AIDS Journal Publishes Findings of Two Important Studies in March 2013 Issue:

Posted on March 4, 2013

1. Research Results Show Current CDC HIV Screening Guidelines Are Too Conservative and Not Cost-Effective

2. Study Says Heavy Drinking Leads to Increased HIV Risk for Men Who Have Sex with Men

Philadelphia, Pa. (March 4, 2013) –The results of two important studies have been published in the March issue of AIDS, the official journal of the International AIDS Society. One study notes that screening for HIV should be performed more frequently—up to every three months for the highest-risk patients, while low-risk groups to be tested every three years. A second study demonstrates a link between heavy drinking and risky behaviors for men who have sex with men (MSM). AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Northwestern University Study Researches the Most Cost-Effective Approach to HIV Screening

The mathematical modeling study was performed to assess “optimal testing frequencies” for HIV screening in different risk groups. Current Centers for Disease Control and Prevention (CDC) guidelines recommend annual testing for high-risk groups, such as people with HIV-positive partners, people with multiple partners, injection drug users, and sex workers and once-in-a-lifetime testing for low-risk groups (whose annual risk of acquiring HIV is only one-hundredth of one percent).

The researchers modeled various scenarios in an attempt to “optimize the tradeoff” between the societal costs of testing versus the benefits of earlier HIV diagnosis over a patient’s lifetime. Frequent testing is shown to be an effective method for identifying new HIV infections. In the past, people with new HIV infections weren’t treated until they had significant declines in immune functioning, as measured by the CD4 cell count. But there’s a growing consensus that antiretroviral treatment is beneficial for all HIV-infected patients, regardless of CD4 count. Starting treatment immediately after diagnosis also reduces the risk of transmitting HIV.

Within its limitations, the study suggests that current recommendations for HIV testing are “too conservative, especially for low risk groups who would benefit from more frequent testing,” according to Lucas and Armbruster. They conclude, “These results should encourage policymakers and medical professionals to reconsider how often adolescents and adults should be tested for HIV.”

The full article is available on the AIDS journal homepage and in the March 13 print and online edition.

University of North Carolina Study Reveals Heavy Drinking Affects HIV Risk for MSM

Researchers analyzed long-term follow-up data on MSM from a large study of HIV risk factors. All men were HIV-negative at the beginning of the study. Using special statistical weighting techniques, Dr Cole and colleagues analyzed the joint effects of alcohol consumption and sexual behavior on the risk of acquiring HIV (seroconversion) during follow-up. Findings show that for men who have sex with men (MSM), heavy drinking may lead to an increased risk of acquiring HIV.

Overall, 529 cases of HIV seroconversion were identified during follow-up. Thirty percent of the men reported having unprotected sex with multiple partners in the two years before the study.

Risk is especially high for men who are heavy drinkers and have multiple partners, suggests the study by Stephen R. Cole, PhD, of University of North Carolina, Chapel Hill, and colleagues. They write, “These findings suggest that alcohol interventions to reduce heavy drinking among MSM should be integrated into existing HIV prevention activities.”

The full article can be read by visiting the AIDS journal homepage and can also be found in the March 13 print edition.

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field. Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Infectious Disease, Public Health, Publications | Leave a comment

‘Very Low’ Risk of Infections in Advanced Brain Procedures

Posted on March 4, 2013

Results Question Need for Routine Antibiotics, Reports Study in Neurosurgery

Philadelphia, Pa. (March 4, 2013) – Patients undergoing cerebral angiography and neurointerventional procedures on the brain are at very low risk of infection—even without preventive antibiotics, reports a study in the March issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“These data suggest that the overall risk of infection associated with most neuroangiographic procedures is very low,” according to the study by Dr. Prashant S. Kelkar and colleagues of University of Alabama, Birmingham. Based on their results, the researchers believe routine preventive antibiotics may not be needed for patients undergoing brain angiography and interventions.

