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PODCAST: Medical home model connects patients, docs via phone, e-mail
NEW YORK – A Canadian pilot program encourages patients and primary care physicians to communicate as often as necessary by phone or e-mail, rather than always in person, to improve continuity of care.
“We believe that if one has continuity of care, one can be a lot more creative in delivery models,” explained Dr. Garey Mazowita, president of the College of Family Physicians of Canada.
In an interview at the annual meeting of the North American Primary Care Research Group, Dr. Mazowita outlined the pilot program’s rationale and implementation, and he discussed the key role that trust between patient and physician plays in the success of such a program.
On Twitter @whitneymcknight
NEW YORK – A Canadian pilot program encourages patients and primary care physicians to communicate as often as necessary by phone or e-mail, rather than always in person, to improve continuity of care.
“We believe that if one has continuity of care, one can be a lot more creative in delivery models,” explained Dr. Garey Mazowita, president of the College of Family Physicians of Canada.
In an interview at the annual meeting of the North American Primary Care Research Group, Dr. Mazowita outlined the pilot program’s rationale and implementation, and he discussed the key role that trust between patient and physician plays in the success of such a program.
On Twitter @whitneymcknight
NEW YORK – A Canadian pilot program encourages patients and primary care physicians to communicate as often as necessary by phone or e-mail, rather than always in person, to improve continuity of care.
“We believe that if one has continuity of care, one can be a lot more creative in delivery models,” explained Dr. Garey Mazowita, president of the College of Family Physicians of Canada.
In an interview at the annual meeting of the North American Primary Care Research Group, Dr. Mazowita outlined the pilot program’s rationale and implementation, and he discussed the key role that trust between patient and physician plays in the success of such a program.
On Twitter @whitneymcknight
EXPERT ANALYSIS FROM NAPCRG 2014
VIDEO: Family physicians can fill rural maternity care gaps
NEW YORK– Rather than relying on more obstetricians to practice in rural settings with limited access to maternity care, family physicians should be trusted to provide “excellent, quality care” to expectant mothers living in less populated areas – including delivering babies by cesarean section.
That’s the recommendation of Dr. Richard A. Young, director of research in family medicine at John Peters Smith Hospital, Fort Worth, Tex.
In a video interview at the annual meeting of the North American Primary Care Research Group, Dr. Young talked about the role family physicians can play in providing quality obstetrical care in underserved areas, and how they can collaborate with local obstetricians to ensure quality care even in complex cases.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
NEW YORK– Rather than relying on more obstetricians to practice in rural settings with limited access to maternity care, family physicians should be trusted to provide “excellent, quality care” to expectant mothers living in less populated areas – including delivering babies by cesarean section.
That’s the recommendation of Dr. Richard A. Young, director of research in family medicine at John Peters Smith Hospital, Fort Worth, Tex.
In a video interview at the annual meeting of the North American Primary Care Research Group, Dr. Young talked about the role family physicians can play in providing quality obstetrical care in underserved areas, and how they can collaborate with local obstetricians to ensure quality care even in complex cases.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
NEW YORK– Rather than relying on more obstetricians to practice in rural settings with limited access to maternity care, family physicians should be trusted to provide “excellent, quality care” to expectant mothers living in less populated areas – including delivering babies by cesarean section.
That’s the recommendation of Dr. Richard A. Young, director of research in family medicine at John Peters Smith Hospital, Fort Worth, Tex.
In a video interview at the annual meeting of the North American Primary Care Research Group, Dr. Young talked about the role family physicians can play in providing quality obstetrical care in underserved areas, and how they can collaborate with local obstetricians to ensure quality care even in complex cases.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
AT NAPCRG 2014
Ospemifene’s effect more comprehensive than its FDA indication
NATIONAL HARBOR, MD. – Ospemifene, a treatment for dyspareunia in postmenopausal women, also improved other symptoms of vaginal vulvar atrophy, according to a secondary analysis of two pivotal phase III trials presented here.
Marketed as Osphena (Shionogi), ospemifene is an oral estrogen agonist/antagonist approved in 2013 by the U.S. Food and Drug Administration for use in postmenopausal women with dyspareunia.
Had the drug been approved prior to FDA guidance added in 2013, however, ospemifene’s indications might have been more inclusive.
“A lot of people will look at this indication and [think], ‘Why would you just improve dyspareunia when you’re actually working with the estrogen receptor?’ ” said Dr. Ginger Constantine, a researcher at EndoRheum in Malvern, Pa., and a presenter at this year’s annual meeting of the North American Menopause Society, whose secondary analysis of the studies indicated the drug also eases vaginal dryness, itching, irritation, and painful urination in postmenopausal women.
“One would think that you would also be improving dryness ... and that is what you do see,” she said. However, when the patient-reported most bothersome symptom experienced at baseline is considered, different endpoints are achieved, resulting in packaging inserts that don’t necessarily reflect the full scope of what the product can successfully be used to treat, according to Dr. Constantine.
The estradiol acetate vaginal ring, Femring (Actavis), which was FDA-approved in 2002, has a more general indication, based on several combined study endpoints of relief from moderate to severe menopausal symptoms, including vulvar and vaginal atrophy.
Current guidance is more specific, calling for improvement in the patient-reported most bothersome symptom at baseline, as rated on a scale of 0-3, with 2 being moderate and 3 being severe. Dr. Constantine said this has led to controversy because women often have more than one symptom. “A patient might score a 3 for vaginal dryness and a 2 for dyspareunia, but she may not be so worried about her vaginal dryness,” Dr. Constantine said. “It’s her dyspareunia that’s more problematic [for her].”
Factoring in only the most bothersome symptom could impair investigators’ ability to detect statistical significance, and the result of predicating a product’s indication on the most bothersome symptom as part of a study’s construct has the potential to confuse both the clinician and the patient. “Most [postmenopausal] women have vaginal dryness, and now we’re asking them to tell us what ‘really’ bothers them, and they have to flip a coin,” Dr. Constantine said in response to an audience member’s question about whether the FDA’s labeling was too restrictive.
For the analysis, Dr. Constantine and her associates reviewed data from a 12-week, double-blind, pivotal phase III study of 826 postmenopausal women randomly assigned to either 30 mg of daily oral ospemifene, 60 mg daily of the study drug, or placebo.
Although 544 women across the study reported more than one symptom at baseline, the study’s endpoint was improvement in the most bothersome symptom. At baseline, a third of all participants reported experiencing vaginal dryness; 43% reported dyspareunia; and nearly a fifth reported vaginal itching and irritation. However, the No. 1 most bothersome symptom was dyspareunia, with nearly half, 45%, of all women reporting it as their chief complaint.
By the study’s end, the severity scores for the 120 women who’d reported dyspareunia as their most bothersome symptom were significantly improved from baseline (P = .023).
When dryness was assessed either with or without the consideration of a most bothersome symptom, then significant improvements were found (P = .001 and P = .021, respectively).
In a second pivotal, double-blind, phase III study reviewed by Dr. Constantine and her coinvestigators, 919 postmenopausal women were randomly assigned to 60 mg of daily oral ospemifene or placebo for 12 weeks, and were stratified according to the most bothersome symptom of either dyspareunia or dryness.
