One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

One of the most frustrating problems we encounter is helping patients with skin issues that we cannot immediately fix or cure. Teaching them the art of concealing skin blemishes gives patients a sense of relief. Color correction is an art and requires an understanding of basic color theory and Fitzpatrick skin type.

On the color wheel, each color sits directly across from another color, making them complementary colors.

Thoth_Adan (thinkstockimages)

If we look at red, the color opposing it is green. When red and green are combined, they neutralize each other. One of the greatest dermatologists of all time and my mentor, Timothy Berger, MD, taught me that in dermatology color “hue” is a clue to understanding morphology. Everything that is red cannot just be called “erythematous.” There is orange/red (pityriasis rosea, tinea versicolor, seborrheic dermatitis), deep red (cellulitis, Sweet’s syndrome, acne scars, rosacea, psoriasis), purple/red (vasculitis, lichen planus (LP), veins, under-eye circles), brown/red (pigmented purpura, pigmented acne scars, sarcoid).

The combination of the underlying pathology, morphology, and Fitzpatrick type is both a clue to diagnosis and a pallet for skin concealers. We can use the following techniques to help patients color correct skin imperfections:

Red: rosacea, acne scars, acne

Green-based concealers and primers are the best option to significantly reduce the redness. While green primers and correctors tend to be great for Fitzpatrick skin types I-III, a yellow-based concealer/corrector can help to cover redness on those with skin types IV-VI.

Blue: periorbital veins

If you are dealing with blue-toned skin lesions, such as periorbital veins, the ideal corrector is one with a peach or orange undertones. For skin types I-III, a peach/salmon corrector works best, whereas skin types IV-VI requires an orange-toned corrector.

Purple: under-eye circles, LP, postprocedure bruising

If under-eye circles tend to have a more purple hue to them, a yellow-based corrector works best for skin types I-III. For skin types IV-VI skin types, you will need a corrector with a red undertone.

Yellow: bruising

Purple/lavender correctors are best suited for eliminating yellow tones from the face. Purple also combats sallow undertones of the skin.

Brown: lentigines, melasma, seborrheic keratosis, post-inflammatory hyperpigmentation, nevi, café au lait spots

Brown is actually the hardest of all colors to correct. The deeper the pigment (ashy dermatitis, melasma) the more gray the areas appear with skin concealers. The more superficial the pigment (ephelides, lentigines), the easier it is to correct. Generally speaking, peach toned concealers work best, not beige or brown. The corrector, however, should be lighter than the skin tone or the lesion itself will appear darker.

Helping patients conceal imperfections with these simple guidelines is a great way to help relieve some anxiety and help our patients fell more confident in their skin.

Dr. Talakoub and Dr. Wesley are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected].

PARIS – Same-day discharge after uncomplicated transradial-access percutaneous coronary intervention (PCI) in patients with stable coronary artery disease is both feasible and safe, according to the findings of a multicenter prospective Spanish registry study.

Under the Spanish investigators’ protocol for same-day discharge, roughly three-quarters of patients successfully completed the 4- to 12-hour post-PCI surveillance period and were expeditiously sent home without spending a night in the hospital, Juan Gabriel Cordoba Soriano, MD, reported at the annual congress of the European Association of Percutaneous Cardiovascular Interventions.

The other 26% of patients were admitted, most often because they showed clinical instability during the surveillance period, less frequently due to a suboptimal angiographic result, explained Dr. Cordoba Soriano of the University of Albacete, Spain.

The rationale for same-day discharge post PCI – provided it has first been shown to be safe, as was the case using the Spanish criteria – is that it reduces costs by avoiding an expensive hospital bed. Also, most patients prefer to sleep in their own bed and avoid a hospital stay, he continued.

Eligibility for same-day discharge in the Spanish study was restricted to patients with stable coronary artery disease undergoing elective transradial PCI with no complications during the procedure and with clinical stability during the subsequent 4- to 12-hour observation period. Patients undergoing complex PCIs – for example, treatment of left main lesions, complex bifurcation lesions, or chronic total occlusions – were ineligible.

Why restrict eligibility to patients undergoing transradial PCI? Multiple studies convincingly show it is safer than femoral access. And outside of the United States, it is by far the more popular access route. In a show of hands, virtually all of Dr. Cordoba Soriano’s audience indicated they perform more than 70% of their PCIs via transradial access. And patients with stable CAD are less likely to experience stent thrombosis or acute occlusion of the treated artery or side branches, he continued.

Of 989 patients who presented to the three participating Spanish medical centers for elective PCI, 257 were immediately excluded from the registry because they underwent elective femoral access. That left 732 patients, 74% of whom got same-day discharge.

The same-day discharge and hospital admission groups were closely similar in terms of baseline characteristics with two exceptions: The prevalence of peripheral arterial disease in the same-day discharge group was less than half of the 10% figure in the hospitalized group, and kidney function was better in patients who ultimately received same-day discharge as evidenced by a serum creatinine of 0.9 mg/dL, half that of the hospitalized patients.

Procedural characteristics were mostly similar for the two groups as well. Although the same-day discharge group had a 26-minute shorter median procedure time, were less likely to undergo multivessel PCI, and had fewer stents implanted per patient, in a multivariate regression analysis the only independent predictors of admission post PCI were the presence of peripheral arterial disease, with an associated 2.2-fold increased risk; multivessel PCI, with a 1.8-fold risk; ad hoc as opposed to a scheduled PCI, with a 4.0-fold increased risk; and a history of prior transradial catheterization, which cut the risk of hospitalization in half.

Turning to the safety of same-day discharge, the cardiologist deemed the rate of major complications in the first 24 hours to be acceptable at 0.18% for a single case of significant bleeding. Minor complications were confined to a 1.8% incidence of hematomas greater than 5 cm in size.

The major complication rate from 24 hours to 30 days post PCI was 0.54% (two deaths, one stroke), with a 2.2% incidence of minor complications.

Dr. Cordoba Soriano noted that investigators at the Quebec Heart and Lung Institute have published a meta-analysis of 13 studies of same-day discharge after PCI totaling more than 111,000 patients (JACC Cardiovasc Interv. 2013 Feb;6[2]:99-112). The investigators concluded that a definitive randomized trial would require more than 17,000 subjects, and in the absence of such evidence same-day discharge after uncomplicated PCI “seems a reasonable approach in selected patients.”

Stanford University investigators have published a separate meta-analysis of same-day discharge after PCI in nearly 13,000 patients in 30 observational and 7 randomized controlled trials. They concluded that it appears to be as safe as overnight observation (J Am Coll Cardiol. 2013 Jul 23;62[4]:275-85).

Nevertheless, the Society for Cardiovascular Angiography and Interventions has yet to update its 2009 expert consensus document stating that the standard of care is an overnight stay following PCI (Catheter Cardiovasc Interv. 2009 Jun 1;73[7]:847-58), Dr. Cordoba Soriano observed.

He reported having no financial conflicts regarding the registry study, which was conducted with university research funds.

[email protected]

PARIS – Same-day discharge after uncomplicated transradial-access percutaneous coronary intervention (PCI) in patients with stable coronary artery disease is both feasible and safe, according to the findings of a multicenter prospective Spanish registry study.

Under the Spanish investigators’ protocol for same-day discharge, roughly three-quarters of patients successfully completed the 4- to 12-hour post-PCI surveillance period and were expeditiously sent home without spending a night in the hospital, Juan Gabriel Cordoba Soriano, MD, reported at the annual congress of the European Association of Percutaneous Cardiovascular Interventions.

The other 26% of patients were admitted, most often because they showed clinical instability during the surveillance period, less frequently due to a suboptimal angiographic result, explained Dr. Cordoba Soriano of the University of Albacete, Spain.

The rationale for same-day discharge post PCI – provided it has first been shown to be safe, as was the case using the Spanish criteria – is that it reduces costs by avoiding an expensive hospital bed. Also, most patients prefer to sleep in their own bed and avoid a hospital stay, he continued.

Eligibility for same-day discharge in the Spanish study was restricted to patients with stable coronary artery disease undergoing elective transradial PCI with no complications during the procedure and with clinical stability during the subsequent 4- to 12-hour observation period. Patients undergoing complex PCIs – for example, treatment of left main lesions, complex bifurcation lesions, or chronic total occlusions – were ineligible.

Why restrict eligibility to patients undergoing transradial PCI? Multiple studies convincingly show it is safer than femoral access. And outside of the United States, it is by far the more popular access route. In a show of hands, virtually all of Dr. Cordoba Soriano’s audience indicated they perform more than 70% of their PCIs via transradial access. And patients with stable CAD are less likely to experience stent thrombosis or acute occlusion of the treated artery or side branches, he continued.

Of 989 patients who presented to the three participating Spanish medical centers for elective PCI, 257 were immediately excluded from the registry because they underwent elective femoral access. That left 732 patients, 74% of whom got same-day discharge.

