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  • October 18, 2016 8:34 AM | Deleted user

    Journal of Clinical Outcomes Management 

    In an article recently published in the Journal of Clinical Outcomes Management, researchers found that an expanded PA hospitalist staffing model at a community hospital provided similar outcomes and a lower cost of care than a conventional one. Researchers did a retrospective study comparing two hospitalist groups at a 384-bed community hospital in Annapolis, Md. One group had an expanded PA staffing model, with three physicians and three PAs. The other group had a "conventional" staffing model, with nine physicians and two PAs.

    Between January 2012 and June 2013, researchers examined the in-hospital mortality, cost of care, readmission, length of stay and consultant use. Between the two groups, there was no statistically significant difference for in-hospital mortality, readmission, length of stay, or consultant use. Cost of care was less in the expanded PA group. In conclusion, an expanding PA staff modeling can yield a similar level of care at a lower cost.

    AAPA sees this as an important study that has broader implications for PA utilization in a hospital setting across all service lines.

    Read more

  • October 14, 2016 2:04 PM | Deleted user

    Researchers found Zika virus sequences in placenta and cord blood in newborns, supporting prior evidence of vertical transmission of Zika virus during pregnancy, according to data published inJAMA Neurology. However, the investigators did not observe changes in umbilical and cerebral blood flow.

    Previous studies have reported an increase of microcephaly cases in fetuses whose mothers were infected with Zika virus.  Amilcar Tanuri, MD, PhD, from the Federal University of Rio de Janeiro, and colleagues sought to examine the prenatal evolution and perinatal outcomes in 11 neonates with neurologic damage associated with Zika virus infection.

    The researchers observed the infants from gestation to 6 months in Paraiba, Brazil. Seven infants were female, and the median maternal age at delivery was 25 years. Ten of the 11 women included in the study presented with symptoms of Zika during the first half of pregnancy, but all 11 women had Zika infection confirmed in several tissues by serology or polymerase chain reaction.

    The investigators used intrauterine ultrasonography and magnetic resonance imaging to confirm brain damage, and they performed histopathologic analysis on placenta and brain tissue in infants who died. They also investigated the Zika virus genome in several tissues and performed genome sequencing for phylogenetic analysis.

    The perinatal mortality rate was 27.3%. The median cephalic perimeter at birth was 31 cm, which was lower than the limit to consider a microcephaly case.  The researchers observed neurologic impairments in all patients, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence.

    The Zika virus genome was identified in both maternal and neonatal tissues, including amniotic fluid, cord blood, placenta, and brain tissue. In addition, phylogenetic analyses revealed an intrahost variation between Zika virus sequences of some postmortem tissues.

    The researchers concluded that amniotic fluid may be valuable for prenatal diagnosis of Zika virus. They did not note changes in umbilical and cerebral blood flow, and they also note that microcephaly could be a consequence of several brain injuries.

    “Based on confirmed [Zika virus] ZIKV-associated cases of microcephaly reported by the Brazilian Ministry of Health, the northeastern region of Brazil has a 10 times larger incidence of confirmed cases compared with the rest of Brazil as well other Latin American countries where ZIKV circulates,” the study authors noted. “This fact suggests that there must be some additional unknown factor to enhance ZIKV fetal infection in this region. Coinfections as well as environmental factors should be explored to clear this unexpected finding.”

    Reference

    1. Suely de Oliveira Melo A, Aguiar RS, Amorim MMR, et al. Congenital Zika virus infection: Beyond neonatal microcephaly. JAMA Neurol. 2016; doi: 10.1001/jamaneurol.2016.3720.


  • October 14, 2016 1:40 PM | Deleted user

    Neil Silverman, MD will provide an update on Zika Virus to APAOG members and non-members on November 10, 2016.

    APAOG Members: Be sure you are logged in to receive the member rate! Not a member? Sign up today!

    Lecture Objectives:

    1. To understand the evolving epidemiology of Zika currently, including its implications in the US

    2. To appreciate the unique risks of Zika infection during pregnancy and their impact on the fetus and newborn

    3. To understand current testing protocols for diagnosing Zika infection

    4. To better counsel couples planning pregnancy regarding risks of travel to Zika-endemic areas  


  • October 12, 2016 11:16 AM | Deleted user

    Helping women who want to delay or avoid pregnancy during the Zika virus outbreak is a primary strategy to reduce Zika-related adverse pregnancy and birth outcomes, including microcephaly and severe fetal brain defects. 

    The best way to reduce the risk of unintended pregnancy is for sexually active women and their partners to correctly and consistently use effective birth control. 

