Three months is how long I’ll leave a magazine out in my waiting room. When its lobby lifespan is up, I’ll usually recycle it, though sometimes will take it home to read myself when I have down time.

pinkomelet/Thinkstock

Leafing through an accumulated pile of them over the recent holiday break, I was struck by how many carry ads for questionable “cures”: magnetic bracelets for headaches, copper-based topical creams that claim to cure diabetic neuropathy. Another was from a company with something that looks like a standard tanning bed advertising that it has special lights to “alternatively treat cancer.”

How on Earth is this legal?

Seriously. Since college I’ve been through 4 years of medical school, another 5 combined of residency and fellowship, and now 21 years of frontline neurology experience. And if, after all that, I were to start marketing such horse hockey as a cure for anything (besides my wallet), I’d be hounded by the Food and Drug Administration and state board and probably driven out of practice.

Yet, people with no “real” (science-based) medical treatment experience are free to market this stuff to a public who, for the most part, don’t have the training, knowledge, or experience to know it’s a crock.

I’m sure some of the people selling this stuff really believe they’re helping. Admittedly, there are a lot of things we don’t know in medicine. But anything that’s making such claims should have real evidence – like a large double-blind, placebo-controlled trial – behind it. Not anecdotal reports, small uncontrolled trials, and patient testimonials. The placebo effect is remarkably strong.

There are also some selling this stuff who are less than scrupulous. They’ll claim to have good intentions, but are well aware they’re bilking people – often desperate – out of their savings. They’re no better than the doctors who make headlines for Medicare and insurance fraud by performing unnecessary surgeries and billing for medications that weren’t given.

Either way, the point is the same. Unproven treatments are just that – unproven – and shouldn’t be marketed as effective ones. If it works, let the evidence prove it. But if it doesn’t, no one should be promoting it to anyone, regardless of how long (and where) they went to school.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Three months is how long I’ll leave a magazine out in my waiting room. When its lobby lifespan is up, I’ll usually recycle it, though sometimes will take it home to read myself when I have down time.

pinkomelet/Thinkstock

Leafing through an accumulated pile of them over the recent holiday break, I was struck by how many carry ads for questionable “cures”: magnetic bracelets for headaches, copper-based topical creams that claim to cure diabetic neuropathy. Another was from a company with something that looks like a standard tanning bed advertising that it has special lights to “alternatively treat cancer.”

How on Earth is this legal?

Seriously. Since college I’ve been through 4 years of medical school, another 5 combined of residency and fellowship, and now 21 years of frontline neurology experience. And if, after all that, I were to start marketing such horse hockey as a cure for anything (besides my wallet), I’d be hounded by the Food and Drug Administration and state board and probably driven out of practice.

Yet, people with no “real” (science-based) medical treatment experience are free to market this stuff to a public who, for the most part, don’t have the training, knowledge, or experience to know it’s a crock.

I’m sure some of the people selling this stuff really believe they’re helping. Admittedly, there are a lot of things we don’t know in medicine. But anything that’s making such claims should have real evidence – like a large double-blind, placebo-controlled trial – behind it. Not anecdotal reports, small uncontrolled trials, and patient testimonials. The placebo effect is remarkably strong.

There are also some selling this stuff who are less than scrupulous. They’ll claim to have good intentions, but are well aware they’re bilking people – often desperate – out of their savings. They’re no better than the doctors who make headlines for Medicare and insurance fraud by performing unnecessary surgeries and billing for medications that weren’t given.

Either way, the point is the same. Unproven treatments are just that – unproven – and shouldn’t be marketed as effective ones. If it works, let the evidence prove it. But if it doesn’t, no one should be promoting it to anyone, regardless of how long (and where) they went to school.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Three months is how long I’ll leave a magazine out in my waiting room. When its lobby lifespan is up, I’ll usually recycle it, though sometimes will take it home to read myself when I have down time.

pinkomelet/Thinkstock

Leafing through an accumulated pile of them over the recent holiday break, I was struck by how many carry ads for questionable “cures”: magnetic bracelets for headaches, copper-based topical creams that claim to cure diabetic neuropathy. Another was from a company with something that looks like a standard tanning bed advertising that it has special lights to “alternatively treat cancer.”

How on Earth is this legal?

Seriously. Since college I’ve been through 4 years of medical school, another 5 combined of residency and fellowship, and now 21 years of frontline neurology experience. And if, after all that, I were to start marketing such horse hockey as a cure for anything (besides my wallet), I’d be hounded by the Food and Drug Administration and state board and probably driven out of practice.

Yet, people with no “real” (science-based) medical treatment experience are free to market this stuff to a public who, for the most part, don’t have the training, knowledge, or experience to know it’s a crock.

I’m sure some of the people selling this stuff really believe they’re helping. Admittedly, there are a lot of things we don’t know in medicine. But anything that’s making such claims should have real evidence – like a large double-blind, placebo-controlled trial – behind it. Not anecdotal reports, small uncontrolled trials, and patient testimonials. The placebo effect is remarkably strong.