When compared with placebo, an improvement in dryness as the most bothersome symptom was not statistically significant (P = .0803), although an improvement from baseline in moderate to severe dryness was (P < .001).
Because the endpoints in both studies were improvement in the most bothersome symptom, the treatment was given the indication for dyspareunia only. As to why the statistical significance for dryness was diminished, Dr. Constantine said that because the women studied were allowed to use lubricants, which meant “the dryness really did get better,” it could have interfered with the results.
Compared with placebo, dyspareunia was significantly improved both as a moderate to severe symptom at baseline, and as the most bothersome symptom (P = .0003 and P < .0001, respectively).
Other symptoms such as irritation, itching, and painful urination also were improved, but did not achieve statistical significance in either study.
Given the data seen in this context, Dr. Constantine concluded that ospemifene’s limited indication was predicated more on study constructs than on failure to provide relief from other moderate to severe symptoms.
Dr. Constantine is a paid consultant and board member for Shionogi, the maker of Osphena.
On Twitter @whitneymcknight
NATIONAL HARBOR, MD. – Ospemifene, a treatment for dyspareunia in postmenopausal women, also improved other symptoms of vaginal vulvar atrophy, according to a secondary analysis of two pivotal phase III trials presented here.
Marketed as Osphena (Shionogi), ospemifene is an oral estrogen agonist/antagonist approved in 2013 by the U.S. Food and Drug Administration for use in postmenopausal women with dyspareunia.
Had the drug been approved prior to FDA guidance added in 2013, however, ospemifene’s indications might have been more inclusive.
“A lot of people will look at this indication and [think], ‘Why would you just improve dyspareunia when you’re actually working with the estrogen receptor?’ ” said Dr. Ginger Constantine, a researcher at EndoRheum in Malvern, Pa., and a presenter at this year’s annual meeting of the North American Menopause Society, whose secondary analysis of the studies indicated the drug also eases vaginal dryness, itching, irritation, and painful urination in postmenopausal women.
“One would think that you would also be improving dryness ... and that is what you do see,” she said. However, when the patient-reported most bothersome symptom experienced at baseline is considered, different endpoints are achieved, resulting in packaging inserts that don’t necessarily reflect the full scope of what the product can successfully be used to treat, according to Dr. Constantine.
The estradiol acetate vaginal ring, Femring (Actavis), which was FDA-approved in 2002, has a more general indication, based on several combined study endpoints of relief from moderate to severe menopausal symptoms, including vulvar and vaginal atrophy.
Current guidance is more specific, calling for improvement in the patient-reported most bothersome symptom at baseline, as rated on a scale of 0-3, with 2 being moderate and 3 being severe. Dr. Constantine said this has led to controversy because women often have more than one symptom. “A patient might score a 3 for vaginal dryness and a 2 for dyspareunia, but she may not be so worried about her vaginal dryness,” Dr. Constantine said. “It’s her dyspareunia that’s more problematic [for her].”
Factoring in only the most bothersome symptom could impair investigators’ ability to detect statistical significance, and the result of predicating a product’s indication on the most bothersome symptom as part of a study’s construct has the potential to confuse both the clinician and the patient. “Most [postmenopausal] women have vaginal dryness, and now we’re asking them to tell us what ‘really’ bothers them, and they have to flip a coin,” Dr. Constantine said in response to an audience member’s question about whether the FDA’s labeling was too restrictive.
For the analysis, Dr. Constantine and her associates reviewed data from a 12-week, double-blind, pivotal phase III study of 826 postmenopausal women randomly assigned to either 30 mg of daily oral ospemifene, 60 mg daily of the study drug, or placebo.
Although 544 women across the study reported more than one symptom at baseline, the study’s endpoint was improvement in the most bothersome symptom. At baseline, a third of all participants reported experiencing vaginal dryness; 43% reported dyspareunia; and nearly a fifth reported vaginal itching and irritation. However, the No. 1 most bothersome symptom was dyspareunia, with nearly half, 45%, of all women reporting it as their chief complaint.
By the study’s end, the severity scores for the 120 women who’d reported dyspareunia as their most bothersome symptom were significantly improved from baseline (P = .023).
When dryness was assessed either with or without the consideration of a most bothersome symptom, then significant improvements were found (P = .001 and P = .021, respectively).
In a second pivotal, double-blind, phase III study reviewed by Dr. Constantine and her coinvestigators, 919 postmenopausal women were randomly assigned to 60 mg of daily oral ospemifene or placebo for 12 weeks, and were stratified according to the most bothersome symptom of either dyspareunia or dryness.
When compared with placebo, an improvement in dryness as the most bothersome symptom was not statistically significant (P = .0803), although an improvement from baseline in moderate to severe dryness was (P < .001).
Because the endpoints in both studies were improvement in the most bothersome symptom, the treatment was given the indication for dyspareunia only. As to why the statistical significance for dryness was diminished, Dr. Constantine said that because the women studied were allowed to use lubricants, which meant “the dryness really did get better,” it could have interfered with the results.
Compared with placebo, dyspareunia was significantly improved both as a moderate to severe symptom at baseline, and as the most bothersome symptom (P = .0003 and P < .0001, respectively).
Other symptoms such as irritation, itching, and painful urination also were improved, but did not achieve statistical significance in either study.
Given the data seen in this context, Dr. Constantine concluded that ospemifene’s limited indication was predicated more on study constructs than on failure to provide relief from other moderate to severe symptoms.
Dr. Constantine is a paid consultant and board member for Shionogi, the maker of Osphena.
On Twitter @whitneymcknight
NATIONAL HARBOR, MD. – Ospemifene, a treatment for dyspareunia in postmenopausal women, also improved other symptoms of vaginal vulvar atrophy, according to a secondary analysis of two pivotal phase III trials presented here.
Marketed as Osphena (Shionogi), ospemifene is an oral estrogen agonist/antagonist approved in 2013 by the U.S. Food and Drug Administration for use in postmenopausal women with dyspareunia.
Had the drug been approved prior to FDA guidance added in 2013, however, ospemifene’s indications might have been more inclusive.
“A lot of people will look at this indication and [think], ‘Why would you just improve dyspareunia when you’re actually working with the estrogen receptor?’ ” said Dr. Ginger Constantine, a researcher at EndoRheum in Malvern, Pa., and a presenter at this year’s annual meeting of the North American Menopause Society, whose secondary analysis of the studies indicated the drug also eases vaginal dryness, itching, irritation, and painful urination in postmenopausal women.
“One would think that you would also be improving dryness ... and that is what you do see,” she said. However, when the patient-reported most bothersome symptom experienced at baseline is considered, different endpoints are achieved, resulting in packaging inserts that don’t necessarily reflect the full scope of what the product can successfully be used to treat, according to Dr. Constantine.
The estradiol acetate vaginal ring, Femring (Actavis), which was FDA-approved in 2002, has a more general indication, based on several combined study endpoints of relief from moderate to severe menopausal symptoms, including vulvar and vaginal atrophy.