    Long-acting reversible contraception (LARC), specifically IUDs and implants, is the most effective type of reversible birth control. LARC can be inserted or implanted in a woman and remains highly effective at preventing pregnancy for many years. 

    LARC is safe for most women to use, including female adolescents. To increase access to and availability of LARC, state and jurisdictional level-strategies can be implemented by state, local, and territorial agencies, health systems, and healthcare providers. 

    Download the resource here for more information.

  • October 07, 2016 12:20 PM | Deleted user

    Dorothy L. Tengler
    Thursday, October 06, 2016

    About 85 percent of menopausal women report at least one of the symptoms of menopause, which occurs due to a complex series of hormonal changes. The most common symptoms, often lasting for several years, include:

    • sleep disorder (insomnia, waking and sleeping difficulties)
    • sexual dysfunctions (reduced libido, urogenital disorders)
    • depressive disorders and irritability
    • hot flashes and excessive sweating
    • discomfort associated with muscle, joint pain (discomfort of bone-joint system, osteoporosis)

    In some women, these symptoms are so severe that they affect their social and daily lives.

    Although some women go through premature menopause at age 40, the average age of onset for natural menopause is 51 in the United States. However, 1 in every 10 women experiences natural menopause by age 45.

    In a study published recently in the journal Menopause, researchers at the University of Pittsburgh School of Medicine found that women who experience hot flashes and night sweats early in life were more likely to die from cardiovascular disease. The research suggests menopausal symptoms in younger midlife women may mark adverse changes in dysfunction of the endothelium, or lining of the blood vessels, placing them at risk for heart disease.

    The Women's Ischemia Syndrome Evaluation enrolled women referred for coronary angiography for suspected myocardial ischemia. A total of 254 women — aged more than 50 years, postmenopausal, with both ovaries and not taking hormone therapy — underwent a baseline evaluation and were followed annually. A subset of participants underwent brachial artery ultrasound for flow-mediated dilation (FMD).

    Researchers noted that women who had hot flashes before age 42 were more likely to have lower FMD, suggesting adverse endothelial changes and higher mortality rates.

    This connection is important because heart disease is the leading cause of death for women in the U.S., killing 289,758 women in 2013 — about 1 in every 4 female deaths. Even with no symptoms, women may still be at risk for heart disease. In fact, almost two-thirds (64 percent) of women who die suddenly of coronary heart disease had no previous symptoms.

    Despite increases in awareness over the past decade, only 54 percent of women recognize that heart disease is their number 1 killer.

    Although studies have linked vasomotor symptoms (VMS) to markers of cardiovascular disease risk, few have considered clinical cardiovascular events. Dr. Rebecca C. Thurston, Ph.D., professor of psychiatry at Pittsburgh School of medicine, noted that future research may help predict midlife women at increased risk of cardiovascular disease, which would enable early prevention strategies.

    Original Post: http://exclusive.multibriefs.com/content/an-alarming-link-between-early-menopause-and-cardiovascular-disease/medical-allied-healthcare


  • October 05, 2016 2:56 PM | Deleted user

    By David Templeton / Pittsburgh Post-Gazette

    Amid the growing surge of Zika research, the University of Pittsburgh School of Medicine has announced early success with two experimental vaccines that prevented the pups of immunized female mice from becoming infected with the virus.

    Both vaccines, with one more effective than the other, succeeded in producing an immune response to the virus that was transferred from mother to her pups. That would represent an important goal in a human vaccine, given the severe neurological birth defects including microcephaly (an abnormally small head) and Guillan-Barre syndrome that the viral infection can cause.

    “We’ve not only developed a promising vaccine candidate to move toward larger pre-clinical and, eventually, human clinical trials, but also a delivery format that would be inexpensive to produce and distribute to hundreds of thousands of people,” said Andrea Gambotto, an associate professor of surgery at the medical school who was senior author of the study, published online Monday in the EBioMedicine journal.

    Congress recently allocated $1.1 billion for Zika research, money that Pitt researchers hope to tap to advance their vaccines to human clinical trials, potentially within a year, Dr. Gambotto said.

    The Pitt focus is creating a vaccine given to the mother that protects the fetus and newborn against birth defects. So far, so good.

    “Pups born to mice immunized with [the one Pitt vaccine] were all protected against lethal challenge infection without weight loss or neurological signs,” while 50 percent of the pups born to dams immunized with the second Pitt virus were protected, the study says.

    One vaccine involved a standard injection. The other used crystals affixed to a patch similar to a Band-Aid to keep them in contact with the skin until they dissolved.

    The vaccines generate an immune response against an antigen — a protein — on the outer shell of the virus. The Pitt study describes the immunization as “a promising candidate vaccine” for the prevention of Zika virus disease.

