Plan to Join APAOG at the Southern Obstetric and Gynecologic  Seminar!

Stay tuned for more information about an APAOG meeting at the Southern Obstetric and Gynecologic Seminar. 

July 13, 2016 - July 16, 2016

Description:In its 62nd season, the Southern Obstetric and Gynecologic Seminar is a three day educational event designed to address relevant and timely topics in women’s health for the busy provider. Distinguished lecturers and leading experts in the field of obstetrics and gynecology will present clinical best-practices and care recommendations the provider can easily implement to improve patient care and outcomes. The content covered in this year’s conference was derived from assessing the information needs and educational gaps reported by Southern’s physician membership. Information will be delivered through a series of four lectures each day, case-studies, and question and answer sessions. 

Accompanying the academic portion of the annual meeting, Southern’s members value the opportunity to interact socially with longstanding and new members. This year Southern has moved the Seminar to the Biltmore Estate, Gerorge W. Vanderbilt's summer house. Make plans to attend Wednesday evening’s Welcome Reception in Cedric's Loft at the Biltmore and the Friday evening Membership Banquet in the Antler Hill Main Barn at the Biltmore. 

Book your overnight accommodations at the Village Hotel on the Biltmore Estate by clicking here or by calling(866) 779-6277 and identifying yourself as being part of the Southern Ob/Gyn Seminar room block. The cut-off date for reserving a room at the Village Hotel on the Biltmore Estate is May 29, 2016. 

As always, Annual Meeting registration fees are determined by your membership status. You may register and pay both your annual meeting fee and membership dues online by clicking the Registration tab. Should you prefer, you can click the pdf brochure icon and print a hard copy registration form to register or pay due via fax or mail. 

More information on Southern Obstetric and Gynecologic Seminar can be found here.

Location: Biltmore Estate, One Lodge Street, Asheville, NC

Faculty:

• Sarah Ellestad, MD
• Sean Esplin, MD
• Jeffrey Garris, MD
• Mahreen Hashmi, MD
• Hytham Imseis, MD
• Grover May, MD, FACOG
• Rebecca Usadi, MD
  

AAPA 
AAPA is looking for a PA member to serve as a medical liaison to the American Medical Association (AMA). As a medical liaison, you should be well-versed in AAPA's policy positions and strategic agenda, trends in healthcare, the U.S. political landscape, clinical issues, and policies and sensitivities of AMA and its constituencies. Be ready to assertively address issues with physicians and medical organizations, and secure physician support for PA issues. The deadline is Dec. 30 — so apply today!

AAPA

 
NCCPA no longer requires PAs to complete self-assessment CME and PI-CME to remain certified. Instead, PAs who complete these types of CME will be provided with an incentive for doing so. PAs will receive an additional 50 percent weighting for all self-assessment credits logged with NCCPA, and the first 20 PI-CME credits logged during every two-year cycle will now be doubled. This incentive will apply only to NCCPA's calculations regarding CME requirements. 

PAs should be aware that the additional weighting applies only to NCCPA certification. States that require CME for license renewal purposes do not apply any additional weighting for self-assessment or PI-CME. For state license purposes, PAs must report credits exactly as awarded on their CME certificates. 

PAs are encouraged to pay close attention to state licensing agency requirements for license renewal. For additional information, check the renewal requirements for your state licensing agency, the summary information for your state and AAPA's Certification Maintenance and CME FAQ.

AAPA's Learning Central

New, free CME you can complete by Dec. 31! Address the challenges of HPV vaccination with a video-based roundtable discussion (approved for AAPA Category 1 CME credit) coupled with an interactive, text-based case study (approved for AAPA Category 1 Self-Assessment CME credit). Activities outline barriers to HPV vaccination and provide strategies for successful HPV vaccination in the pediatric and/or adult clinic setting.

FDA approved bevacizumab (Avastin, Genentech) for patients with platinum-sensitive recurrent epithelial ovarian (psOC), fallopian tube or primary peritoneal cancer.

While Avastin was approved in 2014, this is the first new treatment option for women with psOC in the US in more than a decade. FDA approved Avastin either in combination with carboplatin and paclitaxel or in combination with carboplatin and gemcitabine chemotherapy, followed by Avastin alone.

Related: Breast cancer biosimilar shows equivalency to brand

Patients are said to have a ‘platinum-sensitive’ form of the disease if a relapse occurs 6 months or longer following the last treatment with a platinum-based chemotherapy.

“With today’s approval of Avastin plus chemotherapy, women in the US with recurrent, platinum-sensitive ovarian cancer now have a treatment option that showed a survival difference of more than 5 months compared to chemotherapy alone in a clinical trial,” said Sandra Horning, MD, chief medical officer and head of global product development at Genentech.

