FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE

Siblings of children with food allergy should not be screened routinely for such allergies before food introduction, results of a large cohort study suggest.

In a study of 478 food-allergic children and 642 of their siblings, 53% of the siblings were sensitized without clinical reactivity and only 13.6% were found to have a clinically reactive food allergy, wrote Ruchi S. Gupta, MD, of Northwestern University, Chicago, and her associates.

The investigators noted that their findings support current guidelines from the National Institute of Allergy and Infectious Diseases to not screen siblings based on another sibling having a food allergy.

“Given the lack of a dramatically increased risk of food allergy in siblings, compared with that of the general population, as well as the high rate of what are falsely positive diagnostic test results among siblings of a food allergic child, [these siblings] should not have routine screening for food allergy before food introduction,” the investigators concluded. “Such siblings are likely to be mislabeled as allergic when they are actually tolerant to the food, which may lead to an increased risk of developing allergy via avoidance,” and both quality of life and nutrition may be adversely impacted.

Dr. Gupta has received research support from Mylan, Food Allergy Research and Education, and United Health Care.

Read the full study here (http://dx.doi.org/10.1016/j.jaip.2016.04.009)

[email protected]

FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE

Siblings of children with food allergy should not be screened routinely for such allergies before food introduction, results of a large cohort study suggest.

In a study of 478 food-allergic children and 642 of their siblings, 53% of the siblings were sensitized without clinical reactivity and only 13.6% were found to have a clinically reactive food allergy, wrote Ruchi S. Gupta, MD, of Northwestern University, Chicago, and her associates.

The investigators noted that their findings support current guidelines from the National Institute of Allergy and Infectious Diseases to not screen siblings based on another sibling having a food allergy.

“Given the lack of a dramatically increased risk of food allergy in siblings, compared with that of the general population, as well as the high rate of what are falsely positive diagnostic test results among siblings of a food allergic child, [these siblings] should not have routine screening for food allergy before food introduction,” the investigators concluded. “Such siblings are likely to be mislabeled as allergic when they are actually tolerant to the food, which may lead to an increased risk of developing allergy via avoidance,” and both quality of life and nutrition may be adversely impacted.

Dr. Gupta has received research support from Mylan, Food Allergy Research and Education, and United Health Care.

Read the full study here (http://dx.doi.org/10.1016/j.jaip.2016.04.009)

[email protected]

FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE

Siblings of children with food allergy should not be screened routinely for such allergies before food introduction, results of a large cohort study suggest.

In a study of 478 food-allergic children and 642 of their siblings, 53% of the siblings were sensitized without clinical reactivity and only 13.6% were found to have a clinically reactive food allergy, wrote Ruchi S. Gupta, MD, of Northwestern University, Chicago, and her associates.

The investigators noted that their findings support current guidelines from the National Institute of Allergy and Infectious Diseases to not screen siblings based on another sibling having a food allergy.

“Given the lack of a dramatically increased risk of food allergy in siblings, compared with that of the general population, as well as the high rate of what are falsely positive diagnostic test results among siblings of a food allergic child, [these siblings] should not have routine screening for food allergy before food introduction,” the investigators concluded. “Such siblings are likely to be mislabeled as allergic when they are actually tolerant to the food, which may lead to an increased risk of developing allergy via avoidance,” and both quality of life and nutrition may be adversely impacted.

Dr. Gupta has received research support from Mylan, Food Allergy Research and Education, and United Health Care.

Read the full study here (http://dx.doi.org/10.1016/j.jaip.2016.04.009)

[email protected]

Angina is underrecognized by cardiologists in clinic visits, compared with assessments made by the patients themselves, suggesting that a standard screening tool be used to improve accuracy.

Researchers conducted a survey of 1,257 patients and their 155 doctors at 25 cardiology outpatient practices in 19 states. All patients had documented coronary artery disease and completed the Seattle Angina Questionnaire (SAQ) before their office visits to assess angina symptoms and frequency. Right after they left, their cardiologists estimated and recorded their idea of how often their patients had heart pain and what their symptoms were.

Patient and physician estimates didn’t match: 411 patients (33%) reported at least one bout of angina in the previous month, but their physicians estimated a frequency of 14% (173 patients). Heart failure patients were more than three times as likely to have their angina underestimated, and patients who reported a single bout of angina per month were about 70% less likely than those who reported daily or weekly attacks.

Years in practice and the number of angina patients in the case load didn’t seem to make a difference. Patient demographics, atypical symptoms, and comorbidities besides heart failure didn’t either. “Some physicians were much better at recognizing the frequency of patients’ angina,” said lead investigator Suzanne Arnold, MD, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and her associates.

“Evaluation of angina is subject to limitations inherent in history taking, including pre-existing biases and time constraints on the part of physicians and patients. ... Under-recognition of angina by physicians may result in under treatment with revascularization or medications that could improve patients’ quality of life,” and it wastes healthcare dollars, they said.

The team concluded that angina needs to be assessed directly from patients with a standardized survey like the Seattle Angina Questionnaire (SAQ). “We still routinely depend solely on an unstructured interview instead of directly asking patients using standardized assessments,” the investigators noted. “A more systematic approach is needed for eliciting a history and assessing angina in patients with coronary artery disease to appropriately guide further testing and treatment. ... The use of a validated, patient-centered tool for eliciting patients’ angina, such as the SAQ, should be tested in routine clinical care to see if it improves angina recognition, treatment, and outcomes,” the study team said (Circ Cardiovasc Qual Outcomes. 2016 AUG 16;doi: 10.1161/CIRCOUTCOMES.116.002781).