The same-day discharge and hospital admission groups were closely similar in terms of baseline characteristics with two exceptions: The prevalence of peripheral arterial disease in the same-day discharge group was less than half of the 10% figure in the hospitalized group, and kidney function was better in patients who ultimately received same-day discharge as evidenced by a serum creatinine of 0.9 mg/dL, half that of the hospitalized patients.

Procedural characteristics were mostly similar for the two groups as well. Although the same-day discharge group had a 26-minute shorter median procedure time, were less likely to undergo multivessel PCI, and had fewer stents implanted per patient, in a multivariate regression analysis the only independent predictors of admission post PCI were the presence of peripheral arterial disease, with an associated 2.2-fold increased risk; multivessel PCI, with a 1.8-fold risk; ad hoc as opposed to a scheduled PCI, with a 4.0-fold increased risk; and a history of prior transradial catheterization, which cut the risk of hospitalization in half.

Turning to the safety of same-day discharge, the cardiologist deemed the rate of major complications in the first 24 hours to be acceptable at 0.18% for a single case of significant bleeding. Minor complications were confined to a 1.8% incidence of hematomas greater than 5 cm in size.

The major complication rate from 24 hours to 30 days post PCI was 0.54% (two deaths, one stroke), with a 2.2% incidence of minor complications.

Dr. Cordoba Soriano noted that investigators at the Quebec Heart and Lung Institute have published a meta-analysis of 13 studies of same-day discharge after PCI totaling more than 111,000 patients (JACC Cardiovasc Interv. 2013 Feb;6[2]:99-112). The investigators concluded that a definitive randomized trial would require more than 17,000 subjects, and in the absence of such evidence same-day discharge after uncomplicated PCI “seems a reasonable approach in selected patients.”

Stanford University investigators have published a separate meta-analysis of same-day discharge after PCI in nearly 13,000 patients in 30 observational and 7 randomized controlled trials. They concluded that it appears to be as safe as overnight observation (J Am Coll Cardiol. 2013 Jul 23;62[4]:275-85).

Nevertheless, the Society for Cardiovascular Angiography and Interventions has yet to update its 2009 expert consensus document stating that the standard of care is an overnight stay following PCI (Catheter Cardiovasc Interv. 2009 Jun 1;73[7]:847-58), Dr. Cordoba Soriano observed.

He reported having no financial conflicts regarding the registry study, which was conducted with university research funds.

[email protected]

PARIS – Same-day discharge after uncomplicated transradial-access percutaneous coronary intervention (PCI) in patients with stable coronary artery disease is both feasible and safe, according to the findings of a multicenter prospective Spanish registry study.

Under the Spanish investigators’ protocol for same-day discharge, roughly three-quarters of patients successfully completed the 4- to 12-hour post-PCI surveillance period and were expeditiously sent home without spending a night in the hospital, Juan Gabriel Cordoba Soriano, MD, reported at the annual congress of the European Association of Percutaneous Cardiovascular Interventions.

The other 26% of patients were admitted, most often because they showed clinical instability during the surveillance period, less frequently due to a suboptimal angiographic result, explained Dr. Cordoba Soriano of the University of Albacete, Spain.

The rationale for same-day discharge post PCI – provided it has first been shown to be safe, as was the case using the Spanish criteria – is that it reduces costs by avoiding an expensive hospital bed. Also, most patients prefer to sleep in their own bed and avoid a hospital stay, he continued.

Eligibility for same-day discharge in the Spanish study was restricted to patients with stable coronary artery disease undergoing elective transradial PCI with no complications during the procedure and with clinical stability during the subsequent 4- to 12-hour observation period. Patients undergoing complex PCIs – for example, treatment of left main lesions, complex bifurcation lesions, or chronic total occlusions – were ineligible.

Why restrict eligibility to patients undergoing transradial PCI? Multiple studies convincingly show it is safer than femoral access. And outside of the United States, it is by far the more popular access route. In a show of hands, virtually all of Dr. Cordoba Soriano’s audience indicated they perform more than 70% of their PCIs via transradial access. And patients with stable CAD are less likely to experience stent thrombosis or acute occlusion of the treated artery or side branches, he continued.

Of 989 patients who presented to the three participating Spanish medical centers for elective PCI, 257 were immediately excluded from the registry because they underwent elective femoral access. That left 732 patients, 74% of whom got same-day discharge.

The same-day discharge and hospital admission groups were closely similar in terms of baseline characteristics with two exceptions: The prevalence of peripheral arterial disease in the same-day discharge group was less than half of the 10% figure in the hospitalized group, and kidney function was better in patients who ultimately received same-day discharge as evidenced by a serum creatinine of 0.9 mg/dL, half that of the hospitalized patients.

Procedural characteristics were mostly similar for the two groups as well. Although the same-day discharge group had a 26-minute shorter median procedure time, were less likely to undergo multivessel PCI, and had fewer stents implanted per patient, in a multivariate regression analysis the only independent predictors of admission post PCI were the presence of peripheral arterial disease, with an associated 2.2-fold increased risk; multivessel PCI, with a 1.8-fold risk; ad hoc as opposed to a scheduled PCI, with a 4.0-fold increased risk; and a history of prior transradial catheterization, which cut the risk of hospitalization in half.

Turning to the safety of same-day discharge, the cardiologist deemed the rate of major complications in the first 24 hours to be acceptable at 0.18% for a single case of significant bleeding. Minor complications were confined to a 1.8% incidence of hematomas greater than 5 cm in size.

The major complication rate from 24 hours to 30 days post PCI was 0.54% (two deaths, one stroke), with a 2.2% incidence of minor complications.

Dr. Cordoba Soriano noted that investigators at the Quebec Heart and Lung Institute have published a meta-analysis of 13 studies of same-day discharge after PCI totaling more than 111,000 patients (JACC Cardiovasc Interv. 2013 Feb;6[2]:99-112). The investigators concluded that a definitive randomized trial would require more than 17,000 subjects, and in the absence of such evidence same-day discharge after uncomplicated PCI “seems a reasonable approach in selected patients.”

Stanford University investigators have published a separate meta-analysis of same-day discharge after PCI in nearly 13,000 patients in 30 observational and 7 randomized controlled trials. They concluded that it appears to be as safe as overnight observation (J Am Coll Cardiol. 2013 Jul 23;62[4]:275-85).

Nevertheless, the Society for Cardiovascular Angiography and Interventions has yet to update its 2009 expert consensus document stating that the standard of care is an overnight stay following PCI (Catheter Cardiovasc Interv. 2009 Jun 1;73[7]:847-58), Dr. Cordoba Soriano observed.

He reported having no financial conflicts regarding the registry study, which was conducted with university research funds.

[email protected]

In the August podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses recent approvals by the Food and Drug Administration – for uridine triacetate as an antidote for 5-fluorouracil overdose and toxicity, and for two therapies for multiple myeloma, the monoclonal antibody elotuzumab and the proteasome inhibitor ixazomib. Also in this month’s line-up are study findings on abnormal vaginal bleeding and contraception counseling in women who are undergoing chemotherapy; the effects of IV iron treatment with ferumoxytol on health-related quality of life of patients with iron deficiency anemia; and on mindfulness-based cancer recovery in survivors recovering from chemotherapy and radiation. Two Case Reports focus on gastrointestinal cancers, one in a patients with high-grade leiomyosarcoma of the transverse colon and who presented with bowel perforation, and another on 1,25-dihydroxyvitamin D hypercalcemia and imatinib hepatotoxicity in a patient with GIST, and the New Therapies feature provides a detailed examination of recent advances in managing gynecologic cancers.

Listen to the podcast below.

In the August podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses recent approvals by the Food and Drug Administration – for uridine triacetate as an antidote for 5-fluorouracil overdose and toxicity, and for two therapies for multiple myeloma, the monoclonal antibody elotuzumab and the proteasome inhibitor ixazomib. Also in this month’s line-up are study findings on abnormal vaginal bleeding and contraception counseling in women who are undergoing chemotherapy; the effects of IV iron treatment with ferumoxytol on health-related quality of life of patients with iron deficiency anemia; and on mindfulness-based cancer recovery in survivors recovering from chemotherapy and radiation. Two Case Reports focus on gastrointestinal cancers, one in a patients with high-grade leiomyosarcoma of the transverse colon and who presented with bowel perforation, and another on 1,25-dihydroxyvitamin D hypercalcemia and imatinib hepatotoxicity in a patient with GIST, and the New Therapies feature provides a detailed examination of recent advances in managing gynecologic cancers.

Listen to the podcast below.

