Whitney Palmer

Healthcare. Politics. Family.

Unsung Hero of First U.S. Penile Transplant: Radiology

Published on the May 27, 2016, DiagnosticImaging.com website

By Whitney L.J. Howell

This month, medical news has been filled with fanfare about the first successful penis transplantation in the United States. According to all reports, the surgery was a success, but little attention has been paid to why the procedure went so well.

Working collaboratively, it took a multidisciplinary team of a dozen surgeons and approximately 30 additional members to attach a penis from a deceased donor to a 64-year-old man who had his penis removed due to penile cancer. But, crucial to this win , buried under the spectacle– and driving the capability to correctly attach the organ and provide full functionality – was radiology. Having clear glimpses into the body was critical for the surgical team.

“Radiology was integral because they created a road map for us with the diagnostic arterial angiography, CT angiography, and MRI,” said co-lead surgeon Dicken Ko, MD, director of the Massachusetts General Hospital (MGH) Urology Regional Program and associate professor of surgery at Harvard Medical School. “We could actually define how much tissue was left behind and what the possibilities were for reconstruction.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/interventional-radiology/unsung-hero-first-us-penile-transplant-radiology

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May 30, 2016 Posted by | Healthcare | , , , , , | Leave a comment

Right From the Start

Published in the Spring 2016 University of North Carolina Greensboro Research Magazine

By Whitney L.J. Howell

The best foot forward. It’s what we all want for our children in those first few years. But, the question is — how do we get there?

Nationally and locally, debates rage. It’s difficult to find consensus on the best way to educate our children or even prepare them to be educated. One thing we can be sure of? It’s no simple task. It will require a lot of work and collaboration to get it right.

UNCG is leading the way. Here, researchers have investigated — sometimes for years — what it takes to make sure children are healthy and ready to learn. And, now, investigators are combining their knowledge, resources, and networks to meet these challenges directly.

Faculty and staff, from the UNCG Department of Human Development and Family Studies to the UNCG Center for Youth, Family, and Community Partnerships, conduct basic research, translate research into evidence-based practice, and help create local, state, and national educational policy. As they reach out to families, help towns and cities identify and intervene with struggling children, and teach professionals vital skills for the classroom, these investigators have one goal in mind — giving every child the right start.

“We take what we glean from research and teaching and put it together to make a difference. That knowledge shouldn’t remain in the academy,” says Dr. Chris Payne, director of the Center for Youth, Family, and Community Partnerships. “It’s our mission to work for the greater good of our community.”

The Importance of Early Social & Emotional Development

For children to maximize their educational experiences, it’s critical they come into the classroom ready to learn. That makes the first five years invaluable to healthy growth, Payne says. During that time, approximately 90 percent of brain structures develop, establishing the foundation for how a child learns and processes information.

The healthiest growth occurs, explains Payne, when children have secure relationships with their caregivers and feel free to express emotions, including fear, anger, and happiness.

Emotion Regulation

Although school carries an inherent focus on grades, academic ability isn’t the only factor determining whether a child is actually classroom-ready. Another key indicator is whether he or she can appropriately regulate emotions, says Dr. Susan Calkins. “The more structured preschool and school environments present a unique set of challenges to children — challenges that require emotional readiness.”

If you visit the Human Development and Family Studies (HDFS) professor’s lab while her team collects data, you’ll observe children singing, counting, or playing games. Others might be crying and flailing fists. They’re expressing a wide range of emotional abilities, dependent on their age and experiences.

While some children control their impulses by employing various learned strategies, others lack these skills and have trouble delaying gratification or managing frustrating tasks. Their negative emotional responses indicate immature emotional readiness.

“Being able to manage emotions is critical for academic achievement, school readiness, and mental health,” Calkins explains. Without emotion regulation skills, children can’t establish positive student-teacher and peer-to-peer relationships. If they can’t express themselves or manage their feelings in ageappropriate ways, they also risk social rejection. “If children don’t master emotional regulation, they face challenges for years to come.”