Out of 2,900 Procedures, Just Three Infections

The authors reviewed their experience with more than 2,900 cerebral angiograms and neurointerventional procedures performed between 2004 and 2011. An angiogram is an x-ray procedure using a special dye injected into the brain blood vessels. Neurointerventional procedures are various types of minimally invasive (nonsurgical) procedures performed to treat brain lesions such as aneurysms.

Both types of procedures are performed by threading a catheter through the patient’s blood vessels—usually accessing the femoral artery through a tiny incision in the upper thigh. Unlike at some other centers, the authors did not routinely give antibiotics to prevent infections in patients undergoing these procedures.

The experience included approximately 2,000 angiographic and 900 neurointerventional procedures. Just three patients had infections directly attributable to the procedure—a rate of one-tenth of one percent (0.1%). All were localized infections involving the femoral artery access site in the thigh. There were no infections of the brain or central nervous system.

All infections were successfully treated with antibiotics; two of the patients underwent minor surgery as well. In one patient, the infection was likely related to suppressed immune function because of cancer treatment. None of the patients died as a result of their infection.

Routine Antibiotics May Be Unnecessary

Cerebral angiography is a common diagnostic test for patients with stroke and other disorders. Neurointerventional procedures provide a less-invasive alternative to surgery for selected patients with aneurysms or other lesions of the brain blood vessels.

At many hospitals, patients undergoing these procedures are routinely given antibiotics to prevent infections. However, few studies have evaluated the risk of infection in patients undergoing cerebral angiography and neurointerventional procedures.

The new study finds that the risk of infection is very low, even without routine use of antibiotics. The authors suggest the low risk of infection may reflect the minimally invasive nature of these procedures; their short duration, compared to brain surgery; and the “blood-brain barrier” preventing bacteria from crossing from the bloodstream into the brain.

Dr. Kelkar and colleagues believe their results question the need for routine antibiotics for patients undergoing these procedures. “Prophylatic antibiotic use may be a reasonable option for selected patients,” they write, “but is probably unnecessary for standard use in the context of meticulous care during procedures.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications, Surgery - Neurosurgery | Leave a comment

‘OK’ Contact Lenses Work by Flattening Front of Cornea, Not the Entire Cornea, Suggests Study in Optometry and Vision Science

Posted on March 4, 2013

Study Confirms Rapid Effectiveness of Temporary, Nonsurgical Alternative to LASIK

Philadelphia, Pa. (March 04, 2013) – A contact lens technique called overnight orthokeratology (OK) brings rapid improvement in vision for nearsighted patients. Now a new study shows that OK treatment works mainly by flattening the front of the cornea, reports a recent study, “Posterior Corneal Shape Changes in Myopic Overnight Orthokeratology”, appearing in the March issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“This study appears to show that it is only, or primarily, the very front surface layers of the cornea that are altered by OK contact lens treatment,” comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. The study was performed by Jeong Ho Yoon, PhD, of University of Choonhae Health Science, Ulsan, Republic of Korea, and Helen A. Swarbick, PhD, FAAO, of University of New South Wales, Sydney, Australia.

Overnight Orthokeratology Works—But How?

Orthokeratology is a clinical technique to reduce nearsightedness (myopia) using specially designed rigid contact lenses to manipulate the shape of the cornea—the transparent front part that lets light into the eye. Dr Adams likens OK therapy to orthodontic treatment using braces to change the alignment of the teeth.

He explains “Wearing these lenses overnight for about six hours is currently the treatment approach for most clinicians who use OK for the temporary correction of low to moderate myopia.” But it has been unclear exactly how OK works to reduce myopia: Do the contact lenses reshape just the front surface of the cornea, or do they bend and flatten the entire cornea?

To find out, Drs Yoon and Swarbick had 18 young adults with “low” (relatively mild) myopia wear OK lenses overnight for 14 days. Using sophisticated techniques, the researchers made detailed measurements of corneal shape and thickness before, during, and after treatment.

