Books

There are a number of classic textbooks that serve as primary resources for dermatology training^1-4; however, there also are other options if memorizing these books seems a little daunting. The “first aid” books of dermatology are the Derm In-Review binder and Jain’s⁵ Dermatology: Illustrated Study Guide and Comprehensive Board Review. Mariwalla and Leffell’s⁶Primer in Dermatologic Surgery: A Study Companion is helpful for surgical review and is available at a discounted price for members of the American Society for Dermatologic Surgery (https://www.asds.net/store/product.aspx?id=3914&terms=primer%20in%20Dermatologic%20surgery). The American Academy of Dermatology (AAD) provides a list of additional textbooks that dermatology residents may find useful for board review.⁷

Guided Study

The AAD offers board review courses for dermatology residents (cost varies).⁷ The Florida Dermatology and Dermatopathology Board Review Course (http://dermatology.med.ufl.edu/education/florida-dermatology-and-dermatopathology-board-review-course/) is an annual review course held in Tampa (early registration fee, $800 [does not include travel costs]). The Oakstone Institute also offers its Dermatology Board Review Course, which is a self-study program that can be completed online for approximately $1195 (http://www.oakstone.com/dermatology-board-review-course). Be sure to take advantage of free didactics lectures, society meetings with board review courses, and study groups, as these resources can be just as helpful and more budget friendly.

Digital Resources

The Derm In-Review question bank (http://dermatologyinreview.com/Merz) is probably one of the most popular board review resources and is free to US dermatology residents; however, be cautious when using this resource, as a fair number of the answers to questions may actually be outdated or based on older studies. A group study session can help tease out why certain answers are erroneous and provide a forum for discussing what would be a more correct answer. Take advantage of the opportunity to provide feedback on this website, as your comments will improve this resource for future dermatology residents.

Beyond traditional dermatopathology textbooks, there also are some excellent mobile applications (apps) available. The Clearpath app is a user-friendly dermatopathology study tool that is free for download in the iTunes store (https://itunes.apple.com/us/app/clearpath/id540260769?mt=8). However, the app is only compatible with iPads. The Clearpath website also offers virtual study slide sets that are easier to access (http://dermpathlab.com/slide-study-set-program). Your institution’s glass slide sets also are useful for building pattern recognition skills and practicing for the actual board examination. The DermOID website (http://www.derm-oid.com), which is powered by the David Geffen School of Medicine at the University of California, Los Angeles, is another online dermatopathology study database with free registration for access to the site. Another fun way to test your dermatopathology skills is in the exhibition hall at the AAD annual meeting where some vendors may offer daily dermatopathology quizzes and prizes for the residents with the most correct answers. Also, it is worth reviewing the Cutis^® Fast Facts for Board Review (http://www.cutis.com/articles/fast-facts-for-board-review/), as this section offers many outstanding fact sheets that are an easy read and an efficient way to gain board knowledge. Some recent topics include fillers, paraneoplastic skin conditions, and medications in dermatology.

Many residents enjoy using the Anki flashcard app (http://ankisrs.net) for reviewing kodachromes. The AAD website also includes a Boards’ Fodder archive that is worth reviewing (https://www.aad.org/members/residents-fellows/boards-study-tools/boards-fodder/boards-fodder). New board review resources are constantly being posted on the AAD website, so definitely check this out. You may be able to access this resource through your residency program; it is also available for purchase ($425 for AAD members; $850 for nonmembers).

Journals

All the major dermatology journals are helpful in preparing for the board examination. Your resident journal club will likely review many of the most clinically relevant dermatology articles published over the course of your residency. Some other helpful journal resources that are recommended for board review include the Journal of the American Medical Association’s Clinical Challenge, which has many dermatologic cases (http://jama.jamanetwork.com/public/QuizzesAndPolls.aspx), and the New England Journal of Medicine’s Journal Watch (http://www.jwatch.org) and Image Challenge (http://www.nejm.org/image-challenge).

Practice Examinations

The American Board of Dermatology’s In-Training Examination is the most well-known practice examination among dermatology residents.⁸ A link to an additional practice examination usually is provided a few weeks prior to the examination. The Derm In-Review website also offers diagnostic practice examinations with some ability to custom select questions for your studying needs.

Conclusion

There are many board review resources out there. Find the ones that work for you, and be encouraged that your studying and hard work will pay off!

Books

There are a number of classic textbooks that serve as primary resources for dermatology training^1-4; however, there also are other options if memorizing these books seems a little daunting. The “first aid” books of dermatology are the Derm In-Review binder and Jain’s⁵ Dermatology: Illustrated Study Guide and Comprehensive Board Review. Mariwalla and Leffell’s⁶Primer in Dermatologic Surgery: A Study Companion is helpful for surgical review and is available at a discounted price for members of the American Society for Dermatologic Surgery (https://www.asds.net/store/product.aspx?id=3914&terms=primer%20in%20Dermatologic%20surgery). The American Academy of Dermatology (AAD) provides a list of additional textbooks that dermatology residents may find useful for board review.⁷

Guided Study

The AAD offers board review courses for dermatology residents (cost varies).⁷ The Florida Dermatology and Dermatopathology Board Review Course (http://dermatology.med.ufl.edu/education/florida-dermatology-and-dermatopathology-board-review-course/) is an annual review course held in Tampa (early registration fee, $800 [does not include travel costs]). The Oakstone Institute also offers its Dermatology Board Review Course, which is a self-study program that can be completed online for approximately $1195 (http://www.oakstone.com/dermatology-board-review-course). Be sure to take advantage of free didactics lectures, society meetings with board review courses, and study groups, as these resources can be just as helpful and more budget friendly.

Digital Resources

The Derm In-Review question bank (http://dermatologyinreview.com/Merz) is probably one of the most popular board review resources and is free to US dermatology residents; however, be cautious when using this resource, as a fair number of the answers to questions may actually be outdated or based on older studies. A group study session can help tease out why certain answers are erroneous and provide a forum for discussing what would be a more correct answer. Take advantage of the opportunity to provide feedback on this website, as your comments will improve this resource for future dermatology residents.

Beyond traditional dermatopathology textbooks, there also are some excellent mobile applications (apps) available. The Clearpath app is a user-friendly dermatopathology study tool that is free for download in the iTunes store (https://itunes.apple.com/us/app/clearpath/id540260769?mt=8). However, the app is only compatible with iPads. The Clearpath website also offers virtual study slide sets that are easier to access (http://dermpathlab.com/slide-study-set-program). Your institution’s glass slide sets also are useful for building pattern recognition skills and practicing for the actual board examination. The DermOID website (http://www.derm-oid.com), which is powered by the David Geffen School of Medicine at the University of California, Los Angeles, is another online dermatopathology study database with free registration for access to the site. Another fun way to test your dermatopathology skills is in the exhibition hall at the AAD annual meeting where some vendors may offer daily dermatopathology quizzes and prizes for the residents with the most correct answers. Also, it is worth reviewing the Cutis^® Fast Facts for Board Review (http://www.cutis.com/articles/fast-facts-for-board-review/), as this section offers many outstanding fact sheets that are an easy read and an efficient way to gain board knowledge. Some recent topics include fillers, paraneoplastic skin conditions, and medications in dermatology.

Many residents enjoy using the Anki flashcard app (http://ankisrs.net) for reviewing kodachromes. The AAD website also includes a Boards’ Fodder archive that is worth reviewing (https://www.aad.org/members/residents-fellows/boards-study-tools/boards-fodder/boards-fodder). New board review resources are constantly being posted on the AAD website, so definitely check this out. You may be able to access this resource through your residency program; it is also available for purchase ($425 for AAD members; $850 for nonmembers).

Journals

All the major dermatology journals are helpful in preparing for the board examination. Your resident journal club will likely review many of the most clinically relevant dermatology articles published over the course of your residency. Some other helpful journal resources that are recommended for board review include the Journal of the American Medical Association’s Clinical Challenge, which has many dermatologic cases (http://jama.jamanetwork.com/public/QuizzesAndPolls.aspx), and the New England Journal of Medicine’s Journal Watch (http://www.jwatch.org) and Image Challenge (http://www.nejm.org/image-challenge).

Practice Examinations

The American Board of Dermatology’s In-Training Examination is the most well-known practice examination among dermatology residents.⁸ A link to an additional practice examination usually is provided a few weeks prior to the examination. The Derm In-Review website also offers diagnostic practice examinations with some ability to custom select questions for your studying needs.