To help children reach appropriate levels of emotional maturity, adults must recognize their natural responses and know how to handle them, Calkins says. To find the tools parents and caregivers need, she and her team have recruited children from more than 450 families to participate in the RIGHT Track study.

Although we can begin to understand emotion regulation by observing the behavior of and collecting information from children and their caregivers, collecting data at the physiological level also provides a key piece of the puzzle in understanding not only how emotional regulation develops but also the degree to which it impacts various areas of the child development.

In one component of the study, Calkins team attaches heart rate electrodes to each child to measure their physiological arousal and then presents them with a frustrating task. Two-year-olds are asked to open a cookie jar that was glued shut or wait to open a present, while 5-yearolds are tasked with unlocking a box using a set of keys that does not actually include the correct key.

The team watches both the child’s actions as well as the caregiver’s responses. Did the children quit or did they stick with the task? Did the parent offer guidance or withdraw from the situation? Children and parents returned to the lab for more advanced tests as they aged.

“So far, we’ve seen that children who get extremely frustrated with these tasks also experience behavior problems,” Calkins says. “These kids who lack skills to control their emotions and cope are also more likely to experience depression and academic and health issues and to engage in substance abuse and risky sexual behavior later in life.”

There are many ways children can rein in overwhelming feelings. Distractions, such as singing songs, diverting concentration, or engaging in self-soothing behaviors, can effectively control emotions.

Knowing how to implement these behaviors helps a child navigate social and academic environments, says Calkins. They also help children stay focused on tasks and enhance their autonomy. When children have these skills, they can approach difficult situations without adult intervention.

Calkins’ findings are important not just for parents but for educators too. Early development of a positive teacher-student relationship can help children sidestep many of the aforementioned problems. “This is critical knowledge, especially in today’s kindergarten climate where we’re getting young children ready for a series of tasks and tests.”

Parent-Child Relationships

Healthy emotion regulation is imperative for children to achieve school readiness, but of course they can’t do it alone. Parents must be involved, points out HDFS professor Esther Leerkes. And, at every step, parents must provide age-appropriate guidance or children won’t internalize the correct skills.

“The quality of parenting matters. We know that how parents respond when a child is upset can help children learn to regulate their emotions — which in turn affects their early cognitive development and school readiness,” she says. “We also know if children struggle emotionally, they are more likely to struggle academically.”

Inside Leerkes’ lab, parents and young children are completing a treasure hunt. They must find the best route for a bear to cross a body of water and reach a prize on an island. While the child’s goal is getting to the treasure, the research team’s objective is to determine how differing parenting styles affect a child’s emotional and cognitive abilities and early readiness for school.

The kids and adults are participants in the School Transition and Academic Readiness (STAR) project. With over $6 million in funding over the last decade from the National Institute of Child Health and Human Development, Leerkes and her collaborators are following over 500 children from age 4 to the first grade.

It matters, she says, whether parents engage children in stimulating ways. The adults can choose to withdraw from the game, take it over, or engage the child and guide him or her through the process, helping them understand and make decisions.

The most successful children, she says, have emotionally supportive parents. They were involved in play and offered age-appropriate guidance, praise, and encouragement. Children faltered when parents took charge, became frustrated, or didn’t participate at all. Children were also more likely to lose interest, appear bored, or withdraw when parents pushed too hard or became negative.

Leerkes’ team also assesses the children’s physiological and neural activity as they problem solve.

For example, the team puts each child through a Stroop test. These tests tax participants by requiring them to inhibit their initial responses — a child might be required to say the word “night” when they see a picture of the sun. The researchers observe which regions of the brain are active, and they record how many picture presentations the children get right.

They’re looking to see, Leerkes says, what types of brain activity correlate to high performance levels. One day, their findings could help predict a child’s level of academic performance and perhaps even help identify children who need early interventions.