There are also some selling this stuff who are less than scrupulous. They’ll claim to have good intentions, but are well aware they’re bilking people – often desperate – out of their savings. They’re no better than the doctors who make headlines for Medicare and insurance fraud by performing unnecessary surgeries and billing for medications that weren’t given.

Either way, the point is the same. Unproven treatments are just that – unproven – and shouldn’t be marketed as effective ones. If it works, let the evidence prove it. But if it doesn’t, no one should be promoting it to anyone, regardless of how long (and where) they went to school.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

The Diagnosis: Proliferating Pilar Tumor  

Proliferating pilar tumor (PPT), or cyst, is a neoplasm of trichilemmal keratinization first described by Wilson-Jones¹ in 1966. Proliferating pilar tumors lie on a spectrum with malignant PPT, which is a rare adnexal neoplasm first described by Saida et al² in 1983. The incidence of PPT is unknown given the paucity of cases and the possible misdiagnosis as squamous cell carcinoma (SCC). Proliferating pilar tumors tend to present on the head and neck of older females as a multilobular and sometimes ulcerating nodule.³ Although PPT can occur de novo, the majority of cases are thought to develop progressively from a benign pilar cyst. Histopathologically, PPT is characterized by cords and nests of squamous cells that display trichilemmal keratinization (quiz images).  

Classification of PPT as benign or malignant is challenging, though criteria have been proposed.^3-7 Lesions with minimal infiltration into the surrounding dermis and scant mitosis typically behave in a benign manner, while lesions showing nuclear atypia, atypical mitosis, and irregular infiltration into the surrounding dermis can have up to a 50% locoregional recurrence rate.³ In addition, distinguishing a PPT from an SCC or trichilemmal carcinoma also can be difficult; however, SCC is favored when there is a lack of trichilemmal keratinization or when squamous atypia is present in the adjacent epidermis.⁸ Trichilemmal carcinoma is a rare tumor that has been questioned as a distinct entity.^9-12  

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign pilar tumor that presents as a slowly growing nodule on the head or neck area or arms.^13,14 Most pilomatricomas develop by the second decade of life. Multiple lesions may be present in association with myotonic dystrophy or Gardner syndrome among other syndromes.^15-17 Similar to PPT, pilomatricomas present as large dermal nodules; however, they tend to be circumscribed and have a trabecular network that consists of basophilic cells and eosinophilic keratinized shadow cells (Figure 1).¹⁸ Calcification may be seen and bone formation subsequently may occur.¹⁹  

Most sources now consider keratoacanthoma (KA) as a well-differentiated SCC.²⁰ The typical presentation consists of a rapidly growing erythematous to flesh-colored nodule with a central keratinous plug that develops over a period of weeks. If untreated, KAs may resolve over a period of months and leave a depressed scar. Local destruction can result from KAs, and they have the potential to transform into a more aggressive SCC. Accordingly, most clinicians use tissue destructive methods, excision, or Mohs micrographic surgery for treatment based on location. Histologically, a well-circumscribed proliferation of glassy cytoplasm is noted. A depressed keratin-filled center is surrounded by a lip of epithelium extending over the lesion (Figure 2).^20,21 Pseudoepitheliomatous hyperplasia accompanied by hypergranulosis is seen in the center of KAs rather than at the periphery, which is typical of non-KA SCCs. Typical KAs lack acantholysis, a feature suggesting a non-KA type of SCC. Neutrophilic microabscesses and eosinophils commonly are seen in KAs.^20,21  

Inverted follicular keratosis is a benign tumor that gained traction as its own entity in the 1960s.²² These lesions typically develop from the follicular infundibulum, but some consider them a version of a wart or seborrheic keratosis.²³ They generally are flesh-colored nodules on the upper cutaneous lip or face. Treatment usually consists of complete excision. There are many different growth patterns described, but they typically are endophytic tumors with eosinophilic squamous cells in the center and more basophilic cells at the periphery (Figure 3).²⁴ Characteristically, there are squamous eddies throughout the tumor (Figure 3 [inset]). There also may be a scant lymphohistiocytic infiltrate within the dermis surrounding the lesion.  

Trichilemmomas are flesh-colored adnexal neoplasms that may present as a solitary lesion or in clusters on the face. They have been reported to occur on all nonglabrous skin sites.²⁵ Multiple lesions may occur in association with Cowden syndrome or with nevus sebaceous.²⁶ A desmoplastic variant of trichilemmomas has been reported.²⁷ Desmoplastic trichilemmomas appear as well-circumscribed tumors of outer root sheath differentiation with lobules extending down into the dermis.²⁸ Vacuolated glycogen-filled keratinocytes are scattered throughout the lesion but are most prominent at the base. At the periphery of the lobules, peripheral palisading of basaloid cells is accompanied by a thickened eosinophilic basement membrane that is periodic acid-Schiff positive. Typical trichilemmomas also can display these features; however, the main differentiating feature of a desmoplastic trichilemmoma is the pink hyalinized stroma separating small islets of basophilic cells (Figure 4). Differentiation from an invasive malignant carcinoma sometimes can be challenging without a focus of typical trichilemmoma or if the biopsy specimen is too superficial.²⁹ 

Pilar cysts are common tumors that typically arise on the scalp and sometimes are proliferating. Proliferating pilar tumor should be kept on the differential when secondary changes such as ulceration occur in the primary lesion of the scalp. Microscopically, and sometimes clinically, PPT can be difficult to differentiate from other mimickers.  