As in previous studies, wearing OK contact lenses led to reduced myopia, thus improving vision. The changes were significant after the first night wearing OK lenses, By 14 days, myopia was almost completely eliminated and the participants had near-normal uncorrected (without glasses) visual acuity.

Results ‘Achieved Primarily through Remodeling of Anterior Cornea’

These changes were linked to significant flattening of the anterior (front) portion of the cornea. Like the vision changes, the change in corneal shape was significant after the first night wearing OK lenses. Although corneal flattening continued throughout the 14-day treatment period, about 80 percent of the change occurred in the first four days.

In contrast, OK lenses caused only a small and temporary change in the shape of the posterior (rear) cornea, and only slight thinning of the central cornea. “Overall, our results support the current hypothesis that the OK refractive effect is achieved primarily through remodeling of the anterior corneal layers, without overall corneal bending,” according to Drs Yoon and Swarbick.

Overnight OK contact lenses provide an effective treatment for relatively mild myopia. It requires custom-made rigid contact lenses designed to accommodate the shape and desired change of the patient’s eye. While OK lenses provide an alternative to LASIK surgery for correction of myopia, the patient must continue nightly contact lens wear to maintain the improvement.

The authors hope their results “will provide a more complete picture of overall corneal changes during myopic OK.” In particular, the study demonstrates that overnight OK lenses don’t change the curvature of the posterior cornea—”at least in the first two weeks of lens wear.”

To read the article “Posterior Corneal Shape Changes in Myopic Overnight Orthokeratology”, please visit http://journals.lww.com/optvissci/fulltext/2013/03000/Posterior_Corneal_Shape_Changes_in_Myopic.3.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Optometry, Publications | Leave a comment

Round or ‘Shaped,’ Implants Yield Good Results in Breast Reconstruction, Reports Plastic and Reconstructive Surgery

Posted on March 1, 2013

Study Provides Data on ‘Patient-Reported Outcomes’ for Different Types of Silicone Implants

Philadelphia, Pa. (February 28, 2013) –For women undergoing breast reconstruction using implants, most patient-reported outcomes are similar with two different shapes of silicone gel-filled implants, reports a study in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Assessment of key areas of quality of life after breast reconstruction shows few significant differences with conventional round implants versus newer “shaped” implants, according to the new research, led by Dr. Sheina A. Macadam of University of British Columbia, Vancouver.

Does Implant Shape Affect Breast Reconstruction Outcomes?

The researchers evaluated patient-reported outcomes in women who underwent breast reconstruction with implants after mastectomy for breast cancer. Reconstructions were done using two different types of silicone gel-filled implants: conventional round implants and anatomical “shaped” implants. The study included 65 women receiving round implants and 63 receiving shaped implants; the round implants all had a smooth surface, while the shaped implants had a textured surface

The patients completed the BREAST-Q© questionnaire, which evaluated changes in several areas of health-related quality of life, including satisfaction with breasts and with overall outcome, psychosocial, sexual, and physical well-being, and satisfaction with care. Quality of life is increasingly regarded as an important factor in evaluating the benefits of various types of medical or surgical treatments.

Data on patient-reported outcomes was collected one to four years after breast reconstruction. About 80 percent of women in both groups had reconstruction immediately after mastectomy.

The BREAST-Q data showed good overall outcomes with both types of implants. Average scores for satisfaction with the overall reconstruction (on a 100-point scale) were approximately 77 for women receiving shaped implants and 75 for those with round implants. Scores for satisfaction with the breasts were about 64 in both groups.

Scores in other areas—including psychological and sexual well-being—were also similar for the two groups. Just one area differed significantly between groups: women with shaped implants rated their breasts as firmer than women with round implants.

