From Pediatric to Adult Care: Six Core Elements to Consider
Published on the April 27, 2016, Rheumatology Network website
By Whitney L.J. Howell
Nearly one-quarter of approximately 18 million Americans 18-21 years old have chronic conditions, including rheumatic diseases. However, little guidance exists for transitioning them into adult healthcare.
According to an April Arthritis & Rheumatology study, patient and pediatric and adult provider dissatisfaction is prompting greater guidance on pivoting young rheumatic patients into effective adult care. This sentiment has led to the creation of specialty-specific transition tools for pediatric and adult rheumatologists.
Pediatric rheumatology patients experience more severe disease, existing research states, with many becoming hospitalized or developing advanced disease within a year the adult-care transition.
Consequently, investigators wrote, establishing clear transition strategies is crucial for juvenile patient outcomes.
“Planning for transfer is an essential part of reinforcing young adults’ engagement with their health and their new adult provider,” they said. “It is important that all individuals involved enthusiastically support the adult provider to quickly establish a solid relationship with the new young adult, so that young adult stays engaged and returns for follow-up care.”
A Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey reported 56 percent of pediatric rheumatology providers are unsatisfied with transition policies for pediatric patients to adult care. They identify inadequate provider training, inadequate time, lack of reimbursement, and insufficient resources and personnel as care barriers.
The American Academy of Pediatrics, American College of Physicians, and the American Association of Family Physicians collaborated in the Got Transition: The Center for Health Care Transition Improvement report, offering primary and secondary-care provider guidance on practice-based transition support, beginning between ages 12 and 14 and ending between ages 18 and 21.
The report includes six core elements, addressing three phases of transition – preparation, transfer, and integration into adult healthcare. For pediatrics, those elements are: transition policy, tracking and monitoring, readiness assessment, transition planning, transfer of care, and transfer completion. For adults, they are: transition and young adult care policy, tracking and monitoring, orientation to adult practice, integration into adult approach to care, initial visit, and ongoing care.
The report also offers three transition packages: 1) transitioning youth to adult healthcare providers, 2) transitioning to the adult approach without changing providers, and 3) integrating young adults into adult healthcare.
To read the article at its original location: http://www.rheumatologynetwork.com/news/pediatric-adult-care-six-core-elements-consider
Neurological Signs in Sjogren’s Too Often Ignored
Published on the April 25, 2016, Rheumatology Network website
By Whitney L.J. Howell
Clinicians should pay more attention to neurological signs in patients with high-activity primary Sjögren’s Syndrome or those with prior neurological involvements.
Among patients with primary Sjögren’s Syndrome (pSS), approximately 20 percent exhibit neurological manifestations. In many cases, neurological symptoms are the first characteristics to appear.
A study published this month in RMD Open divided neurological manifestations into both peripheral and central neurological manifestations. The new data breaks the overall 20-percent prevalence down, revealing that peripheral (PNS) and central neurological (CNS) manifestations occur in 15 percent and 5 percent of cases, respectively.
“These findings are consistent with previous reports indicating that about 20 percent of patients with pSS have neurological manifestations,” researchers wrote. “Nevertheless, few studies were as large as our study.”
Primary Sjögren’s Syndrome symptoms are pure sensory neuropathy, sensorimotor neuropathy, neuronopathy, cranial nerve involvement, polyneuropathy, mononeuritis multiplex and polyradiculoneuropathy. Central neurological manifestations are meningitis, meningoencephalitis, encephalitis, seizure, stroke, transverse myelitis, and cerebral vasculitis. Investigators also evaluated articular, cutaneous, muscular, renal, cardiovascular, and pulmonary involvement, Raynaud’s phenomenon, and vasculitis.
According to investigators, the study had multiple objectives. First, researchers studied neurological manifestations prevalence in the French study, Assessment of Systemic Significant Evaluation in Sjögren’s Syndrome (ASSESS). Second, researchers investigated demographic and clinical characteristics of patients with PNS, CNS, or neurological manifestations, the influence of pre-existing neurological manifestations, and primary Sjögren’s Syndrome activity assessed using the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI).
In a 15-center study, investigators examined neurological manifestations affecting the skin, joints, lungs, kidneys, PNS, CNS, muscles, and vessels of 392 individuals. Based on results, past or present neurological manifestations existed in 74 individuals (18.9 percent). PNS were present in 63 (16 percent), CNS in 14 (3.6 percent).
Pure sensory neuropathy and sensorimotor neuropathy were the most common primary Sjögren’s Syndrome symptoms, totaling 9.2 percent and 5.3 percent, respectively. Of the 14 patients with CNS manifestations, one had meningitis, five had seizures, five had cerebral vasculitis, and three had transverse myelitis.