Patients in the study were, on average, 69 years old, and the majority were white men. About 40% reported previous myocardial infarctions, and more than half were stented. Well over three quarters were on beta-blockers for angina.

The senior investigator, John Spertus, MD, holds a copyright on the SAQ used in the study. Gilead Sciences funded the work. Investigators reported ties to Gilead, Abbvie, Genentech, Glumetrics, Maquet, Sanofi, AstraZeneca, Edwards Life Sciences, Roche, St. Jude Medical, Regeneron, Lilly, and ZS Pharma.

[email protected]

Angina is underrecognized by cardiologists in clinic visits, compared with assessments made by the patients themselves, suggesting that a standard screening tool be used to improve accuracy.

Researchers conducted a survey of 1,257 patients and their 155 doctors at 25 cardiology outpatient practices in 19 states. All patients had documented coronary artery disease and completed the Seattle Angina Questionnaire (SAQ) before their office visits to assess angina symptoms and frequency. Right after they left, their cardiologists estimated and recorded their idea of how often their patients had heart pain and what their symptoms were.

Patient and physician estimates didn’t match: 411 patients (33%) reported at least one bout of angina in the previous month, but their physicians estimated a frequency of 14% (173 patients). Heart failure patients were more than three times as likely to have their angina underestimated, and patients who reported a single bout of angina per month were about 70% less likely than those who reported daily or weekly attacks.

Years in practice and the number of angina patients in the case load didn’t seem to make a difference. Patient demographics, atypical symptoms, and comorbidities besides heart failure didn’t either. “Some physicians were much better at recognizing the frequency of patients’ angina,” said lead investigator Suzanne Arnold, MD, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and her associates.

“Evaluation of angina is subject to limitations inherent in history taking, including pre-existing biases and time constraints on the part of physicians and patients. ... Under-recognition of angina by physicians may result in under treatment with revascularization or medications that could improve patients’ quality of life,” and it wastes healthcare dollars, they said.

The team concluded that angina needs to be assessed directly from patients with a standardized survey like the Seattle Angina Questionnaire (SAQ). “We still routinely depend solely on an unstructured interview instead of directly asking patients using standardized assessments,” the investigators noted. “A more systematic approach is needed for eliciting a history and assessing angina in patients with coronary artery disease to appropriately guide further testing and treatment. ... The use of a validated, patient-centered tool for eliciting patients’ angina, such as the SAQ, should be tested in routine clinical care to see if it improves angina recognition, treatment, and outcomes,” the study team said (Circ Cardiovasc Qual Outcomes. 2016 AUG 16;doi: 10.1161/CIRCOUTCOMES.116.002781).

Patients in the study were, on average, 69 years old, and the majority were white men. About 40% reported previous myocardial infarctions, and more than half were stented. Well over three quarters were on beta-blockers for angina.

The senior investigator, John Spertus, MD, holds a copyright on the SAQ used in the study. Gilead Sciences funded the work. Investigators reported ties to Gilead, Abbvie, Genentech, Glumetrics, Maquet, Sanofi, AstraZeneca, Edwards Life Sciences, Roche, St. Jude Medical, Regeneron, Lilly, and ZS Pharma.

[email protected]

Angina is underrecognized by cardiologists in clinic visits, compared with assessments made by the patients themselves, suggesting that a standard screening tool be used to improve accuracy.

Researchers conducted a survey of 1,257 patients and their 155 doctors at 25 cardiology outpatient practices in 19 states. All patients had documented coronary artery disease and completed the Seattle Angina Questionnaire (SAQ) before their office visits to assess angina symptoms and frequency. Right after they left, their cardiologists estimated and recorded their idea of how often their patients had heart pain and what their symptoms were.

Patient and physician estimates didn’t match: 411 patients (33%) reported at least one bout of angina in the previous month, but their physicians estimated a frequency of 14% (173 patients). Heart failure patients were more than three times as likely to have their angina underestimated, and patients who reported a single bout of angina per month were about 70% less likely than those who reported daily or weekly attacks.

Years in practice and the number of angina patients in the case load didn’t seem to make a difference. Patient demographics, atypical symptoms, and comorbidities besides heart failure didn’t either. “Some physicians were much better at recognizing the frequency of patients’ angina,” said lead investigator Suzanne Arnold, MD, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and her associates.

“Evaluation of angina is subject to limitations inherent in history taking, including pre-existing biases and time constraints on the part of physicians and patients. ... Under-recognition of angina by physicians may result in under treatment with revascularization or medications that could improve patients’ quality of life,” and it wastes healthcare dollars, they said.

The team concluded that angina needs to be assessed directly from patients with a standardized survey like the Seattle Angina Questionnaire (SAQ). “We still routinely depend solely on an unstructured interview instead of directly asking patients using standardized assessments,” the investigators noted. “A more systematic approach is needed for eliciting a history and assessing angina in patients with coronary artery disease to appropriately guide further testing and treatment. ... The use of a validated, patient-centered tool for eliciting patients’ angina, such as the SAQ, should be tested in routine clinical care to see if it improves angina recognition, treatment, and outcomes,” the study team said (Circ Cardiovasc Qual Outcomes. 2016 AUG 16;doi: 10.1161/CIRCOUTCOMES.116.002781).

Patients in the study were, on average, 69 years old, and the majority were white men. About 40% reported previous myocardial infarctions, and more than half were stented. Well over three quarters were on beta-blockers for angina.