In the August podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses recent approvals by the Food and Drug Administration – for uridine triacetate as an antidote for 5-fluorouracil overdose and toxicity, and for two therapies for multiple myeloma, the monoclonal antibody elotuzumab and the proteasome inhibitor ixazomib. Also in this month’s line-up are study findings on abnormal vaginal bleeding and contraception counseling in women who are undergoing chemotherapy; the effects of IV iron treatment with ferumoxytol on health-related quality of life of patients with iron deficiency anemia; and on mindfulness-based cancer recovery in survivors recovering from chemotherapy and radiation. Two Case Reports focus on gastrointestinal cancers, one in a patients with high-grade leiomyosarcoma of the transverse colon and who presented with bowel perforation, and another on 1,25-dihydroxyvitamin D hypercalcemia and imatinib hepatotoxicity in a patient with GIST, and the New Therapies feature provides a detailed examination of recent advances in managing gynecologic cancers.

Listen to the podcast below.

A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.

Projected growth in the HIV provider workforce by 2019 will not accommodate the increased number of HIV-infected persons requiring care, according to a study in Clinical Infectious Diseases. The authors said facilities funded by the Ryan White HIV/AIDS Program may face attrition of highly qualified providers.

©alexskopje/ThinkStock.com

South African HIV-infected children receiving antiretroviral therapy have lower bone mass, compared with HIV-uninfected controls, according to a study by the CHANGES Bone Study group. The authors said accrued bone mass is positively associated with switching to efavirenz-based ART, compared with remaining on ritonavir-boosted lopinavir.

Sexually transmitted infection acquisition in HIV-infected adolescents and young adults is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection, according to a study in the Journal of the Pediatric Infectious Diseases Society.

A study in the journal AIDS found that viral escape in the Nef peptide is elevated preferentially in STEP vaccine–treated individuals, suggesting that vaccination primarily modulated initial cytotoxic T-lymphocyte responses.

A clinical HIV vaccine trial found that vaccination was associated with increases in HIV cell-associated RNA and HIV-specific responses during antiretroviral therapy.

The European Medicines Agency (EMA) has recommended granting a marketing authorization in the European Union (EU) for Truvada (emtricitabine/tenofovir disoproxil) for preexposure prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults at high risk.

Five-year outcomes from the IMPAACT-P1060 trial of HIV-infected antiretroviral-eligible children supported the WHO recommendation of lopinavir/ritonavir (LPV/r) in first-line ART regimens for HIV-infected children.

A systematic review of medical literature, published in Tropical Medicine & International Health, found that rigorously evaluated interventions for adult posttraumatic stress disorder in people living with HIV are rare.

HIV-infected adolescents and young adults are vulnerable to virologic failure, especially during the transitional period, a recent study found. The authors said identification of HIV-infected adolescents at high risk for virologic failure might help to improve treatment success.

Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of antiretroviral therapy, according to a study in JAIDS, and may shorten the time to virologic suppression.

New research indicates that Measurement-Based Care (MBC) interventions on depression, if implemented among HIV-infected depressed adults in routine care, may be less effective than in randomized controlled trials but can still be expected to reduce depression.

A study published in Mycoses revealed that H. capsulatum is an important agent of disseminated disease in AIDS patients in Brazil. The authors said this reinforces the importance of making available modern diagnostic tests as well as safer antifungal agents for the treatment of histoplasmosis.

An epidemiologic analysis indicates that substantial decreases in HIV incidence are possible in South Africa from sufficient uptake of both primary prevention and antiretroviral therapy, but with continuation of the status quo, HIV elimination in the country is unlikely within a 50-year time scale.

A meta-analysis showed a consistent increased risk of mortality for HIV-exposed uninfected vs. HIV-unexposed uninfected infants and children, although the authors said longitudinal research is needed to elucidate underlying mechanisms, which may help explain the differences in mortality.

A number of factors can identify HIV-infected patients at low risk of rebound with protease inhibitor (PI) monotherapy, said investigators in the PIVOT trial, and this may help to better target those who may benefit from this management strategy.

Concomitant administration of cytotoxic chemotherapy and combination antiretroviral therapy does not induce expression of membrane drug transporter protein (MTP) in HIV-infected patients, according to a study in HIV Clinical Trials. The authors said no significant changes in viral resistance were observed before and after chemotherapy, suggesting mutagenic cytotoxic chemotherapy seems not to induce mutations in HIV pro-viral DNA.

A study of HIV-infected patients with cryptococcal meningitis in the Ivory Coast revealed a high genetic diversity among Cryptococcus isolates, the occurrence of mixed infections and a high antifungal susceptibility for the majority of Ivorian cryptococcal isolates.

A Zambian study found no associations between hormonal contraception use among HIV-positive women and the risk of female-to-male HIV transmission.

Despite late presentation to HIV care, foreign-born persons can subsequently engage in their own HIV care as well as U.S.-born persons, according to a study in AIDS Care. The authors recommend interventions that promote HIV screening in foreign-born persons as a promising way to improve outcomes in these populations.

[email protected]

On Twitter @richpizzi

A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.

Projected growth in the HIV provider workforce by 2019 will not accommodate the increased number of HIV-infected persons requiring care, according to a study in Clinical Infectious Diseases. The authors said facilities funded by the Ryan White HIV/AIDS Program may face attrition of highly qualified providers.

©alexskopje/ThinkStock.com

South African HIV-infected children receiving antiretroviral therapy have lower bone mass, compared with HIV-uninfected controls, according to a study by the CHANGES Bone Study group. The authors said accrued bone mass is positively associated with switching to efavirenz-based ART, compared with remaining on ritonavir-boosted lopinavir.

Sexually transmitted infection acquisition in HIV-infected adolescents and young adults is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection, according to a study in the Journal of the Pediatric Infectious Diseases Society.

A study in the journal AIDS found that viral escape in the Nef peptide is elevated preferentially in STEP vaccine–treated individuals, suggesting that vaccination primarily modulated initial cytotoxic T-lymphocyte responses.

A clinical HIV vaccine trial found that vaccination was associated with increases in HIV cell-associated RNA and HIV-specific responses during antiretroviral therapy.

The European Medicines Agency (EMA) has recommended granting a marketing authorization in the European Union (EU) for Truvada (emtricitabine/tenofovir disoproxil) for preexposure prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults at high risk.

Five-year outcomes from the IMPAACT-P1060 trial of HIV-infected antiretroviral-eligible children supported the WHO recommendation of lopinavir/ritonavir (LPV/r) in first-line ART regimens for HIV-infected children.

A systematic review of medical literature, published in Tropical Medicine & International Health, found that rigorously evaluated interventions for adult posttraumatic stress disorder in people living with HIV are rare.

HIV-infected adolescents and young adults are vulnerable to virologic failure, especially during the transitional period, a recent study found. The authors said identification of HIV-infected adolescents at high risk for virologic failure might help to improve treatment success.

Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of antiretroviral therapy, according to a study in JAIDS, and may shorten the time to virologic suppression.

New research indicates that Measurement-Based Care (MBC) interventions on depression, if implemented among HIV-infected depressed adults in routine care, may be less effective than in randomized controlled trials but can still be expected to reduce depression.

A study published in Mycoses revealed that H. capsulatum is an important agent of disseminated disease in AIDS patients in Brazil. The authors said this reinforces the importance of making available modern diagnostic tests as well as safer antifungal agents for the treatment of histoplasmosis.

An epidemiologic analysis indicates that substantial decreases in HIV incidence are possible in South Africa from sufficient uptake of both primary prevention and antiretroviral therapy, but with continuation of the status quo, HIV elimination in the country is unlikely within a 50-year time scale.

A meta-analysis showed a consistent increased risk of mortality for HIV-exposed uninfected vs. HIV-unexposed uninfected infants and children, although the authors said longitudinal research is needed to elucidate underlying mechanisms, which may help explain the differences in mortality.

A number of factors can identify HIV-infected patients at low risk of rebound with protease inhibitor (PI) monotherapy, said investigators in the PIVOT trial, and this may help to better target those who may benefit from this management strategy.

Concomitant administration of cytotoxic chemotherapy and combination antiretroviral therapy does not induce expression of membrane drug transporter protein (MTP) in HIV-infected patients, according to a study in HIV Clinical Trials. The authors said no significant changes in viral resistance were observed before and after chemotherapy, suggesting mutagenic cytotoxic chemotherapy seems not to induce mutations in HIV pro-viral DNA.

A study of HIV-infected patients with cryptococcal meningitis in the Ivory Coast revealed a high genetic diversity among Cryptococcus isolates, the occurrence of mixed infections and a high antifungal susceptibility for the majority of Ivorian cryptococcal isolates.

A Zambian study found no associations between hormonal contraception use among HIV-positive women and the risk of female-to-male HIV transmission.

Despite late presentation to HIV care, foreign-born persons can subsequently engage in their own HIV care as well as U.S.-born persons, according to a study in AIDS Care. The authors recommend interventions that promote HIV screening in foreign-born persons as a promising way to improve outcomes in these populations.

[email protected]

On Twitter @richpizzi

A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.

Projected growth in the HIV provider workforce by 2019 will not accommodate the increased number of HIV-infected persons requiring care, according to a study in Clinical Infectious Diseases. The authors said facilities funded by the Ryan White HIV/AIDS Program may face attrition of highly qualified providers.