Ovarian cancer causes more deaths annually in the United States than any other gynecologic cancer, said David Barley, CEO of the National Ovarian Cancer Coalition (NOCC).

FDA’s approval was based on results from 2 randomized, controlled phase 3 studies, GOG-0213 and OCEANS. The GOG-0213 study demonstrated that adding Avastin to chemotherapy showed an overall survival difference of 5 months compared to chemotherapy alone.

Related: Sharp price increases for cancer drugs

Both the GOG-0213 and OCEANS studies demonstrated a significant improvement in the time women lived without their disease getting worse (progression-free survival, PFS). The GOG-0213 study showed that women lived a median of 3.4 months longer without disease progression with the addition of Avastin to chemotherapy compared to chemotherapy alone. And the OCEANS study showed that Avastin in combination with chemotherapy significantly improved PFS compared to placebo plus chemotherapy (median PFS: 12.4 months vs. 8.4 months).

Overall survival, one of the secondary end points in the OCEANS study, was not significantly improved with the addition of Avastin to chemotherapy.

Adverse events in both studies were consistent with those seen in previous trials of Avastin across tumor types for approved indications, but also included fatigue, low white blood cell count with fever, low sodium level in the blood, pain in extremity, low platelet count, too much protein in the urine, high blood pressure and headache.

Source: http://formularyjournal.modernmedicine.com/formulary-journal/news/fda-approves-expansion-avastin-ovarian-cancer

On December 7, the Senate followed the House of Representatives and passed the 21st Century Cures Act by an overwhelming majority. The bipartisan bill will now be sent to President Obama who has said he will sign the measure into law. The legislation will accelerate Food and Drug Administration (FDA) approved treatments, therapies, and drugs by modernizing FDA regulations considered by Congress to unnecessarily delay the approval of new drugs and devices. Additionally, the legislation provides $4.8 billion to the National Institutes of Health which covers support for the president’s Precision Medicine Initiative to drive research on the effects of genetics, lifestyle, and environment on disease, as well as support for Vice President Biden’s “Cancer Moonshot” initiative and increased research to improve understanding of diseases affecting the brain, such as Alzheimer’s. The bill also provides $1 billion in grants to states to combat opioid addiction and addresses the country’s mental health crisis.

The role of PAs in mental healthcare is acknowledged for the first time in federal mental health policy through key mental health provisions of the soon-to-be law, such as:

• Inclusion of PAs as high-need providers in mental healthcare through a required mental health strategic plan;
• Including PAs who specialize in mental healthcare as members of advisory councils authorized by the Public Health Service Act;
• Adding PAs with experience in treating serious mental illnesses or serious emotional disturbances as potential committee members to a federal Interdepartmental Serious Mental Illness Coordinating Committee;
• Strengthening the mental and substance use disorders workforce by awarding grants to eligible entities to support training for PAs and other providers to offer integrated primary care, mental health, and substance use disorder treatment services in underserved areas; and
• Requiring the Department of Health and Human Services (HHS) to identify model programs and materials for training PAs and other healthcare providers on permitted uses and disclosures of health information when caring for patients with mental illnesses.

AAPA continues to seek clarification that PAs are also included in legislative provisions on peer review, mental and behavioral health education and training grants, the minority fellowship program, and increasing access to pediatric mental healthcare.

Mental health system reforms passed by the House in July through the Helping Families in Mental Health Crisis Act were also part of the bill's package. In addition to strengthening the mental health workforce, these provisions are intended to reform the nation’s mental health delivery system by establishing a new assistant secretary for mental health within the HHS; creating a system to award grants based on evidence-based mental health and substance use treatment policy; evaluating privacy law to improve mental health treatment through increased communication among providers, families, and patients; and improving care for children and adults with serious behavioral and mental illness.

AAPA worked closely with relevant House and Senate committees and members throughout the development of the mental health provisions in the bill, educating them on the interface of PAs in primary and other medical care with patients experiencing behavioral health issues, the increasing number of PAs who provide mental healthcare , and the valuable role of PAs in building the behavioral healthcare workforce.

- See more at: https://www.aapa.org/twocolumn.aspx?id=6442451789#sthash.AWSTJjxW.dpuf

By Lisa Rapaport

Age-related decline in women’s lung function may speed up during and after menopause, a recent study suggests.

Past research has shown that young women can boost their lung function through their mid-twenties by following a healthy lifestyle that includes getting plenty of aerobic exercise and avoiding cigarettes. After that, lung function declines gradually, and the process can be sped up when people smoke or carry excess fat around their midsection.