The senior investigator, John Spertus, MD, holds a copyright on the SAQ used in the study. Gilead Sciences funded the work. Investigators reported ties to Gilead, Abbvie, Genentech, Glumetrics, Maquet, Sanofi, AstraZeneca, Edwards Life Sciences, Roche, St. Jude Medical, Regeneron, Lilly, and ZS Pharma.

[email protected]

Perhaps it’s the northern climate. Perhaps it’s that people at my office work a lot in the absence of office windows. But there are a lot of seasonal affective disorder lamps around me.

The one in my office turns on automatically (frequently in my absence), and the eerie blue light from my office floods the cubicles outside my door.

At a social gathering the other day, I related the story of my “moody blues office,” and somebody asked if the blue light for seasonal affective disorder was better than the white light. I did not know, so I did some reading.

It turns out that there is a retinal photoreceptor in the ganglion cells with a maximum sensitivity of 470-490 nm to blue light. These non-image–forming photoreceptors play a role in regulating the biological clock. Experiments have been conducted evaluating the impact of different wavelengths of light on symptoms of SAD.

In a study of people with subsyndromal SAD, investigators randomized 48 participants to bright white fluorescent light or narrow-band blue light (peak LED wavelength, 470 nm). Patients were exposed to the light for 20 minutes on 5 consecutive days. Standard scales measuring mood and fatigue were administered (BMC Psychiatry. 2016 Feb 18;16:27).

Investigators did not detect differences between the groups, and the authors concluded they had comparable efficacy.

Although the sample size is small, the data suggest that blue light is comparable to white light. I will start needing to pay attention if the folks in the cubicles outside my office are less depressed.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. Dr. Ebbert has no relevant financial disclosures about this article.

Perhaps it’s the northern climate. Perhaps it’s that people at my office work a lot in the absence of office windows. But there are a lot of seasonal affective disorder lamps around me.

The one in my office turns on automatically (frequently in my absence), and the eerie blue light from my office floods the cubicles outside my door.

At a social gathering the other day, I related the story of my “moody blues office,” and somebody asked if the blue light for seasonal affective disorder was better than the white light. I did not know, so I did some reading.

It turns out that there is a retinal photoreceptor in the ganglion cells with a maximum sensitivity of 470-490 nm to blue light. These non-image–forming photoreceptors play a role in regulating the biological clock. Experiments have been conducted evaluating the impact of different wavelengths of light on symptoms of SAD.

In a study of people with subsyndromal SAD, investigators randomized 48 participants to bright white fluorescent light or narrow-band blue light (peak LED wavelength, 470 nm). Patients were exposed to the light for 20 minutes on 5 consecutive days. Standard scales measuring mood and fatigue were administered (BMC Psychiatry. 2016 Feb 18;16:27).

Investigators did not detect differences between the groups, and the authors concluded they had comparable efficacy.

Although the sample size is small, the data suggest that blue light is comparable to white light. I will start needing to pay attention if the folks in the cubicles outside my office are less depressed.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. Dr. Ebbert has no relevant financial disclosures about this article.

Perhaps it’s the northern climate. Perhaps it’s that people at my office work a lot in the absence of office windows. But there are a lot of seasonal affective disorder lamps around me.

The one in my office turns on automatically (frequently in my absence), and the eerie blue light from my office floods the cubicles outside my door.

At a social gathering the other day, I related the story of my “moody blues office,” and somebody asked if the blue light for seasonal affective disorder was better than the white light. I did not know, so I did some reading.

It turns out that there is a retinal photoreceptor in the ganglion cells with a maximum sensitivity of 470-490 nm to blue light. These non-image–forming photoreceptors play a role in regulating the biological clock. Experiments have been conducted evaluating the impact of different wavelengths of light on symptoms of SAD.

In a study of people with subsyndromal SAD, investigators randomized 48 participants to bright white fluorescent light or narrow-band blue light (peak LED wavelength, 470 nm). Patients were exposed to the light for 20 minutes on 5 consecutive days. Standard scales measuring mood and fatigue were administered (BMC Psychiatry. 2016 Feb 18;16:27).

Investigators did not detect differences between the groups, and the authors concluded they had comparable efficacy.

Although the sample size is small, the data suggest that blue light is comparable to white light. I will start needing to pay attention if the folks in the cubicles outside my office are less depressed.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. Dr. Ebbert has no relevant financial disclosures about this article.

Cognitive impairment in individuals at the time of multiple sclerosis diagnosis imparts a significantly higher risk for disability progression, transition to secondary progressive disease, and cortical thinning, according to results from a retrospective, 8-year, longitudinal observational study.

The results, note first author Marco Pitteri, PhD, of the University of Verona (Italy) and his colleagues, “confirm and extend previous studies showing that cognitive impairment could represent a clinical marker of more aggressive gray matter pathology,” and also identified cortical thinning as a neuroimaging correlate of cognitive impairment that was detected only at follow-up between the cognitively impaired and cognitively normal patients who were otherwise similar at baseline.

©Zerbor/thinkstockphotos.com

The study involved 78 consecutive patients with relapsing-remitting multiple sclerosis who underwent neurologic exams during 2015 at a single center in Italy. They all had a cognitive assessment and an MRI scan at the time of diagnosis and at least 8 years of clinical follow-up, including neurologic examination every 6 months. At the time of enrollment into the study, most patients were taking immunomodulatory therapy: 38 were treated with interferon beta-1a, 14 with interferon beta-1b, 15 with glatiramer acetate, and 6 with azathioprine, and 5 were untreated.