Current guidance is more specific, calling for improvement in the patient-reported most bothersome symptom at baseline, as rated on a scale of 0-3, with 2 being moderate and 3 being severe. Dr. Constantine said this has led to controversy because women often have more than one symptom. “A patient might score a 3 for vaginal dryness and a 2 for dyspareunia, but she may not be so worried about her vaginal dryness,” Dr. Constantine said. “It’s her dyspareunia that’s more problematic [for her].”
Factoring in only the most bothersome symptom could impair investigators’ ability to detect statistical significance, and the result of predicating a product’s indication on the most bothersome symptom as part of a study’s construct has the potential to confuse both the clinician and the patient. “Most [postmenopausal] women have vaginal dryness, and now we’re asking them to tell us what ‘really’ bothers them, and they have to flip a coin,” Dr. Constantine said in response to an audience member’s question about whether the FDA’s labeling was too restrictive.
For the analysis, Dr. Constantine and her associates reviewed data from a 12-week, double-blind, pivotal phase III study of 826 postmenopausal women randomly assigned to either 30 mg of daily oral ospemifene, 60 mg daily of the study drug, or placebo.
Although 544 women across the study reported more than one symptom at baseline, the study’s endpoint was improvement in the most bothersome symptom. At baseline, a third of all participants reported experiencing vaginal dryness; 43% reported dyspareunia; and nearly a fifth reported vaginal itching and irritation. However, the No. 1 most bothersome symptom was dyspareunia, with nearly half, 45%, of all women reporting it as their chief complaint.
By the study’s end, the severity scores for the 120 women who’d reported dyspareunia as their most bothersome symptom were significantly improved from baseline (P = .023).
When dryness was assessed either with or without the consideration of a most bothersome symptom, then significant improvements were found (P = .001 and P = .021, respectively).
In a second pivotal, double-blind, phase III study reviewed by Dr. Constantine and her coinvestigators, 919 postmenopausal women were randomly assigned to 60 mg of daily oral ospemifene or placebo for 12 weeks, and were stratified according to the most bothersome symptom of either dyspareunia or dryness.
When compared with placebo, an improvement in dryness as the most bothersome symptom was not statistically significant (P = .0803), although an improvement from baseline in moderate to severe dryness was (P < .001).
Because the endpoints in both studies were improvement in the most bothersome symptom, the treatment was given the indication for dyspareunia only. As to why the statistical significance for dryness was diminished, Dr. Constantine said that because the women studied were allowed to use lubricants, which meant “the dryness really did get better,” it could have interfered with the results.
Compared with placebo, dyspareunia was significantly improved both as a moderate to severe symptom at baseline, and as the most bothersome symptom (P = .0003 and P < .0001, respectively).
Other symptoms such as irritation, itching, and painful urination also were improved, but did not achieve statistical significance in either study.
Given the data seen in this context, Dr. Constantine concluded that ospemifene’s limited indication was predicated more on study constructs than on failure to provide relief from other moderate to severe symptoms.
Dr. Constantine is a paid consultant and board member for Shionogi, the maker of Osphena.
On Twitter @whitneymcknight
AT THE NAMS 2014 ANNUAL MEETING
Key clinical point: Ospemifene could be an effective treatment for a range of moderate to severe menopausal symptoms.
Major finding: Ospemifine 60 mg daily, FDA-approved for dyspareunia, also yielded statistically significant improvement in vaginal dryness.
Data source: Secondary analysis of two randomly controlled, double-blind, pivotal phase III trials of 826 women treated with either 30 mg or 60 mg of daily oral ospemifene or placebo, and 919 women treated with either 60 mg ospemifene daily or placebo, stratified at randomization by most bothersome symptom at baseline.
Disclosures: Dr. Constantine is a paid consultant and board member for Shionogi, maker of Osphena.
Primary care screening tool reveals sleep disorders risk
AUSTIN, TEX. – An online, self-reported tool to determine risk of sleep disorders such as insomnia and restless legs syndrome outperformed assessment by a sleep specialist, new data show.
“Our results suggest that [the online survey] may be used in the primary care setting as a screening method for several sleep disorders,” Dr. Michael Morgenstern, a neurologist at the North Shore Long Island Jewish Medical Center, New Hyde Park, N.Y., said during an original investigation session at the annual meeting of the American College of Chest Physicians.
“The SNORE [Sleep Disorder and Narcolepsy Online Reference for Evaluation] online screening tool performs at least as well as the interviewer in detecting the risk of common sleep disorders, and at times it performs better,” Dr. Morgenstern said.
For obstructive sleep apnea and sleep disruption, the online screening tool and sleep physician interview were equal at assessing risk.
In a random, prospective, crossover trial of 53 adult sleep-clinic patients and 24 adult primary care–setting patients, two-thirds of whom were male, the SNORE self-report screening tool demonstrated both high sensitivity and high specificity for determining sleep disorder risks: between 94% and 85%, and 76% and 65%, respectively.
According to the American Academy of Sleep Medicine’s criteria for sleep disorder assessment, sleep specialists accurately determined the risk for insomnia 40.2% of the time, compared with SNORE’s 51.4%.
The online tool also bested a sleep specialist when it came to determining the risk of restless legs syndrome: The tool identified 44.1% of at-risk cases, while the specialist identified 23.3%.
Sleep specialists were slightly better than SNORE at determining patients at risk for sleep apnea: 78% for an interview with a specialist vs. 75.3% using the self-report tool.
Sleep disruption risk was determined equally by either method: 60% by a sleep specialist vs. 60% by SNORE.
Patients in the study were asked to complete the SNORE survey before they were interviewed by a sleep specialist. The sleep specialist was blinded to the patient’s history and survey results. Polysomnography was not included in the assessment, because risk assessment, not diagnosis, was the goal. A third of all participants were randomly assigned to take the SNORE test first or to be interviewed first.
The median overall time necessary to take the entire survey was 6 minutes. If a shortened version was used, the survey took an average of 4 minutes.
Using the survey in the primary care setting could lead to earlier detection and treatment of sleep disorders, Dr. Morgenstern noted, which would aid in overall health.
“For a lot of people who come to a primary care clinic, they don’t think to mention sleep-related symptoms, and the primary care doctor doesn’t really have time to ask about complaints the person isn’t there to talk about,” Dr. Morgenstern said. “But sleep is part of a person’s overall picture of health. Wouldn’t it be great if we had a way to identify issues so patients and providers could talk about it?”
Dr. Morgenstern said he had no relevant financial disclosures.
On Twitter @whitneymcknight
AUSTIN, TEX. – An online, self-reported tool to determine risk of sleep disorders such as insomnia and restless legs syndrome outperformed assessment by a sleep specialist, new data show.
“Our results suggest that [the online survey] may be used in the primary care setting as a screening method for several sleep disorders,” Dr. Michael Morgenstern, a neurologist at the North Shore Long Island Jewish Medical Center, New Hyde Park, N.Y., said during an original investigation session at the annual meeting of the American College of Chest Physicians.
“The SNORE [Sleep Disorder and Narcolepsy Online Reference for Evaluation] online screening tool performs at least as well as the interviewer in detecting the risk of common sleep disorders, and at times it performs better,” Dr. Morgenstern said.
For obstructive sleep apnea and sleep disruption, the online screening tool and sleep physician interview were equal at assessing risk.