©alexskopje/ThinkStock.com

South African HIV-infected children receiving antiretroviral therapy have lower bone mass, compared with HIV-uninfected controls, according to a study by the CHANGES Bone Study group. The authors said accrued bone mass is positively associated with switching to efavirenz-based ART, compared with remaining on ritonavir-boosted lopinavir.

Sexually transmitted infection acquisition in HIV-infected adolescents and young adults is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection, according to a study in the Journal of the Pediatric Infectious Diseases Society.

A study in the journal AIDS found that viral escape in the Nef peptide is elevated preferentially in STEP vaccine–treated individuals, suggesting that vaccination primarily modulated initial cytotoxic T-lymphocyte responses.

A clinical HIV vaccine trial found that vaccination was associated with increases in HIV cell-associated RNA and HIV-specific responses during antiretroviral therapy.

The European Medicines Agency (EMA) has recommended granting a marketing authorization in the European Union (EU) for Truvada (emtricitabine/tenofovir disoproxil) for preexposure prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults at high risk.

Five-year outcomes from the IMPAACT-P1060 trial of HIV-infected antiretroviral-eligible children supported the WHO recommendation of lopinavir/ritonavir (LPV/r) in first-line ART regimens for HIV-infected children.

A systematic review of medical literature, published in Tropical Medicine & International Health, found that rigorously evaluated interventions for adult posttraumatic stress disorder in people living with HIV are rare.

HIV-infected adolescents and young adults are vulnerable to virologic failure, especially during the transitional period, a recent study found. The authors said identification of HIV-infected adolescents at high risk for virologic failure might help to improve treatment success.

Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of antiretroviral therapy, according to a study in JAIDS, and may shorten the time to virologic suppression.

New research indicates that Measurement-Based Care (MBC) interventions on depression, if implemented among HIV-infected depressed adults in routine care, may be less effective than in randomized controlled trials but can still be expected to reduce depression.

A study published in Mycoses revealed that H. capsulatum is an important agent of disseminated disease in AIDS patients in Brazil. The authors said this reinforces the importance of making available modern diagnostic tests as well as safer antifungal agents for the treatment of histoplasmosis.

An epidemiologic analysis indicates that substantial decreases in HIV incidence are possible in South Africa from sufficient uptake of both primary prevention and antiretroviral therapy, but with continuation of the status quo, HIV elimination in the country is unlikely within a 50-year time scale.

A meta-analysis showed a consistent increased risk of mortality for HIV-exposed uninfected vs. HIV-unexposed uninfected infants and children, although the authors said longitudinal research is needed to elucidate underlying mechanisms, which may help explain the differences in mortality.

A number of factors can identify HIV-infected patients at low risk of rebound with protease inhibitor (PI) monotherapy, said investigators in the PIVOT trial, and this may help to better target those who may benefit from this management strategy.

Concomitant administration of cytotoxic chemotherapy and combination antiretroviral therapy does not induce expression of membrane drug transporter protein (MTP) in HIV-infected patients, according to a study in HIV Clinical Trials. The authors said no significant changes in viral resistance were observed before and after chemotherapy, suggesting mutagenic cytotoxic chemotherapy seems not to induce mutations in HIV pro-viral DNA.

A study of HIV-infected patients with cryptococcal meningitis in the Ivory Coast revealed a high genetic diversity among Cryptococcus isolates, the occurrence of mixed infections and a high antifungal susceptibility for the majority of Ivorian cryptococcal isolates.

A Zambian study found no associations between hormonal contraception use among HIV-positive women and the risk of female-to-male HIV transmission.

Despite late presentation to HIV care, foreign-born persons can subsequently engage in their own HIV care as well as U.S.-born persons, according to a study in AIDS Care. The authors recommend interventions that promote HIV screening in foreign-born persons as a promising way to improve outcomes in these populations.

[email protected]

On Twitter @richpizzi

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial 

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial 

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial 

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial

[email protected]

On Twitter @whitneymcknight

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial

[email protected]

On Twitter @whitneymcknight

BETHESDA, MD. – A smartphone application helped decrease depressive symptoms and improve confidence in self care for low-income pregnant women in their third trimester, a pilot study has shown.

“There is a difficulty in bringing mental health into the OB setting, particularly for underserved communities, in part because of too much to accomplish during a visit or because some women don’t think it’s the appropriate place to talk about their mental health concerns,” Liisa Hantsoo, PhD, a researcher at the Penn Center for Women’s Behavioral Wellness in Philadelphia, said during the annual National Institute of Mental Health Conference on Mental Health Services Research.

However, in a single academic site pilot study of 64 pregnant women, most of whom were covered under Medicaid, Dr. Hantsoo and her colleagues found that when the women were given access to their obstetrician’s office via a smartphone app integrated into the practice, they were significantly more likely to open up about their mental health concerns, spend more time in conversation with their clinician when symptoms increased, and experience fewer symptoms of depression and anxiety.

“Participants used the app frequently, they reported feeling more positive about their emotions, and they reported feeling more confident about taking care of their own health during their third trimester,” Dr. Hantsoo said.

All women in the study were assessed for depression using the Patient Health Questionnaire depression module (PHQ-9). Women with scores of 5 or higher who were no more than 32 weeks pregnant were included in the study. The women – more than half of whom had a prior history of mental illness – were also assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). And they were asked to rate their satisfaction levels with their OB care at baseline, including whether they believed their care team connected with them as individuals. The study participants were all in their mid-20s and had previously given birth.

Twenty-two women were randomly assigned to use a control app, which only allowed self-initiated communication with the practice through an established patient portal not designed specifically for mental health. Another 23 women were assigned to the same control app plus an app designed by Ginger.io for mental health self-care and symptom tracking. The study app included daily cognitive-behavioral therapy messages, other behavioral health educational messages, and prompts to record self-assessments of mood that were monitored daily by a care coordinator. The remaining 19 women were assigned to both apps and received additional prompts throughout the day to record their thoughts and mood, which were also monitored. If a patient’s depressive symptoms increased, the care coordinator alerted a physician in the practice, who then contacted the patient.

By week 8, the study app users had significantly decreased PHQ-9 scores (P = .001) and significantly decreased GAD-7 scores (P = .003). The combined study cohorts (women using the study app and those with the study app plus prompts to record mood) also self-reported significantly improved mood ratings at week 8 (P = .03). The combined study groups also reported more confidence in their ability to care for themselves, particularly in their third trimester, compared with women using only the control app (P = .002).

The difference is likely because of the ways that the study app was integrated into care, Dr. Hantsoo said. “Apps allow self-monitoring and identify your patterns over time, but they are also limited in that they aren’t often integrated into treatment or care, leaving a person hanging in distress if they enter their data, but then not having it seem to go anywhere. This app allowed patients to interact with their providers.”

Use of any app did not significantly affect how participants rated their overall care, although at least half of all study app users reported feeling more confident in their ability to assess and manage their moods and their overall health, particularly in their third trimester.

As for the physicians who participated in the study, they reported needing more time each week to respond to app-triggered patient needs. “It was a bit of a disruption, but they did report they thought it was worthwhile to do,” Dr. Hantsoo said in an interview.

Support for this study was provided by Ginger.io and by the Penn Medicine Center for Health Care Innovation. Dr. Hantsoo reported having no relevant financial

[email protected]

On Twitter @whitneymcknight

In 2015, researchers in China announced they had found for the first time a bacterial gene conferring resistance to colistin. The gene was present in samples from agricultural animals and in 1% of tested patients.1 Colistin, an antibiotic from the 1950s, is rarely prescribed; it is often considered an antibiotic of last resort.

In May 2016, the U.S. Department of Defense announced this gene, called mcr-1, had been found in E. coli isolated from the urine of a patient in Pennsylvania presenting with symptoms of a urinary tract infection.2 Subsequent surveillance also found mcr-1 E. coli in a pig.

The news has been met with grave concern by public health officials, scientists, infectious disease specialists, and countless physicians around the U.S. It has also served as a reminder that good antibiotic stewardship is a national, if not international, imperative.

“The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria,” the authors of the recent U.S. study, from the Walter Reed National Military Medical Center, wrote in their opening sentence.

In November 2015, the Society of Hospital Medicine (SHM) launched an antibiotic stewardship campaign, “Fight the Resistance,” in partnership with the Centers for Disease Control and Prevention (CDC). Hospitalists around the country have taken the lead on confronting the issue head on.

When the CDC and the White House called for action last year, “SHM jumped in with both feet,” says Eric Howell, MD, MHM, SHM’s senior physician advisor, chief of the Division of Hospital Medicine at Johns Hopkins Bayview, and professor of medicine at Johns Hopkins University in Baltimore. The “Fight the Resistance” campaign calls for the nation’s 44,000 hospitalists to commit to responsible antibiotic-prescribing practices.