At baseline, 39 cognitively normal patients had a mean age of about 36 years, none had conversion to secondary progressive disease, and just 15% had disability progression on the Expanded Disability Status Scale (EDSS). Cortical thickness changed a mean of 3.6%.

The 26 patients with mild cognitive impairment (classified as failure of up to two tests on the Brief Repeatable Battery) were 38 years old at baseline, and only 4 transitioned to secondary progressive disease. Just over half experienced EDSS progression (an average of 0.85 points) and cortical thickness changed by an average of 17%.

The 13 remaining patients with severe cognitive impairment at baseline (three or more failed tests) were about 44 years of age on average and nearly all (92%) experienced EDSS progression, which averaged 1.31 points. Cortical thickness also changed a mean of 34%. Relapsing disease converted to secondary progressive disease in a total of six patients with severe cognitive impairment.

Patients with severe cognitive impairment at baseline had more severe white matter lesion volume at baseline than did others, but there was no difference in the accumulation of white matter lesions during follow-up between patients with normal cognition, mild cognitive impairment, and severe cognitive impairment, which corroborates previous studies. However, the predictive ability of early cognitive impairment in identifying patients with disability progression on the EDSS and cortical thinning “is in line with several previous longitudinal studies showing a strong relationship between gray matter damage and the development of cognitive impairment,” the authors wrote (Brain. 2012 Oct;135[Pt 10]:2952-61 and Neurology. 2013 Nov 12;81[20]:1759-67).

Although the administration of neuropsychological batteries is time consuming and requires expertise, the authors argued that their results “underline the need of using extended screening neuropsychological batteries instead of brief screening batteries, at least at the time of diagnosis, in order to increase the probability to detect even mild forms of cognitive impairment as early as possible in the disease course.”

Read the full paper online in Multiple Sclerosis (2016 Aug 15. doi: 10.1177/1352458516665496).

[email protected]

Cognitive impairment in individuals at the time of multiple sclerosis diagnosis imparts a significantly higher risk for disability progression, transition to secondary progressive disease, and cortical thinning, according to results from a retrospective, 8-year, longitudinal observational study.

The results, note first author Marco Pitteri, PhD, of the University of Verona (Italy) and his colleagues, “confirm and extend previous studies showing that cognitive impairment could represent a clinical marker of more aggressive gray matter pathology,” and also identified cortical thinning as a neuroimaging correlate of cognitive impairment that was detected only at follow-up between the cognitively impaired and cognitively normal patients who were otherwise similar at baseline.

©Zerbor/thinkstockphotos.com

The study involved 78 consecutive patients with relapsing-remitting multiple sclerosis who underwent neurologic exams during 2015 at a single center in Italy. They all had a cognitive assessment and an MRI scan at the time of diagnosis and at least 8 years of clinical follow-up, including neurologic examination every 6 months. At the time of enrollment into the study, most patients were taking immunomodulatory therapy: 38 were treated with interferon beta-1a, 14 with interferon beta-1b, 15 with glatiramer acetate, and 6 with azathioprine, and 5 were untreated.

At baseline, 39 cognitively normal patients had a mean age of about 36 years, none had conversion to secondary progressive disease, and just 15% had disability progression on the Expanded Disability Status Scale (EDSS). Cortical thickness changed a mean of 3.6%.

The 26 patients with mild cognitive impairment (classified as failure of up to two tests on the Brief Repeatable Battery) were 38 years old at baseline, and only 4 transitioned to secondary progressive disease. Just over half experienced EDSS progression (an average of 0.85 points) and cortical thickness changed by an average of 17%.

The 13 remaining patients with severe cognitive impairment at baseline (three or more failed tests) were about 44 years of age on average and nearly all (92%) experienced EDSS progression, which averaged 1.31 points. Cortical thickness also changed a mean of 34%. Relapsing disease converted to secondary progressive disease in a total of six patients with severe cognitive impairment.

Patients with severe cognitive impairment at baseline had more severe white matter lesion volume at baseline than did others, but there was no difference in the accumulation of white matter lesions during follow-up between patients with normal cognition, mild cognitive impairment, and severe cognitive impairment, which corroborates previous studies. However, the predictive ability of early cognitive impairment in identifying patients with disability progression on the EDSS and cortical thinning “is in line with several previous longitudinal studies showing a strong relationship between gray matter damage and the development of cognitive impairment,” the authors wrote (Brain. 2012 Oct;135[Pt 10]:2952-61 and Neurology. 2013 Nov 12;81[20]:1759-67).

Although the administration of neuropsychological batteries is time consuming and requires expertise, the authors argued that their results “underline the need of using extended screening neuropsychological batteries instead of brief screening batteries, at least at the time of diagnosis, in order to increase the probability to detect even mild forms of cognitive impairment as early as possible in the disease course.”

Read the full paper online in Multiple Sclerosis (2016 Aug 15. doi: 10.1177/1352458516665496).

[email protected]

Cognitive impairment in individuals at the time of multiple sclerosis diagnosis imparts a significantly higher risk for disability progression, transition to secondary progressive disease, and cortical thinning, according to results from a retrospective, 8-year, longitudinal observational study.

The results, note first author Marco Pitteri, PhD, of the University of Verona (Italy) and his colleagues, “confirm and extend previous studies showing that cognitive impairment could represent a clinical marker of more aggressive gray matter pathology,” and also identified cortical thinning as a neuroimaging correlate of cognitive impairment that was detected only at follow-up between the cognitively impaired and cognitively normal patients who were otherwise similar at baseline.