In another study with infants and toddlers, the team monitors both parents and children as children are presented with frightening or frustrating situations. Leerkes’ team has found that a younger child’s emotional control is strongly linked to the caregiver’s behavior and emotions. If parents exhibit frustration, irritation, or anxiety — identified by elevated heart rates accompanied by poor regulation — children aren’t as able to control their emotions and behavior. To minimize a child’s exposure to negativity, Leerkes suggests that parents pay attention to their own emotions while interacting with their children. Imagine your child’s perspective, she advises, and calm yourself by pausing to take deep breaths and relax when you can feel your own strong emotions rising.

When parent-child interaction is positive, everyone benefits, Leerkes says. Children develop better emotional control, and they use that skill to maintain their attention and manage their frustration, both critical for adaptive peer relationships and active engagement in school. And parents proudly watch their children succeed in school transitions.

Child Care Program Quality and Teacher Support

In laying the foundation for school readiness and a lifetime of success, we know that quality of parent-child interactions and the home environment is critical. But quality in other child care environments, including preschools and child care centers, is just as crucial.

It’s important for parents to know what an early childhood program offers, how effective their teachers are, and where the curricula are strong. In 1999, HDFS faculty Dr. Deb Cassidy, Dr. Linda Hestenes, Dr. Sharon Mims, and Dr. Steve Hestenes began collaborating with the N.C. Division of Child Development and Early Education to help parents make these important choices.

Their long-running N.C. Rated License Assessment project, which has received over $50 million in funding, rates child care programs throughout the state — currently over 7,000 programs. Of these, 45 percent of child care centers and approximately 11 percent of home-based programs have earned the top, five-star rating.

The N.C. Rated License Assessment project is just one of many ways UNCG is helping improve the overall quality of child care and education statewide. Another example? In conjunction with the N.C. Department of Public Instruction, HDFS Associate Professor Catherine Scott-Little is providing technical support for a new North Carolina K-3 assessment system. The system collects data on students from kindergarten through third grade, to help individualize their teaching and learning. Teachers, support staff, and families provide information for the assessment from observations, conversations, work samples, and more.

Teachers are better prepared and can better personalize teaching strategies when they understand how children learn. The K-3 Assessment system will arm teachers with a more complete picture of each of their students, improving their instruction and helping to meet their individual needs. With the information from the assessment Scott-Little is helping to design, teachers can more effectively target and teach to areas where high-need children need the most help.

A well-educated, prepared teaching staff is the biggest factor in achieving a five-star rating in the current N.C. Rated License guidelines. But finding the best qualified teachers to choose from can be difficult in the current environment of student loan debts and low teacher wages statewide. UNCG is taking steps to help grow our pool of highly educated teachers and to make sure they are supported and paid a living wage to keep them in the field.

HDFS Professor Deborah Cassidy has led the charge in preparing North Carolina teachers for more than two decades. Her latest focus is the EQuIPD (Education Quality Improvement & Professional Development) program. Funded by a Smart Start grant from the Guilford County Partnership for Children, EQuIPD is bringing professional development directly to existing early childhood professionals in Guilford County.

“Traditionally, early childhood professionals struggle to find the time and resources to get the continuing education and professional development they need,” says Cassidy. “Through this program, our staff brings interconnected services, such as peer coaching and training, directly to teachers and directors in early childhood settings. Together, we are implementing strategies we know have a direct impact on increasing the quality of early care and education.”

Another example of efforts in this area, says Cassidy, is UNCG’s mentoring program, which pairs teachers working in higher-quality programs with those working in lower-quality programs over a four month period. Mentors — who receive a stipend — meet regularly with mentees to discuss problems, strategies, and tactics. These conversations help identify opportunities for reaching children, as well as actions that might hamper a child’s academic progress. The connections are designed to give teachers a safe, reliable sounding board to analyze problems.

“The relationships that develop are more important than the content discussed. Being an early-education teacher can be isolating,” Cassidy says. “Having someone to discuss issues with can be invaluable.”