Conclusion

There are many board review resources out there. Find the ones that work for you, and be encouraged that your studying and hard work will pay off!

Books

There are a number of classic textbooks that serve as primary resources for dermatology training^1-4; however, there also are other options if memorizing these books seems a little daunting. The “first aid” books of dermatology are the Derm In-Review binder and Jain’s⁵ Dermatology: Illustrated Study Guide and Comprehensive Board Review. Mariwalla and Leffell’s⁶Primer in Dermatologic Surgery: A Study Companion is helpful for surgical review and is available at a discounted price for members of the American Society for Dermatologic Surgery (https://www.asds.net/store/product.aspx?id=3914&terms=primer%20in%20Dermatologic%20surgery). The American Academy of Dermatology (AAD) provides a list of additional textbooks that dermatology residents may find useful for board review.⁷

Guided Study

The AAD offers board review courses for dermatology residents (cost varies).⁷ The Florida Dermatology and Dermatopathology Board Review Course (http://dermatology.med.ufl.edu/education/florida-dermatology-and-dermatopathology-board-review-course/) is an annual review course held in Tampa (early registration fee, $800 [does not include travel costs]). The Oakstone Institute also offers its Dermatology Board Review Course, which is a self-study program that can be completed online for approximately $1195 (http://www.oakstone.com/dermatology-board-review-course). Be sure to take advantage of free didactics lectures, society meetings with board review courses, and study groups, as these resources can be just as helpful and more budget friendly.

Digital Resources

The Derm In-Review question bank (http://dermatologyinreview.com/Merz) is probably one of the most popular board review resources and is free to US dermatology residents; however, be cautious when using this resource, as a fair number of the answers to questions may actually be outdated or based on older studies. A group study session can help tease out why certain answers are erroneous and provide a forum for discussing what would be a more correct answer. Take advantage of the opportunity to provide feedback on this website, as your comments will improve this resource for future dermatology residents.

Beyond traditional dermatopathology textbooks, there also are some excellent mobile applications (apps) available. The Clearpath app is a user-friendly dermatopathology study tool that is free for download in the iTunes store (https://itunes.apple.com/us/app/clearpath/id540260769?mt=8). However, the app is only compatible with iPads. The Clearpath website also offers virtual study slide sets that are easier to access (http://dermpathlab.com/slide-study-set-program). Your institution’s glass slide sets also are useful for building pattern recognition skills and practicing for the actual board examination. The DermOID website (http://www.derm-oid.com), which is powered by the David Geffen School of Medicine at the University of California, Los Angeles, is another online dermatopathology study database with free registration for access to the site. Another fun way to test your dermatopathology skills is in the exhibition hall at the AAD annual meeting where some vendors may offer daily dermatopathology quizzes and prizes for the residents with the most correct answers. Also, it is worth reviewing the Cutis^® Fast Facts for Board Review (http://www.cutis.com/articles/fast-facts-for-board-review/), as this section offers many outstanding fact sheets that are an easy read and an efficient way to gain board knowledge. Some recent topics include fillers, paraneoplastic skin conditions, and medications in dermatology.

Many residents enjoy using the Anki flashcard app (http://ankisrs.net) for reviewing kodachromes. The AAD website also includes a Boards’ Fodder archive that is worth reviewing (https://www.aad.org/members/residents-fellows/boards-study-tools/boards-fodder/boards-fodder). New board review resources are constantly being posted on the AAD website, so definitely check this out. You may be able to access this resource through your residency program; it is also available for purchase ($425 for AAD members; $850 for nonmembers).

Journals

All the major dermatology journals are helpful in preparing for the board examination. Your resident journal club will likely review many of the most clinically relevant dermatology articles published over the course of your residency. Some other helpful journal resources that are recommended for board review include the Journal of the American Medical Association’s Clinical Challenge, which has many dermatologic cases (http://jama.jamanetwork.com/public/QuizzesAndPolls.aspx), and the New England Journal of Medicine’s Journal Watch (http://www.jwatch.org) and Image Challenge (http://www.nejm.org/image-challenge).

Practice Examinations

The American Board of Dermatology’s In-Training Examination is the most well-known practice examination among dermatology residents.⁸ A link to an additional practice examination usually is provided a few weeks prior to the examination. The Derm In-Review website also offers diagnostic practice examinations with some ability to custom select questions for your studying needs.

Conclusion

There are many board review resources out there. Find the ones that work for you, and be encouraged that your studying and hard work will pay off!

Thanks to the generosity of our donors, the AGA Research Foundation is cultivating the future of the GI community through research grants to young investigators. The work and discoveries of AGA-funded recipients will open doors to new treatments and exciting new areas of knowledge.

With your support, we are building a community of investigators whose work serves the greater community and benefits all our patients. Here are just a few of the researchers the AGA Research Foundation is funding.

AGA Institute

Silvia Giugliano, Ph.D.

University of Colorado, Denver

2016 AGA Research Scholar Award Recipient

“I am extremely honored to receive this award and would like to sincerely thank the AGA Research Foundation. The training period provided by this award is ideally designed to support me in developing my knowledge of hepatic biology and immunology and will allow me to develop the skills and resources necessary to complete my transition into an independent scientist.” – Her goal is to develop an independent research career focused on the role that liver sinusoidal endothelial cells play in different models of hepatic disease.

Brian J. DeBosch, M.D., Ph.D.

Washington University

2016 AGA–Gilead Sciences Research Scholar Award in Liver Disease Recipient

“I would like to extend my sincere appreciation to the AGA Research Foundation, Gilead Sciences, and those individuals and sponsors who have made this award possible. This support comes at a key juncture in my career development, bridging the critical gap between fellowship and postdoctoral research training to full independence.” – He will use this research funding to build a research program focused on hepatic determinants of metabolic diseases, such as metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease (NAFLD).

Alexander W. Worix

Southern Illinois University

2016 AGA Investing in the Future Student Research Fellowship

“I have never in my life been so grateful for an opportunity like this. It is important for a future physician to understand how the field of medicine is changing and developing constantly. This fellowship will take my basic understanding from previous research and take it to a new and more elevated level.” – He will use this award to perform gastroenterological research at his alma mater, The University of Michigan.

Donate today to help us fulfill our vision of fostering the future of young investigators in gastroenterology and hepatology. Make a tax-deductible donation at www.gastro.org/donateonline.

Thanks to the generosity of our donors, the AGA Research Foundation is cultivating the future of the GI community through research grants to young investigators. The work and discoveries of AGA-funded recipients will open doors to new treatments and exciting new areas of knowledge.

With your support, we are building a community of investigators whose work serves the greater community and benefits all our patients. Here are just a few of the researchers the AGA Research Foundation is funding.

AGA Institute

Silvia Giugliano, Ph.D.

University of Colorado, Denver

2016 AGA Research Scholar Award Recipient

“I am extremely honored to receive this award and would like to sincerely thank the AGA Research Foundation. The training period provided by this award is ideally designed to support me in developing my knowledge of hepatic biology and immunology and will allow me to develop the skills and resources necessary to complete my transition into an independent scientist.” – Her goal is to develop an independent research career focused on the role that liver sinusoidal endothelial cells play in different models of hepatic disease.

Brian J. DeBosch, M.D., Ph.D.

Washington University

2016 AGA–Gilead Sciences Research Scholar Award in Liver Disease Recipient

“I would like to extend my sincere appreciation to the AGA Research Foundation, Gilead Sciences, and those individuals and sponsors who have made this award possible. This support comes at a key juncture in my career development, bridging the critical gap between fellowship and postdoctoral research training to full independence.” – He will use this research funding to build a research program focused on hepatic determinants of metabolic diseases, such as metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease (NAFLD).

Alexander W. Worix

Southern Illinois University

2016 AGA Investing in the Future Student Research Fellowship

“I have never in my life been so grateful for an opportunity like this. It is important for a future physician to understand how the field of medicine is changing and developing constantly. This fellowship will take my basic understanding from previous research and take it to a new and more elevated level.” – He will use this award to perform gastroenterological research at his alma mater, The University of Michigan.

Donate today to help us fulfill our vision of fostering the future of young investigators in gastroenterology and hepatology. Make a tax-deductible donation at www.gastro.org/donateonline.

Thanks to the generosity of our donors, the AGA Research Foundation is cultivating the future of the GI community through research grants to young investigators. The work and discoveries of AGA-funded recipients will open doors to new treatments and exciting new areas of knowledge.