“While it’s extremely alarming, leading up to this, we knew there was a crisis of antibiotic resistance,” says Megan Mack, MD, a hospitalist and clinical instructor in the University of Michigan Health System in Ann Arbor. “We know more antibiotic use is not the answer, stronger is not the answer. We need to be peeling back antibiotic use, honing when we need them, narrowing how we use them as much as possible, and keeping the duration as short as possible.”

Dr. Mack is first author of a new study in the Journal of Hospital Medicine that examines hospitalist-driven antibiotic stewardship efforts in five hospitals around the country.3

The Institute for Healthcare Improvement, with the CDC, recruited Dr. Mack and her study coauthors, hospitalists Jeff Rohde, MD, and Scott Flanders, MD, MHM, to participate.

“We were interested in the opportunity to put into place interventions in five different hospitals and to be able to share our successes and our barriers, which we did twice monthly,” Dr. Mack says.

Each hospital in the collaborative, which included teaching and non-teaching community hospitals and academic medical centers, focused on its own data and tailored its stewardship interventions to three strategies shown to be quality indicators of successful stewardship programs.

These strategies included:

• Enhanced documentation with regard to antimicrobial prescribing and use
• Improved quality and accessibility of guidelines for common infections
• Adoption of a 72-hour antibiotic timeout to reassess a patient’s antibiotic treatment plan once culture results were available

Each hospital used its own particular antibiotic stewardship practice data to educate and inform its physicians, which Dr. Mack says was important to the success of interventions because it was “concrete and realistic.”

The study found that in two hospitals, complete antibiotic documentation in patient records increased to 51% from 4% and to 65% from 8%. It also recorded 726 antibiotic timeouts, resulting in 218 antibiotic treatment adjustments or discontinuations. It also found several barriers to improved antibiotic stewardship.

“[Hospitalists] are stretched for time. We’re constantly being pulled in multiple directions,” Dr. Mack says. “We are bombarded daily with quality improvement initiatives and with constantly meeting metrics deemed to be priorities, so we tried interventions that were easily incorporated into daily workflow.”

The team learned that workflow integration was a requirement for success. For instance, Dr. Mack suggests building antibiotic prescribing into hospitalists’ electronic health records, with automatic stop dates that must be overridden by a physician. “It’s too easy to overlook it, and 10 days later, your patient is still on vancomycin.”

The experience, she says, made her fellow physicians in the collaborative realize that, despite some skepticism, good antimicrobial stewardship can be achieved without significant disruption.

“If we don’t change our practice patterns, there are not enough antibiotics in the pipeline to mitigate the effects,” of resistance, says Dr. Howell, who was not involved in the study. “We can’t stop resistance, but we can change our practice patterns so we slow the rate of resistance and give ourselves time to develop new therapies to treat infections.”

This includes behavioral changes hospitalists can easily incorporate, Dr. Howell says, which align with the strategies assessed in Dr. Mack’s study. These include rethinking the treatment time course, antibiotic timeouts, and adhering to prescribing guidelines.

Hospitalists, he says, are well-positioned to lead antibiotic stewardship efforts.

“We’re quality improvement experts … and there are not enough infectious disease physicians in the country to roll out antibiotic stewardship programs, so there is space for hospitalists,” Dr. Howell explains. “In every hospital, we are prescribing these medications, so we own the problem.” TH

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Liu YY, Wang Y, Walsh TR, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2016;16(2):161-168. doi:10.1016/S1473-3099(15)00424-7.
2. McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: First report of mcr-1 in the USA. Antimicrob Agents Chemother. 2016;60(7):4420-4421.
3. Mack MR, Rohde JM, Jacobsen D, et al. Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative [published online ahead of print on April 30, 2016]. J Hosp Med. doi:10.1002/jhm.2599.

In 2015, researchers in China announced they had found for the first time a bacterial gene conferring resistance to colistin. The gene was present in samples from agricultural animals and in 1% of tested patients.1 Colistin, an antibiotic from the 1950s, is rarely prescribed; it is often considered an antibiotic of last resort.

In May 2016, the U.S. Department of Defense announced this gene, called mcr-1, had been found in E. coli isolated from the urine of a patient in Pennsylvania presenting with symptoms of a urinary tract infection.2 Subsequent surveillance also found mcr-1 E. coli in a pig.

The news has been met with grave concern by public health officials, scientists, infectious disease specialists, and countless physicians around the U.S. It has also served as a reminder that good antibiotic stewardship is a national, if not international, imperative.

“The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria,” the authors of the recent U.S. study, from the Walter Reed National Military Medical Center, wrote in their opening sentence.

In November 2015, the Society of Hospital Medicine (SHM) launched an antibiotic stewardship campaign, “Fight the Resistance,” in partnership with the Centers for Disease Control and Prevention (CDC). Hospitalists around the country have taken the lead on confronting the issue head on.

When the CDC and the White House called for action last year, “SHM jumped in with both feet,” says Eric Howell, MD, MHM, SHM’s senior physician advisor, chief of the Division of Hospital Medicine at Johns Hopkins Bayview, and professor of medicine at Johns Hopkins University in Baltimore. The “Fight the Resistance” campaign calls for the nation’s 44,000 hospitalists to commit to responsible antibiotic-prescribing practices.

“While it’s extremely alarming, leading up to this, we knew there was a crisis of antibiotic resistance,” says Megan Mack, MD, a hospitalist and clinical instructor in the University of Michigan Health System in Ann Arbor. “We know more antibiotic use is not the answer, stronger is not the answer. We need to be peeling back antibiotic use, honing when we need them, narrowing how we use them as much as possible, and keeping the duration as short as possible.”

Dr. Mack is first author of a new study in the Journal of Hospital Medicine that examines hospitalist-driven antibiotic stewardship efforts in five hospitals around the country.3

The Institute for Healthcare Improvement, with the CDC, recruited Dr. Mack and her study coauthors, hospitalists Jeff Rohde, MD, and Scott Flanders, MD, MHM, to participate.

“We were interested in the opportunity to put into place interventions in five different hospitals and to be able to share our successes and our barriers, which we did twice monthly,” Dr. Mack says.

Each hospital in the collaborative, which included teaching and non-teaching community hospitals and academic medical centers, focused on its own data and tailored its stewardship interventions to three strategies shown to be quality indicators of successful stewardship programs.

These strategies included:

• Enhanced documentation with regard to antimicrobial prescribing and use
• Improved quality and accessibility of guidelines for common infections
• Adoption of a 72-hour antibiotic timeout to reassess a patient’s antibiotic treatment plan once culture results were available

Each hospital used its own particular antibiotic stewardship practice data to educate and inform its physicians, which Dr. Mack says was important to the success of interventions because it was “concrete and realistic.”

The study found that in two hospitals, complete antibiotic documentation in patient records increased to 51% from 4% and to 65% from 8%. It also recorded 726 antibiotic timeouts, resulting in 218 antibiotic treatment adjustments or discontinuations. It also found several barriers to improved antibiotic stewardship.

“[Hospitalists] are stretched for time. We’re constantly being pulled in multiple directions,” Dr. Mack says. “We are bombarded daily with quality improvement initiatives and with constantly meeting metrics deemed to be priorities, so we tried interventions that were easily incorporated into daily workflow.”

The team learned that workflow integration was a requirement for success. For instance, Dr. Mack suggests building antibiotic prescribing into hospitalists’ electronic health records, with automatic stop dates that must be overridden by a physician. “It’s too easy to overlook it, and 10 days later, your patient is still on vancomycin.”

The experience, she says, made her fellow physicians in the collaborative realize that, despite some skepticism, good antimicrobial stewardship can be achieved without significant disruption.

“If we don’t change our practice patterns, there are not enough antibiotics in the pipeline to mitigate the effects,” of resistance, says Dr. Howell, who was not involved in the study. “We can’t stop resistance, but we can change our practice patterns so we slow the rate of resistance and give ourselves time to develop new therapies to treat infections.”

This includes behavioral changes hospitalists can easily incorporate, Dr. Howell says, which align with the strategies assessed in Dr. Mack’s study. These include rethinking the treatment time course, antibiotic timeouts, and adhering to prescribing guidelines.

Hospitalists, he says, are well-positioned to lead antibiotic stewardship efforts.

“We’re quality improvement experts … and there are not enough infectious disease physicians in the country to roll out antibiotic stewardship programs, so there is space for hospitalists,” Dr. Howell explains. “In every hospital, we are prescribing these medications, so we own the problem.” TH

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Liu YY, Wang Y, Walsh TR, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2016;16(2):161-168. doi:10.1016/S1473-3099(15)00424-7.
2. McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: First report of mcr-1 in the USA. Antimicrob Agents Chemother. 2016;60(7):4420-4421.
3. Mack MR, Rohde JM, Jacobsen D, et al. Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative [published online ahead of print on April 30, 2016]. J Hosp Med. doi:10.1002/jhm.2599.