In a random, prospective, crossover trial of 53 adult sleep-clinic patients and 24 adult primary care–setting patients, two-thirds of whom were male, the SNORE self-report screening tool demonstrated both high sensitivity and high specificity for determining sleep disorder risks: between 94% and 85%, and 76% and 65%, respectively.
According to the American Academy of Sleep Medicine’s criteria for sleep disorder assessment, sleep specialists accurately determined the risk for insomnia 40.2% of the time, compared with SNORE’s 51.4%.
The online tool also bested a sleep specialist when it came to determining the risk of restless legs syndrome: The tool identified 44.1% of at-risk cases, while the specialist identified 23.3%.
Sleep specialists were slightly better than SNORE at determining patients at risk for sleep apnea: 78% for an interview with a specialist vs. 75.3% using the self-report tool.
Sleep disruption risk was determined equally by either method: 60% by a sleep specialist vs. 60% by SNORE.
Patients in the study were asked to complete the SNORE survey before they were interviewed by a sleep specialist. The sleep specialist was blinded to the patient’s history and survey results. Polysomnography was not included in the assessment, because risk assessment, not diagnosis, was the goal. A third of all participants were randomly assigned to take the SNORE test first or to be interviewed first.
The median overall time necessary to take the entire survey was 6 minutes. If a shortened version was used, the survey took an average of 4 minutes.
Using the survey in the primary care setting could lead to earlier detection and treatment of sleep disorders, Dr. Morgenstern noted, which would aid in overall health.
“For a lot of people who come to a primary care clinic, they don’t think to mention sleep-related symptoms, and the primary care doctor doesn’t really have time to ask about complaints the person isn’t there to talk about,” Dr. Morgenstern said. “But sleep is part of a person’s overall picture of health. Wouldn’t it be great if we had a way to identify issues so patients and providers could talk about it?”
Dr. Morgenstern said he had no relevant financial disclosures.
On Twitter @whitneymcknight
AUSTIN, TEX. – An online, self-reported tool to determine risk of sleep disorders such as insomnia and restless legs syndrome outperformed assessment by a sleep specialist, new data show.
“Our results suggest that [the online survey] may be used in the primary care setting as a screening method for several sleep disorders,” Dr. Michael Morgenstern, a neurologist at the North Shore Long Island Jewish Medical Center, New Hyde Park, N.Y., said during an original investigation session at the annual meeting of the American College of Chest Physicians.
“The SNORE [Sleep Disorder and Narcolepsy Online Reference for Evaluation] online screening tool performs at least as well as the interviewer in detecting the risk of common sleep disorders, and at times it performs better,” Dr. Morgenstern said.
For obstructive sleep apnea and sleep disruption, the online screening tool and sleep physician interview were equal at assessing risk.
In a random, prospective, crossover trial of 53 adult sleep-clinic patients and 24 adult primary care–setting patients, two-thirds of whom were male, the SNORE self-report screening tool demonstrated both high sensitivity and high specificity for determining sleep disorder risks: between 94% and 85%, and 76% and 65%, respectively.
According to the American Academy of Sleep Medicine’s criteria for sleep disorder assessment, sleep specialists accurately determined the risk for insomnia 40.2% of the time, compared with SNORE’s 51.4%.
The online tool also bested a sleep specialist when it came to determining the risk of restless legs syndrome: The tool identified 44.1% of at-risk cases, while the specialist identified 23.3%.
Sleep specialists were slightly better than SNORE at determining patients at risk for sleep apnea: 78% for an interview with a specialist vs. 75.3% using the self-report tool.
Sleep disruption risk was determined equally by either method: 60% by a sleep specialist vs. 60% by SNORE.
Patients in the study were asked to complete the SNORE survey before they were interviewed by a sleep specialist. The sleep specialist was blinded to the patient’s history and survey results. Polysomnography was not included in the assessment, because risk assessment, not diagnosis, was the goal. A third of all participants were randomly assigned to take the SNORE test first or to be interviewed first.
The median overall time necessary to take the entire survey was 6 minutes. If a shortened version was used, the survey took an average of 4 minutes.
Using the survey in the primary care setting could lead to earlier detection and treatment of sleep disorders, Dr. Morgenstern noted, which would aid in overall health.
“For a lot of people who come to a primary care clinic, they don’t think to mention sleep-related symptoms, and the primary care doctor doesn’t really have time to ask about complaints the person isn’t there to talk about,” Dr. Morgenstern said. “But sleep is part of a person’s overall picture of health. Wouldn’t it be great if we had a way to identify issues so patients and providers could talk about it?”
Dr. Morgenstern said he had no relevant financial disclosures.
On Twitter @whitneymcknight
AT CHEST 2014
Key clinical point: A self-reported online screening tool may effectively assess a patient’s risk of sleep disorders.
Major finding: The SNORE screening survey performed significantly better than a sleep specialist at identifying risk of insomnia and restless legs syndrome.
Data source: A random, prospective, crossover trial of 53 sleep-clinic patients and 24 primary care–setting patients given the survey and a sleep specialist interview.
Disclosures: Dr. Morgenstern said he had no relevant financial disclosures.
Soy isoflavones safe in postmenopausal women, data from 3-year trial showed
NATIONAL HARBOR, MD. – Soy isoflavones are safe for postmenopausal women to take long term, having no treatment effect on endometrial thickness, reproductive hormones, or thyroid function, the results of a 3-year study have shown.
Despite previous reports that soy isoflavones have deleterious effects, they still are often used by postmenopausal women as an alternative to hormone therapy, according to study author, D. Lee Alekel, Ph.D., program director of women’s health at the National Center for Complementary and Alternative Medicine at the National Institutes of Health.
“It behooves us to examine the safety-related outcomes and rates of any adverse events in women consuming over-the-counter soy isoflavone supplements, which could be 100 mg of isoflavones a day or more,” Dr. Alekel said at the annual meeting of the North American Menopause Society. “That’s five times the intake from typical Asian diets, so it’s quite a bit more.”
The findings are from the dual-site, double-blind, placebo-controlled Soy Isoflavones for Reducing Bone Loss (SIRBL) study of women randomly assigned to placebo, or either 80 mg or 120 mg of daily soy isoflavones. No treatment effects on endometrial thickness or circulating hormone concentrations, including thyroid function, were detected using transvaginal ultrasound in any of the study groups (Menopause 2014 [doi: 10.1097/GME.0000000000000280]).
All women in the study were between 48 and 65 years of age at the time of enrollment, had experienced natural onset of menopause, did not smoke, agreed to avoid soy-based foods for the duration of the study, and maintained a healthy weight. The investigators also took into account lactation duration, and excluded from the study any women using hormone therapy or chronic medication. All participants had to have an annual physical, mammogram, gynecologic exam, and breast exam performed by their own physicians in order to remain in the study.
After losing 12% to follow-up, 224 women remained in the intent-to-treat analysis, and 208 women who were compliant with their assigned treatment fully completed the study.
Assessments done at 6, 12, 18, 24, and 36 months showed declines in median endometrial thickness in all three treatment groups: from 1.5 to 1.1 mm at the Iowa site, and from 2.6 to 1.9 mm at the California site. Neither the 80 mg nor the 120 mg dose were found to have a treatment effect (P = .57 and P = 0.43, respectively).