With your support, we are building a community of investigators whose work serves the greater community and benefits all our patients. Here are just a few of the researchers the AGA Research Foundation is funding.

AGA Institute

Silvia Giugliano, Ph.D.

University of Colorado, Denver

2016 AGA Research Scholar Award Recipient

“I am extremely honored to receive this award and would like to sincerely thank the AGA Research Foundation. The training period provided by this award is ideally designed to support me in developing my knowledge of hepatic biology and immunology and will allow me to develop the skills and resources necessary to complete my transition into an independent scientist.” – Her goal is to develop an independent research career focused on the role that liver sinusoidal endothelial cells play in different models of hepatic disease.

Brian J. DeBosch, M.D., Ph.D.

Washington University

2016 AGA–Gilead Sciences Research Scholar Award in Liver Disease Recipient

“I would like to extend my sincere appreciation to the AGA Research Foundation, Gilead Sciences, and those individuals and sponsors who have made this award possible. This support comes at a key juncture in my career development, bridging the critical gap between fellowship and postdoctoral research training to full independence.” – He will use this research funding to build a research program focused on hepatic determinants of metabolic diseases, such as metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease (NAFLD).

Alexander W. Worix

Southern Illinois University

2016 AGA Investing in the Future Student Research Fellowship

“I have never in my life been so grateful for an opportunity like this. It is important for a future physician to understand how the field of medicine is changing and developing constantly. This fellowship will take my basic understanding from previous research and take it to a new and more elevated level.” – He will use this award to perform gastroenterological research at his alma mater, The University of Michigan.

Donate today to help us fulfill our vision of fostering the future of young investigators in gastroenterology and hepatology. Make a tax-deductible donation at www.gastro.org/donateonline.

As part of our ongoing advocacy that the American Board of Internal Medicine (ABIM) reform maintenance of certification (MOC), AGA sent a letter to ABIM in April seeking to understand its plan for re-engineering MOC to reflect the changing nature of medical practice.

This followed ABIM’s launch of a study in March to “examine ways ABIM diplomates might have access to online resources during a portion of the MOC assessment.” ABIM President and CEO Dr. Richard Baron promised a timetable and plan, based on what they have heard from the physician community.

AGA and other societies asked for clarification of this plan through a series of questions in the letter including:

1. What is the overall vision or philosophy ABIM is looking to embrace regarding MOC?

2. What additional changes to MOC is ABIM considering?

3. Will ABIM consult the internal medicine community prior to announcement – let alone implementation – of further changes? If so, when and how?

4. What is ABIM’s timeline for implementing the co-created, re-engineered MOC? Could ABIM share its current form and provide updates as adjustments occur? For example, part of the 2020 Task Force assessment was to reconsider the secure exam. For many diplomates, the 10-year exam is due soon. Should they wait to see if a different method of “exam”/assessment will be rolled out?

5. What does ABIM view as the respective roles of the ABIM Board of Directors, ABIM Council, ABIM specialty boards and ABIM staff in this process?

The full letter, which you can read on gastro.org, was signed by AGA, American College of Rheumatology, American Society of Nephrology, Endocrine Society, Infectious Diseases Society of America, Society of Hospital Medicine, American Association of Clinical Endocrinologists, ACG, American Geriatrics Society, Renal Physicians Association, ASGE, and American Society of Clinical Oncology.

As part of our ongoing advocacy that the American Board of Internal Medicine (ABIM) reform maintenance of certification (MOC), AGA sent a letter to ABIM in April seeking to understand its plan for re-engineering MOC to reflect the changing nature of medical practice.

This followed ABIM’s launch of a study in March to “examine ways ABIM diplomates might have access to online resources during a portion of the MOC assessment.” ABIM President and CEO Dr. Richard Baron promised a timetable and plan, based on what they have heard from the physician community.

AGA and other societies asked for clarification of this plan through a series of questions in the letter including:

1. What is the overall vision or philosophy ABIM is looking to embrace regarding MOC?

2. What additional changes to MOC is ABIM considering?

3. Will ABIM consult the internal medicine community prior to announcement – let alone implementation – of further changes? If so, when and how?

4. What is ABIM’s timeline for implementing the co-created, re-engineered MOC? Could ABIM share its current form and provide updates as adjustments occur? For example, part of the 2020 Task Force assessment was to reconsider the secure exam. For many diplomates, the 10-year exam is due soon. Should they wait to see if a different method of “exam”/assessment will be rolled out?

5. What does ABIM view as the respective roles of the ABIM Board of Directors, ABIM Council, ABIM specialty boards and ABIM staff in this process?

The full letter, which you can read on gastro.org, was signed by AGA, American College of Rheumatology, American Society of Nephrology, Endocrine Society, Infectious Diseases Society of America, Society of Hospital Medicine, American Association of Clinical Endocrinologists, ACG, American Geriatrics Society, Renal Physicians Association, ASGE, and American Society of Clinical Oncology.

As part of our ongoing advocacy that the American Board of Internal Medicine (ABIM) reform maintenance of certification (MOC), AGA sent a letter to ABIM in April seeking to understand its plan for re-engineering MOC to reflect the changing nature of medical practice.

This followed ABIM’s launch of a study in March to “examine ways ABIM diplomates might have access to online resources during a portion of the MOC assessment.” ABIM President and CEO Dr. Richard Baron promised a timetable and plan, based on what they have heard from the physician community.

AGA and other societies asked for clarification of this plan through a series of questions in the letter including:

1. What is the overall vision or philosophy ABIM is looking to embrace regarding MOC?

2. What additional changes to MOC is ABIM considering?

3. Will ABIM consult the internal medicine community prior to announcement – let alone implementation – of further changes? If so, when and how?

4. What is ABIM’s timeline for implementing the co-created, re-engineered MOC? Could ABIM share its current form and provide updates as adjustments occur? For example, part of the 2020 Task Force assessment was to reconsider the secure exam. For many diplomates, the 10-year exam is due soon. Should they wait to see if a different method of “exam”/assessment will be rolled out?

5. What does ABIM view as the respective roles of the ABIM Board of Directors, ABIM Council, ABIM specialty boards and ABIM staff in this process?

The full letter, which you can read on gastro.org, was signed by AGA, American College of Rheumatology, American Society of Nephrology, Endocrine Society, Infectious Diseases Society of America, Society of Hospital Medicine, American Association of Clinical Endocrinologists, ACG, American Geriatrics Society, Renal Physicians Association, ASGE, and American Society of Clinical Oncology.

If you’re planning to attend Digestive Disease Week® (DDW), make sure to take advantage of all AGA has to offer, including the 2016 AGA Postgraduate Course: Cognitive and Technical Skills for the Gastroenterologist.

This year’s course will host more than 60 expert presenters – the best in the world – including five AGA Governing Board members.

You won’t want to miss these talks:

• Michael Camilleri, M.D., AGAF

“Overlooked, Overused, and Emerging Therapies for Common Gastrointestinal Disorders”

• Sheila Crowe, M.D., AGAF

“Bloating, Functional Bowel Disease and Food Sensitivity: Non-Celiac Gluten-Sensitivity, the Low-FODMAP Diet and Beyond”

• Gregory Gores, M.D., AGAF

“Managing the Possibly Malignant Biliary Stricture”

• John Inadomi, M.D., AGAF

“Colon Cancer Screening”

• Rajeev Jain, M.D., AGAF

“A Primer on Performance Measures and Bundled Payment: Volume to Value”

The course takes place May 21 and 22, 2016. Learn more at http://www.gastro.org/pgc.

Also, make sure to check out the AGA Institute Council Highlights at DDW 2016 booklet and online tool to find out about section programming, committee-sponsored and joint society sessions, as well as a plethora of basic science offerings.

We look forward to seeing you in San Diego.

If you’re planning to attend Digestive Disease Week® (DDW), make sure to take advantage of all AGA has to offer, including the 2016 AGA Postgraduate Course: Cognitive and Technical Skills for the Gastroenterologist.

This year’s course will host more than 60 expert presenters – the best in the world – including five AGA Governing Board members.