©Zerbor/thinkstockphotos.com

The study involved 78 consecutive patients with relapsing-remitting multiple sclerosis who underwent neurologic exams during 2015 at a single center in Italy. They all had a cognitive assessment and an MRI scan at the time of diagnosis and at least 8 years of clinical follow-up, including neurologic examination every 6 months. At the time of enrollment into the study, most patients were taking immunomodulatory therapy: 38 were treated with interferon beta-1a, 14 with interferon beta-1b, 15 with glatiramer acetate, and 6 with azathioprine, and 5 were untreated.

At baseline, 39 cognitively normal patients had a mean age of about 36 years, none had conversion to secondary progressive disease, and just 15% had disability progression on the Expanded Disability Status Scale (EDSS). Cortical thickness changed a mean of 3.6%.

The 26 patients with mild cognitive impairment (classified as failure of up to two tests on the Brief Repeatable Battery) were 38 years old at baseline, and only 4 transitioned to secondary progressive disease. Just over half experienced EDSS progression (an average of 0.85 points) and cortical thickness changed by an average of 17%.

The 13 remaining patients with severe cognitive impairment at baseline (three or more failed tests) were about 44 years of age on average and nearly all (92%) experienced EDSS progression, which averaged 1.31 points. Cortical thickness also changed a mean of 34%. Relapsing disease converted to secondary progressive disease in a total of six patients with severe cognitive impairment.

Patients with severe cognitive impairment at baseline had more severe white matter lesion volume at baseline than did others, but there was no difference in the accumulation of white matter lesions during follow-up between patients with normal cognition, mild cognitive impairment, and severe cognitive impairment, which corroborates previous studies. However, the predictive ability of early cognitive impairment in identifying patients with disability progression on the EDSS and cortical thinning “is in line with several previous longitudinal studies showing a strong relationship between gray matter damage and the development of cognitive impairment,” the authors wrote (Brain. 2012 Oct;135[Pt 10]:2952-61 and Neurology. 2013 Nov 12;81[20]:1759-67).

Although the administration of neuropsychological batteries is time consuming and requires expertise, the authors argued that their results “underline the need of using extended screening neuropsychological batteries instead of brief screening batteries, at least at the time of diagnosis, in order to increase the probability to detect even mild forms of cognitive impairment as early as possible in the disease course.”

Read the full paper online in Multiple Sclerosis (2016 Aug 15. doi: 10.1177/1352458516665496).

[email protected]

A Danish population-based cohort study identified a significant association between patients who have rosacea and their risk of having certain other gastrointestinal diseases – specifically, celiac disease, Crohn’s disease, ulcerative colitis, and irritable bowel syndrome.

“While a co-occurrence of rosacea and gastrointestinal disorders has previously been evaluated, the topic remains controversial,” wrote the authors, led by Alexander Egeberg, MD, of the department of dermatology and allergy, Herlev and Gentofte Hospital, Hellerup, Denmark (Br J Dermatol. 2016 Aug 8. doi: 10.1111/bjd.14930).

Dr. Egeberg and his coinvestigators conducted a nationwide cohort study of adults aged 18 years and older from national administrative registers, starting on Jan. 1, 2008, through Dec. 31, 2012. In total, 49,475 rosacea patients were included, with 4,312,213 individuals from the general population who were used as controls. The outcomes were any occurrences of celiac disease (CeD), Crohn’s disease (CD), ulcerative colitis (UC), and irritable bowel syndrome (IBS), Helicobactor pylori (HP) infection, and small intestinal bacterial overgrowth that occurred during the study period, conditions that were chosen “due to their potential mechanistic and pathogenic overlap with rosacea,” they wrote.

At baseline, the prevalence of CeD, CD, UC, HP infection, small intestinal bacterial overgrowth, and IBS was significantly higher among the patients with rosacea, compared with the controls.

Adjusted hazard ratios showed a significant association between patients with rosacea and one of the following GI diagnoses: CeD (Hazard ratio, 1.46), CD (HR, 1.45), UC (HR, 1.19), and IBS (HR, 1.34). However, no significant association was found between rosacea and HP infection or small intestinal bacterial overgrowth.

“The findings from this study raise an important question about the pathogenic overlap between the studied gastrointestinal disorders and rosacea,” Dr. Egeberg and his coauthors wrote. Most of the outcomes examined in the study, they noted, “carry several autoimmune characteristics and, although speculative, it is possible that shared autoimmune susceptibility may provide a link between rosacea and the examined gastrointestinal disorders.”

No funding was received for this study. Dr. Egeberg and his coauthors reported no relevant financial disclosures.

[email protected]

A Danish population-based cohort study identified a significant association between patients who have rosacea and their risk of having certain other gastrointestinal diseases – specifically, celiac disease, Crohn’s disease, ulcerative colitis, and irritable bowel syndrome.

“While a co-occurrence of rosacea and gastrointestinal disorders has previously been evaluated, the topic remains controversial,” wrote the authors, led by Alexander Egeberg, MD, of the department of dermatology and allergy, Herlev and Gentofte Hospital, Hellerup, Denmark (Br J Dermatol. 2016 Aug 8. doi: 10.1111/bjd.14930).

Dr. Egeberg and his coinvestigators conducted a nationwide cohort study of adults aged 18 years and older from national administrative registers, starting on Jan. 1, 2008, through Dec. 31, 2012. In total, 49,475 rosacea patients were included, with 4,312,213 individuals from the general population who were used as controls. The outcomes were any occurrences of celiac disease (CeD), Crohn’s disease (CD), ulcerative colitis (UC), and irritable bowel syndrome (IBS), Helicobactor pylori (HP) infection, and small intestinal bacterial overgrowth that occurred during the study period, conditions that were chosen “due to their potential mechanistic and pathogenic overlap with rosacea,” they wrote.