"Our study adds, that with increasing reproductive age slope of decline becomes steeper and the decline becomes faster, and it accelerates beyond the age-related expectations," said lead study author Kai Triebner, a researcher at the University of Bergen in Norway.

The good news for women is they can take steps to manage their respiratory health early in life to limit the potential for declines in lung function with menopause to lead to meaningful health problems, Triebner added by email.

"Generally speaking you cannot build up lung function again unless the loss was due to a medical condition, but you can manage the decline," Triebner added.

Women go through menopause when they stop menstruating, which typically happens between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterwards, women can experience symptoms ranging from irregular periods and vaginal dryness to mood swings and insomnia.

For the current study, researchers examined data on 1,438 women who were followed for 20 years starting when they were between 25 and 48 years old.

None of the women had started going through menopause when they joined the study. By the end, they had either started or completed the process of going through menopause.

To assess shifts in lung function tied to menopause, researchers examined what's known as forced vital capacity (FVC), a measure of lung size, as well as forced expiratory volume (FEV1), or how much air can be pushed out of the lungs in one second.

Lung function decline was faster during the transition to menopause and sped up even further after menopause, compared to when women were still menstruating, researchers report in the American Journal of Respiratory and Critical Care Medicine.

For example, transitional women lost about 10 milliliters of forced vital lung capacity more per year than pre-menopausal women, and after menopause women lost a mean of 12 ml/year more.

For forced vital capacity, the decline after menopause was comparable to smoking 20 cigarettes a day for 10 years, the study found.

With forced expiratory volume, the decline after menopause was comparable to smoking 20 cigarettes a day for two years.

The more pronounced decline in forced vital capacity compared to forced expiratory volume suggests that menopause may be more likely to lead to what's known as restrictive breathing problems, such as sarcoidosis, that make it difficult to fully expand the lungs when inhaling, rather than breathing problems such as chronic obstructive pulmonary disorder (COPD) that make it difficult to exhale air from the lungs, the authors conclude.

The study is observational and doesn't prove menopause directly causes breathing problems, the authors note.

While the findings don't explain why lung function dropped for women after menopause, it's possible that hormonal changes during this time that are linked to systemic inflammation may also trigger lung function declines, the authors point out.

Hormonal changes are also implicated in osteoporosis, which shortens the height of the chest vertebrae and may, in turn, limit the amount of air a person can inhale.

Both before and after menopause, though, the rate of decline in lung function is slow, and may only be significant in women with lung disease, said Dr. David Jacoby, a researcher at Oregon Health and Science University in Portland who wasn't involved in the study.

"Someone with lungs damaged by smoking who has no symptoms at age 30 may have symptoms of her lung disease later in life as her lung function declines with age," Jacoby said by email. "The message, an obvious one, is to avoid smoking to avoid damaging your lungs, and if you have chronic lung disease, take your medications to keep your lung function as good as possible."

Source: http://www.reuters.com/article/us-health-menopause-lung-function-idUSKBN13V2IA

Frequent removal of pubic hair is associated with an increased risk for herpes, syphilis and human papillomavirus, doctors at the University of California, San Francisco, reported Monday in the journal Sexually Transmitted Infections.

People who have "mowed the lawn" at least once in their lifetimes were nearly twice as likely to say they had had at least one STD. And "extreme groomers" – those who remove all their pubic hair more than 11 times each year — were more than four times as likely to have had an infection. "High-frequency groomers," who just trim their hair a few times a month, fell between the two extremes. They were about three times more likely to have reported an STD.

"We were surprised at how big the effect was," says Benjamin Breyer, a urologist at the University of California, San Francisco, who led the study. "Right now, we have no way knowing if grooming causes the increase in risk for infections. All we can say is that they're correlated. But I probably would avoid an aggressive shave right before having sex."

In the study, Breyer and his team surveyed about 7,500 men and women between ages 18 and 65. They asked them about their grooming habits: How often do you shave or wax? Do you shave it all off or just give it a trim? And they asked about their sex lives: How many partners have you had? What STDs have you had?

About two-thirds of men and more than 80 percent of the women said they had done some manscaping or tended their lady garden at least once before. And a little more than 10 percent said they were "extreme groomers," who like to keep things completely hairless.

Infections that affect the skin, such as HPV and syphilis, were most strongly associated with aggressive grooming. But for other types of sexually transmitted infections, such as gonorrhea and lice, the link wasn't as clear. Lice actually cement their eggs to hair shafts. So if you remove all your hair, there's nowhere for the insects to breed.