You won’t want to miss these talks:

• Michael Camilleri, M.D., AGAF

“Overlooked, Overused, and Emerging Therapies for Common Gastrointestinal Disorders”

• Sheila Crowe, M.D., AGAF

“Bloating, Functional Bowel Disease and Food Sensitivity: Non-Celiac Gluten-Sensitivity, the Low-FODMAP Diet and Beyond”

• Gregory Gores, M.D., AGAF

“Managing the Possibly Malignant Biliary Stricture”

• John Inadomi, M.D., AGAF

“Colon Cancer Screening”

• Rajeev Jain, M.D., AGAF

“A Primer on Performance Measures and Bundled Payment: Volume to Value”

The course takes place May 21 and 22, 2016. Learn more at http://www.gastro.org/pgc.

Also, make sure to check out the AGA Institute Council Highlights at DDW 2016 booklet and online tool to find out about section programming, committee-sponsored and joint society sessions, as well as a plethora of basic science offerings.

We look forward to seeing you in San Diego.

If you’re planning to attend Digestive Disease Week® (DDW), make sure to take advantage of all AGA has to offer, including the 2016 AGA Postgraduate Course: Cognitive and Technical Skills for the Gastroenterologist.

This year’s course will host more than 60 expert presenters – the best in the world – including five AGA Governing Board members.

You won’t want to miss these talks:

• Michael Camilleri, M.D., AGAF

“Overlooked, Overused, and Emerging Therapies for Common Gastrointestinal Disorders”

• Sheila Crowe, M.D., AGAF

“Bloating, Functional Bowel Disease and Food Sensitivity: Non-Celiac Gluten-Sensitivity, the Low-FODMAP Diet and Beyond”

• Gregory Gores, M.D., AGAF

“Managing the Possibly Malignant Biliary Stricture”

• John Inadomi, M.D., AGAF

“Colon Cancer Screening”

• Rajeev Jain, M.D., AGAF

“A Primer on Performance Measures and Bundled Payment: Volume to Value”

The course takes place May 21 and 22, 2016. Learn more at http://www.gastro.org/pgc.

Also, make sure to check out the AGA Institute Council Highlights at DDW 2016 booklet and online tool to find out about section programming, committee-sponsored and joint society sessions, as well as a plethora of basic science offerings.

We look forward to seeing you in San Diego.

AMSTERDAM – A novel intra-articular allogeneic cell therapy improved knee osteoarthritis pain, physical activity, and patients’ quality of life in a randomized, placebo-controlled, double-blind, phase III trial reported at the World Congress on Osteoarthritis.

During a 1-year follow up, single-dose treatment with TissueGene C (Invossa) in patients with degenerative knee osteoarthritis (OA) led to significantly greater improvements in International Knee Documentation Committee (IKDC) knee pain, Likert visual analog scale (VAS) pain score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores than in those given a saline placebo.

©Nandyphotos/Thinkstock

The positive results of the trial, which was conducted exclusively in Korea, now pave the way for a similar phase III clinical trial to be run in the United States. The study design is being finalized and will follow the usual criteria for a phase III trial, but it will add one refinement on the design used in the Korean trial in that the TissueGene C (TG-C) will be given by image-guided intra-articular injection.

TG-C consists of two different populations of chondrocytes derived from a single human subject with polydactyly finger, of which one cell population has been genetically modified to express the gene for transforming growth factor-beta 1 (TGF-B1). It is a single-dose treatment that is intended to provide symptomatic relief and delay the structural progression of knee OA.

The proposed mode of action is that it targets cartilage degradation by enhancing chondrocyte proliferation, essentially improving cartilage structure by redirecting immune responses via effects on interleukin-10 and on M2 macrophages.

The target population is patients with with Kellgren-Lawrence grade II and III knee OA, Dr. Bumsup Lee of Kolon Life Science said during a company-sponsored symposium held during the congress, which was sponsored by Osteoarthritis Research Society International. Dr. Lee is chief operating officer of TissueGene Inc. in the United States, which is collaborating with Kolon Life Science, the Korean-based biochemical company that developed the novel OA therapy.

The aim is to develop a disease-modifying osteoarthritis drug (DMOAD) that fits criteria suggested by the Food and Drug Administration and the European Medicines Agency, Dr. Lee said. The clinical development program started in 2006, with phase I, II, and III studies now completed in Korea and phase II and III studies underway in the United States.

The results of the phase III Korean trial, which involved 163 patients, were presented during a poster session and during the industry-sponsored symposium. These showed that IKDC scores progressively increased (improved) for TG-C–treated patients from baseline through months 1, 3, 6, 9, and 12 with scores of 40.3, 42.9, 48.9, 53.2, 53.6, and 55.4, respectively, versus placebo scores at the same time points of 39.6, 44.6, 45.2, 36.5, 47.1, and 44.6. The differences became significant at 6 months. Changes in IKDC scores from baseline were also only significantly in favor of TG-C versus placebo starting at 6 months (12.9 vs. 6.9), then extending to 9 months (13.3 vs. 7.5) and 12 months (15.1 vs. 5.0).

TG-C proved superior to placebo in improving VAS pain scores at 6, 9, and 12 months, and changes in WOMAC scores were significant after 12 months with a mean change of –13.9 with TG-C and –6.2 with placebo.

The OMERACT-OARSI response rate was also assessed. A responder was identified as someone with an improvement in VAS pain score of 50% or more and an absolute change in score of at least 10 points and at least a 50% improvement in IKDC score with an absolute change of at least 20 points. The response rate for TG-C and placebo was 70% versus 52% (P = .02) at 6 months, 77% versus 52% at 9 months (P = .0011), and 84% versus 45% (P less than .001) at 12 months.

The most common adverse events seen were related to the intra-articular injection, Dr. Lee noted. Two serious adverse events – arthralgia and joint swelling – occurred in one subject who received the novel treatment, but this resolved within 10 days of administration.

Biomarker analyses have been performed and it appears that patients with greater joint space width, and higher baseline levels of CTX-II and C3M may be more likely to respond to TG-C. Some changes in CTX-I and CTX-II were clinically meaningful, and although the MRI data are still being evaluated, there was one striking feature: Patients treated with TG-C did not grow any osteophytes, compared with patients on placebo.

“Invossa holds great potential for a disease-modifying osteoarthritis drug,” said Dr. Gurdyal Kalsi, chief medical officer of TissueGene Inc. Based on the evidence today, which includes a phase II trial conducted in the United States (Osteoarthritis Cartilage. 2015;23:2109-18), he said that the novel treatment “offers sustained improvement of pain and function over 2 years with a single injection.” OMERACT-OARSI response rates were 81%-86% in patients not responding to conservative therapies in the phase II study.

It is envisioned that the phase III U.S. trial will start enrolling patients from the start of next year, with the last patient enrolled around May 2018 and the first results appearing around the summer of 2019. TissueGene Inc. would then expect to have the full trial results by 2020 and make a Biologics License Application to the FDA in early 2021.

“We believe we truly have something that we hope would fulfill a DMOAD application,” Dr. Kalsi said.

Kolon Life Science and TissueGene Inc. sponsored the studies. Dr. Lee and Dr. Kalsi are employees of TissueGene Inc.

AMSTERDAM – A novel intra-articular allogeneic cell therapy improved knee osteoarthritis pain, physical activity, and patients’ quality of life in a randomized, placebo-controlled, double-blind, phase III trial reported at the World Congress on Osteoarthritis.

During a 1-year follow up, single-dose treatment with TissueGene C (Invossa) in patients with degenerative knee osteoarthritis (OA) led to significantly greater improvements in International Knee Documentation Committee (IKDC) knee pain, Likert visual analog scale (VAS) pain score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores than in those given a saline placebo.

©Nandyphotos/Thinkstock

The positive results of the trial, which was conducted exclusively in Korea, now pave the way for a similar phase III clinical trial to be run in the United States. The study design is being finalized and will follow the usual criteria for a phase III trial, but it will add one refinement on the design used in the Korean trial in that the TissueGene C (TG-C) will be given by image-guided intra-articular injection.

TG-C consists of two different populations of chondrocytes derived from a single human subject with polydactyly finger, of which one cell population has been genetically modified to express the gene for transforming growth factor-beta 1 (TGF-B1). It is a single-dose treatment that is intended to provide symptomatic relief and delay the structural progression of knee OA.

The proposed mode of action is that it targets cartilage degradation by enhancing chondrocyte proliferation, essentially improving cartilage structure by redirecting immune responses via effects on interleukin-10 and on M2 macrophages.