In 2015, researchers in China announced they had found for the first time a bacterial gene conferring resistance to colistin. The gene was present in samples from agricultural animals and in 1% of tested patients.1 Colistin, an antibiotic from the 1950s, is rarely prescribed; it is often considered an antibiotic of last resort.

In May 2016, the U.S. Department of Defense announced this gene, called mcr-1, had been found in E. coli isolated from the urine of a patient in Pennsylvania presenting with symptoms of a urinary tract infection.2 Subsequent surveillance also found mcr-1 E. coli in a pig.

The news has been met with grave concern by public health officials, scientists, infectious disease specialists, and countless physicians around the U.S. It has also served as a reminder that good antibiotic stewardship is a national, if not international, imperative.

“The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria,” the authors of the recent U.S. study, from the Walter Reed National Military Medical Center, wrote in their opening sentence.

In November 2015, the Society of Hospital Medicine (SHM) launched an antibiotic stewardship campaign, “Fight the Resistance,” in partnership with the Centers for Disease Control and Prevention (CDC). Hospitalists around the country have taken the lead on confronting the issue head on.

When the CDC and the White House called for action last year, “SHM jumped in with both feet,” says Eric Howell, MD, MHM, SHM’s senior physician advisor, chief of the Division of Hospital Medicine at Johns Hopkins Bayview, and professor of medicine at Johns Hopkins University in Baltimore. The “Fight the Resistance” campaign calls for the nation’s 44,000 hospitalists to commit to responsible antibiotic-prescribing practices.

“While it’s extremely alarming, leading up to this, we knew there was a crisis of antibiotic resistance,” says Megan Mack, MD, a hospitalist and clinical instructor in the University of Michigan Health System in Ann Arbor. “We know more antibiotic use is not the answer, stronger is not the answer. We need to be peeling back antibiotic use, honing when we need them, narrowing how we use them as much as possible, and keeping the duration as short as possible.”

Dr. Mack is first author of a new study in the Journal of Hospital Medicine that examines hospitalist-driven antibiotic stewardship efforts in five hospitals around the country.3

The Institute for Healthcare Improvement, with the CDC, recruited Dr. Mack and her study coauthors, hospitalists Jeff Rohde, MD, and Scott Flanders, MD, MHM, to participate.

“We were interested in the opportunity to put into place interventions in five different hospitals and to be able to share our successes and our barriers, which we did twice monthly,” Dr. Mack says.

Each hospital in the collaborative, which included teaching and non-teaching community hospitals and academic medical centers, focused on its own data and tailored its stewardship interventions to three strategies shown to be quality indicators of successful stewardship programs.

These strategies included:

• Enhanced documentation with regard to antimicrobial prescribing and use
• Improved quality and accessibility of guidelines for common infections
• Adoption of a 72-hour antibiotic timeout to reassess a patient’s antibiotic treatment plan once culture results were available

Each hospital used its own particular antibiotic stewardship practice data to educate and inform its physicians, which Dr. Mack says was important to the success of interventions because it was “concrete and realistic.”

The study found that in two hospitals, complete antibiotic documentation in patient records increased to 51% from 4% and to 65% from 8%. It also recorded 726 antibiotic timeouts, resulting in 218 antibiotic treatment adjustments or discontinuations. It also found several barriers to improved antibiotic stewardship.

“[Hospitalists] are stretched for time. We’re constantly being pulled in multiple directions,” Dr. Mack says. “We are bombarded daily with quality improvement initiatives and with constantly meeting metrics deemed to be priorities, so we tried interventions that were easily incorporated into daily workflow.”

The team learned that workflow integration was a requirement for success. For instance, Dr. Mack suggests building antibiotic prescribing into hospitalists’ electronic health records, with automatic stop dates that must be overridden by a physician. “It’s too easy to overlook it, and 10 days later, your patient is still on vancomycin.”

The experience, she says, made her fellow physicians in the collaborative realize that, despite some skepticism, good antimicrobial stewardship can be achieved without significant disruption.

“If we don’t change our practice patterns, there are not enough antibiotics in the pipeline to mitigate the effects,” of resistance, says Dr. Howell, who was not involved in the study. “We can’t stop resistance, but we can change our practice patterns so we slow the rate of resistance and give ourselves time to develop new therapies to treat infections.”

This includes behavioral changes hospitalists can easily incorporate, Dr. Howell says, which align with the strategies assessed in Dr. Mack’s study. These include rethinking the treatment time course, antibiotic timeouts, and adhering to prescribing guidelines.

Hospitalists, he says, are well-positioned to lead antibiotic stewardship efforts.

“We’re quality improvement experts … and there are not enough infectious disease physicians in the country to roll out antibiotic stewardship programs, so there is space for hospitalists,” Dr. Howell explains. “In every hospital, we are prescribing these medications, so we own the problem.” TH

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Liu YY, Wang Y, Walsh TR, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2016;16(2):161-168. doi:10.1016/S1473-3099(15)00424-7.
2. McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: First report of mcr-1 in the USA. Antimicrob Agents Chemother. 2016;60(7):4420-4421.
3. Mack MR, Rohde JM, Jacobsen D, et al. Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative [published online ahead of print on April 30, 2016]. J Hosp Med. doi:10.1002/jhm.2599.

Rhesus macaque

Photo by Einar Fredriksen

Three types of investigational vaccines can protect monkeys from Zika virus infection, according to research published in Science.

Investigators found that an inactivated virus vaccine, a DNA-based vaccine, and an adenovirus vector-based vaccine induced immune responses and protected against infection in rhesus macaques challenged with the Zika virus.

In addition, there were no adverse events observed with any of the vaccines.

The investigators first tested the inactivated Zika virus vaccine in 16 rhesus macaques. Eight animals received the experimental vaccine, and 8 received a placebo injection.

Within 2 weeks of the initial injection, all vaccinated animals developed neutralizing antibodies as well as antibodies specific to the viral envelope protein, a key vaccine target on the Zika virus. A second dose was given 4 weeks later, which substantially boosted antibody levels.

The monkeys were then challenged with Zika virus. Following exposure, the vaccinated animals had no detectable virus and showed no other evidence of infection, while the group that received the placebo injection developed high levels of virus replication in the blood and other tissues for 6 to 7 days.

In another experiment, the investigators administered 2 doses of a DNA vaccine, 1 dose of an adenovirus vector vaccine, or a placebo injection to 3 groups of 4 monkeys each. The group that received the DNA vaccine received a booster shot 4 weeks after the initial vaccination.

Minimal levels of antibodies were detected after the first injection of the DNA vaccine. However, after the second injection, investigators detected Zika-specific neutralizing antibodies in the animals.

The adenovirus vector-based vaccine induced Zika-specific neutralizing antibodies 2 weeks after the single injection.

The animals were exposed to Zika virus 4 weeks after the final vaccination. Both the DNA vaccine and the adenovirus vector vaccine provided complete protection against infection.

The investigators said these encouraging findings suggest a path forward for clinical development of Zika vaccines in humans.

Rhesus macaque

Photo by Einar Fredriksen

Three types of investigational vaccines can protect monkeys from Zika virus infection, according to research published in Science.

Investigators found that an inactivated virus vaccine, a DNA-based vaccine, and an adenovirus vector-based vaccine induced immune responses and protected against infection in rhesus macaques challenged with the Zika virus.

In addition, there were no adverse events observed with any of the vaccines.

The investigators first tested the inactivated Zika virus vaccine in 16 rhesus macaques. Eight animals received the experimental vaccine, and 8 received a placebo injection.

Within 2 weeks of the initial injection, all vaccinated animals developed neutralizing antibodies as well as antibodies specific to the viral envelope protein, a key vaccine target on the Zika virus. A second dose was given 4 weeks later, which substantially boosted antibody levels.

The monkeys were then challenged with Zika virus. Following exposure, the vaccinated animals had no detectable virus and showed no other evidence of infection, while the group that received the placebo injection developed high levels of virus replication in the blood and other tissues for 6 to 7 days.

In another experiment, the investigators administered 2 doses of a DNA vaccine, 1 dose of an adenovirus vector vaccine, or a placebo injection to 3 groups of 4 monkeys each. The group that received the DNA vaccine received a booster shot 4 weeks after the initial vaccination.

Minimal levels of antibodies were detected after the first injection of the DNA vaccine. However, after the second injection, investigators detected Zika-specific neutralizing antibodies in the animals.

The adenovirus vector-based vaccine induced Zika-specific neutralizing antibodies 2 weeks after the single injection.

The animals were exposed to Zika virus 4 weeks after the final vaccination. Both the DNA vaccine and the adenovirus vector vaccine provided complete protection against infection.

The investigators said these encouraging findings suggest a path forward for clinical development of Zika vaccines in humans.

Rhesus macaque

Photo by Einar Fredriksen

Three types of investigational vaccines can protect monkeys from Zika virus infection, according to research published in Science.