Findings May Help to Guide Women’s Choice of Implants

In a finding important to plastic surgeons, there was no difference in implant “rippling” between groups. Rippling, or wrinkling, had been a drawback of the first generation of shaped implants. Newer shaped silicone implants are not yet approved in the United States; clinical trials are underway.

New implants are introduced to the breast reconstruction market with limited data on the outcomes important to patients—especially in terms of how the reconstruction affects key areas of quality of life. “Patient-reported outcomes data is required to provide guidance based on previous patients’ experience and satisfaction profiles,” Dr. Macadam and colleagues write.

The new study finds few differences in patient-reported outcomes after breast reconstruction with round versus shaped implants. “[T]hese two types of silicone implants are equivalent in terms of satisfaction with outcome,” according to the authors.

Dr. Macadam and colleagues point out the increased firmness of shaped implants as “the one notable difference” between the two types. They believe their findings will help surgeons inform patients about the expected outcomes of reconstruction using round versus shaped implants, and may help to guide introduction of the shaped implants for widespread use.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Publications, Surgery - General, Surgery - Plastic and Reconstructive | Leave a comment

Secondary Facelift Achieves Good Results, Reports Plastic and Reconstructive Surgery

Posted on March 1, 2013

Most Patients Found to Have a Second Facelift Ten Years After the First

Philadelphia, Pa. (February 28, 2013) – Performed an average of a decade after initial facelift surgery, a “secondary” facelift can achieve similarly lasting results with a low complication rate, according to a paper in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Dr. Rod J. Rohrich and colleagues of University of Southwestern Medical Center, Dallas, report their 20-year experience with secondary facelift surgery, or “rhytidectomy.” The researchers conclude that, with attention to some key surgical principles, “Secondary rhytidectomy is a safe and effective procedure for continued surgical facial rejuvenation in the aging patient.”

Experience Shows Good Results with Secondary Facelift Surgery

From 1990 through 2010, Dr. Rohrich performed more than 800 facelift operations. Sixty of those were secondary facelifts—repeat procedures to treat recurrent signs of facial aging. The new study reviewed this experience to gain insights into the technique, outcomes and longevity of the results of secondary facelifts. (The analysis excluded patients undergoing minor “revisions” after facelift surgery.)

The experience included 57 women and three men undergoing secondary rhytidectomy. The patients averaged 51 years of age at the time of their initial facelift and 60 years at their secondary facelift. Thus for these patients, the results of the initial facelift lasted an average of nine years.

Of the 60 patients undergoing a second facelift, 10 later underwent a third facelift procedure. The time between the second and third procedures was 7.5 years—suggesting that the results of the secondary facelift lasted about as long as those of the initial procedure.

The complication rate after secondary rhytidectomy was about five percent. Consistent with previous studies, the risk of complications was about the same after secondary versus primary facelift surgery. In contrast to some reports, there was no increase in the rate of facial nerve injury after secondary facelift.

Study Highlights Importance of the ‘Five R’s’

An increasing number of patients have undergone second or even third facelifts in recent years. “With an ever-growing middle-aged population and an overall interest in facial rejuvenation at an earlier age, there has been a substantial increase in patients undergoing secondary rhytidectomy,” according to Dr. Rohrich and colleagues.

While their experience suggests good results, researchers emphasize that secondary facelift procedures may require some unique surgical techniques. Dr. Rohrich and colleagues outline some important principles for plastic surgeons to follow in planning and carrying out secondary facelifts. They write, “Adherence to the five R’s of secondary rhytidectomy (resect, release, reshape, refill and redrape) will enable the plastic surgeon to safely restore youth and correct stigmata of primary facelift.”