The target population is patients with with Kellgren-Lawrence grade II and III knee OA, Dr. Bumsup Lee of Kolon Life Science said during a company-sponsored symposium held during the congress, which was sponsored by Osteoarthritis Research Society International. Dr. Lee is chief operating officer of TissueGene Inc. in the United States, which is collaborating with Kolon Life Science, the Korean-based biochemical company that developed the novel OA therapy.

The aim is to develop a disease-modifying osteoarthritis drug (DMOAD) that fits criteria suggested by the Food and Drug Administration and the European Medicines Agency, Dr. Lee said. The clinical development program started in 2006, with phase I, II, and III studies now completed in Korea and phase II and III studies underway in the United States.

The results of the phase III Korean trial, which involved 163 patients, were presented during a poster session and during the industry-sponsored symposium. These showed that IKDC scores progressively increased (improved) for TG-C–treated patients from baseline through months 1, 3, 6, 9, and 12 with scores of 40.3, 42.9, 48.9, 53.2, 53.6, and 55.4, respectively, versus placebo scores at the same time points of 39.6, 44.6, 45.2, 36.5, 47.1, and 44.6. The differences became significant at 6 months. Changes in IKDC scores from baseline were also only significantly in favor of TG-C versus placebo starting at 6 months (12.9 vs. 6.9), then extending to 9 months (13.3 vs. 7.5) and 12 months (15.1 vs. 5.0).

TG-C proved superior to placebo in improving VAS pain scores at 6, 9, and 12 months, and changes in WOMAC scores were significant after 12 months with a mean change of –13.9 with TG-C and –6.2 with placebo.

The OMERACT-OARSI response rate was also assessed. A responder was identified as someone with an improvement in VAS pain score of 50% or more and an absolute change in score of at least 10 points and at least a 50% improvement in IKDC score with an absolute change of at least 20 points. The response rate for TG-C and placebo was 70% versus 52% (P = .02) at 6 months, 77% versus 52% at 9 months (P = .0011), and 84% versus 45% (P less than .001) at 12 months.

The most common adverse events seen were related to the intra-articular injection, Dr. Lee noted. Two serious adverse events – arthralgia and joint swelling – occurred in one subject who received the novel treatment, but this resolved within 10 days of administration.

Biomarker analyses have been performed and it appears that patients with greater joint space width, and higher baseline levels of CTX-II and C3M may be more likely to respond to TG-C. Some changes in CTX-I and CTX-II were clinically meaningful, and although the MRI data are still being evaluated, there was one striking feature: Patients treated with TG-C did not grow any osteophytes, compared with patients on placebo.

“Invossa holds great potential for a disease-modifying osteoarthritis drug,” said Dr. Gurdyal Kalsi, chief medical officer of TissueGene Inc. Based on the evidence today, which includes a phase II trial conducted in the United States (Osteoarthritis Cartilage. 2015;23:2109-18), he said that the novel treatment “offers sustained improvement of pain and function over 2 years with a single injection.” OMERACT-OARSI response rates were 81%-86% in patients not responding to conservative therapies in the phase II study.

It is envisioned that the phase III U.S. trial will start enrolling patients from the start of next year, with the last patient enrolled around May 2018 and the first results appearing around the summer of 2019. TissueGene Inc. would then expect to have the full trial results by 2020 and make a Biologics License Application to the FDA in early 2021.

“We believe we truly have something that we hope would fulfill a DMOAD application,” Dr. Kalsi said.

Kolon Life Science and TissueGene Inc. sponsored the studies. Dr. Lee and Dr. Kalsi are employees of TissueGene Inc.

AMSTERDAM – A novel intra-articular allogeneic cell therapy improved knee osteoarthritis pain, physical activity, and patients’ quality of life in a randomized, placebo-controlled, double-blind, phase III trial reported at the World Congress on Osteoarthritis.

During a 1-year follow up, single-dose treatment with TissueGene C (Invossa) in patients with degenerative knee osteoarthritis (OA) led to significantly greater improvements in International Knee Documentation Committee (IKDC) knee pain, Likert visual analog scale (VAS) pain score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores than in those given a saline placebo.

©Nandyphotos/Thinkstock

The positive results of the trial, which was conducted exclusively in Korea, now pave the way for a similar phase III clinical trial to be run in the United States. The study design is being finalized and will follow the usual criteria for a phase III trial, but it will add one refinement on the design used in the Korean trial in that the TissueGene C (TG-C) will be given by image-guided intra-articular injection.

TG-C consists of two different populations of chondrocytes derived from a single human subject with polydactyly finger, of which one cell population has been genetically modified to express the gene for transforming growth factor-beta 1 (TGF-B1). It is a single-dose treatment that is intended to provide symptomatic relief and delay the structural progression of knee OA.

The proposed mode of action is that it targets cartilage degradation by enhancing chondrocyte proliferation, essentially improving cartilage structure by redirecting immune responses via effects on interleukin-10 and on M2 macrophages.

The target population is patients with with Kellgren-Lawrence grade II and III knee OA, Dr. Bumsup Lee of Kolon Life Science said during a company-sponsored symposium held during the congress, which was sponsored by Osteoarthritis Research Society International. Dr. Lee is chief operating officer of TissueGene Inc. in the United States, which is collaborating with Kolon Life Science, the Korean-based biochemical company that developed the novel OA therapy.

The aim is to develop a disease-modifying osteoarthritis drug (DMOAD) that fits criteria suggested by the Food and Drug Administration and the European Medicines Agency, Dr. Lee said. The clinical development program started in 2006, with phase I, II, and III studies now completed in Korea and phase II and III studies underway in the United States.

The results of the phase III Korean trial, which involved 163 patients, were presented during a poster session and during the industry-sponsored symposium. These showed that IKDC scores progressively increased (improved) for TG-C–treated patients from baseline through months 1, 3, 6, 9, and 12 with scores of 40.3, 42.9, 48.9, 53.2, 53.6, and 55.4, respectively, versus placebo scores at the same time points of 39.6, 44.6, 45.2, 36.5, 47.1, and 44.6. The differences became significant at 6 months. Changes in IKDC scores from baseline were also only significantly in favor of TG-C versus placebo starting at 6 months (12.9 vs. 6.9), then extending to 9 months (13.3 vs. 7.5) and 12 months (15.1 vs. 5.0).

TG-C proved superior to placebo in improving VAS pain scores at 6, 9, and 12 months, and changes in WOMAC scores were significant after 12 months with a mean change of –13.9 with TG-C and –6.2 with placebo.

The OMERACT-OARSI response rate was also assessed. A responder was identified as someone with an improvement in VAS pain score of 50% or more and an absolute change in score of at least 10 points and at least a 50% improvement in IKDC score with an absolute change of at least 20 points. The response rate for TG-C and placebo was 70% versus 52% (P = .02) at 6 months, 77% versus 52% at 9 months (P = .0011), and 84% versus 45% (P less than .001) at 12 months.

The most common adverse events seen were related to the intra-articular injection, Dr. Lee noted. Two serious adverse events – arthralgia and joint swelling – occurred in one subject who received the novel treatment, but this resolved within 10 days of administration.

Biomarker analyses have been performed and it appears that patients with greater joint space width, and higher baseline levels of CTX-II and C3M may be more likely to respond to TG-C. Some changes in CTX-I and CTX-II were clinically meaningful, and although the MRI data are still being evaluated, there was one striking feature: Patients treated with TG-C did not grow any osteophytes, compared with patients on placebo.

“Invossa holds great potential for a disease-modifying osteoarthritis drug,” said Dr. Gurdyal Kalsi, chief medical officer of TissueGene Inc. Based on the evidence today, which includes a phase II trial conducted in the United States (Osteoarthritis Cartilage. 2015;23:2109-18), he said that the novel treatment “offers sustained improvement of pain and function over 2 years with a single injection.” OMERACT-OARSI response rates were 81%-86% in patients not responding to conservative therapies in the phase II study.

It is envisioned that the phase III U.S. trial will start enrolling patients from the start of next year, with the last patient enrolled around May 2018 and the first results appearing around the summer of 2019. TissueGene Inc. would then expect to have the full trial results by 2020 and make a Biologics License Application to the FDA in early 2021.

“We believe we truly have something that we hope would fulfill a DMOAD application,” Dr. Kalsi said.

Kolon Life Science and TissueGene Inc. sponsored the studies. Dr. Lee and Dr. Kalsi are employees of TissueGene Inc.