It’s also important, Cassidy says, for teachers to feel comfortable instructing students on complicated subject matters. To foster that confidence, UNCG supports community-training events that raise awareness of early-education topics through keynote speakers and workshops. For example, a recent session offered guidance for teaching science and math in age-appropriate ways. The hope, she said, is these sessions will enhance teachers’ abilities to create strong curricula that reach children of all readiness levels.

But having high-quality teachers who know how to reach students and who have targeted curricula that teach to every student’s needs means nothing if those teachers don’t make it into or stay in the classroom. There’s only one way to ensure high quality teachers are available, Cassidy says. Current and future educators must receive salaries that accurately reflect the time and effort that goes into the job.

To highlight this dire need, HDFS hosts Worthy Wage Day, an event that invites community leaders and politicians to work a child-care job for two hours, earning a teacher’s hourly pay — $10.97. They’re presented an honorary check during a press conference and are given the opportunity to discuss their experience.

Not only does Worthy Wage Day give community leaders a first-hand view of what teaching and caring for young children actually requires, but it also highlights the dire income insecurity experienced by many of North Carolina’s early-education teachers. Up to 45 percent receive income support. In fact, many can’t afford to enroll their own children where they work. Until this inequality is sufficiently addressed, Cassidy says, the state will continue to struggle to maintain a well-educated, dedicated, quality teacher workforce.

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2016/04/onlineUNCGResearchSpring016.pdf

 

May 25, 2016 Posted by | Education, Politics | , , , , , , , , , , , , , , , , , | Leave a comment

Beth Mayer-Davis

Published in the Spring 2016 Carolina Public Health Magazine

By Whitney L.J. Howell

Eat better and move more — that’s the quintessential prescription for what chronically ails most people. It’s simple and effective, and it works for many.

However, for some, despite their wish to be healthier, the prescription isn’t enough. There may be too little money to buy nutritious foods. Parents working two jobs may believe they have too little time to exercise or may need more education about how to implement changes. Because genes also play a key role in the development of chronic diseases such as diabetes, diet and physical activity might not be enough to prevent illness. Attention to lifestyle is critical, however, in preventing many complications of this very serious disease.

These circumstances highlight the need for targeted interventions to promote healthy lifestyles in communities that face more than their share of chronic conditions.

Gillings School of Global Public Health researchers are involved in a number of efforts to prevent or better manage diabetes, from discovery to application. (See sph.unc.edu/global/diabetes.)

Elizabeth Mayer-Davis, PhD, the Cary C. Boshamer Distinguished Professor and chair of nutrition at the UNC Gillings School, is one of those who are known and respected globally. For 25 years, Mayer-Davis has led the charge against diabetes, combating it through nutrition.

“I’m engaged to improve population health,” said Mayer-Davis. Social determinants are central to whether a person can succeed in preventing diabetes, can seek diabetes care if they’re diagnosed, and can care for themselves as they live with diabetes.”

Mayer-Davis has brought together academic, community and professional partners on several projects to fight diabetes.

Understanding the culture helps us face the challenge

Until the 1950s, there was no record of Type 2 diabetes in American Indian populations, but the disease began to surge in the 1960s and ’70s. Poverty, poor access to nutritious food, few opportunities and little support for physical exercise, and insufficient health education have added to the challenges.

“Reversing this trend among youth is critical, and the most effective strategy is weight management through healthful dietary choices and increased physical activity,” Mayer-Davis says.

However, effective interventions for weight management in American Indian youth have not been identified yet. In fact, even a “one-tribe-fits-all” approach won’t work, so Mayer-Davis’ team conducted a community-based participatory research study both with North Carolina’s Eastern Band Cherokee tribe and people from the Navajo tribe in Shiprock, Ariz.

In a two-year, National Institutes of Health-funded study, the team enrolled 61 children and their parents in a multi-component intervention that included a 12-session after-school program. The program offered exercise for children and behavioral-change classes for parents and youth, supplemented by individual child and parent counseling to aid in motivation, goal setting and problem solving.