"This is an excellent study," says Scott Butler, who studies STDs in college students at Georgia College & State University. "It's good for health care providers to be aware of this connection."

But there also are some big limitations to the study, Butler says. Although the analysis took into the number of sexual partners people said they had, it did not consider whether people were having safe sex or getting vaccinated for HPV. And the survey didn't ask people whether they were diagnosed with the STD before or after they started grooming.

That said, it makes sense biologically that shaving and waxing could make you more vulnerable to infections, says Jennifer Gunter, an OB-GYN at Kaiser Permanente Northern California who wasn't involved in the study.

"We know that shaving creates microtears and cuts," Gunter says. And if men and women are doing it right before sex, those wounds might not be healed, making it easier for viruses and bacteria to enter skin.

"Pubic hair is there for a reason," Gunter says. "It's a mechanical barrier, like your eyebrows. It traps bacteria and debris. And there could be health consequences to removing it."

Source: NPR.org

by Salynn Boyles 

This article is a collaboration between MedPage Today® and:

 

Action Points

Avoiding three key risk factors for heart failure between the ages of 45 and 55 lowered later-life heart failure risk by as much as 86%.

According to a study online in JACC: Heart Failure, men who reached the age of 45 without becoming obese or developing hypertension or diabetes lived an average of 10.6 years longer free of heart failure, while women who reached age 45 without any of the cardiovascular risk factors lived, on average, 14.9 years longer without heart failure.

The retrospective study is the first to quantify the impact of mid-life avoidance of heart failure risk factors with heart failure-free survival times later in life, and the researchers concluded that the new information may help clinicians better convey this to patients.

"Quantification of heart failure-free survival may be a novel, useful tool for risk communication to patients for the purpose of promoting cardiovascular health," wrote John Wilkins, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

The findings add to the understanding of how individual risk factors in middle age affect incident heart failure risk late in life, Wilkins told MedPage Today. "The effect size of primordial prevention is massive. Quantifying this risk really illustrates the importance of lifestyle interventions to prevent the onset of diabetes, hypertension, and obesity. Avoiding these risk factors can pay huge dividends in terms of reducing heart failure risk later in life."

When the researchers conducted a pooled, individual-level analysis sampling from communities across the United States, they found that at the ages of 45 and 55, respectively, 53.2% and 43.7% of participants had none of the three risk factors.

The sampling included data from four cohort trials: Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and the Atherosclerosis Risk in Communities studies.

Competing risk-adjusted Cox models, as well as a modified Kaplan-Meir estimator and Irwin's restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival.

For participants at age 45, with over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. At an index age of 55, during 502,252 person years of follow-up, 2,976 cases of incident heart failure were identified.

Diabetes was found to have a strong association with shorter heart failure-free survival: those without diabetes lived, on average, between 8.6 and 10.6 years longer without heart failure.

White and black participants without any of the three risk factors at age 45 lived, respectively, 12.4 and 12.9 years longer without heart failure, and similar trends were seen for the index age of 55.

"The benefits of risk factor avoidance and primordial prevention were consistent and substantial in black and white participants," the researchers wrote. "These data suggest that a public health strategy focused on primordial prevention of risk factors in blacks early on in the life course may reduce disparities in heart failure incidence and prevalence."

In an accompanying editorial, Thomas J. Wang, MD, director of the Division of Cardiovascular Medicine of Vanderbilt University and physician-in-chief of the Vanderbilt Heart and Vascular Institute in Nashville, Tenn., wrote that efforts to shift the focus in heart failure to prevention were bolstered by the introduction, more than a decade ago, of the American College of Cardiology and American Heart Association's two preclinical heart failure stages.

Stage A describes patients with major risk factors for heart failure such as diabetes and heart disease without myocardial infarction, and Stage B includes patients with structural heart disease but no overt symptoms of heart failure.

"The concept of heart failure-free survival adds another dimension to lifetime risk estimates by taking into account the timing of disease onset," Wang wrote. "Because healthy individuals live longer overall, they have more years exposed to the possibility of getting heart failure, which may increase lifetime risk estimates. However, when heart failure does occur in such individuals, it typically does so at a later age. The ability to enjoy more years free of disease is more important for many individuals than simply living longer."

Study limitations cited by the authors and Wang included the differing methods for ascertaining heart failure across the four studies and the inability to distinguish between heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction.

But Wang noted that despite these limitations, the study findings highlight a new way to think about heart failure risk: "Such a perspective is particularly valuable when one considers another result embedded in the data: for almost all of the clinical subgroups, the interval between heart failure diagnosis and death was short (≤2 years)," he said. "Although advancing the care of patients with established heart failure remains an important objective, figuring out how to maximize the number of years free of disease is just as critical."