A positive screen for military sexual trauma among recently discharged male and female veterans may be a predictive factor for homelessness. In addition, the association between military sexual trauma and homelessness is stronger among male veterans, results of a retrospective study published April 20 show.

Emily Brignone, Dr. Adi V. Gundlapalli, and their associates examined health care data from the Veterans Health Administration’s 2011 Operation Enduring Freedom and Operation Iraqi Freedom official roster of veterans. All of the veterans separated from the military between fiscal years 2001 and 2011, and used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 (JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0101).

The total study population included 601,892, 590,989, and 262,589 U.S. veterans who screened positive for military sexual trauma at 30 days, 1 year, and 5 years, respectively, after their initial VHA visit, reported Ms. Brignone and Dr. Gundlapalli, both of whom are affiliated with the Informatics, Decision Enhancement, and Analytic Sciences Center at the VA Salt Lake City Health Care System.

They found that the incidence of homelessness in this population was 1.6%, 4.4%, and 9.6% within 30 days, 1 year, and 5 years, respectively. The rates for male veterans were higher than for their female counterparts, as evidenced by 30-day, 1-year, and 5-year homelessness rates of 2.3%, 6.2%, and 11.8%, respectively, compared with 1.3%, 3.9%, and 8.9%. About 25% of female veterans report experiencing sexual trauma during their military service, compared with 1% of male veterans, research shows (Am J Public Health. 2007;97[12]:2160-6).

Meanwhile, the rates of positive military sexual trauma screens among homeless veterans were almost twice as high, compared with the rates of veterans who were not homeless (0.7%, 1.8%, and 4.3%, respectively).

Logistic regression analysis models adjusted for mental health and substance use diagnoses showed that military sexual trauma screen status remained significantly associated with homelessness, such that veterans with a positive military sexual trauma screen were roughly 1.5-fold more likely to be homelessness than those with a negative screen. The adjusted models also showed that the interaction between military sexual trauma status and sex remained significant for the 30-day and 1-year cohorts.

Ms. Brignone, Dr. Gundlapalli, and their associates cited several limitations. For example, a positive screen for military sexual trauma is a self-reported marker rather than a diagnosis. “Because a positive screen for [military sexual trauma] is associated with increased service use, there may be more opportunities to detect homelessness among veterans with a positive screen,” they wrote.

The investigators said further research is needed to understand the temporal associations between sexual trauma, mental health diagnoses, and sex-dependent differences. Understanding those associations might be useful in attempts at prevention and intervention of postdeployment homelessness, they wrote.

A U.S. Department of Veterans Affairs grant funded this project. The authors disclosed no conflicts of interest.

A positive screen for military sexual trauma among recently discharged male and female veterans may be a predictive factor for homelessness. In addition, the association between military sexual trauma and homelessness is stronger among male veterans, results of a retrospective study published April 20 show.

Emily Brignone, Dr. Adi V. Gundlapalli, and their associates examined health care data from the Veterans Health Administration’s 2011 Operation Enduring Freedom and Operation Iraqi Freedom official roster of veterans. All of the veterans separated from the military between fiscal years 2001 and 2011, and used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 (JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0101).

The total study population included 601,892, 590,989, and 262,589 U.S. veterans who screened positive for military sexual trauma at 30 days, 1 year, and 5 years, respectively, after their initial VHA visit, reported Ms. Brignone and Dr. Gundlapalli, both of whom are affiliated with the Informatics, Decision Enhancement, and Analytic Sciences Center at the VA Salt Lake City Health Care System.

They found that the incidence of homelessness in this population was 1.6%, 4.4%, and 9.6% within 30 days, 1 year, and 5 years, respectively. The rates for male veterans were higher than for their female counterparts, as evidenced by 30-day, 1-year, and 5-year homelessness rates of 2.3%, 6.2%, and 11.8%, respectively, compared with 1.3%, 3.9%, and 8.9%. About 25% of female veterans report experiencing sexual trauma during their military service, compared with 1% of male veterans, research shows (Am J Public Health. 2007;97[12]:2160-6).

Meanwhile, the rates of positive military sexual trauma screens among homeless veterans were almost twice as high, compared with the rates of veterans who were not homeless (0.7%, 1.8%, and 4.3%, respectively).

Logistic regression analysis models adjusted for mental health and substance use diagnoses showed that military sexual trauma screen status remained significantly associated with homelessness, such that veterans with a positive military sexual trauma screen were roughly 1.5-fold more likely to be homelessness than those with a negative screen. The adjusted models also showed that the interaction between military sexual trauma status and sex remained significant for the 30-day and 1-year cohorts.

Ms. Brignone, Dr. Gundlapalli, and their associates cited several limitations. For example, a positive screen for military sexual trauma is a self-reported marker rather than a diagnosis. “Because a positive screen for [military sexual trauma] is associated with increased service use, there may be more opportunities to detect homelessness among veterans with a positive screen,” they wrote.

The investigators said further research is needed to understand the temporal associations between sexual trauma, mental health diagnoses, and sex-dependent differences. Understanding those associations might be useful in attempts at prevention and intervention of postdeployment homelessness, they wrote.

A U.S. Department of Veterans Affairs grant funded this project. The authors disclosed no conflicts of interest.

A positive screen for military sexual trauma among recently discharged male and female veterans may be a predictive factor for homelessness. In addition, the association between military sexual trauma and homelessness is stronger among male veterans, results of a retrospective study published April 20 show.

Emily Brignone, Dr. Adi V. Gundlapalli, and their associates examined health care data from the Veterans Health Administration’s 2011 Operation Enduring Freedom and Operation Iraqi Freedom official roster of veterans. All of the veterans separated from the military between fiscal years 2001 and 2011, and used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 (JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0101).

The total study population included 601,892, 590,989, and 262,589 U.S. veterans who screened positive for military sexual trauma at 30 days, 1 year, and 5 years, respectively, after their initial VHA visit, reported Ms. Brignone and Dr. Gundlapalli, both of whom are affiliated with the Informatics, Decision Enhancement, and Analytic Sciences Center at the VA Salt Lake City Health Care System.

They found that the incidence of homelessness in this population was 1.6%, 4.4%, and 9.6% within 30 days, 1 year, and 5 years, respectively. The rates for male veterans were higher than for their female counterparts, as evidenced by 30-day, 1-year, and 5-year homelessness rates of 2.3%, 6.2%, and 11.8%, respectively, compared with 1.3%, 3.9%, and 8.9%. About 25% of female veterans report experiencing sexual trauma during their military service, compared with 1% of male veterans, research shows (Am J Public Health. 2007;97[12]:2160-6).

Meanwhile, the rates of positive military sexual trauma screens among homeless veterans were almost twice as high, compared with the rates of veterans who were not homeless (0.7%, 1.8%, and 4.3%, respectively).

Logistic regression analysis models adjusted for mental health and substance use diagnoses showed that military sexual trauma screen status remained significantly associated with homelessness, such that veterans with a positive military sexual trauma screen were roughly 1.5-fold more likely to be homelessness than those with a negative screen. The adjusted models also showed that the interaction between military sexual trauma status and sex remained significant for the 30-day and 1-year cohorts.

Ms. Brignone, Dr. Gundlapalli, and their associates cited several limitations. For example, a positive screen for military sexual trauma is a self-reported marker rather than a diagnosis. “Because a positive screen for [military sexual trauma] is associated with increased service use, there may be more opportunities to detect homelessness among veterans with a positive screen,” they wrote.

The investigators said further research is needed to understand the temporal associations between sexual trauma, mental health diagnoses, and sex-dependent differences. Understanding those associations might be useful in attempts at prevention and intervention of postdeployment homelessness, they wrote.

A U.S. Department of Veterans Affairs grant funded this project. The authors disclosed no conflicts of interest.

The Diagnosis: Herpetic Glossitis

Oral lesions of the tongue are common during primary herpetic gingivostomatitis, though most primary oral herpes simplex virus (HSV) infections occur during childhood or early adulthood. Reactivation of HSV type 1 most commonly manifests as herpes labialis.¹ When recurrent HSV involves intraoral lesions, they are typically confined to the gingiva and palate, sparing the tongue.