    Bites from mosquitoes of the Aedes species represent the key method of viral transmission, with sexual transmission also possible. Various South American, Central American and Caribbean nations are experiencing epidemic levels of infection, while Florida has reported Zika infections contracted from local mosquitoes. The virus already has spread to 50 nations, with 6,400 cases in the United States and its territories, the National institute of Health reports.

    The National Institute of Allergy and Infectious Diseases currently is working on five Zika vaccines, with the Aug. 2 launch of a human clinical trial.

    Once a vaccine is developed, it typically is tested in mice then monkeys. If successful, the next step is three phases of human clinical trials to determine safety and effectiveness before it goes before the U.S. Food and Drug Administration for approval. Even if the institute’s vaccine proceeds on the current fast track, its effectiveness on humans won’t be clear until early to mid-2018, said institute director Anthony S. Fauci. Consider, however, that vaccines typically take seven to 10 years to be developed and approved.

    Developing a Zika virus poses no serious difficulties in vaccine science, given that similar flavivirus vaccines already have been developed for yellow fever and several types of encephalitis.

    Besides the five NIH vaccines, pharmaceutical companies, universities and others also have reported their development of vaccines.

    “The more shots on goal you have, the better the chance of getting a vaccine,” Dr. Fauci said. “If history holds true, there should be an effective vaccine against Zika.”

    David Templeton: dtempleton@post-gazette.com or 412-263-1578.


  • October 03, 2016 11:57 AM | Deleted user

    AAPA
    AAPA President Josanne Pagel with U.S. Surgeon General Vivek Murthy at the HHS Office on Women's Health (OWH) National Meeting on Opioid Use, Abuse and Overdose in Women last Thursday. Pagel was part of the national conversation to examine the unique prevention, treatment, and recovery issues for women who use, abuse, or overdose on opioids. This meeting will build upon the HHS Secretary's opioid initiative, examining the unique and specific needs of women in the context of that epidemic. September is Pain Awareness Month.

    On July 22, in response to pressure from AAPA and other national groups, the Comprehensive Addiction and Recovery Act (CARA) was signed into law. PAs will soon be eligible to become waivered to prescribe buprenorphine for five years as part of medication assisted treatment (MAT) for the treatment of opioid addiction with the passage of this legislation. CARA was overwhelmingly passed by Congress.

  • October 03, 2016 11:54 AM | Deleted user

    By Steven Reinberg
    HealthDay Reporter

    THURSDAY, Sept. 29, 2016 (HealthDay News) -- The vaccine against human papillomavirus (HPV) infection, which doctors believe causes most cases of cervical cancer, appears even more effective than believed, a new study finds.

    "After eight years of vaccination, the reduction in the incidence of cervical neoplasia [abnormal growth of cells], including pre-cancers, have been reduced approximately 50 percent. This is greater than what was expected -- that's pretty exciting," said lead researcher Cosette Wheeler. She is a professor of pathology and obstetrics and gynecology at the University of New Mexico, in Albuquerque.

    The study also showed that the protection appears to occur even when only one or two of the recommended doses of the vaccine are given.

    "Right now, the recommendation is three doses for girls and boys before the 13th birthday, so that you are protected before you become exposed," Wheeler explained.

    "People thought that three doses of vaccine were necessary, but there's a lot of people who are getting one and two doses, and people are getting protection from one or two doses," she said.

    On average, 40 percent of girls aged 13 to 17 in New Mexico had received all three doses in 2014, the researchers found. But, Wheeler said, "It may be that two doses are sufficient."

    Protection from HPV is also coming from what's called herd immunity, which increases as more people are vaccinated and reduces the spread of HPV, Wheeler said. "Herd immunity means that the probability of getting infected decreases for everybody, even the people who aren't vaccinated," she explained.

    Moreover, the vaccines protect against more types of HPV than they were designed to do, she added.

    Although this is not the first report to show the effectiveness of the vaccine, it's the first to show declines in precancerous lesions across a large population, Wheeler said. The researchers also found that the reductions in the number of precancerous lesions were greater than anticipated.

    This study even took into account changes in Pap test screening over the last 10 years.

    In 2009, the American College of Obstetrics and Gynecology said most women under 21 do not need Pap test screening and recommended longer times between screening. In 2012, the U.S. Preventive Services Task Force said women, regardless of age, do not need to get screened more than every three years, Wheeler said.

    If these changes were not taken into account, the effect of the vaccine would appear even greater than it already is, because it would assume that more women were being screened than actually were, she said.

    "Parents and doctors should pay attention. These vaccines are highly efficacious," Wheeler said.