Overall, new neurological manifestations were much more common among patients with prior neurological involvements (32.4 percent) than those without (6.7 percent). Patients with and without neurological manifestations had 1.8 +/- 1.2 and 1.2 +/- 1.1 ESSDAI domain affected, respectively. The average ESSDAI in patients with and without neurological involvement was 9.4 +/- 6.8 and 4.3 +/- 4.8, respectively.
To read the post at its original location: http://www.rheumatologynetwork.com/sjogrens-syndrome/neurological-signs-sjogren%E2%80%99s-too-often-ignored
Classification of Macrophage Activation Syndrome in JIA
Published on the April 25, 2016, Rheumatology Network website
By Whitney L.J. Howell
A new set of classification criteria for macrophage activation syndrome (MAS)-complicating systemic juvenile idiopathic arthritis (JIA) can be used to improve clinical study enrollment, according to researchers.
MAS, the potentially life-threatening complication of systemic inflammatory disorders, occurs most commonly in JIA. Prevalence of this overwhelming inflammatory response in JIA has been estimated at approximately 10 percent, but recent reports suggest subclinical MAS might occur in as many as 30 percent-to-40 percent of JIA patients, making timely diagnosis and prompt treatment imperative.
But, identifying MAS early is challenging due to a lack of a single pathognomonic clinical or laboratory feature. Add in the recent treatment advances and understanding of the pathophysiology and underlying genetic defects and there’s a need for accurate criteria physicians can use to correctly classify patients with MAS.
The goal, according to a group of international research collaborators, is to augment the understanding of MAS in systemic JIA, enhancing effective therapies. Investigators from the European League Against Rheumatism, the American College of Rheumatology, and the Pediatric Rheumatology International Trials Organization participated in this initiative.
The criteria were developed by a 28-expert panel at the International Consensus Conference on MAS Classification Criteria, held in Genoa, Italy in May 2014. They participated in a 6-step, web-based process and classified 428 international patient profiles as being MSA-positive or not based on clinical and laboratory features recorded at disease onset. Their consensus was categorized as the gold standard for disease classification.
Alongside developing the classification criteria, the initiative also ventured to analyze the role changes in laboratory findings over time MAS detection. It’s important to note, researchers added, that the criteria are mostly intended for investigatory use.
“Although possibly useful for diagnostic purposes, the classification criteria are primarily intended for use in clinical trials and research studies,” investigators wrote. “The criteria exhibited high accuracy and face/content validity in consensus and statistical evaluations, but it should be taken into account that they were developed using expert consensus as the gold standard.”
Experts reached consensus on 391 patients – 91.4 percent – 95 of which were classified as having MAS. They found 10 variables had the greatest ability to identify MAS patients: ferritin level, platelet count, levels of aspartate transaminase, lactate dehydrogenase, triglycerides, alanine transaminase, fibrinogen, central nervous system involvements, hepatomegaly, and hemorrhagic manifestations.
These criteria include mainly laboratory variables because the criteria focus on early-stage diagnosis. The only clinical variable include was fever. The study focused more on laboratory features because previous research indicated clinical features appear later, delaying diagnosis. Consequently, it’s important to note that the classification might not capture all MAS cases encountered in a routine clinical setting.
Ultimately, investigators wrote, the criteria could help standardize the design and implementation of future clinical trials and research studies, as well as contribute to broader MAS understanding and awareness.
To read the story at its original location: http://www.rheumatologynetwork.com/juvenile-arthritis/classification-macrophage-activation-syndrome-jia
Back Pain Improves with Mindfulness and Psychotherapy
Published on the April 20, 2016, Rheumatology Network website
By Whitney L.J. Howell
Mediterranean Diet Associated with Lower Risk of Hip Fractures
Published on the April 20, 2016, Rheumatology Network website
By Whitney L.J. Howell
“Our data support an association between the extent of adherence to a healthy diet characterized by adherence to a Mediterranean diet and lower fracture risk,” researchers wrote. “However, given the apparent risk reductions across various dietary patterns, a specific dietary index may not be associated with lower risk; rather, high diet quality reflected by various dietary indexes and their common components may achieve a lower risk.”
The study should be considered cautiously, however. According to Walter C. Willett, M.D., DrPH, from the Harvard T.H. Chan School of Public Health, additional research is needed to confirm these results.
“In the analysis…only a single measure of diet and physical activity was available, and participants with better diets might have improved their level of physical activity during the follow-up. Repeated measures of activity could have helped to reduce measurement error,” Willett wrote in a commentary published with the study. “Had physical activity been measured even somewhat better, it is likely that the observed inverse association between diet quality and risk of hip fracture would have become nonsignificant.”