Investigators found that an inactivated virus vaccine, a DNA-based vaccine, and an adenovirus vector-based vaccine induced immune responses and protected against infection in rhesus macaques challenged with the Zika virus.

In addition, there were no adverse events observed with any of the vaccines.

The investigators first tested the inactivated Zika virus vaccine in 16 rhesus macaques. Eight animals received the experimental vaccine, and 8 received a placebo injection.

Within 2 weeks of the initial injection, all vaccinated animals developed neutralizing antibodies as well as antibodies specific to the viral envelope protein, a key vaccine target on the Zika virus. A second dose was given 4 weeks later, which substantially boosted antibody levels.

The monkeys were then challenged with Zika virus. Following exposure, the vaccinated animals had no detectable virus and showed no other evidence of infection, while the group that received the placebo injection developed high levels of virus replication in the blood and other tissues for 6 to 7 days.

In another experiment, the investigators administered 2 doses of a DNA vaccine, 1 dose of an adenovirus vector vaccine, or a placebo injection to 3 groups of 4 monkeys each. The group that received the DNA vaccine received a booster shot 4 weeks after the initial vaccination.

Minimal levels of antibodies were detected after the first injection of the DNA vaccine. However, after the second injection, investigators detected Zika-specific neutralizing antibodies in the animals.

The adenovirus vector-based vaccine induced Zika-specific neutralizing antibodies 2 weeks after the single injection.

The animals were exposed to Zika virus 4 weeks after the final vaccination. Both the DNA vaccine and the adenovirus vector vaccine provided complete protection against infection.

The investigators said these encouraging findings suggest a path forward for clinical development of Zika vaccines in humans.

Nonpharmacological factors including being female and having cardiovascular disease have an impact on early response among patients hospitalized with cellulitis, a single-center prospective study found.

“Cellulitis is usually caused by beta-hemolytic streptococci (BHS) susceptible to penicillin and other narrow-spectrum antibiotics,” researchers led by Trond Bruun, MD, of the department of clinical science at the University of Bergen, Norway, wrote in a study published online on July 11, 2016, in Clinical Infectious Diseases.

“However, there are significant treatment challenges, including overuse of broad-spectrum and intravenous antibiotics, difficulties regarding when to initiate rescue therapy and when to stop treatment, as well as frequent recurrences. Toxin effects and profound local inflammation, not necessarily corresponding to bacterial burden or antibiotic needs, may contribute to these problems.”

In an effort to better understand the clinical course, response dynamics, and associated factors involved with cellulitis care, the researchers evaluated 216 patients hospitalized with the condition at Haukeland University Hospital, Norway. They analyzed clinical and biochemical response data during the first 3 days of treatment in relation to baseline factors, antibiotic use, surgery, and outcome (Clin Infect Dis. 2016 Jul 11. pii: ciw463. [Epub ahead of print]).

The median age of the patients was 55 years and 57% had a lower extremity infection. After 1 day of treatment, the researchers found that 55% of evaluable patients (116 of 211) had cessation of lesion spread and 52% (109 of 211) had improvement of local inflammation. Local clinical response – defined as a combination of cessation of lesion spread and improvement of local inflammation – was observed in 39% of patients (82 of 212), while local clinical response or biochemical response was seen in 74% of cases (148 of 200).

Nonpharmacological factors found to predict nonresponse on treatment day 3 were cardiovascular disease (odds ratio, 2.83), female gender (OR, 2.09), and a higher body mass index (OR, 1.03). A shorter duration of symptoms and cellulitis other than typical erysipelas were also predictive of nonresponse on treatment day 3. On the other hand, baseline factors were not predictive of clinical failure assessed post treatment.

Among patients who received antibiotic treatment escalation within 2 days of starting treatment, most (90%) had nonresponse on treatment day 1, but only 5% had inappropriate initial therapy. Nonresponse on treatment day 3 was a predictor of treatment duration exceeding 14 days, but not of clinical failure.

“Overall, the study indicates that nonantibiotic factors with impact on early treatment response should be considered as an integrated part of the clinical management of cellulitis,” the researchers concluded. “This may improve individualization of treatment and reduce costs and unnecessary rescue therapy.”

The study was supported by a research grant from the department of clinical science at the University of Bergen. The researchers reported having no financial disclosures.

[email protected]

Nonpharmacological factors including being female and having cardiovascular disease have an impact on early response among patients hospitalized with cellulitis, a single-center prospective study found.

“Cellulitis is usually caused by beta-hemolytic streptococci (BHS) susceptible to penicillin and other narrow-spectrum antibiotics,” researchers led by Trond Bruun, MD, of the department of clinical science at the University of Bergen, Norway, wrote in a study published online on July 11, 2016, in Clinical Infectious Diseases.

“However, there are significant treatment challenges, including overuse of broad-spectrum and intravenous antibiotics, difficulties regarding when to initiate rescue therapy and when to stop treatment, as well as frequent recurrences. Toxin effects and profound local inflammation, not necessarily corresponding to bacterial burden or antibiotic needs, may contribute to these problems.”

In an effort to better understand the clinical course, response dynamics, and associated factors involved with cellulitis care, the researchers evaluated 216 patients hospitalized with the condition at Haukeland University Hospital, Norway. They analyzed clinical and biochemical response data during the first 3 days of treatment in relation to baseline factors, antibiotic use, surgery, and outcome (Clin Infect Dis. 2016 Jul 11. pii: ciw463. [Epub ahead of print]).

The median age of the patients was 55 years and 57% had a lower extremity infection. After 1 day of treatment, the researchers found that 55% of evaluable patients (116 of 211) had cessation of lesion spread and 52% (109 of 211) had improvement of local inflammation. Local clinical response – defined as a combination of cessation of lesion spread and improvement of local inflammation – was observed in 39% of patients (82 of 212), while local clinical response or biochemical response was seen in 74% of cases (148 of 200).

Nonpharmacological factors found to predict nonresponse on treatment day 3 were cardiovascular disease (odds ratio, 2.83), female gender (OR, 2.09), and a higher body mass index (OR, 1.03). A shorter duration of symptoms and cellulitis other than typical erysipelas were also predictive of nonresponse on treatment day 3. On the other hand, baseline factors were not predictive of clinical failure assessed post treatment.

Among patients who received antibiotic treatment escalation within 2 days of starting treatment, most (90%) had nonresponse on treatment day 1, but only 5% had inappropriate initial therapy. Nonresponse on treatment day 3 was a predictor of treatment duration exceeding 14 days, but not of clinical failure.

“Overall, the study indicates that nonantibiotic factors with impact on early treatment response should be considered as an integrated part of the clinical management of cellulitis,” the researchers concluded. “This may improve individualization of treatment and reduce costs and unnecessary rescue therapy.”

The study was supported by a research grant from the department of clinical science at the University of Bergen. The researchers reported having no financial disclosures.

[email protected]

Nonpharmacological factors including being female and having cardiovascular disease have an impact on early response among patients hospitalized with cellulitis, a single-center prospective study found.

“Cellulitis is usually caused by beta-hemolytic streptococci (BHS) susceptible to penicillin and other narrow-spectrum antibiotics,” researchers led by Trond Bruun, MD, of the department of clinical science at the University of Bergen, Norway, wrote in a study published online on July 11, 2016, in Clinical Infectious Diseases.

“However, there are significant treatment challenges, including overuse of broad-spectrum and intravenous antibiotics, difficulties regarding when to initiate rescue therapy and when to stop treatment, as well as frequent recurrences. Toxin effects and profound local inflammation, not necessarily corresponding to bacterial burden or antibiotic needs, may contribute to these problems.”

In an effort to better understand the clinical course, response dynamics, and associated factors involved with cellulitis care, the researchers evaluated 216 patients hospitalized with the condition at Haukeland University Hospital, Norway. They analyzed clinical and biochemical response data during the first 3 days of treatment in relation to baseline factors, antibiotic use, surgery, and outcome (Clin Infect Dis. 2016 Jul 11. pii: ciw463. [Epub ahead of print]).

The median age of the patients was 55 years and 57% had a lower extremity infection. After 1 day of treatment, the researchers found that 55% of evaluable patients (116 of 211) had cessation of lesion spread and 52% (109 of 211) had improvement of local inflammation. Local clinical response – defined as a combination of cessation of lesion spread and improvement of local inflammation – was observed in 39% of patients (82 of 212), while local clinical response or biochemical response was seen in 74% of cases (148 of 200).

Nonpharmacological factors found to predict nonresponse on treatment day 3 were cardiovascular disease (odds ratio, 2.83), female gender (OR, 2.09), and a higher body mass index (OR, 1.03). A shorter duration of symptoms and cellulitis other than typical erysipelas were also predictive of nonresponse on treatment day 3. On the other hand, baseline factors were not predictive of clinical failure assessed post treatment.