Clinical presentation of herpetic glossitis varies. Recurrent herpetic glossitis has been described in immunocompromised patients, particularly those with hematologic malignancies and organ transplants.² In addition, immunocompromised and human immunodeficiency virus–infected patients may present with deep and/or broad ulcers. A case of herpes infection presenting with nodules on the tongue has been reported in Hodgkin disease.³ Herpetic geometric glossitis also has been described, which is a linear, crosshatched, or sharply angled branching with painful fissuring of the tongue. Herpetic geometric glossitis has been reported to occur in both immunocompetent and immunocompromised individuals.⁴ Tongue involvement during oral reactivation of HSV is exceedingly rare and the pathogenesis remains elusive, though one hypothesis proposes a protective role of salivary-specific IgA and lysozyme.⁵ Here, we report a case in which a patient developed similar lingual HSV lesions following recent immunosuppression.

The Diagnosis: Herpetic Glossitis

Oral lesions of the tongue are common during primary herpetic gingivostomatitis, though most primary oral herpes simplex virus (HSV) infections occur during childhood or early adulthood. Reactivation of HSV type 1 most commonly manifests as herpes labialis.¹ When recurrent HSV involves intraoral lesions, they are typically confined to the gingiva and palate, sparing the tongue.

Clinical presentation of herpetic glossitis varies. Recurrent herpetic glossitis has been described in immunocompromised patients, particularly those with hematologic malignancies and organ transplants.² In addition, immunocompromised and human immunodeficiency virus–infected patients may present with deep and/or broad ulcers. A case of herpes infection presenting with nodules on the tongue has been reported in Hodgkin disease.³ Herpetic geometric glossitis also has been described, which is a linear, crosshatched, or sharply angled branching with painful fissuring of the tongue. Herpetic geometric glossitis has been reported to occur in both immunocompetent and immunocompromised individuals.⁴ Tongue involvement during oral reactivation of HSV is exceedingly rare and the pathogenesis remains elusive, though one hypothesis proposes a protective role of salivary-specific IgA and lysozyme.⁵ Here, we report a case in which a patient developed similar lingual HSV lesions following recent immunosuppression.

The Diagnosis: Herpetic Glossitis

Oral lesions of the tongue are common during primary herpetic gingivostomatitis, though most primary oral herpes simplex virus (HSV) infections occur during childhood or early adulthood. Reactivation of HSV type 1 most commonly manifests as herpes labialis.¹ When recurrent HSV involves intraoral lesions, they are typically confined to the gingiva and palate, sparing the tongue.

Clinical presentation of herpetic glossitis varies. Recurrent herpetic glossitis has been described in immunocompromised patients, particularly those with hematologic malignancies and organ transplants.² In addition, immunocompromised and human immunodeficiency virus–infected patients may present with deep and/or broad ulcers. A case of herpes infection presenting with nodules on the tongue has been reported in Hodgkin disease.³ Herpetic geometric glossitis also has been described, which is a linear, crosshatched, or sharply angled branching with painful fissuring of the tongue. Herpetic geometric glossitis has been reported to occur in both immunocompetent and immunocompromised individuals.⁴ Tongue involvement during oral reactivation of HSV is exceedingly rare and the pathogenesis remains elusive, though one hypothesis proposes a protective role of salivary-specific IgA and lysozyme.⁵ Here, we report a case in which a patient developed similar lingual HSV lesions following recent immunosuppression.

WAIKOLOA, HAWAII – The topical vasoconstrictor brimonidine 0.33% gel brings impressive improvement in the facial redness component of rosacea, but it does nothing to address the inflammatory lesions of the disease, Dr. Joseph F. Fowler, Jr., said at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

Rebound flushing wasn’t seen in the 52-week, large, open-label safety study of brimonidine gel, but has been anecdotally reported since its approval. Flushing occurs 12-24 hours after application, and usually lasts a day or two, according to Dr. Fowler, who was the first author of several multicenter randomized trials of the therapy.

“The rebound phenomenon is not something that frightens me or others I know who use the medication routinely, because it’s not something that’s going to cause a long-term problem,” he declared. Indeed, once brimonidine gel (Mirvaso) has quelled the erythema, the inflammatory lesions will stand out even more prominently, noted Dr. Fowler, the conference co-director and a dermatologist at the University of Louisville. “You’ve got to do something about the inflammatory component.”

Two topical therapies that address the inflammatory component include ivermectin 1% cream (Soolantra), shown to reduce counts of papules and pustules in two 40-week extension studies of phase III trials (J Drugs Dermatol. 2014 Nov;13[11]:1380-6), and azelaic acid 15% foam (Finacea), which also achieved an impressive reduction in inflammatory lesion counts in a phase III trial (Cutis. 2015 Jul;96[1]:54-61).

Both agents were well tolerated in those studies. That’s a major treatment consideration because rosacea patients have elevated facial skin sensitivity and often can’t tolerate older off-label topical therapies because of stinging and burning, according to Dr. Fowler.

Some rosacea patients are so intolerant of topicals that they prefer oral therapy. For those patients, subantimicrobial-dose doxycycline is a good option, Dr. Fowler said.

In addition to its anti-inflammatory effects, topical ivermectin kills Demodex. While rosacea is an inflammatory disorder, not an infection, drugs like ivermectin and crotamiton 10% cream (Eurax) that kill Demodex also improve rosacea, he observed.

The initial irritation event rate with azelaic acid 15% foam in the phase III trial was in the 2%-5% range, and those events were short lived. Irritation is a much bigger problem with the older azelaic acid 15% gel, with event rates in the 15%-25% range.

Dr. Fowler has also had good results using topical calcineurin inhibitors off-label for rosacea. Pimecrolimus cream (Elidel) is in ongoing studies for treatment of seborrheic dermatitis, which often coexists with rosacea, he noted.

He reported serving as a consultant to half a dozen pharmaceutical companies, including Galderma, which markets ivermectin cream and brimonidine gel, and Bayer, which markets azelaic acid foam.

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

[email protected]

WAIKOLOA, HAWAII – The topical vasoconstrictor brimonidine 0.33% gel brings impressive improvement in the facial redness component of rosacea, but it does nothing to address the inflammatory lesions of the disease, Dr. Joseph F. Fowler, Jr., said at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

Rebound flushing wasn’t seen in the 52-week, large, open-label safety study of brimonidine gel, but has been anecdotally reported since its approval. Flushing occurs 12-24 hours after application, and usually lasts a day or two, according to Dr. Fowler, who was the first author of several multicenter randomized trials of the therapy.

“The rebound phenomenon is not something that frightens me or others I know who use the medication routinely, because it’s not something that’s going to cause a long-term problem,” he declared. Indeed, once brimonidine gel (Mirvaso) has quelled the erythema, the inflammatory lesions will stand out even more prominently, noted Dr. Fowler, the conference co-director and a dermatologist at the University of Louisville. “You’ve got to do something about the inflammatory component.”

Two topical therapies that address the inflammatory component include ivermectin 1% cream (Soolantra), shown to reduce counts of papules and pustules in two 40-week extension studies of phase III trials (J Drugs Dermatol. 2014 Nov;13[11]:1380-6), and azelaic acid 15% foam (Finacea), which also achieved an impressive reduction in inflammatory lesion counts in a phase III trial (Cutis. 2015 Jul;96[1]:54-61).

Both agents were well tolerated in those studies. That’s a major treatment consideration because rosacea patients have elevated facial skin sensitivity and often can’t tolerate older off-label topical therapies because of stinging and burning, according to Dr. Fowler.

Some rosacea patients are so intolerant of topicals that they prefer oral therapy. For those patients, subantimicrobial-dose doxycycline is a good option, Dr. Fowler said.

In addition to its anti-inflammatory effects, topical ivermectin kills Demodex. While rosacea is an inflammatory disorder, not an infection, drugs like ivermectin and crotamiton 10% cream (Eurax) that kill Demodex also improve rosacea, he observed.

The initial irritation event rate with azelaic acid 15% foam in the phase III trial was in the 2%-5% range, and those events were short lived. Irritation is a much bigger problem with the older azelaic acid 15% gel, with event rates in the 15%-25% range.

Dr. Fowler has also had good results using topical calcineurin inhibitors off-label for rosacea. Pimecrolimus cream (Elidel) is in ongoing studies for treatment of seborrheic dermatitis, which often coexists with rosacea, he noted.

He reported serving as a consultant to half a dozen pharmaceutical companies, including Galderma, which markets ivermectin cream and brimonidine gel, and Bayer, which markets azelaic acid foam.