The article includes brief descriptions of individual cases illustrating the authors’ approach to some of the unique challenges of secondary rhytidectomy—reflecting not only the effects of continued aging, but also some “stigmata” of the initial facelift. Dr. Rohrich and colleagues conclude, “Use of five ‘R’s’ described in this article…will help patients return to a natural and youthful look of beauty, even a second time.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

About ASPS

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Publications, Surgery - Plastic and Reconstructive | Leave a comment

Wolters Kluwer Health Named Publisher of the Journal of the American Academy of Physician Assistants

Posted on February 28, 2013

New York, NY — (February 28, 2013) – Wolters Kluwer Health and the American Academy of Physician Assistants (AAPA) announced today an agreement to publish its official journal effective with the June 2013 issue. Lippincott Williams & Wilkins (LWW), part of Wolters Kluwer Health, will be the journal’s publisher of record.

“We are delighted to be named publishing partner by the American Academy of Physician Assistants to help broaden the reach of its official peer-reviewed journal for this important and growing group of healthcare professionals,” said Jayne Marks, Vice President of Publishing at Wolters Kluwer Health, Medical Research. “We look forward to developing new services and digital content channels to support the Academy’s membership and journal subscribers.”

As the physician assistant (PA) profession expands rapidly, growing an estimated 39 percent over the next decade, LWW will help develop and enhance the content strategy of the Journal of the American Academy of Physician Assistants (JAAPA) with digital and online solutions keeping in step with how PAs want to access their professional literature and engage with the PA community. Other initiatives include diversifying and expanding offerings that support AAPA growth as well as providing value and benefits to members.

“The clinical content and insights into innovative models of care presented by JAAPA support and inform PAs, who are playing vital roles in today’s dynamic healthcare landscape,” said James E. Delaney, PA-C, AAPA President. “A strong publishing partnership with Wolters Kluwer Health that builds on JAAPA’s strengths as a first-rate clinical journal and enhances the quality of its research is important to our membership and the PA profession.”

Reamer L. Bushardt, PharmD, PA-C, JAAPA Editor-in-Chief and Professor and Chair, Department of Physician Assistant Studies, Wake Forest School of Medicine added, “JAAPA is the premier print journal for PAs, and LWW is providing publishing expertise to enrich our online presence and launch innovative new digital platforms, including an iPad app. Through the partnership, we’ll extend the journal brand through Wolters Kluwer Health’s Ovid medical research platform, firmly establishing it as the global authority on PA practice and research. We’re also pleased to offer AAPA members with value-added access to the OvidMD clinical interface, providing PAs with quick access to important resources to support patient care decisions. Last year, JAAPA celebrated its 25th anniversary and the future is looking even brighter.”

PAs practice in every type of clinical healthcare setting, including solo practices, long-term care facilities, hospital emergency rooms, and also serve as administrators, educators and researchers. About one-third of PAs currently work in primary care and the remaining two-thirds practice in virtually every medical specialty and subspecialty.

PAs are also one of the fastest-growing healthcare professions in the U.S., and the Patient Protection and Affordable Care Act in 2010 recognized PAs as one of three healthcare professionals in primary care. The employment of physician assistants is expected to increase 30 percent from 2010 to 2020, much faster than the average for all occupations.

About the American Academy of Physician Assistants

Founded in 1968, the American Academy of Physician Assistants is the national professional society for physician assistants. It represents a profession of more than 90,000 certified PAs across all medical and surgical specialties in all 50 states, the District of Columbia, the majority of the U.S. territories and within the uniformed services. AAPA advocates and educates on behalf of the profession and the patients PAs serve. It works to ensure the professional growth, personal excellence and recognition of physician assistants and to enhance their ability to improve the quality, accessibility and cost-effectiveness of patient-centered healthcare. Visit www.aapa.org to learn more.