Adverse event rates varied by site, but not treatment arms: a higher rate of upper respiratory tract infections was noted in women studied in Iowa, compared with women enrolled at the second site in southern California (P ≤ .0001). The investigators theorized this difference was due to Iowa having longer, harsher winters. The 80-mg arm had more genitourinary issues (P = .005), primarily urinary tract infections, than did the 120-mg group.
Previous studies also have suggested soy isoflavones have no adverse effect on the endometrium, regardless of the form or dose of isoflavone; however, one study cited by Dr. Alekel “did show that 150 mg of soy taken per day for up to 5 years increased endometrial hyperplasia about 4%, but there was no endometrial carcinoma detected” (Fertil. Steril. 2004 Jul;82:145-8).
On Twitter @whitneymcknight
NATIONAL HARBOR, MD. – Soy isoflavones are safe for postmenopausal women to take long term, having no treatment effect on endometrial thickness, reproductive hormones, or thyroid function, the results of a 3-year study have shown.
Despite previous reports that soy isoflavones have deleterious effects, they still are often used by postmenopausal women as an alternative to hormone therapy, according to study author, D. Lee Alekel, Ph.D., program director of women’s health at the National Center for Complementary and Alternative Medicine at the National Institutes of Health.
“It behooves us to examine the safety-related outcomes and rates of any adverse events in women consuming over-the-counter soy isoflavone supplements, which could be 100 mg of isoflavones a day or more,” Dr. Alekel said at the annual meeting of the North American Menopause Society. “That’s five times the intake from typical Asian diets, so it’s quite a bit more.”
The findings are from the dual-site, double-blind, placebo-controlled Soy Isoflavones for Reducing Bone Loss (SIRBL) study of women randomly assigned to placebo, or either 80 mg or 120 mg of daily soy isoflavones. No treatment effects on endometrial thickness or circulating hormone concentrations, including thyroid function, were detected using transvaginal ultrasound in any of the study groups (Menopause 2014 [doi: 10.1097/GME.0000000000000280]).
All women in the study were between 48 and 65 years of age at the time of enrollment, had experienced natural onset of menopause, did not smoke, agreed to avoid soy-based foods for the duration of the study, and maintained a healthy weight. The investigators also took into account lactation duration, and excluded from the study any women using hormone therapy or chronic medication. All participants had to have an annual physical, mammogram, gynecologic exam, and breast exam performed by their own physicians in order to remain in the study.
After losing 12% to follow-up, 224 women remained in the intent-to-treat analysis, and 208 women who were compliant with their assigned treatment fully completed the study.
Assessments done at 6, 12, 18, 24, and 36 months showed declines in median endometrial thickness in all three treatment groups: from 1.5 to 1.1 mm at the Iowa site, and from 2.6 to 1.9 mm at the California site. Neither the 80 mg nor the 120 mg dose were found to have a treatment effect (P = .57 and P = 0.43, respectively).
Adverse event rates varied by site, but not treatment arms: a higher rate of upper respiratory tract infections was noted in women studied in Iowa, compared with women enrolled at the second site in southern California (P ≤ .0001). The investigators theorized this difference was due to Iowa having longer, harsher winters. The 80-mg arm had more genitourinary issues (P = .005), primarily urinary tract infections, than did the 120-mg group.
Previous studies also have suggested soy isoflavones have no adverse effect on the endometrium, regardless of the form or dose of isoflavone; however, one study cited by Dr. Alekel “did show that 150 mg of soy taken per day for up to 5 years increased endometrial hyperplasia about 4%, but there was no endometrial carcinoma detected” (Fertil. Steril. 2004 Jul;82:145-8).
On Twitter @whitneymcknight
NATIONAL HARBOR, MD. – Soy isoflavones are safe for postmenopausal women to take long term, having no treatment effect on endometrial thickness, reproductive hormones, or thyroid function, the results of a 3-year study have shown.
Despite previous reports that soy isoflavones have deleterious effects, they still are often used by postmenopausal women as an alternative to hormone therapy, according to study author, D. Lee Alekel, Ph.D., program director of women’s health at the National Center for Complementary and Alternative Medicine at the National Institutes of Health.
“It behooves us to examine the safety-related outcomes and rates of any adverse events in women consuming over-the-counter soy isoflavone supplements, which could be 100 mg of isoflavones a day or more,” Dr. Alekel said at the annual meeting of the North American Menopause Society. “That’s five times the intake from typical Asian diets, so it’s quite a bit more.”
The findings are from the dual-site, double-blind, placebo-controlled Soy Isoflavones for Reducing Bone Loss (SIRBL) study of women randomly assigned to placebo, or either 80 mg or 120 mg of daily soy isoflavones. No treatment effects on endometrial thickness or circulating hormone concentrations, including thyroid function, were detected using transvaginal ultrasound in any of the study groups (Menopause 2014 [doi: 10.1097/GME.0000000000000280]).
All women in the study were between 48 and 65 years of age at the time of enrollment, had experienced natural onset of menopause, did not smoke, agreed to avoid soy-based foods for the duration of the study, and maintained a healthy weight. The investigators also took into account lactation duration, and excluded from the study any women using hormone therapy or chronic medication. All participants had to have an annual physical, mammogram, gynecologic exam, and breast exam performed by their own physicians in order to remain in the study.
After losing 12% to follow-up, 224 women remained in the intent-to-treat analysis, and 208 women who were compliant with their assigned treatment fully completed the study.
Assessments done at 6, 12, 18, 24, and 36 months showed declines in median endometrial thickness in all three treatment groups: from 1.5 to 1.1 mm at the Iowa site, and from 2.6 to 1.9 mm at the California site. Neither the 80 mg nor the 120 mg dose were found to have a treatment effect (P = .57 and P = 0.43, respectively).
Adverse event rates varied by site, but not treatment arms: a higher rate of upper respiratory tract infections was noted in women studied in Iowa, compared with women enrolled at the second site in southern California (P ≤ .0001). The investigators theorized this difference was due to Iowa having longer, harsher winters. The 80-mg arm had more genitourinary issues (P = .005), primarily urinary tract infections, than did the 120-mg group.
Previous studies also have suggested soy isoflavones have no adverse effect on the endometrium, regardless of the form or dose of isoflavone; however, one study cited by Dr. Alekel “did show that 150 mg of soy taken per day for up to 5 years increased endometrial hyperplasia about 4%, but there was no endometrial carcinoma detected” (Fertil. Steril. 2004 Jul;82:145-8).
On Twitter @whitneymcknight
AT THE NAMS 2014 ANNUAL MEETING
Key clinical point: Soy isoflavones taken long term can be an effective nonpharmacogenic treatment of postmenopausal symptoms.
Major finding: Neither 80 mg (P = 0.57) nor 120 mg dose (P = 0.43) taken daily for 3 years had an effect on endometrial thickness.
Data source: Double-blind, random, controlled, multisite study of 208 postmenopausal women given placebo, 80 mg daily, or 120 mg daily of soy isoflavones for 36 months.