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

[email protected]

WAIKOLOA, HAWAII – The topical vasoconstrictor brimonidine 0.33% gel brings impressive improvement in the facial redness component of rosacea, but it does nothing to address the inflammatory lesions of the disease, Dr. Joseph F. Fowler, Jr., said at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

Rebound flushing wasn’t seen in the 52-week, large, open-label safety study of brimonidine gel, but has been anecdotally reported since its approval. Flushing occurs 12-24 hours after application, and usually lasts a day or two, according to Dr. Fowler, who was the first author of several multicenter randomized trials of the therapy.

“The rebound phenomenon is not something that frightens me or others I know who use the medication routinely, because it’s not something that’s going to cause a long-term problem,” he declared. Indeed, once brimonidine gel (Mirvaso) has quelled the erythema, the inflammatory lesions will stand out even more prominently, noted Dr. Fowler, the conference co-director and a dermatologist at the University of Louisville. “You’ve got to do something about the inflammatory component.”

Two topical therapies that address the inflammatory component include ivermectin 1% cream (Soolantra), shown to reduce counts of papules and pustules in two 40-week extension studies of phase III trials (J Drugs Dermatol. 2014 Nov;13[11]:1380-6), and azelaic acid 15% foam (Finacea), which also achieved an impressive reduction in inflammatory lesion counts in a phase III trial (Cutis. 2015 Jul;96[1]:54-61).

Both agents were well tolerated in those studies. That’s a major treatment consideration because rosacea patients have elevated facial skin sensitivity and often can’t tolerate older off-label topical therapies because of stinging and burning, according to Dr. Fowler.

Some rosacea patients are so intolerant of topicals that they prefer oral therapy. For those patients, subantimicrobial-dose doxycycline is a good option, Dr. Fowler said.

In addition to its anti-inflammatory effects, topical ivermectin kills Demodex. While rosacea is an inflammatory disorder, not an infection, drugs like ivermectin and crotamiton 10% cream (Eurax) that kill Demodex also improve rosacea, he observed.

The initial irritation event rate with azelaic acid 15% foam in the phase III trial was in the 2%-5% range, and those events were short lived. Irritation is a much bigger problem with the older azelaic acid 15% gel, with event rates in the 15%-25% range.

Dr. Fowler has also had good results using topical calcineurin inhibitors off-label for rosacea. Pimecrolimus cream (Elidel) is in ongoing studies for treatment of seborrheic dermatitis, which often coexists with rosacea, he noted.

He reported serving as a consultant to half a dozen pharmaceutical companies, including Galderma, which markets ivermectin cream and brimonidine gel, and Bayer, which markets azelaic acid foam.

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

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Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

WASHINGTON (Reuters) - Climate change can be expected to boost the number of annual premature U.S. deaths from heat waves in coming decades and to increase mental health problems from extreme weather like hurricanes and floods, a U.S. study said on Monday.

"I don't know that we've seen something like this before, where we have a force that has such a multitude of effects," Surgeon General Vivek Murthy told reporters at the White House about the study. "There's not one single source that we can target with climate change, there are multiple paths that we have to address."

Heat waves were estimated to cause 670 to 1,300 U.S. deaths annually in recent years. Premature U.S. deaths from heat waves can be expected to rise more than 27,000 per year by 2100, from a 1990 baseline, one scenario in the study said. The rise outpaced projected decreases in deaths from extreme cold.

Extreme heat can cause more forest fires and increase pollen counts and the resulting poor air quality threatens people with asthma and other lung conditions. The report said poor air quality will likely lead to hundreds of thousands of premature deaths, hospital visits, and acute respiratory illness each year by 2030.

Climate change also threatens mental health, the study found. Post traumatic stress disorder, depression, and general anxiety can all result in places that suffer extreme weather linked to climate change, such as hurricanes and floods. More study needs to be done on assessing the risks to mental health, it said.

The peer-reviewed study by eight federal agencies can be found at: https://health2016.globalchange.gov/

Cases of mosquito and tick-borne diseases can also be expected to increase, though the study, completed over three years, did not look at whether locally-transmitted Zika virus cases would be more likely to hit the U.S.

President Barack Obama's administration has taken steps to cut carbon emissions by speeding a switch from coal and oil to cleaner energy sources. In February, the Supreme Court dealt a blow to the White House's climate ambitions by putting a hold on Obama's plan to cut emissions from power plants. Administration officials say the plan is on safe legal footing.John Holdren, Obama's senior science adviser, said steps the world agreed to in Paris last year to curb emissions through 2030 can help fight the risks to health.

"We will need a big encore after 2030 . . . in order to avoid the bulk of the worst impacts described in this report,"he said.

WASHINGTON (Reuters) - Climate change can be expected to boost the number of annual premature U.S. deaths from heat waves in coming decades and to increase mental health problems from extreme weather like hurricanes and floods, a U.S. study said on Monday.

"I don't know that we've seen something like this before, where we have a force that has such a multitude of effects," Surgeon General Vivek Murthy told reporters at the White House about the study. "There's not one single source that we can target with climate change, there are multiple paths that we have to address."

Heat waves were estimated to cause 670 to 1,300 U.S. deaths annually in recent years. Premature U.S. deaths from heat waves can be expected to rise more than 27,000 per year by 2100, from a 1990 baseline, one scenario in the study said. The rise outpaced projected decreases in deaths from extreme cold.

Extreme heat can cause more forest fires and increase pollen counts and the resulting poor air quality threatens people with asthma and other lung conditions. The report said poor air quality will likely lead to hundreds of thousands of premature deaths, hospital visits, and acute respiratory illness each year by 2030.

Climate change also threatens mental health, the study found. Post traumatic stress disorder, depression, and general anxiety can all result in places that suffer extreme weather linked to climate change, such as hurricanes and floods. More study needs to be done on assessing the risks to mental health, it said.

The peer-reviewed study by eight federal agencies can be found at: https://health2016.globalchange.gov/

Cases of mosquito and tick-borne diseases can also be expected to increase, though the study, completed over three years, did not look at whether locally-transmitted Zika virus cases would be more likely to hit the U.S.

President Barack Obama's administration has taken steps to cut carbon emissions by speeding a switch from coal and oil to cleaner energy sources. In February, the Supreme Court dealt a blow to the White House's climate ambitions by putting a hold on Obama's plan to cut emissions from power plants. Administration officials say the plan is on safe legal footing.John Holdren, Obama's senior science adviser, said steps the world agreed to in Paris last year to curb emissions through 2030 can help fight the risks to health.

"We will need a big encore after 2030 . . . in order to avoid the bulk of the worst impacts described in this report,"he said.

WASHINGTON (Reuters) - Climate change can be expected to boost the number of annual premature U.S. deaths from heat waves in coming decades and to increase mental health problems from extreme weather like hurricanes and floods, a U.S. study said on Monday.

"I don't know that we've seen something like this before, where we have a force that has such a multitude of effects," Surgeon General Vivek Murthy told reporters at the White House about the study. "There's not one single source that we can target with climate change, there are multiple paths that we have to address."

Heat waves were estimated to cause 670 to 1,300 U.S. deaths annually in recent years. Premature U.S. deaths from heat waves can be expected to rise more than 27,000 per year by 2100, from a 1990 baseline, one scenario in the study said. The rise outpaced projected decreases in deaths from extreme cold.

Extreme heat can cause more forest fires and increase pollen counts and the resulting poor air quality threatens people with asthma and other lung conditions. The report said poor air quality will likely lead to hundreds of thousands of premature deaths, hospital visits, and acute respiratory illness each year by 2030.

Climate change also threatens mental health, the study found. Post traumatic stress disorder, depression, and general anxiety can all result in places that suffer extreme weather linked to climate change, such as hurricanes and floods. More study needs to be done on assessing the risks to mental health, it said.

The peer-reviewed study by eight federal agencies can be found at: https://health2016.globalchange.gov/

Cases of mosquito and tick-borne diseases can also be expected to increase, though the study, completed over three years, did not look at whether locally-transmitted Zika virus cases would be more likely to hit the U.S.

President Barack Obama's administration has taken steps to cut carbon emissions by speeding a switch from coal and oil to cleaner energy sources. In February, the Supreme Court dealt a blow to the White House's climate ambitions by putting a hold on Obama's plan to cut emissions from power plants. Administration officials say the plan is on safe legal footing.John Holdren, Obama's senior science adviser, said steps the world agreed to in Paris last year to curb emissions through 2030 can help fight the risks to health.

"We will need a big encore after 2030 . . . in order to avoid the bulk of the worst impacts described in this report,"he said.