To read the story at its original location: http://www.rheumatologynetwork.com/osteoarthritis/mediterranean-diet-associated-lower-risk-hip-fractures
Beyond Watson: AI in Radiology
Published on the April 14, 2016, DiagnosticImaging.com website
By Whitney L.J. Howell
Imagine this: your hospital administrator asks you to help reduce the length of inpatient stays and they need a plan within a week. Could you do it?
Chances are, most of you couldn’t. But, the technology to mine and analyze your data does exist. Much like your daily Google searches, it’s possible to input your search criteria, click Enter, and have answers at your fingertips in seconds.
Doing so is part of radiology’s push toward using big data, said Woojin Kim, MD, director of innovation at Montage Healthcare Solutions, Inc.
“Radiology doesn’t yet have big data like other industries, but that’s changing rapidly. People want access to data to be able to turn insight into action,” he said. “Providers want quick easy access to radiology reports, and they want to mine through data intelligently for research and quality and performance improvements.”
That’s why Kim, along with William Boonn, MD, Curtis Langlotz, MD, and Rajan Agarwal, MD, co-founded Montage. Its products use proprietary natural language processing to search and pull information from your RIS and electronic medical record (EMR), pinpointing clinical findings to augment business performance and clinical-quality analytics.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/pacs-and-informatics/beyond-watson-ai-radiology
Aggressive Cost-Sharing Forces Some Patients to go Without
Published on the April 13, 2016 Rheumatology Network website
By Whitney L.J. Howell
Specialty drugs have long been associated with higher prices and greater patient cost-sharing, but a new study delved into whether current cost-sharing requirements impact a patient’s likelihood to forego, delay or reduce specialty drug-adherence.
In an article from the Perelman School of Medicine published in the March 2016 American Journal of Managed Care, researchers evaluated existing literature to determine whether cost-sharing impacted the use of non-drug medical services, health outcomes and spending.
Currently, individuals using specialty drugs comprise between 1 percent and 5 percent of patients and account for $95 billion in drug spending – roughly 29 percent of all prescription drug expenditures nationwide. Drugs for cancer and autoimmune conditions, such as rheumatoid arthritis (RA) or multiple sclerosis (MS), are responsible for two-thirds of that price tag. In fact, patients frequently pay co-insurance equal to between 30 and 50 percent of the drug cost.
Researchers conducted a literature review, analyzing Medline-indexed studies in OVID from 1995 to 2014 to determine the cost-sharing impact. They identified 19 studies focused on specialty drugs for RA (8), MS (9), and cancer (8). The studies addressing RA touched on prescription abandonment (2), initiation (4), adherence (3), persistence/discontinuation (3), and drug spending (1).
According to these studies, if cost-sharing doubles, there’s a 5 to 9 percent drop in the number of RA patients taking a specialty drug for the first time (initiation). There’s also a 3.8 percent reduction in continuation if cost-sharing doubles after they start. Existing research also revealed non-initiation, non-compliance or abandonment are less likely among patients with life-threatening conditions, such as cancer, than among those with auto-immune disease.
To help determine how best to address cost-sharing in the future, researchers suggested establishing policies that could offer patients additional protections against aggressive cost-sharing policies. Such measures could result in higher medication compliance and improved health outcomes.
Traditional three-tiered cost-sharing designs are seldom used by insurers and pharmacy benefit managers because there often few options in specialty medicine. Instead, they use utilization management (UM) tools, such as prior authorization and quantity limits.
“Nevertheless, growing pressure to control spending has led insurers to increasingly place self-administered specialty drugs on new, separate “specialty tiers,” the authors wrote.
Specialty tiers are usually associated with a co-insurance that can be as high as 30-50 percent of the drug cost. But cost-sharing is typically associated with fixed co-payments of increasing amounts for generics, preferred brands and non-preferred brands.
“There is a critical need for methodologically rigorous research to further evaluate whether the aggressive cost-sharing arrangements found in the current marketplace may cause patients to forego, delay or decrease adherence to specialty drugs and whether that results in poor health outcomes and higher total spending,” the authors wrote.
To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/aggressive-cost-sharing-forces-some-patients-go-without
Study: This Corticosteroid Reduces OA Pain
Published on the April 4, 2016, Rheumatology Network website
By Whitney L.J. Howell
The extended-release corticosteroid FX006 (Zilretta) has been shown to have a maximal analgesic effect in patients with knee osteoarthritis (OA) over the standard TCA 40 mg suspension after an intra-articular injection. However, the dose response rate for FX006 between 20mg and 40mg has, to-date, been unknown.