Disclosures: Dr. Alekel did not have any relevant disclosures.
CPAP compliance compatible with good sex
AUSTIN, TEX. – Patients who consider themselves too sexy for their continuous positive airway pressure devices should reconsider, according to a presenter at the annual meeting of the American College of Chest Physicians.
“Despite the unsexy appearance of a positive airway pressure device in the bedroom, patients who don’t comply with their CPAP [protocols] do not have a better sexual quality of life,” said Dr. Salman Alim, who presented the original investigation during a quality and clinical improvement session.
Sexual quality of life questionnaires were distributed to 52 men being treated at a single site with continuous positive airway pressure (CPAP) for obstructive sleep apnea. The 10-question survey used a scale of 1-8, with 80 being the highest score, to evaluate aspects of the participants’ emotional and physical satisfaction with their sex lives. Patients were considered CPAP-compliant if they used their device 4 or more hours nightly at least 70% of the time before going to sleep.
The compliant cohort of 27 men, whose average age was 59 years, had a sexual quality of life score of about 38. The noncompliant group of 25 men, whose average age was 56 years, had a score of about 48.
After adjusting for confounding variables such as age, body mass index, erectile dysfunction, use of phosphodiesterase inhibitors, and depression, CPAP compliance did not predict one’s sexual quality of life, reported Dr. Alim, who was with Rosalind Franklin University in North Chicago, Ill., at the time of the study and is now with Physicians Regional Healthcare System in Naples, Fla.
“Although this is not a validated survey … the study’s findings can be the basis to develop a hypothesis that can be tested more rigorously. At the least, the results provide clinicians with useful information on counseling patients on adherence with CPAP,” Dr. Mark Rosen, medical director of the American College of Chest Physicians, said in an interview.
The authors of the study said that they had no relevant disclosures.
On Twitter @whitneymcknight
Dr. Octavian C. Ioachimescu, FCCP, comments: Adherence to CPAP therapy for obstructive sleep apnea (OSA) remains a problem in day-to-day practice. Whenever a patient, often but not always a young patient, brings up the issue of CPAP not being 'sexy' in the bedroom, I ask a simple question: "How sexy do you think it is to be snoring, snorting, gasping, choking, or drooling?" That realization seems to work, at least for a while.
If validated, a sexual quality of life questionnaire may be a good instrument to assess this domain of OSA symptoms. If findings of better CPAP adherence being correlated with better sexual quality of life are reproduced in a rigorous trial, then we would welcome another tool in our armamentarium to motivate, engage and empower our patients to participate in the act of therapy. Why not 6 hours and 80% of the nights? Or 8 hours and 100% of the nights?
Dr. Ioachimescu is an associate professor of pulmonary medicine at the Emory University Atlanta VA Medical Center in Decatur, Georgia.
Dr. Octavian C. Ioachimescu, FCCP, comments: Adherence to CPAP therapy for obstructive sleep apnea (OSA) remains a problem in day-to-day practice. Whenever a patient, often but not always a young patient, brings up the issue of CPAP not being 'sexy' in the bedroom, I ask a simple question: "How sexy do you think it is to be snoring, snorting, gasping, choking, or drooling?" That realization seems to work, at least for a while.
If validated, a sexual quality of life questionnaire may be a good instrument to assess this domain of OSA symptoms. If findings of better CPAP adherence being correlated with better sexual quality of life are reproduced in a rigorous trial, then we would welcome another tool in our armamentarium to motivate, engage and empower our patients to participate in the act of therapy. Why not 6 hours and 80% of the nights? Or 8 hours and 100% of the nights?
Dr. Ioachimescu is an associate professor of pulmonary medicine at the Emory University Atlanta VA Medical Center in Decatur, Georgia.
Dr. Octavian C. Ioachimescu, FCCP, comments: Adherence to CPAP therapy for obstructive sleep apnea (OSA) remains a problem in day-to-day practice. Whenever a patient, often but not always a young patient, brings up the issue of CPAP not being 'sexy' in the bedroom, I ask a simple question: "How sexy do you think it is to be snoring, snorting, gasping, choking, or drooling?" That realization seems to work, at least for a while.
If validated, a sexual quality of life questionnaire may be a good instrument to assess this domain of OSA symptoms. If findings of better CPAP adherence being correlated with better sexual quality of life are reproduced in a rigorous trial, then we would welcome another tool in our armamentarium to motivate, engage and empower our patients to participate in the act of therapy. Why not 6 hours and 80% of the nights? Or 8 hours and 100% of the nights?
Dr. Ioachimescu is an associate professor of pulmonary medicine at the Emory University Atlanta VA Medical Center in Decatur, Georgia.
AUSTIN, TEX. – Patients who consider themselves too sexy for their continuous positive airway pressure devices should reconsider, according to a presenter at the annual meeting of the American College of Chest Physicians.
“Despite the unsexy appearance of a positive airway pressure device in the bedroom, patients who don’t comply with their CPAP [protocols] do not have a better sexual quality of life,” said Dr. Salman Alim, who presented the original investigation during a quality and clinical improvement session.
Sexual quality of life questionnaires were distributed to 52 men being treated at a single site with continuous positive airway pressure (CPAP) for obstructive sleep apnea. The 10-question survey used a scale of 1-8, with 80 being the highest score, to evaluate aspects of the participants’ emotional and physical satisfaction with their sex lives. Patients were considered CPAP-compliant if they used their device 4 or more hours nightly at least 70% of the time before going to sleep.
The compliant cohort of 27 men, whose average age was 59 years, had a sexual quality of life score of about 38. The noncompliant group of 25 men, whose average age was 56 years, had a score of about 48.
After adjusting for confounding variables such as age, body mass index, erectile dysfunction, use of phosphodiesterase inhibitors, and depression, CPAP compliance did not predict one’s sexual quality of life, reported Dr. Alim, who was with Rosalind Franklin University in North Chicago, Ill., at the time of the study and is now with Physicians Regional Healthcare System in Naples, Fla.
“Although this is not a validated survey … the study’s findings can be the basis to develop a hypothesis that can be tested more rigorously. At the least, the results provide clinicians with useful information on counseling patients on adherence with CPAP,” Dr. Mark Rosen, medical director of the American College of Chest Physicians, said in an interview.
The authors of the study said that they had no relevant disclosures.
On Twitter @whitneymcknight
AUSTIN, TEX. – Patients who consider themselves too sexy for their continuous positive airway pressure devices should reconsider, according to a presenter at the annual meeting of the American College of Chest Physicians.
“Despite the unsexy appearance of a positive airway pressure device in the bedroom, patients who don’t comply with their CPAP [protocols] do not have a better sexual quality of life,” said Dr. Salman Alim, who presented the original investigation during a quality and clinical improvement session.
Sexual quality of life questionnaires were distributed to 52 men being treated at a single site with continuous positive airway pressure (CPAP) for obstructive sleep apnea. The 10-question survey used a scale of 1-8, with 80 being the highest score, to evaluate aspects of the participants’ emotional and physical satisfaction with their sex lives. Patients were considered CPAP-compliant if they used their device 4 or more hours nightly at least 70% of the time before going to sleep.