    It's up to doctors to be sure kids are vaccinated, she said. "It's their job, just like other vaccines, to provide them to their patients. They are the key to get this done," Wheeler added.

    In addition to cervical cancer, HPV can cause genital warts in men and women, and some head and neck cancers.

    Although cervical cancer can take decades to develop, it's important to protect children before they become sexually active and risk getting infected with HPV, which is why Wheeler strongly recommends: "Get your kids vaccinated -- both your boys and your girls -- before their 13th birthday."

    For the study, Wheeler and colleagues collected data on young women tested for cervical cancer with Pap tests from 2007 to 2014, who were part of the New Mexico HPV Pap Registry. New Mexico should be considered representative of the whole country, Wheeler said.

    One expert said the findings make the case for HPV vaccination even stronger.

    "These data highlight and provide even more evidence as to the efficacy of the vaccine in preventing HPV infections and related diseases," said Fred Wyand, a spokesman for the American Sexual Health Association/National Cervical Cancer Coalition.

    Increasing HPV vaccination rates "goes back to the importance of health care provider's recommending the vaccine to parents and patients," he said. "Provider recommendation carries much weight, and parents are far more likely to have their child vaccinated if the provider encourages it."

    Another approach to increasing vaccination rates is to "normalize" HPV vaccines, he said. "Rather than treat it as something exotic, it should just be offered as part of the routine adolescent vaccine program," Wyand said.

    Dr. Metee Comkornruecha, an adolescent medicine specialist at Nicklaus Children's Hospital in Miami, agrees that the vaccine "is effective, and parents should have their sons and daughters vaccinated."

    The report was published online Sept. 29 in the journal JAMA Oncology.

    More information

    Visit the U.S. Centers for Disease Control and Prevention for more on the HPV vaccine.

    SOURCES: Cosette Wheeler, Ph.D., professor, pathology and obstetrics and gynecology, University of New Mexico, Albuquerque; Fred Wyand, spokesman, American Sexual Health Association/National Cervical Cancer Coalition, Research Triangle Park, N.C.; Metee Comkornruecha, M.D., adolescent medicine specialist, Nicklaus Children's Hospital, Miami; Sept. 29, 2016, JAMA Oncology, online

    Last Updated: Sep 29, 2016

    Copyright © 2016 HealthDay. All rights reserved.


  • September 28, 2016 12:31 PM | Deleted user

    On September 27, 2016 APAOG hosted a webinar called "Let's Talk about Sex: Addressing reproductive health with patients who are LGBT." This webinar was presented by Lis Shell, PhD, MPAS, PA-C from the University of Texas Medical Branch, Galveston, Texas. The presentation was well received by attendees.

    A webinar recording of this presentation is available to members here.

    APAOG's next webinar is on November 10, 2016 and will cover Zika. Register today!

  • September 27, 2016 9:24 AM | Deleted user

    If you’re a pregnant woman and have a backache or headache, or a fever, your options for over-the-counter treatment basically boil down to one medication: the pain reliever acetaminophen, better known as Tylenol. Doctors advise against using nonsteroidal anti-inflammatories, like ibuprofen and aspirin, during late pregnancy because they can compromise fetal circulation and have other adverse consequences.

    But evidence has accumulated that, when taken during pregnancy, acetaminophen may increase the risk that children will develop asthma or attention deficit hyperactivity disorder. The elevated risk in most studies is small, and whether the drug itself is really to blame is debatable. But considering that more than 65 percent of pregnant women in the United States use acetaminophen at some point during their pregnancy, the number of children with problems stemming from it could be substantial.

    The odd thing about acetaminophen is that even after decades of widespread use, no one knows precisely how it blunts pain. But it has earned a reputation for strange side effects. Experiments indicate that it impedes people’s ability to empathize. It may undercut the brain’s ability to detect errors. When taken after a vaccine, it may suppress the immune system. Why might the drug affect both asthma and A.D.H.D. rates? Scientists have variously speculated that it could tweak the immune system during pregnancy, or disrupt hormones, or change growth factors in the developing brain. In short, no one knows.

    The prevalence of asthma doubled between 1980 and 2000. At the same time, worries over Reye’s syndrome, a rare complication in children who take aspirin, led to a rise in the popularity of acetaminophen. On the basis of this circumstantial — and rather weak — evidence, 16 years ago, scientists at King’s College London proposed a link between rising acetaminophen use and the so-called asthma epidemic. Their reasoning was that acetaminophen depleted the body’s native antioxidant, called glutathione, spurring inflammation of the lungs.

    Numerous studies followed showing an association with asthma, but they often relied on mothers’ potentially unreliable memories of what they took, or simply compared one group — mothers of asthmatic children, say — to a control group, a suboptimal study design.