In an April 2 presentation entitled, “Sustained and Profound Analgesic Benefits in People With Osteoporosis of the Knee Using FX006, an Intra-Articular Extended-Release Formulation of Triamcinolone Acetonide: Results From a Double-Blind, Randomized, Parallel-Group, Dose-Ranging Study,” Philip Conaghan, from the University of Leeds in the United Kingdom discussed FX006 effectiveness over other options.
A total of 306 patients, with documented knee OA with Kellgren-Lawrence grade 2 or 3 and pain intensities from 5-to-9 on a scale of 1-to-10, were treated with either a single IA injection of 20mg or 40mg FX006 or a saline placebo. Baseline age, race, body mass index, and knee characteristics were similar across groups. Researchers monitored participants over 24 weeks for efficacy and safety. The primary endpoint was a change from baseline measures at week 12.
According to the results, Mixed Model Repeat Measures FX006 20mg demonstrated significant improvement in daily pain levels from weeks 1 through 9. FX006 also offered improvement from weeks 1 to 13. In the LOCF/BOCF analysis, FX006 20mg from weeks 1 through 8, and FX006 showed improvement from weeks 1 to 13. In a secondary analysis, FX006 performed better than the placebo for each week.
For all patients with OA, FX006 demonstrated higher efficacy than a placebo. FX006 20mg and 40mg reach maximum performance at week 5, and a phase 3 trial is underway to compare FX006 40mg with standard TCA suspension 40mg and placebo.
To read the article at its original location: http://www.rheumatologynetwork.com/osteoarthritis/study-corticosteroid-reduces-oa-pain
OA Progression as Seen in a Biomarker Panel
Published on the Apr. 4, 2016, Rheumatology Network website
By Whitney L.J. Howell
There are better ways to predict knee osteoarthritis (OA) progression, according to a Duke University physician scientist reporting at OARSI 2016 World Congress.
Currently, most physicians rely on poor predictors, such as age, sex, body mass index, knee pain, general bone mineral content and joint space width, but osteoarthritis comes in phases, reported Virginia Kraus, M.D., Ph.D., of the Duke Molecular Physiology Institute.
Osteoarthritis is a disease associated with periods of inactivity with no more than 30 percent of individuals affected by the progression of knee OA at any one time. These periods of quiescence effect clinical trials — the majority of which in OA suffer from “low power” due to an inability to identify progressors, Dr. Kraus reported.
During an April 1 presentation at OARSI 2016 in Amsterdam earlier this month, Dr. Kraus reported that serum biomarkers may offer a more accurate measure of osteoarthritis progression.
“We developed a method of predicting OA progression based on a panel of mass spectrometry and ELISA based biomarkers. Markers predicting osteophyte progression were distinctly different from those predicting JSN progression. These results suggest that a select set of biomarkers identified from targeted and non-targeted analyses could significantly improve prediction of knee OA progression and could be useful for enriching knee OA clinical trials for progressors,” she reported.
The Kraus study pulled participant data from the Prediction of Osteoarthritis Progression cohort and Genetics of Generalized OA studies. Kraus’s team ran a mass spectrometry analysis to create a Multiple Reaction Monitoring (MRM) panel on 146 peptides (99 proteins) in serum that included synovial fluid (n=23), urine (n=45), and serum (n=40) from knee osteoarthritis radiographic progressors and non-progressors.
Dr. Kraus and colleagues found that MRM or ELISA-based biomarkers, in combination with clinical parameters, significantly improved the prediction of OA progression (all definitions) over clinical variables alone achieving AUCs ranging from 0.84-0.97.
Of the subject population, 82 percent were female with a mean age of 64 and mean BMI of 28. The percentage of each sample meeting the knee OA progress definition was: 75 percent ANY, 52 percent JSN, 66 percent osteophyte, and 29 percent KL progression. Age, gender, and BMI were only significant in predicting osteophyte progression.
Knee osteoarthritis progression was defined as any knee osteoarthritis progression or osteophyte, joint space narrowing (JSN) or Kellgren Lawrence (KL) grade progression within four years. Any progression was predicted by 10 MRM markers; osteophyte progression by 7 MRM markers; JSN progression by 6 ELISA markers; and KL progression by 1 ELISA marker.
To read the article at its original location: http://www.rheumatologynetwork.com/osteoarthritis/oa-progression-seen-biomarker-panel
Who am I?
I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.
I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.
-
Archives
- October 2019 (3)
- May 2018 (2)
- October 2017 (2)
- November 2016 (5)
- October 2016 (1)
- September 2016 (8)
- August 2016 (6)
- July 2016 (1)
- June 2016 (5)
- May 2016 (8)
- April 2016 (14)
- March 2016 (2)
-
Categories
-
RSS
Entries RSS
Comments RSS
Whitney Palmer 