A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•What is Alpha-1 Antitrypsin Deficiency?

•AAT Deficiency is Widely Underrecognized

•Why Are Rates of Diagnosis So Low?

•Optimal Diagnosis and Management Strategies
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Leonard Fromer, MD
Assistant Clinical Professor, Family Medicine
David Geffen School of Medicine
University of California
Los Angeles
Dr. Fromer is a consultant for Talecris Biotherapeutics, Inc.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•What is Alpha-1 Antitrypsin Deficiency?

•AAT Deficiency is Widely Underrecognized

•Why Are Rates of Diagnosis So Low?

•Optimal Diagnosis and Management Strategies
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Leonard Fromer, MD
Assistant Clinical Professor, Family Medicine
David Geffen School of Medicine
University of California
Los Angeles
Dr. Fromer is a consultant for Talecris Biotherapeutics, Inc.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•What is Alpha-1 Antitrypsin Deficiency?

•AAT Deficiency is Widely Underrecognized

•Why Are Rates of Diagnosis So Low?

•Optimal Diagnosis and Management Strategies
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Leonard Fromer, MD
Assistant Clinical Professor, Family Medicine
David Geffen School of Medicine
University of California
Los Angeles
Dr. Fromer is a consultant for Talecris Biotherapeutics, Inc.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.

•Topics
•Faculty/Faculty Disclosures

To view the supplement, click the image above.

•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

A supplement to Internal Medicine News and supported by Takeda Pharmaceuticals North America, Inc.

•Faculty

To view the supplement, click the image above.

This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
Faculty

Harold Fields, MD
Founder, Village Family Practice
Houston, TX

Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

A supplement to Internal Medicine News and supported by Takeda Pharmaceuticals North America, Inc.

•Faculty

To view the supplement, click the image above.

This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
Faculty

Harold Fields, MD
Founder, Village Family Practice
Houston, TX

Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

A supplement to Internal Medicine News and supported by Takeda Pharmaceuticals North America, Inc.

•Faculty

To view the supplement, click the image above.

This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
Faculty

Harold Fields, MD
Founder, Village Family Practice
Houston, TX

Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

A supplement to Internal Medicine News and supported by Amylin/Lilly.

•Faculty

To view the supplement, click the image above.

Anne Peters, MD, FACP, CDE
Director
University of Southern
California Clinical
Diabetes Programs
Los Angeles, Calif.

A supplement to Internal Medicine News and supported by Amylin/Lilly.

•Faculty

To view the supplement, click the image above.

Anne Peters, MD, FACP, CDE
Director
University of Southern
California Clinical
Diabetes Programs
Los Angeles, Calif.

A supplement to Internal Medicine News and supported by Amylin/Lilly.

•Faculty

To view the supplement, click the image above.

Anne Peters, MD, FACP, CDE
Director
University of Southern
California Clinical
Diabetes Programs
Los Angeles, Calif.

A supplement to Internal Medicine News supported by Supported by Santarus, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Sheila E. Crowe, MD
Associate Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Digestive Health Center of Excellence
University of Virginia

A supplement to Internal Medicine News supported by Supported by Santarus, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Sheila E. Crowe, MD
Associate Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Digestive Health Center of Excellence
University of Virginia

A supplement to Internal Medicine News supported by Supported by Santarus, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Sheila E. Crowe, MD
Associate Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Digestive Health Center of Excellence
University of Virginia

A supplement to Internal Medicine News supported by Takeda Pharmaceuticals North America, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Anthony J. Lembo, MD
Assistant Professor of Medicine
Beth Israel Deaconess
Medical Center
Harvard Medical School

A supplement to Internal Medicine News supported by Takeda Pharmaceuticals North America, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Anthony J. Lembo, MD
Assistant Professor of Medicine
Beth Israel Deaconess
Medical Center
Harvard Medical School

A supplement to Internal Medicine News supported by Takeda Pharmaceuticals North America, Inc. The supplement is based on a faculty interview.

To view the supplement, click the image above.

FACULTY
Anthony J. Lembo, MD
Assistant Professor of Medicine
Beth Israel Deaconess
Medical Center
Harvard Medical School

A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.

Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.

Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.