cardiology/single-article-page/rises-in-ldl-and-hdl-cholesterol-triglycerides-tied-to-lower-diabetes-risk/1c99fd4b400f60185df3f4de7d895f5f.html.

Studies suggest that patients with chronic obstructive pulmonary disease (COPD) have a poorer quality of life, as well as more anxiety and depression, than patients who are terminally ill with lung cancer. And a retrospective review of patient records from 2010 to 2013 showed that providers referred only 5% of patients with COPD for palliative care, even though COPD is one of the most common causes of hospital admissions and treatments are often aimed at palliation of symptoms. It was findings like these that prompted researchers to conduct a quality improvement (QI) initiative to explore the benefits of integrating palliative care in the care of patients with COPD. Read about the outcome of their QI initiative in Federal Practitioner at: http://www.fedprac.com/the-publication/issue-single-view/integrating-palliative-care-in-copd-treatment/e4e785616a398de4c5f4d3ddad5b4330/ocregister.html.

Studies suggest that patients with chronic obstructive pulmonary disease (COPD) have a poorer quality of life, as well as more anxiety and depression, than patients who are terminally ill with lung cancer. And a retrospective review of patient records from 2010 to 2013 showed that providers referred only 5% of patients with COPD for palliative care, even though COPD is one of the most common causes of hospital admissions and treatments are often aimed at palliation of symptoms. It was findings like these that prompted researchers to conduct a quality improvement (QI) initiative to explore the benefits of integrating palliative care in the care of patients with COPD. Read about the outcome of their QI initiative in Federal Practitioner at: http://www.fedprac.com/the-publication/issue-single-view/integrating-palliative-care-in-copd-treatment/e4e785616a398de4c5f4d3ddad5b4330/ocregister.html.

Studies suggest that patients with chronic obstructive pulmonary disease (COPD) have a poorer quality of life, as well as more anxiety and depression, than patients who are terminally ill with lung cancer. And a retrospective review of patient records from 2010 to 2013 showed that providers referred only 5% of patients with COPD for palliative care, even though COPD is one of the most common causes of hospital admissions and treatments are often aimed at palliation of symptoms. It was findings like these that prompted researchers to conduct a quality improvement (QI) initiative to explore the benefits of integrating palliative care in the care of patients with COPD. Read about the outcome of their QI initiative in Federal Practitioner at: http://www.fedprac.com/the-publication/issue-single-view/integrating-palliative-care-in-copd-treatment/e4e785616a398de4c5f4d3ddad5b4330/ocregister.html.

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.”

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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.