About Lippincott Williams & Wilkins and Wolters Kluwer Health

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Health Professions, Physician Assistant, Publications | Leave a comment

VHA Plays Leading Role in Health Information Technology Implementation and Research

Posted on February 22, 2013

Special Issue Looks at New Research Using Information Technology to Improve Quality of Health Care

Philadelphia, Pa. (February 21, 2012) – The Veterans Health Administration (VHA) is aiming to become a leader in using health information technology (HIT) to change the way patients experience medical care, to decrease medical mistakes, and to improve health outcomes. A special March supplement of Medical Care highlights new research into the many and varied types of HIT projects being explored to improve the quality of patient care throughout the VHA system. Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue also maps out key areas for future research to develop and evaluate effective approaches for using HIT for ongoing quality improvement in healthcare. “Our research infrastructure is critical to supporting the type of HIT innovation that can support changes in the way we organize and deliver care,” according to an editorial comment by the VHA’s Dr. David Atkins, Acting Director of Health Services Research and Development, and Dr. Theresa Cullen, Director of Health Informatics.

VHA Provides Leadership in HIT Research for Quality Improvement

Health information technology’ is a loose term describing an ever-increasing range of tools and technologies. “The unifying element is not that they involve technology but that they introduce novel ways to collect and analyze health data and to extract knowledge from the data to inform decisions,” Drs. Atkins and Cullen write. Since the early development of health information systems in the 1980s, the VHA has played a leadership role in health informatics.

But the HIT landscape continues to change rapidly, with increased computing power, changing HIT platforms, and changing expectations of patients, health care providers, and payers. “To map out a meaningful research agenda, we must think forward five to ten years,” according to Drs. Atkins and Cullen.

From their perspective at the leading edge of HIT, they outline some of the broad trends affecting HIT, now and in the future. These include:

The emergence of “connected health”—technology will play a central role in medical decision-making, and will supplant an increasing proportion of in-person health care visits.
Patients’ increasing control over their health information and who has access to it.
The increased role of HIT tools to promote and assist patient behavior change.
Standardized data allowing the performance of health care systems to be assessed in “real time,” for the entire population of patients.

Drs. Atkins and Cullen also identify and discuss “distinct sets of questions that are ripe for research” in using HIT for quality improvement, from the standpoint of patients, health care teams, and health care managers.

New Research on HIT to Improve Quality of Care

The special issue also presents eight original research papers using HIT for quality improvement within the VHA system. The studies “highlight a range of specific HIT approaches, including innovative and interactive uses of the VA’s electronic health record, databases, and information systems; and applications of automated systems for intervention, evaluation and tracking patient care,” writes Denise M. Hynes, MPH, PhD, RN, Research Career Scientist and Director of the VA Information Resource Center, in an introductory overview.

For example, one study evaluates the use of electronic kiosks as a way to help improve care outcomes for veterans with schizophrenia. Other HIT approaches evaluated include a system for secure messaging between patients and health care providers, a “home telehealth” monitoring intervention for recently homeless veterans, and programs to increase veterans’ access to and ability to use their personal health records.

“These articles highlight the value of a systematic approach in incorporating and evaluating HIT as part of quality improvement efforts,” Dr. Hynes adds. She is also lead author of a paper exploring the challenges and keys to “sustained effects” of HIT projects in the Quality Enhancement Research Initiative—a major part for the VHA’s systemwide quality improvement program.

The authors of the supplement papers hope their efforts will illustrate the scope of what’s possible through the use of HIT for quality improvement, and help to set the research agenda for continued efforts in the years ahead. As new and practical research designs emerge, Dr. Hynes writes, “Other healthcare quality improvement efforts that rely on HIT can learn from the VHA experience.

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Public Health, Publications | Leave a comment

Inhaled Betadine Leads to Rare Complication

Posted on February 21, 2013

Craniofacial Surgeons Recommend Steps to Lower Risk of Pneumonitis from Povidone-Iodine

Philadelphia, Pa. (February 21, 2013) – A routine step in preparing for cleft palate surgery in a child led to an unusual—but not unprecedented—case of lung inflammation (pneumonitis), according to a report in the The Journal of Craniofacial Surgery. The journal, edited by Mutaz B. Habal, MD, FRCSC, is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The complication resulted from accidental inhalation of povidone-iodine (PI), or Betadine—an antiseptic widely used before surgery. The rare complication led to new surgical “prep” steps to reduce the chances of inhaling PI during head and neck surgery, write Drs. Kyle J. Chepla and Arun K. Gosain of University Hospitals–Case Medical Center, Cleveland.