The compliant cohort of 27 men, whose average age was 59 years, had a sexual quality of life score of about 38. The noncompliant group of 25 men, whose average age was 56 years, had a score of about 48.
After adjusting for confounding variables such as age, body mass index, erectile dysfunction, use of phosphodiesterase inhibitors, and depression, CPAP compliance did not predict one’s sexual quality of life, reported Dr. Alim, who was with Rosalind Franklin University in North Chicago, Ill., at the time of the study and is now with Physicians Regional Healthcare System in Naples, Fla.
“Although this is not a validated survey … the study’s findings can be the basis to develop a hypothesis that can be tested more rigorously. At the least, the results provide clinicians with useful information on counseling patients on adherence with CPAP,” Dr. Mark Rosen, medical director of the American College of Chest Physicians, said in an interview.
The authors of the study said that they had no relevant disclosures.
On Twitter @whitneymcknight
AT CHEST 2014
Key clinical point: Counsel CPAP patients that they can still enjoy sexual intimacy while remaining compliant with sleep apnea treatment.
Major finding: Sexual quality of life scores on a scale up to 80 were 38 in compliant and 48 in noncompliant CPAP patients.
Data source: Survey of 52 obstructive sleep apnea patients treated with CPAP.
Disclosures: The authors of this study said that they had no relevant disclosures.
VIDEO: How U.S. Health Providers Can Contain Ebola
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VIDEO: Should physicians reevaluate the role of clopidogrel?
AUSTIN, TEX.– Genetic testing holds promise for guiding the prescribing of antiplatelet therapies, particularly clopidogrel, but “we’re not there yet,” according to Dr. Steven Hollenberg, director of the coronary care unit at Cooper University Hospital in Camden, N.J.Genetic testing for clopidogrel responsiveness “certainly makes good sense, but I think we’re going to have to wait for good data” that better informs clinical decision making.Dr. Hollenberg discussed the implications of the negative results of the ARCTIC trial, which showed platelet function testing with antiplatelet therapy adjustment failed to improve clinical outcomes compared with standard unmonitored thienopyridine therapy in elective PCI. He also analyzed the results of other studies relevant to optimal antiplatelet and anticoagulant therapy, including the surprising outcomes of the WOEST trial.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
AUSTIN, TEX.– Genetic testing holds promise for guiding the prescribing of antiplatelet therapies, particularly clopidogrel, but “we’re not there yet,” according to Dr. Steven Hollenberg, director of the coronary care unit at Cooper University Hospital in Camden, N.J.Genetic testing for clopidogrel responsiveness “certainly makes good sense, but I think we’re going to have to wait for good data” that better informs clinical decision making.Dr. Hollenberg discussed the implications of the negative results of the ARCTIC trial, which showed platelet function testing with antiplatelet therapy adjustment failed to improve clinical outcomes compared with standard unmonitored thienopyridine therapy in elective PCI. He also analyzed the results of other studies relevant to optimal antiplatelet and anticoagulant therapy, including the surprising outcomes of the WOEST trial.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
AUSTIN, TEX.– Genetic testing holds promise for guiding the prescribing of antiplatelet therapies, particularly clopidogrel, but “we’re not there yet,” according to Dr. Steven Hollenberg, director of the coronary care unit at Cooper University Hospital in Camden, N.J.Genetic testing for clopidogrel responsiveness “certainly makes good sense, but I think we’re going to have to wait for good data” that better informs clinical decision making.Dr. Hollenberg discussed the implications of the negative results of the ARCTIC trial, which showed platelet function testing with antiplatelet therapy adjustment failed to improve clinical outcomes compared with standard unmonitored thienopyridine therapy in elective PCI. He also analyzed the results of other studies relevant to optimal antiplatelet and anticoagulant therapy, including the surprising outcomes of the WOEST trial.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
AT CHEST 2014
VIDEO: How U.S. health providers can contain Ebola
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
On Twitter @whitneymcknight
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
On Twitter @whitneymcknight
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AUSTIN, TEX. – Why would travel restrictions make the Ebola epidemic worse in West Africa and expand its spread to U.S. shores? What can American intensive care units do to prepare, even if they aren’t designated Ebola centers? And are there lessons medical professionals and policymakers can apply from the successes and failures of the AIDS epidemic 30 years ago?
In a video interview at the annual meeting of the American College of Chest Physicians, Dr. Lewis Rubinson offered answers to those questions and perspectives on the current American response to the Ebola outbreak. Dr. Rubinson recently returned from treating more than 300 Ebola patients in Sierra Leone as a consulting physician for the World Health Organization.
“Honestly, I think if we don’t get it under control in the next few months in West Africa, there will be sporadic cases coming back [to the United States] for as long as we can think of,” cautioned Dr. Rubinson, director of the R. Adams Cowley Trauma Shock Center at the University of Maryland, Baltimore.
On Twitter @whitneymcknight
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT CHEST 2014
Extracorporeal membrane oxygenation doubled survival rate of conventional CPR
AUSTIN, TEX. – Extracorporeal membrane oxygenation delivered during cardiopulmonary resuscitation allowed nearly twice as many patients to survive after discharge when compared against typical CPR-only procedures in a small, retrospective study.
“It’s no secret that conventional CPR is not terrifically successful,” Graham Peigh, a second-year medical student at Jefferson Medical College in Philadelphia, said during the Hot Topics in Pulmonary and Critical Care session at the annual meeting of the American College of Chest Physicians. “Extracorporeal membrane oxygenation [ECMO] gives patients a second chance at life.”
Mr. Peigh and his colleagues retrospectively analyzed 100 ECMO procedures performed on adults at a single teaching hospital during 2010-2013 and found that when ECMO was added to CPR, the survival rate to discharge went from 15% as calculated in a previously reported meta-analysis (J. Gen. Intern. Med. 1998;13:805-16) to 29% (P = .04).
When an arrested patient does not respond to CPR, cannulation through the femoral artery and vein can be combined with compressions to improve chances of survival.
In their analysis of ECMO delivered in an academic hospital setting, Mr. Peigh and his colleagues found that in the 24 cases in which ECMO was added to conventional CPR after the patients failed to respond to CPR alone, the survival rate with full neurologic recovery was 29%.
ECMO support was delivered in a number of scenarios, ranging from acute myocardial infarction to malignant arrhythmia to at least one case each of drug overdose induced cardiac arrest, septic shock, postcardiotomy failure, and acute rejection.
The ECMO support was provided for a mean of 5 days. The mean age for all patients studied was 47 years, and 15 were male. All cases followed a 24-hour hypothermia protocol.
Six of the ECMO-CPR patients died post ECMO of anoxic brain injury, stroke, or sepsis while still in the hospital, but the remaining seven patients (54%) survived after discharge and made full neurologic recoveries. The other 11 died during ECMO-CPR. During ECMO-CPR, 11 patients died of anoxic brain injury, stroke, metabolic acidosis, bowel necrosis, and family withdrawal of life support. Predictors of ECMO death were a pre-ECMO creatinine level of 1.7 mg/dL (P = .02) and the presence of acidosis (P = .04).
The ECMO survivor cohort also had what Mr. Peigh said were “encouraging” organ function results, with kidney and liver function remaining essentially unchanged after discharge.“Two of the patients who died of anoxic brain injuries were able to donate multiple organs for transplant,” Mr. Peigh said.