Mayer-Davis says a wide range of topics are discussed in the sessions, including how to select healthful foods (given local food availability and cost), how to cook and how to make physical activity fun. “We tap into local culture in many ways, for example by incorporating native dance and native foods into classes,” Mayer-Davis says. “Native languages are used in all group sessions, and we celebrate local festivals, as appropriate. We provide opportunities for parents and their children to reflect on diet, physical activity and health and to develop specific goals and strategies to attain their goals.”

Understanding that families may face significant economic, medical or other difficulties, the program also provides resources and referrals when issues arise that are critical to the family’s overall well-being.

Initial results are promising. Children in the intervention have shown improvement in body mass index over time.

Type 1 diabetes

Traditionally, it was assumed that youth with Type 1 diabetes were invariably thin or of normal weight. Now, the prevalence of overweight and obesity in this group mimics the general population. Individuals with Type 1 diabetes face the same challenges related to weight management as anyone else, but also face unique challenges related to living with the disease.

Some youths choose not to take insulin to avoid gaining weight, thereby leaving their blood sugar uncontrolled. At the opposite end of the spectrum, low blood sugar requires treatment, typically with simple carbohydrates, and often is associated with hunger and overeating. Fear of low blood sugar can lead to avoidance of physical activity.

Mayer-Davis and colleagues have designed a behavioral intervention to help adolescents with Type 1 diabetes better control their blood sugar and maintain a healthy lifestyle. This intervention, called FL3X, is being tested in a multi-center randomized controlled trial funded by the NIH.

Chronic kidney disease

Chronic kidney disease (CKD) is a common and serious complication of diabetes.

“Nutrition is complicated for this group,” Mayer- Davis says. “CKD requires complex nutrition management designed to address kidney health, management of blood sugar and management of risk factors for cardiovascular disease.”

Through the Practice and Continuing Education (PACE) division in the nutrition department, which she established in 2015, Mayer-Davis collaborates with the Department of Medicine in the UNC School of Medicine. Renal dietitian and clinical assistant professor Shaun Riebl, PhD, RD, LDN, uses state-of-the-art behavioral strategies and motivational interviewing to help patients address their unique nutritional needs. The clinic also provides links to needed resources, including those addressing food insecurities.

“Dr. Mayer-Davis’ work at UNC Health Care is novel and provides smart and innovative ways to solve a population health challenge,” says Gillings School Dean Barbara K. Rimer. “By motivating patients with diabetes and helping them manage their individual nutrition needs, she empowers them to avoid rehospitalization.”

American Diabetes Association

Research-based knowledge is critical, but it is not effective unless translated successfully into clinical practice. Mayer-Davis’ close relationship with the American Diabetes Association, as board member and past president for health care and education, makes that transition easier.

She helped draft clinical guidelines and practice recommendations and led a clinical trial on weight management strategies in rural areas. The trial demonstrated the importance of providing insurance reimbursement for a sufficient number of intervention hours if desired outcomes were to be achieved.

“Our study, ‘Pounds Off With Empowerment,’ highlighted the reality that you may have an effective intervention, but if you can’t pay for it, it will sit on the shelf,” she says.

Overall, her diabetes research has focused upon providing the best possible evidence-based care to solve problems related to diabetes and its complications.

“These experiences inspire my work in population health,” Mayer-Davis says. “We must determine how to integrate clinical care with community and public health services if we are to address the social determinants of health that may have a detrimental impact upon care.”

This is particularly critical for vulnerable populations, including youth and individuals living in under-resourced environments.

“Until the worlds of clinical care and community services meet,” Mayer-Davis says, “we’ll fall short of what we can do to support, care for, and optimize health and well-being for people living with diabetes and other chronic conditions.”

To read the article at its original location: http://sph.unc.edu/cphm/beth-mayer-davis/

May 25, 2016 Posted by | Healthcare | , , , , , , , , | Leave a comment

TNFis Pose No Cancer Risk for Spondyloarthritis Patients

Published on the May 19, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with spondyloarthritis can confidently undergo treatment with tumor necrosis factor ⍺ inhibitors (TNFi) without fear of increasing their overall risk of cancer, a new study finds. Existing safety data is scarce, and cancer risks aren’t clearly understood.