Among patients who received antibiotic treatment escalation within 2 days of starting treatment, most (90%) had nonresponse on treatment day 1, but only 5% had inappropriate initial therapy. Nonresponse on treatment day 3 was a predictor of treatment duration exceeding 14 days, but not of clinical failure.

“Overall, the study indicates that nonantibiotic factors with impact on early treatment response should be considered as an integrated part of the clinical management of cellulitis,” the researchers concluded. “This may improve individualization of treatment and reduce costs and unnecessary rescue therapy.”

The study was supported by a research grant from the department of clinical science at the University of Bergen. The researchers reported having no financial disclosures.

[email protected]

The potential feasibility that in vivo human intestine can be developed from pluripotent stem cells offers hope to short-bowel patients chronically dependent on parenteral nutrition. Perhaps greater than this promise is the opportunity that now exists to develop models to test human-specific intestinal diseases that are not well characterized by human in vitro culture systems or current animal models. Translational examples of this include studies to examine normal and diseased conditions involving intestinal development and common human gastrointestinal infectious diseases.

In contrast to using primary cell cultures that require human intestinal samples, Spence et al (Nature. 2011 Feb;470:105-9) described an in vitro approach for generating human intestinal tissue from pluripotent stem cells termed human intestinal organoids (HIOs). Although these in vitro HIOs have some basic intestinal functionality, this model is insufficient for investigating the broad physiologic mechanisms associated with human intestinal diseases. Taking advantage of the fact that HIOs contain both epithelium and supporting mesenchyme required for engraftment that does not exist in enteroids derived from human crypt biopsies, we recently developed an in vivo transplant model (Nature Med. 2014;20:1310-4). Within 6-8 weeks after transplantation, these structures mature and grow 100-fold larger in volume.

Histologic studies show that engrafted tissue resembles native human intestine with crypt-villus architecture, underlying laminated structures, and smooth muscle layers. Further characterization revealed proliferative cells located in the base of crypts that also expressed stem cell markers. The ability to generate in vitro enteroids from these crypts demonstrates the existence of an intestinal stem cell pool. Functionally engrafted HIOs express an active brush border, barrier function, and peptide uptake. HIOs respond to humeral physiologic factors, as we demonstrated that morphometric adaptive changes with HIOs occur following intestinal resection in the host mouse.

To completely develop a functional human intestine it must contain an enteric nervous system (ENS), have an immune component, and be exposed to luminal nutrients and microbiota. Ongoing studies have developed methods to incorporate a functional ENS derived from the same pluripotent stem cell lines used to develop HIOs. Models to transplant HIOs into the mesentery of the murine bowel have allowed the development of surgical models that expose the HIOs to both luminal nutrition and microbiota. New models involving bone marrow transplantation should provide a human immune system.

Finally, the ability to generate induced pluripotent stem cells (iPS cells) from individual patients offers the unique advantage to study patient-specific factors contributing to human intestinal disease. We believe this model will provide an exciting new opportunity to understand many complex human conditions and test new therapies. Ultimately, the ability to grow functional patient-specific intestinal tissue offers the future reality of tissue replacement without immunosuppression for patients with intestinal failure.

Dr. Helmrath is professor of surgery, director of surgical research and the intestinal rehabilitation program, and the Richard Azizkhan Chair in Pediatric Surgery at Cincinnati Children’s Hospital Medical Center. He made these remarks in a Presidential Plenary session at the 2016 Digestive Disease Week.

The potential feasibility that in vivo human intestine can be developed from pluripotent stem cells offers hope to short-bowel patients chronically dependent on parenteral nutrition. Perhaps greater than this promise is the opportunity that now exists to develop models to test human-specific intestinal diseases that are not well characterized by human in vitro culture systems or current animal models. Translational examples of this include studies to examine normal and diseased conditions involving intestinal development and common human gastrointestinal infectious diseases.

In contrast to using primary cell cultures that require human intestinal samples, Spence et al (Nature. 2011 Feb;470:105-9) described an in vitro approach for generating human intestinal tissue from pluripotent stem cells termed human intestinal organoids (HIOs). Although these in vitro HIOs have some basic intestinal functionality, this model is insufficient for investigating the broad physiologic mechanisms associated with human intestinal diseases. Taking advantage of the fact that HIOs contain both epithelium and supporting mesenchyme required for engraftment that does not exist in enteroids derived from human crypt biopsies, we recently developed an in vivo transplant model (Nature Med. 2014;20:1310-4). Within 6-8 weeks after transplantation, these structures mature and grow 100-fold larger in volume.

Histologic studies show that engrafted tissue resembles native human intestine with crypt-villus architecture, underlying laminated structures, and smooth muscle layers. Further characterization revealed proliferative cells located in the base of crypts that also expressed stem cell markers. The ability to generate in vitro enteroids from these crypts demonstrates the existence of an intestinal stem cell pool. Functionally engrafted HIOs express an active brush border, barrier function, and peptide uptake. HIOs respond to humeral physiologic factors, as we demonstrated that morphometric adaptive changes with HIOs occur following intestinal resection in the host mouse.

To completely develop a functional human intestine it must contain an enteric nervous system (ENS), have an immune component, and be exposed to luminal nutrients and microbiota. Ongoing studies have developed methods to incorporate a functional ENS derived from the same pluripotent stem cell lines used to develop HIOs. Models to transplant HIOs into the mesentery of the murine bowel have allowed the development of surgical models that expose the HIOs to both luminal nutrition and microbiota. New models involving bone marrow transplantation should provide a human immune system.

Finally, the ability to generate induced pluripotent stem cells (iPS cells) from individual patients offers the unique advantage to study patient-specific factors contributing to human intestinal disease. We believe this model will provide an exciting new opportunity to understand many complex human conditions and test new therapies. Ultimately, the ability to grow functional patient-specific intestinal tissue offers the future reality of tissue replacement without immunosuppression for patients with intestinal failure.

Dr. Helmrath is professor of surgery, director of surgical research and the intestinal rehabilitation program, and the Richard Azizkhan Chair in Pediatric Surgery at Cincinnati Children’s Hospital Medical Center. He made these remarks in a Presidential Plenary session at the 2016 Digestive Disease Week.

The potential feasibility that in vivo human intestine can be developed from pluripotent stem cells offers hope to short-bowel patients chronically dependent on parenteral nutrition. Perhaps greater than this promise is the opportunity that now exists to develop models to test human-specific intestinal diseases that are not well characterized by human in vitro culture systems or current animal models. Translational examples of this include studies to examine normal and diseased conditions involving intestinal development and common human gastrointestinal infectious diseases.

In contrast to using primary cell cultures that require human intestinal samples, Spence et al (Nature. 2011 Feb;470:105-9) described an in vitro approach for generating human intestinal tissue from pluripotent stem cells termed human intestinal organoids (HIOs). Although these in vitro HIOs have some basic intestinal functionality, this model is insufficient for investigating the broad physiologic mechanisms associated with human intestinal diseases. Taking advantage of the fact that HIOs contain both epithelium and supporting mesenchyme required for engraftment that does not exist in enteroids derived from human crypt biopsies, we recently developed an in vivo transplant model (Nature Med. 2014;20:1310-4). Within 6-8 weeks after transplantation, these structures mature and grow 100-fold larger in volume.

Histologic studies show that engrafted tissue resembles native human intestine with crypt-villus architecture, underlying laminated structures, and smooth muscle layers. Further characterization revealed proliferative cells located in the base of crypts that also expressed stem cell markers. The ability to generate in vitro enteroids from these crypts demonstrates the existence of an intestinal stem cell pool. Functionally engrafted HIOs express an active brush border, barrier function, and peptide uptake. HIOs respond to humeral physiologic factors, as we demonstrated that morphometric adaptive changes with HIOs occur following intestinal resection in the host mouse.

To completely develop a functional human intestine it must contain an enteric nervous system (ENS), have an immune component, and be exposed to luminal nutrients and microbiota. Ongoing studies have developed methods to incorporate a functional ENS derived from the same pluripotent stem cell lines used to develop HIOs. Models to transplant HIOs into the mesentery of the murine bowel have allowed the development of surgical models that expose the HIOs to both luminal nutrition and microbiota. New models involving bone marrow transplantation should provide a human immune system.

Finally, the ability to generate induced pluripotent stem cells (iPS cells) from individual patients offers the unique advantage to study patient-specific factors contributing to human intestinal disease. We believe this model will provide an exciting new opportunity to understand many complex human conditions and test new therapies. Ultimately, the ability to grow functional patient-specific intestinal tissue offers the future reality of tissue replacement without immunosuppression for patients with intestinal failure.

Dr. Helmrath is professor of surgery, director of surgical research and the intestinal rehabilitation program, and the Richard Azizkhan Chair in Pediatric Surgery at Cincinnati Children’s Hospital Medical Center. He made these remarks in a Presidential Plenary session at the 2016 Digestive Disease Week.