Previously reported ECMO data have shown there is at least a 20% increase in survival without notable neurologic effect, compared with conventional CPR (Lancet 2008;372:554-61; Crit. Care Med. 2011;39:1-7).
However, since these data were derived from centers where code teams were available at all times to treat a high volume of cardiac arrest patients, Mr. Peigh said the results – although indicative of the procedure’s value – “were not generalizable” to all institutions. But he noted that his and his colleagues’ study showed that even in institutions without a dedicated ECMO-CPR code team, ECMO-CPR resulted in demonstrably better outcomes for patients unresponsive to conventional CPR.
On Twitter @whitneymcknight
AUSTIN, TEX. – Extracorporeal membrane oxygenation delivered during cardiopulmonary resuscitation allowed nearly twice as many patients to survive after discharge when compared against typical CPR-only procedures in a small, retrospective study.
“It’s no secret that conventional CPR is not terrifically successful,” Graham Peigh, a second-year medical student at Jefferson Medical College in Philadelphia, said during the Hot Topics in Pulmonary and Critical Care session at the annual meeting of the American College of Chest Physicians. “Extracorporeal membrane oxygenation [ECMO] gives patients a second chance at life.”
Mr. Peigh and his colleagues retrospectively analyzed 100 ECMO procedures performed on adults at a single teaching hospital during 2010-2013 and found that when ECMO was added to CPR, the survival rate to discharge went from 15% as calculated in a previously reported meta-analysis (J. Gen. Intern. Med. 1998;13:805-16) to 29% (P = .04).
When an arrested patient does not respond to CPR, cannulation through the femoral artery and vein can be combined with compressions to improve chances of survival.
In their analysis of ECMO delivered in an academic hospital setting, Mr. Peigh and his colleagues found that in the 24 cases in which ECMO was added to conventional CPR after the patients failed to respond to CPR alone, the survival rate with full neurologic recovery was 29%.
ECMO support was delivered in a number of scenarios, ranging from acute myocardial infarction to malignant arrhythmia to at least one case each of drug overdose induced cardiac arrest, septic shock, postcardiotomy failure, and acute rejection.
The ECMO support was provided for a mean of 5 days. The mean age for all patients studied was 47 years, and 15 were male. All cases followed a 24-hour hypothermia protocol.
Six of the ECMO-CPR patients died post ECMO of anoxic brain injury, stroke, or sepsis while still in the hospital, but the remaining seven patients (54%) survived after discharge and made full neurologic recoveries. The other 11 died during ECMO-CPR. During ECMO-CPR, 11 patients died of anoxic brain injury, stroke, metabolic acidosis, bowel necrosis, and family withdrawal of life support. Predictors of ECMO death were a pre-ECMO creatinine level of 1.7 mg/dL (P = .02) and the presence of acidosis (P = .04).
The ECMO survivor cohort also had what Mr. Peigh said were “encouraging” organ function results, with kidney and liver function remaining essentially unchanged after discharge.“Two of the patients who died of anoxic brain injuries were able to donate multiple organs for transplant,” Mr. Peigh said.
Previously reported ECMO data have shown there is at least a 20% increase in survival without notable neurologic effect, compared with conventional CPR (Lancet 2008;372:554-61; Crit. Care Med. 2011;39:1-7).
However, since these data were derived from centers where code teams were available at all times to treat a high volume of cardiac arrest patients, Mr. Peigh said the results – although indicative of the procedure’s value – “were not generalizable” to all institutions. But he noted that his and his colleagues’ study showed that even in institutions without a dedicated ECMO-CPR code team, ECMO-CPR resulted in demonstrably better outcomes for patients unresponsive to conventional CPR.
On Twitter @whitneymcknight
AUSTIN, TEX. – Extracorporeal membrane oxygenation delivered during cardiopulmonary resuscitation allowed nearly twice as many patients to survive after discharge when compared against typical CPR-only procedures in a small, retrospective study.
“It’s no secret that conventional CPR is not terrifically successful,” Graham Peigh, a second-year medical student at Jefferson Medical College in Philadelphia, said during the Hot Topics in Pulmonary and Critical Care session at the annual meeting of the American College of Chest Physicians. “Extracorporeal membrane oxygenation [ECMO] gives patients a second chance at life.”
Mr. Peigh and his colleagues retrospectively analyzed 100 ECMO procedures performed on adults at a single teaching hospital during 2010-2013 and found that when ECMO was added to CPR, the survival rate to discharge went from 15% as calculated in a previously reported meta-analysis (J. Gen. Intern. Med. 1998;13:805-16) to 29% (P = .04).
When an arrested patient does not respond to CPR, cannulation through the femoral artery and vein can be combined with compressions to improve chances of survival.
In their analysis of ECMO delivered in an academic hospital setting, Mr. Peigh and his colleagues found that in the 24 cases in which ECMO was added to conventional CPR after the patients failed to respond to CPR alone, the survival rate with full neurologic recovery was 29%.
ECMO support was delivered in a number of scenarios, ranging from acute myocardial infarction to malignant arrhythmia to at least one case each of drug overdose induced cardiac arrest, septic shock, postcardiotomy failure, and acute rejection.
The ECMO support was provided for a mean of 5 days. The mean age for all patients studied was 47 years, and 15 were male. All cases followed a 24-hour hypothermia protocol.
Six of the ECMO-CPR patients died post ECMO of anoxic brain injury, stroke, or sepsis while still in the hospital, but the remaining seven patients (54%) survived after discharge and made full neurologic recoveries. The other 11 died during ECMO-CPR. During ECMO-CPR, 11 patients died of anoxic brain injury, stroke, metabolic acidosis, bowel necrosis, and family withdrawal of life support. Predictors of ECMO death were a pre-ECMO creatinine level of 1.7 mg/dL (P = .02) and the presence of acidosis (P = .04).
The ECMO survivor cohort also had what Mr. Peigh said were “encouraging” organ function results, with kidney and liver function remaining essentially unchanged after discharge.“Two of the patients who died of anoxic brain injuries were able to donate multiple organs for transplant,” Mr. Peigh said.
Previously reported ECMO data have shown there is at least a 20% increase in survival without notable neurologic effect, compared with conventional CPR (Lancet 2008;372:554-61; Crit. Care Med. 2011;39:1-7).
However, since these data were derived from centers where code teams were available at all times to treat a high volume of cardiac arrest patients, Mr. Peigh said the results – although indicative of the procedure’s value – “were not generalizable” to all institutions. But he noted that his and his colleagues’ study showed that even in institutions without a dedicated ECMO-CPR code team, ECMO-CPR resulted in demonstrably better outcomes for patients unresponsive to conventional CPR.
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AT CHEST 2014
Key clinical point: ECMO during CPR can improve clinical outcomes for patients in cardiac arrest.
Major finding: The discharge to survival rate for patients given ECMO was 54% with full neurologic recovery.
Data source: A retrospective analysis of 24 ECMO-CPR procedures performed at a single site during 2010-2013.
Disclosures: Mr. Peigh said he had no relevant disclosures.