This research was funded in part by the National Heart, Lung, and Blood Institute and Northwestern University Feinberg School of Medicine.

The researchers reported having no relevant financial relationships with industry related to the study.

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Aerobic fitness should be considered a vital sign, just as body temperature, blood pressure, pulse and breathing rates are now, according to a new scientific statement from the American Heart Association.

The statement points out that fitness can be a better indicator of someone’s risk for heart disease and early death than such standard risk factors as smoking, obesity and high blood pressure. The authors recommend that each of us should have our aerobic fitness assessed as part of medical examinations and, if our fitness is on the low side, we should be advised and helped to start exercising.

The authors also suggest that if your physician does not begin to determine your aerobic fitness in the near future, you should do so yourself, using any of several scientifically validated online tools.

Aerobic, or cardiorespiratory, fitness is a measure of how well your body can deliver oxygen to tissues. Because that process is pervasive and essential within our bodies, it is also a “reflection of overall physiological health and function, especially of the cardiovascular system,” according to the report.

Many past studies have found that relatively low aerobic fitness is linked with a significantly increased risk for heart disease and premature death and that being out of shape may, in fact, represent a greater risk for developing heart disease than if you have a poor cholesterol profile, Type 2 diabetes, a history of smoking or a high body mass index.

But in 2013, when the American Heart Association and American College of Cardiology released new guidelines for assessing someone’s risk for heart disease, the criteria did not include aerobic fitness as a risk factor. The agencies were still uncertain about whether enough science existed to justify including fitness and also worried that the treadmill tests needed to measure aerobic fitness were complicated and costly.

But the research was compelling enough that the American Heart Association decided to convene an expert scientific advisory group that would gather and analyze all of the available studies about fitness, heart health and life spans, and also look into the question of whether fitness could be determined accurately and cheaply, without everyone needing to undergo a treadmill test.

In effect, the advisory board was asked to decide whether aerobic fitness should become a new vital sign.

Their answer, delivered in the new statement, which was published simultaneously in Circulation and Professional Heart Daily, a publication of the National Stroke Association, was a resounding yes.

The authors concluded that the available science overwhelmingly supported the use of aerobic fitness as a measure of general and heart health.

Almost as important from a practical standpoint, the authors also determined that newly developed equations and simple calculators could provide reliable, valid estimates of fitness. Doctors could use a few keystrokes to estimate someone’s fitness, instead of ordering a treadmill test (although some people, especially those at high risk for heart disease based on other factors, should still undergo treadmill testing, the authors write).

The resulting scientific statement “strongly supports” the use of cardiorespiratory fitness as a vital sign and “an important measure and predictor of health,” says Steven Blair, a professor of exercise science and epidemiology at the University of South Carolina and co-chairman of the scientific committee.

The statement, which went through peer review, as well as a separate review and endorsement by the standing scientific advisory board for the American Heart Association, is, however, only a recommendation and does not change the current formal heart disease risk calculations.

But the statement’s authors are hopeful that it will have an immediate and lingering impact.

“In general, I think that doctors understand that cardiorespiratory fitness is important,” says Leonard Kaminsky, the director of the Fisher Institute of Health and Well-Being at Ball State University in Indiana and co-author of the statement.

But many physicians “consider it to be relatively less important than other risk factors,” he continues. “Hopefully this scientific statement will be a resource and give them confidence in the solid evidence base for cardiorespiratory fitness as a vital health measure.”

The statement also should be of interest to and practical use by those of us who do not hold medical degrees but do own hearts and lungs, the authors say.

“It would be an excellent idea” for everyone to learn his or her current, estimated aerobic fitness level and how it compares to age-matched averages, says Dr. Chip Lavie, a cardiologist and exercise scientist at the Ochsner Heart and Vascular Institute in Louisiana and statement co-author.

He suggests using an online fitness calculator developed by Dr. Kaminsky and others, based on data from millions of users, at www.worldfitnesslevel.org.

Take the resulting estimate of your fitness age to your next medical appointment and discuss it with your physician, Dr. Lavie says.

In the meantime, if you are concerned about your current fitness, get up and move. Fitness is quite malleable, the statement co-authors point out. You can find a scientifically designed exercise program to improve cardiorespiratory fitness here, at the website of the Norwegian University of Science and Technology: ntnu.edu/cerg/regimen.

Source: http://www.nytimes.com/2016/11/30/well/move/should-a-simple-fitness-check-be-part-of-your-checkup.html?_r=0