According to a May 4 Annals of the Rheumatic Diseases  (ARD)  study from the Karolinska Institute in Sweden, patients who use TNFi to treat spondyloarthritis (SpA) have an equivalent overall cancer risk as those who have never received TNFi. There is also no increased risk for six site-specific cancers: prostate, lung, colorectal, breast, malignant lymphoma and melanoma.

Traditionally, TNFi is a standard part of treatment for chronic inflammatory disease, including rheumatological arthritis, SpA , ankylosing spondylitis (AS). psoriatic arthritis (PsA) and undifferentiatied spondyloarthritis (SpA UNS). The study aimed to evaluate the role TNFi plays in increasing cancer risk and how it could vary across inflammatory diseases by age, sex, lifestyle and previous treatments.

“Apart from the immediate clinical importance considering the increasing use of TNFi in SpA, the study of cancer risk in these patients may provide new insights different from RA cohorts,” researchers wrote. “Patients with SpA are younger, often male, have different lifestyles, frequently use biological DMARDs as monotherapy and have no intrinsic associations with, for example, malignant lymphoma.”

Researchers gathered data from the Swedish Anti-Rheumatic Therapy in Sweden (ARTIS) and Danish Biologic (DANBIO) registers. They included information on 8,703 SpA patients (ARTIS=5,448; DANBIO=3,255) who used TNFi treatments for the first time between 2001 and 2011. They also gathered data on 28,164 SpA patients who never used TNFi for the Swedish National Patient and Population Registers. In addition, 131,687 patients from the general population were included for comparison.

Based on their results, out of 1, 188 cancers among those SpA patients never used TNFi, the relative risk (RR) of cancer overall was 1.1 (95% CI 1.0 to 1.2). The 147 cancers among SpA TNFi users showed an RR of 0.8 versus TNFi-naïve patients (95% CI 0.7 to 1.0). The results were similar to AS and PsA when analyzed separately. Site-specific RRS were: prostate, 0.5 (95% CI 0.3 to 0.8), lung, 0.6 (95% CI 0.3 to 1.3), colorectal, 1.0 (95% CI 0.5 to 2.0), breast, 1.3 (95% CI 0.9 to 2.0), lymphoma, 0.8 (95% CI 0.4 to 1.8), and melanoma, 1.4 (95% CI 0.7 to 2.6).

Although the study represents the largest assessment of cancer risk after TNFi therapy in patients with SpA to date, there were some limitations to the study, such as the time span which may not have been long enough to detect effects of TNFi therapy that may occur years after exposure.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/tnfis-pose-no-cancer-risk-spondyloarthritis-patients

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

Early Treatment for Early RA Leads to Better Outcomes

Published on the May 16, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with early-active rheumatoid arthritis who receive initial or temporary combination therapies can experience faster clinical improvements than those who don’t, a new study found. These targeted treatments also determine long-term outcomes.

Existing research shows treat-to-target therapy works for rheumatoid arthritis patients, but little evidence exists that highlights the long-term impact of continued targeted treatment. The new study evaluated the long-term outcomes in early-active rheumatoid arthritis patients after 10 years of targeted treatments using four different strategies.

The April 2016 Annals of Internal Medicine study found drug-free remissions — with prevention of functional deterioration and clinically-relevant radiographic damage — and normalized survival are realistic outcomes for rheumatoid arthritis patients.

In the randomized-trial, 508 early-active rheumatoid arthritis patients received a combination of four different strategies: (1) sequential monotherapy, (2) step-up combination therapy, (3) initial combination therapy with prednisone, or (4) infliximab. All strategies were followed by targeted treatments that aimed at low disease activity.

The endpoints were functional ability (measured by the Health Assessment Questionnaire (HAQ) score) and radiographic progression (Sharp-Van Heijde score). Survival in the study was compared with the general population using the standardized mortality ratio.