At baseline, the prevalence of CeD, CD, UC, HP infection, small intestinal bacterial overgrowth, and IBS was significantly higher among the patients with rosacea, compared with the controls.

Adjusted hazard ratios showed a significant association between patients with rosacea and one of the following GI diagnoses: CeD (Hazard ratio, 1.46), CD (HR, 1.45), UC (HR, 1.19), and IBS (HR, 1.34). However, no significant association was found between rosacea and HP infection or small intestinal bacterial overgrowth.

“The findings from this study raise an important question about the pathogenic overlap between the studied gastrointestinal disorders and rosacea,” Dr. Egeberg and his coauthors wrote. Most of the outcomes examined in the study, they noted, “carry several autoimmune characteristics and, although speculative, it is possible that shared autoimmune susceptibility may provide a link between rosacea and the examined gastrointestinal disorders.”

No funding was received for this study. Dr. Egeberg and his coauthors reported no relevant financial disclosures.

[email protected]

A Danish population-based cohort study identified a significant association between patients who have rosacea and their risk of having certain other gastrointestinal diseases – specifically, celiac disease, Crohn’s disease, ulcerative colitis, and irritable bowel syndrome.

“While a co-occurrence of rosacea and gastrointestinal disorders has previously been evaluated, the topic remains controversial,” wrote the authors, led by Alexander Egeberg, MD, of the department of dermatology and allergy, Herlev and Gentofte Hospital, Hellerup, Denmark (Br J Dermatol. 2016 Aug 8. doi: 10.1111/bjd.14930).

Dr. Egeberg and his coinvestigators conducted a nationwide cohort study of adults aged 18 years and older from national administrative registers, starting on Jan. 1, 2008, through Dec. 31, 2012. In total, 49,475 rosacea patients were included, with 4,312,213 individuals from the general population who were used as controls. The outcomes were any occurrences of celiac disease (CeD), Crohn’s disease (CD), ulcerative colitis (UC), and irritable bowel syndrome (IBS), Helicobactor pylori (HP) infection, and small intestinal bacterial overgrowth that occurred during the study period, conditions that were chosen “due to their potential mechanistic and pathogenic overlap with rosacea,” they wrote.

At baseline, the prevalence of CeD, CD, UC, HP infection, small intestinal bacterial overgrowth, and IBS was significantly higher among the patients with rosacea, compared with the controls.

Adjusted hazard ratios showed a significant association between patients with rosacea and one of the following GI diagnoses: CeD (Hazard ratio, 1.46), CD (HR, 1.45), UC (HR, 1.19), and IBS (HR, 1.34). However, no significant association was found between rosacea and HP infection or small intestinal bacterial overgrowth.

“The findings from this study raise an important question about the pathogenic overlap between the studied gastrointestinal disorders and rosacea,” Dr. Egeberg and his coauthors wrote. Most of the outcomes examined in the study, they noted, “carry several autoimmune characteristics and, although speculative, it is possible that shared autoimmune susceptibility may provide a link between rosacea and the examined gastrointestinal disorders.”

No funding was received for this study. Dr. Egeberg and his coauthors reported no relevant financial disclosures.

[email protected]

Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

Colorectal cancer in men was not significantly associated with baseline plasma levels of three inflammatory markers – C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 (TNFR-2), investigators reported online in Cancer Epidemiology.

The nested case-control study included 268 colorectal cancer (CRC) cases and 446 controls matched by age and smoking status from the Physician’s Health Study, a prospective, randomized, placebo-controlled aspirin trial. High TNFR-2 levels were significantly linked with CRC risk in the placebo arm (relative risk, 1.77; 95% confidence interval, 1.02-3.06; P = .02) of the study, and not in the aspirin arm (P = .72), Chul Kim, MD, of University of Minnesota, Minneapolis, and his associates noted. “This may suggest that aspirin exerts its carcinoprotective effect by blocking the TNF-alpha pathway,” they added, noting that in mice, blocking this pathway helps prevent CRC secondary to chronic colitis. However, a test for interactions yielded no evidence that aspirin significantly modifies the relationship between TNFR-2 and CRC, they said (Cancer Epidemiol. 2016;44:65-70).

Courtesy Wikimedia Commons/nephron/Creative Commons License

Chronic inflammation is thought to promote carcinogenesis, including CRC, which is associated with inflammatory bowel disease. Studies have shown that long-term nonsteroidal anti-inflammatory and aspirin therapy attenuates CRC risk, but have not clarified the relationship between baseline plasma inflammatory markers and CRC. Dr. Kim and associates controlled for known CRC risk factors, including body mass index, alcohol consumption, physical activity level, multivitamin use, and dairy intake. In contrast to their findings in men, the Nurses’ Health Study did find a significant link between TNFR-2 levels and CRC risk in women, they noted (RR, 1.67; 95% CI, 1.05-2.68; P = .03).

They acknowledged several limitations. A single inflammatory marker test “may not represent a person’s inflammatory status during the development of colorectal cancer,” and marker levels were assayed during the run-in period of the trial, when all participants received aspirin, they said. Furthermore, the trial only ran for 5 years, after which more than 70% of patients took aspirin, which “would have significantly attenuated the true association that we would observe in this study.”