Betadine Inhlation Leads to Chemical Pneumonitis

Drs. Chepla and Gosain describe their experience with Betadine-induced pneumonitis in a seven-year-old girl undergoing surgery for a persistent cleft palate deformity. After a breathing tube was placed and anesthesia was induced, the patient underwent routine surgical prep—including scrubbing and rinsing the nose and mouth with Betadine.

Betadine is the familiar antiseptic, orange or yellow in color, used before many types of medical and surgical procedures. In the case report, Dr. Kepla writes that he has routinely used Betadine for prep before craniofacial surgery for more than 20 years with no complications.

But in this case, shortly after rinsing the inside of the nose, the surgeons noted Betadine in the patient’s breathing tube. She rapidly developed difficulty breathing, with a drop in blood oxygen levels.

The procedure was stopped and the patient was rushed to the ICU for treatment. Although the child eventually recovered completely, she required seven days of mechanical ventilation.

This patient’s condition was diagnosed as chemical pneumonitis—inflammation of the lungs caused by inhalation of some type of irritant. Pneumonitis most commonly results from inhalation (aspiration) of the stomach contents.

Because it is effective against a wide range of bacteria, viruses, and other pathogens, Betadine is one of the most commonly used disinfectants. It is useful in preparing for surgical procedures of the head and neck, because it does not irritate the mucosal lining. However, studies in animals have shown that Betadine can cause inflammatory damage to the lungs, if inhaled.

Prompted by their experience, Drs. Chepla and Gosain performed a comprehensive review of the medical literature to look for similar cases. The review identified three previous cases of chemical pneumonitis caused by Betadine after disinfection of the mouth. All patients recovered after a period of mechanical ventilation.

Although Betadine-induced pneumonitis appears very rare, Drs. Chepla and Gosain have modified their routines to reduce the risk of this complication. They write, “We conclude that PI is safe to use as a disinfectant before head and neck surgery, but surgeons need to be aware of the risk for PI aspiration and take the appropriate steps to prevent its passage into the tracheobronchial tree.”

About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Publications, Surgery - Plastic and Reconstructive | Leave a comment

Steroid Injection May Lead to Worse Outcomes in Patients with Spinal Stenosis

Posted on February 19, 2013

With or Without Surgery, Outcomes No Better with Epidural Steroids, Suggests Study in Spine

Philadelphia, Pa. (February 19, 2013) – For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study raises questions about the benefits of steroid injection—a widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine. “There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically,” according to the study by Dr Kris E. Radcliff of Thomas Jefferson University, Philadelphia, and colleagues.

Do Steroid Injections Help in Spinal Stenosis?

The researchers analyzed data from the Spine Outcomes Research Trial (SPORT)—one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal problems) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications). Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.

The current analysis focused on the effects of ESI as part of treatment for spinal stenosis. Steroid injection is commonly recommended for patients whose symptoms don’t improve with initial treatment.

Dr Radcliff and colleagues compared outcomes for 69 patients who underwent steroid injection during their first three months of enrollment in SPORT versus 207 patients who did not receive ESI. The two groups were similar in terms of most initial characteristics, although patients receiving steroid injections were more likely to prefer nonsurgical treatment: 62 versus 33 percent.

‘Significantly Less Improvement’ in Patients with ESI

“Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT,” the researchers write. Among patients who eventually had surgery, those who had ESI showed less improvement in physical functioning through four years’ follow-up. For those treated nonsurgically, steroid injections were associated with less improvement in pain as well as functioning.