According to study results, 195 patients – 38 percent of the participating population – dropped out of the study. Twenty-eight percent were from strategy 4 compared to 40 percent to 45 percent in strategies 1 and 3, respectively.

At year 10, 53 percent and 14 percent were in remission and drug-free remission, respectively, without experiencing any differences among strategies. During the same time, mean HAQ scores were 0.69, 0.72, 0.64, and 0.58 in strategies 1 through 4, respectively.

Sharp van-der Heijde estimates during follow-up were 11, 8, 8, and 6 for strategies 1 through 4, respectively. Standardized morality ratio was 1.16 (95% CI, 0.92 to 1.46) based on 72 observed and 62 expected deaths. There were similar survival rates among all four strategies (P=0.81).

To see the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/early-treatment-early-ra-leads-better-outcomes

 

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

Arhalofenate an “Ideal Candidate for Gout”

Published on the May 16, 2016, Rheumatology Network website

By Whitney L.J. Howell

For patients with gout, new evidence suggests arhalofenate can be used to safely prevent flare-ups, as well as reduce serum levels.

A Phase IIb study published in the April 7 issue of Nature Reviews Rheumatology demonstrated the dual mode of action of arhalofenate has a significant advantage over other urate-lowering therapies that can prompt an initial increase in flare-up risk. That spike occurs due to mobilization of stored urate and shrinkage of intra-articular urate crystals, causing phagocytosis and an inflammatory response.

Overall, researchers said, gout is an overlooked and poorly-managed disease, and these new findings could alter treatment.

In a 12-week, double-blind study, 239 participants were randomly assigned to four different treatment protocols: once-daily arhalofenate 600 mg or 800 mg, allopurinol 300 mg, allopurinol 600 mg plus colchicine 0.6 mg, or a placebo. Participants must have experienced more than three gout flare-ups during the previous year, could not have taken colchicine or urate-lowering therapy, and had baseline serum uric acid levels between 7.5 mg/dl and 12.0 mg/dl.

“All of a sudden, we were killing two birds with one stone,” said corresponding study author Pol Boudes, M.D. “IL-1ß is the cytokine that is key to triggering gout flare. The demonstration (in mice) that arholafenate was acting as a brake on local release of IL-1ß following an inflammatory challenge with urate crystals was very relevant to making this drug an ideal candidate for gout.”

According to study results, flare incidence was significantly lower in the high-dose arhalofenate group (0.66) than in the allopurinol-only group (1.24, P=0.0056) or the placebo group (1.13, P=0.0049). It was similar to the allopurinol plus colchicine group (0.40, P=0.091). The arhalofenate 600 mg group experienced a non-significant 16 percent reduction in flare incidence versus allopurinol.

The next step, researchers said, is a Phase III study to determine if the combination treatment could significantly improvement gout management.

To read the article at its original location: http://www.rheumatologynetwork.com/gout/arhalofenate-%E2%80%9Cideal-candidate-gout%E2%80%9D

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

Room for Improvement in Radiology Reports

Published on the May 5, 2016, DiagnosticImaging.com website

By Whitney L.J. Howell

It’s no secret within the industry or health care, as a whole, that the radiology report is the main way you convey your thoughts and diagnosis about a patient’s medical condition and needs. That’s been a radiological truth for more than a century.

But, times are changing – and, according to experts, so are expectations around your most important deliverable.

“The days are numbered when we can simply start with a blank page, pick up a microphone, and tell a story about what we see,” said Curtis Langlotz, MD, professor of radiology and medicine at Stanford University. “Referring clinicians, payers, and patients are all demanding higher quality, which requires some degree of consistency and organization.”

These changes are necessary, he said, because current reports make identifying critical information difficult. Your referring physicians are short on time, and succinct reports that follow a consistent pattern will streamline workflow and patient care.