The National Cancer Institute, National Heart, Lung, and Blood Institute, National Cancer Institute of Canada, and National Institutes of Health provided funding. The authors had no disclosures.

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

I’ve written quite a lot over the past few years about the trend toward soloists and small groups selling their practices to hospitals, multispecialty groups, or larger practices. And I’ve made it fairly clear that I don’t think it’s a particularly good thing that the medical profession is going the way of the corner gas station and the mom-and-pop grocery store; it’s not good for physicians, patients, or private practice.

That said, if retirement looms with no individual buyers in sight, or your overhead is getting out of hand, selling to a larger entity is an option that you may need to consider. Too often, though, sellers are not receiving a fair return on the equity they have worked so hard to build over several decades, either because they have waited too long and must accept what is offered, or because they simply take the buyer’s word for their practice’s value. Don’t put yourself in either of those positions; and don’t entertain any offers until you obtain an objective appraisal from a neutral party.

Of course, a medical practice is trickier to value than is an ordinary business and usually requires the services of an experienced professional appraiser. Entire books have been written about the process, so I can’t hope to cover it completely in 850 words; but three basic yardsticks are essential for determining the equity, or book value, of a practice:

• Tangible Assets: equipment, cash, accounts receivable, and other property owned by the practice.

• Liabilities: accounts payable, outstanding loans, and anything else owed to others.

• Intangible Assets: sometimes called “good will” – the reputation of the physicians, the location and name recognition of the practice, the loyalty and volume of patients, and other, well, intangibles.

Valuing tangible assets is comparatively straightforward, but there are several ways to do it, and when reviewing a practice appraisal, you should ask which of them was used. Depreciated value is the book value of equipment and supplies as determined by their purchase price, less the amount their value has decreased since purchase. Remaining useful life value estimates how long the equipment can be expected to last. Market (or replacement) value is the amount it would cost on the open market to replace all equipment and supplies.

Intangible assets are more difficult to value. Many components are analyzed, including location, interior and exterior decor, accessibility to patients, age and functional status of equipment, systems in place to promote efficiency, reasons why patients come back (if in fact they do), and the overall reputation of the practice in the community. Other important factors include the “payer mix” (what percentage pays cash, how many third-party contracts are in place, and how well they pay, etc.), the extent and strength of the referral base, and the presence of supplemental income streams, such as clinical research.

It is also important to determine to what extent intangible assets are transferable. For example, unique skills with a laser, neurotoxins, or filler substances, or extraordinary personal charisma, may increase your practice’s value to you, but they are worthless to the next owner, and he or she will be unwilling to pay for them unless your services become part of the deal.

Once again, there are many ways to estimate intangible asset value, and once again, you should ask which were used. Cash Flow Analysis works on the assumption that cash flow is a measure of intangible value. Capitalization of Earnings puts a value, or capitalization, on the practice’s income streams using a variety of assumptions. Guideline Comparison uses various databases to compare your practice with other, similar ones that have changed hands in the past.

Two newer techniques that some consider a better estimate of intangible assets are the replacement method, which estimates the costs of starting the practice over again in the current market; and the excess earnings method, which measures how far above average your practice’s earnings (and thus its overall value) are.

Asset-based valuation is the most popular – but by no means the only – method available. Income-based valuation looks at the source and strength of a practice’s income stream as a creator of value, as well as whether or not its income stream under a different owner would mirror its present one. This in turn becomes the basis for an understanding of the fair market value of both tangible and intangible assets. Market valuation combines the asset-based and income-based approaches, along with an analysis of sales and mergers of comparable practices in the community, to determine the value of a practice in its local market.

Whatever methods are used, it is important that the appraisal be done by an experienced and independent financial consultant, that all techniques used in the valuation be divulged and explained, and that documentation is supplied to support the conclusions reached. This is especially important if the appraisal will be relied upon in the sale or merger of the practice.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Dermatology News. Write to him at [email protected].

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

Seventy-four percent of physician specialties saw increases in their compensation in 2015, led by emergency medicine, according to the American Medical Group Association.

Overall, the weighted average increase in median compensation across all physician specialties was 3.1%, according to the 2016 Medical Group Compensation and Productivity Survey. Results were based on responses from 260 medical groups representing more than 92,000 providers.

thinkstockphotos.com

“Once again, we see that physician compensation in general has remained relatively flat, with an average increase around 3.0%,” AMGA President and CEO Donald Fisher, PhD, said in a statement.

“We’ve seen peaks in certain specialties, and dips in others, and much of this reflects the cyclical nature of health care economics,” he added. For example, data from the 2014 survey saw gastroenterology had the largest year-over-year increase and in the 2016 survey, it was one of four specialties to see a decrease in compensation.

Individual specialties seeing the largest median total compensation increase year over year include emergency medicine (9.65% to $355,280), cardiac/thoracic surgery (8.12% to $645,112), cardiology (6.88% to $483.653), and hypertension and nephrology (6.72% to $329,750). Total compensation captures base and variable compensation plus all voluntary salary reductions, but excludes fringe benefits and employer payments to any type of retirement, pension, SERP or tax-deferred profit-sharing plan.

Four specialties saw median decreases in their compensation, including dermatology (–4.27% to $434,520), ophthalmology (–4.17% to $385,149), cardiology-cath lab (–0.81% to $584,118), and gastroenterology (–0.16% to $505,194).

[email protected]

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

A shiitake mushroom extract called lentinan did not improve overall survival in advanced gastric cancer when added to the oral fluoropyrimidine S-1 in a randomized, controlled phase III trial.