    Recently, however, much stronger studies showing a link have emerged. A study of Norwegian women and children published this year in the International Journal of Epidemiology found that prenatal acetaminophen use increased 7-year-olds’ risk of asthma by 13 percent.

    Then, in August, a JAMA Pediatrics study on a British cohort noted that a mother’s use of the pain reliever in midpregnancy increased 7-year-olds’ risk of hyperactivity by 31 percent.

    Of course, some familial trait may push people to reach for acetaminophen, and this quality, as opposed to the drug itself, may explain the increased risks. But that doesn’t seem to be the case. A mother’s use after she gave birth wasn’t associated with more problems in the British and Norwegian studies. Nor was a father’s.

    Still, the authors are the first to note that perhaps they missed something. They don’t always know how much of the drug women take, or why they’re taking it. And there are reasons to think that the infections whose symptoms women might be treating with the pain reliever could themselves increase the risk of asthma and developmental problems. And yet these and some previous studies controlled for infections, and the association remained.

    Not all of the research has confirmed the relationship. But at this point, the number of strong studies that do find a link are hard to overlook, and are unnerving.

    Moreover, there’s evidence that the drug interacts more strongly with certain genotypes. Some of us carry gene variants that naturally alter the activity of the antioxidant glutathione, reducing its ability to detoxify. A 2010 study by Columbia University scientists found that, at age 5, the children with this variant, whose mothers had taken acetaminophen while pregnant, had double the risk of wheezing compared with children without the gene. In fact, without the gene, children had no increased risk of wheezing. So perhaps only a subset of people are vulnerable to the drug’s harmful effects.

    Petra Arck, a professor of fetal-maternal medicine at the University Medical Center Hamburg-Eppendorf, and colleagues gave the pain reliever to pregnant mice, and found it stressed the liver, altered the placenta and increased the pups’ vulnerability to wheezing.

    During pregnancy, the immune system must tolerate the fetus, which is half foreign, while also retaining enough firepower to fend off pathogens. Professor Arck argues that the drug can interfere with this balancing act.

    But two other mouse studies found no such effect on asthma or behavior. A major difference is the amount of acetaminophen given to the animals. Professor Arck used a big dose. The other two studies used less.

    Antonio Saad, a researcher at the University of Texas Medical Branch at Galveston whose own study failed to produce A.D.H.D.-like symptoms in mice, thinks that Professor Arck used an unrealistically high amount. But the dose was intentional, Professor Arck told me. Acetaminophen is in hundreds of medications, making it easy for pregnant women to take too much. Professor Arck thinks some women overdose without knowing it.

    Last year, the Food and Drug Administration reviewed evidence on acetaminophen and developmental outcomes and deemed it “inconclusive.” That was before the more recent studies appeared. When I asked, an F.D.A. spokeswoman told me that the F.D.A. was “actively reviewing” the new research. A spokeswoman for Johnson & Johnson, the maker of Tylenol, said the company wasn’t aware of evidence showing a “causal link” between prenatal use and later problems, but recommended discussing risks and benefits with a doctor.

    The greater problem is that the kind of study that would definitively answer the prenatal acetaminophen question — a trial on pregnant women — is unlikely to happen, because such studies are generally considered unethical.Top of Form

    This leaves mothers-to-be awash in uncertainty when contemplating a drug that’s widely recommended. So what to do? No one I spoke with proposed they avoid acetaminophen outright. There’s nothing else to take. And untreated fever during pregnancy can have severe consequences, premature birth among them.

    Instead, experts suggested that women use the minimum amount possible. Augusto Litonjua, a pulmonologist at Harvard Medical School who follows the research, noted that if women found themselves taking lots of acetaminophen, maybe they should consider non-pharmacological approaches to pain management, like acupuncture or meditation. For what it’s worth, in the recent JAMA Pediatrics study, the No. 1 reason for taking acetaminophen wasn’t infection or more severe problems, but backache. So maybe women’s partners should offer more massages, although that’s unlikely to help women dealing with serious pain.

    The broader takeaway, said Evie Stergiakouli, lead author on the JAMA study, is that just because acetaminophen is easy to acquire doesn’t mean it’s not a drug, and that it doesn’t have potential side effects.

    Moises Velasquez-Manoff, the author of “An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases,” is a contributing opinion writer.

    Follow The New York Times Opinion section on Facebook and Twitter (@NYTOpinion), and sign up for the Opinion Today newsletter

    A version of this op-ed appears in print on September 25, 2016, on page SR5 of the New York edition with the headline: The Trouble With Tylenol. Today's Paper|Subscribe


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