There was also evidence that surgery was more complicated in patients who had previously been treated with epidural steroids. On average, surgery took about one-half hour longer in patients who had received ESI, who also spent about one day longer in the hospital. Patients who received ESI were also more likely to “crossover” from their initially assigned treatment to the other treatment group. There was no evidence that receiving steroid injections helped patients to avoid surgery.

Lumbar spinal stenosis is a common problem in older adults. Epidural steroid injection is a common treatment for spinal stenosis, despite a lack of evidence showing its long-term benefits. The SPORT data provides an opportunity to examine how steroid injections affect long-term outcomes of spinal stenosis.

The new study has some important limitations, especially in that patients weren’t randomly assigned to epidural steroid treatment. However, the results suggest that patients with spinal stenosis who receive ESI have less improvement at four years’ follow-up, whether or not they subsequently undergo surgery.

Dr Radcliff and colleagues conclude, “Despite the common treatment practice of incorporating one or more ESI in the initial nonoperative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis,” write. They believe the “most likely” reason for the worse outcomes after ESI is that the injection causes worsening of the spinal narrowing or result spinal nerve impingement, although other explanations are possible. The authors call for further research to clarify the “indications and results of this common procedure.”

About Spine

Recognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Pain Management, Publications, Uncategorized | Leave a comment

Degenerative Cervical Spine Disease May Not Progress Over Time

Posted on February 19, 2013

Study in Spine Asks, If Condition Doesn’t Progress, Is Surgery Necessary?

Philadelphia, Pa. (February 19, 2013) – Follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time, according to a study in the February 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

For many patients with “unstable” cervical degenerative spondylolisthesis, observation may be a better choice than surgery, according to the new research by Dr Moon Soo Park and colleagues of Medical College of Hallym University, Republic of Korea. They write, “Our results suggest that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.”

Is Unstable Spondylolisthesis Really Unstable?

The researchers analyzed the “natural history” of cervical degenerative spondylolisthesis in 27 patients. Degenerative spondylolisthesis refers to “slipped” vertebrae caused by bone degeneration. Because spondylolisthesis is commonly thought to result in instability of the cervical spine, spinal fusion surgery (arthrodesis) is sometimes considered the appropriate treatment.

The 16 men and 11 women in the study underwent cervical spine radiographs (x-rays) on two occasions at least two years apart. The patients’ average age at the time of the initial radiograph was 59 years; average time to the follow-up radiographs was 39 months. Measurements on the paired radiographs were carefully compared to determine whether and how much the cervical slippage increased over time.

Initial x-rays showed “instability”—at least two millimeters of displacement between vertebrae—in several patients. However, during follow-up, none of the patients had further progression, defined as additional displacement of two millimeters or more. The average progression was only about one-half millimeter.

Twenty-one patients had backward displacement (“retrolisthesis”) of the cervical vertebrae, while six had forward displacement (“anterolisthesis”). The patients with retrolisthesis had somewhat greater slippage during follow-up; however, none had a dislocation or suffered neurological damage.

No Progression of ‘Slippage’ or Symptoms

Of 16 patients who had symptoms such as neck pain or sensory abnormalities at the initial visit, most were successfully managed without surgery. Of the 11 patients who were initially symptom-free, none developed symptoms during follow-up.

The study is one of the few to look at the “natural history” of cervical spondylolisthesis. The results suggest that, at medium-term follow-up, the conditions appears to be “relatively stable” in most patients. Dr Park and colleagues write, “This begs the question, if an ‘unstable’ listhesis does fine without treatment, is it really unstable? Our results suggest that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.”

The researchers acknowledge some important limitations of their study—particularly the small number of patients and relatively short follow-up. However, the results suggest that, for many patients, cervical spondylolisthesis is a non-progressive condition that does not necessarily require surgical treatment. Dr Park and coauthors conclude, “In the absence of neurologic symptoms, we recommend observation of patients with degenerative spondylolistheses of the cervical spine.”

About Spine

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Uncategorized | Leave a comment

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