Patients also experienced treatment failure significantly earlier on lentinan/S-1 than on S-1 monotherapy, Shigefumi Yoshino, MD, of Yamaguchi University Graduate School of Medicine in Ube, Japan, and his associates reported online August 5 in the European Journal of Cancer. “The present study showed no efficacy of lentinan administration combined with S-1 treatment in patients with unresectable or recurrent gastric cancer,” they concluded.

Lentinan, a purified beta-1, 3-glucan from Lentinus edodes (shiitake mushroom) has been shown to boost immune response and humoral antitumor immunity in mice and humans. S-1, a combination of tegafur, gimeracil, and potassium oxonate, is the most widely used therapy for unresectable or recurrent gastric cancer in Japan, the researchers noted. Based on promising results from a pilot trial, they conducted a prospective, multicenter, open-label phase III trial of 309 adults with unresectable or recurrent gastric cancer who were randomly assigned to receive S-1 with lentinan or S-1 alone. “S-1 was given orally twice daily for the first 4 weeks of a 6-week cycle,” they noted. “The dose of S-1 administered was calculated according to the patient’s body surface area as follows: less than 1.25 m², 40 mg; 1.25-1.5 m², 50 mg; and greater than 1.5 m², 60 mg.” Lentinan was given intravenously at a dose of 2 mg weekly. Patients continued treatment until progressive disease, unacceptable toxicity, withdrawal of consent, or a decision to stop treatment by the treating physician (Eur J Cancer. 2016;65:164-71). The S-1 group received a median of three treatment cycles, while the S-1/lentinan group received a median of two S-1 cycles and 22 lentinan infusions, the investigators reported. Median overall survival was statistically similar between the arms (13.8 months with S-1 monotherapy and 9.9 months with combination therapy; P = 0.21). Median time to treatment failure was significantly longer with S-1 alone than with S-1 plus lentinan (4.3 and 2.6 months (P less than 0.001). Overall response rates were 22.3% with S-1 alone and 18.7% with S-1/lentinan combination therapy.

Lentinan did not yield significant safety signals, nor did it seem to affect quality of life, the researchers noted. Patients with relatively higher percentages of lentinan-binding monocytes (that is, at least 2%) who received more than two cycles of chemotherapy did survive significantly longer with lentinan plus S-1 than with S-1 alone, they reported. Within this subgroup, 24% of lentinan/S-1 patients were still alive at 3 years, compared with 3% of patients given S-1 monotherapy. Thus, a patient’s percentage of lentinan-binding monocytes might help predict response to lentinan, the researchers concluded.

The Japanese Foundation for Multidisciplinary Treatment of Cancer funded the study. Dr. Yoshino disclosed personal fees outside the current study from MSD, Taiho, and Chugai.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.

At current prices, PCSK9 inhibitors are not cost-effective for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease, according to an analysis published Aug. 16 in JAMA.

The costs of the cholesterol-lowering drugs would have to be reduced by at least two-thirds to reach cost-effectiveness, on the basis of data from the simulation model of atherosclerotic cardiovascular disease in the United States and the 2015 annual PCSK9 inhibitor costs of $14,350.

The high cost of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition remains a challenge because it is meant for lifelong use, and “the potential increase in health care expenditures at current or even moderately discounted prices could be staggering,” wrote Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, and her colleagues (JAMA 2016 Aug 16;316[7]:743-53).

The researchers used the Cardiovascular Disease Policy Model, which included adults aged 35-94 years and compared the cost-effectiveness of PCSK9 inhibitors and ezetimibe in treating two of the three indications for the drugs, heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD). Homozygous FH was not included in the analysis.

The researchers assumed that statins, ezetimibe, and the two approved PCSK9 inhibitors (evolocumab and alirocumab) each would reduce the risk of cardiovascular events by an identical amount per mg/dL of LDL cholesterol reduction.

They found that, for PCSK9 inhibitors to be cost-effective at less than $100,000 per quality-adjusted life-year (QALY), the annual cost would need to drop from its current cost of roughly $14,000 per patient to $4,536 or less per patient, the researchers said.

Overall, the model showed that adding PCSK9 to statins for patients with heterozygous FH or ASCVD prevented 316,300 major adverse cardiovascular events (defined as cardiovascular death, nonfatal MI, or stroke), compared with adding ezetimibe; the cost was $503,000 per QALY. Adding PCSK9 inhibitors to statins for patients with ASCVD prevented about 4.3 million major cardiac adverse events, compared with adding ezetimibe; the cost was $414,000 per QALY.

In addition, the researchers found that PCSK9 inhibitor use would cut cardiovascular care costs by $29 billion over 5 years. However, the model projected an increase of about $592 in annual drug costs from 2015, as well as a 4% annual increase in U.S. health care costs overall.

The results were limited by several factors including the lack of long-term data on outcomes in patients taking PCSK9 inhibitors, the researchers noted. However, the findings suggest that the best way to improve the value of PCSK9 is to cut the price, they added.

In the meantime, “payers must consider the potential trade-off between paying for new drug treatments like PCSK9 inhibitors and investing in interventions known to improve access, physician prescription rates, and patient adherence to statin therapy among those at high ASCVD risk,” they said.

Dr. Bibbins-Domingo is the chair of the U.S. Preventive Services Task Force, but the study does not represent a recommendation from the USPSTF. She had no personal financial conflicts to disclose. The study was funded in part by the New England Comparative Effectiveness Public Advisory Council, which receives grants from several nonprofit organizations.