In his latest book, The Radiology Report: A Guide to Thoughtful Communication for Radiologists and Other Medical Professionals, Langlotz addresses the challenges radiologists face when composing their reports and what the field can expect, overall, in the near future. Currently, drafting a quality radiology report is fraught with challenges. Are you avoiding clinically significant errors? Are you answering all clinical questions? Do you have dissatisfied referring clinicians? Do you unnecessarily hedge your diagnoses?

Until recently, the efficiency and affordability of dictation have been the main reasons behind slow reporting advancements, he said. Now, however, the biggest hurdle is mastering the swiftly-changing technology needed to upgrade and update your reports.

But, overcoming these stumbling blocks is critical, he said, especially in the face of changing payment systems and increasing quality reporting requirements. Your reports must be clear and concise, and they must include clinically meaningful and actionable information.

Ultimately, he said, many radiologists need better guidance on how to establish habits that will lead the consistent creation of useful radiology reports. And, as you look for tools that will accommodate bold face, underlying, tables, and multimedia components in your reports, Langlotz said, vendors will likely follow suit.

“As radiology practices try to adapt more consistent and efficient reporting formats, I suspect vendors will respond,” he said.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/pacs-and-informatics/room-improvement-radiology-reports

May 5, 2016 Posted by | Healthcare | , , , , | Leave a comment

Herpes Zoster Infection Most Often Associated with Tofacitinib

Published on the May 2, 2016, Rheumatology Network website

By Whitney L.J. Howell

Among individuals with rheumatoid arthritis (RA), those who take tofacitinib experience double the rate of associated herpes zoster (HZ) than individuals taking other biologics.

According to an April Annuals of Rheumatic Disease study, entitled, “Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis,” researchers from the University of Alabama at Birmingham determined the rate of herpes zoster  infection is substantially higher among patients who take tofacitinib than those who take infliximab, tocilizumab and abatacept, or rituximab.

Tofacitinib, a small molecule used to treat rheumatoid arthritis has immunomodulatory effects, mainly inhibits janus kinase (JAK) 1/3 kinases. Almost all tofacitinib data is based on placebo-based trials, so its real-world safety and comparability with biologics, relating to herpes simplex virus and herpes simplex virus (HSV), is unknown. Existing research does show, however, that rheumatoid arthritis patients have an elevated herpes zoster risk compared to the general population.

“Our analysis is the first real-world evaluation of HZ risk involving tofacitinib and biologic therapies simultaneously, while controlling for other HZ risk factors,” researchers wrote. “Our observations are consistent with the conclusions from the tofacitinib clinical trial experience and provide real-world comparative evidence.”

It’s unclear how tofacitnib causes HZ, but cell-mediated immunity is important in controlling the varicella virus. Patients with waning VZV-specific CD4 T-cell function also have a high HZ risk. Researchers also said one potential explanation is that tofacitnib diminishes CD4 T-cell proliferation and subsequent interferon-Ɣ production.

Based on this study’s results, tofacitinib patients were slightly younger at 55 years old than biologics patients. They were also somewhat less likely than biologics patients to use concomitant methotrexate – 39 percent versus 43 to 56 percent.

Investigators used Cox proportional hazard models to evaluate the adjusted association between tofacitinib and herpes zoster. They also analyzed incident cases HSV.

Based on results, crude herpes zoster incidence associated with tofacitinib was 3.57/100 patient years. When tofacitinib use was compared to abatacept, through multivariable adjustments, researchers discovered herpes zoster risk was significantly elevated – HR 2.01 (95 percent CI 1.40 to 2.58).

RA biologics and abatacept rates, as well as adjusted HRs, were comparable. Older age, female sex, >7.5 mg/day of prednisone, prior outpatient infections, and a greater number of hospitalizations were also associated with herpes zoster risk.

The incidence rates for combined outcomes is greatest for tofacitinib (7.61/100 patient years). They are also significantly elevated after adjustment – HR=1.40, 95 percent CI 1.09 to 1.81).

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/herpes-zoster-infection-most-often-associated-tofacitinib

May 2, 2016 Posted by | Healthcare | , , , | Leave a comment

   

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