The Diagnosis: Proliferating Pilar Tumor  

Proliferating pilar tumor (PPT), or cyst, is a neoplasm of trichilemmal keratinization first described by Wilson-Jones¹ in 1966. Proliferating pilar tumors lie on a spectrum with malignant PPT, which is a rare adnexal neoplasm first described by Saida et al² in 1983. The incidence of PPT is unknown given the paucity of cases and the possible misdiagnosis as squamous cell carcinoma (SCC). Proliferating pilar tumors tend to present on the head and neck of older females as a multilobular and sometimes ulcerating nodule.³ Although PPT can occur de novo, the majority of cases are thought to develop progressively from a benign pilar cyst. Histopathologically, PPT is characterized by cords and nests of squamous cells that display trichilemmal keratinization (quiz images).  

Classification of PPT as benign or malignant is challenging, though criteria have been proposed.^3-7 Lesions with minimal infiltration into the surrounding dermis and scant mitosis typically behave in a benign manner, while lesions showing nuclear atypia, atypical mitosis, and irregular infiltration into the surrounding dermis can have up to a 50% locoregional recurrence rate.³ In addition, distinguishing a PPT from an SCC or trichilemmal carcinoma also can be difficult; however, SCC is favored when there is a lack of trichilemmal keratinization or when squamous atypia is present in the adjacent epidermis.⁸ Trichilemmal carcinoma is a rare tumor that has been questioned as a distinct entity.^9-12  

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign pilar tumor that presents as a slowly growing nodule on the head or neck area or arms.^13,14 Most pilomatricomas develop by the second decade of life. Multiple lesions may be present in association with myotonic dystrophy or Gardner syndrome among other syndromes.^15-17 Similar to PPT, pilomatricomas present as large dermal nodules; however, they tend to be circumscribed and have a trabecular network that consists of basophilic cells and eosinophilic keratinized shadow cells (Figure 1).¹⁸ Calcification may be seen and bone formation subsequently may occur.¹⁹  

Most sources now consider keratoacanthoma (KA) as a well-differentiated SCC.²⁰ The typical presentation consists of a rapidly growing erythematous to flesh-colored nodule with a central keratinous plug that develops over a period of weeks. If untreated, KAs may resolve over a period of months and leave a depressed scar. Local destruction can result from KAs, and they have the potential to transform into a more aggressive SCC. Accordingly, most clinicians use tissue destructive methods, excision, or Mohs micrographic surgery for treatment based on location. Histologically, a well-circumscribed proliferation of glassy cytoplasm is noted. A depressed keratin-filled center is surrounded by a lip of epithelium extending over the lesion (Figure 2).^20,21 Pseudoepitheliomatous hyperplasia accompanied by hypergranulosis is seen in the center of KAs rather than at the periphery, which is typical of non-KA SCCs. Typical KAs lack acantholysis, a feature suggesting a non-KA type of SCC. Neutrophilic microabscesses and eosinophils commonly are seen in KAs.^20,21  

Inverted follicular keratosis is a benign tumor that gained traction as its own entity in the 1960s.²² These lesions typically develop from the follicular infundibulum, but some consider them a version of a wart or seborrheic keratosis.²³ They generally are flesh-colored nodules on the upper cutaneous lip or face. Treatment usually consists of complete excision. There are many different growth patterns described, but they typically are endophytic tumors with eosinophilic squamous cells in the center and more basophilic cells at the periphery (Figure 3).²⁴ Characteristically, there are squamous eddies throughout the tumor (Figure 3 [inset]). There also may be a scant lymphohistiocytic infiltrate within the dermis surrounding the lesion.  

Trichilemmomas are flesh-colored adnexal neoplasms that may present as a solitary lesion or in clusters on the face. They have been reported to occur on all nonglabrous skin sites.²⁵ Multiple lesions may occur in association with Cowden syndrome or with nevus sebaceous.²⁶ A desmoplastic variant of trichilemmomas has been reported.²⁷ Desmoplastic trichilemmomas appear as well-circumscribed tumors of outer root sheath differentiation with lobules extending down into the dermis.²⁸ Vacuolated glycogen-filled keratinocytes are scattered throughout the lesion but are most prominent at the base. At the periphery of the lobules, peripheral palisading of basaloid cells is accompanied by a thickened eosinophilic basement membrane that is periodic acid-Schiff positive. Typical trichilemmomas also can display these features; however, the main differentiating feature of a desmoplastic trichilemmoma is the pink hyalinized stroma separating small islets of basophilic cells (Figure 4). Differentiation from an invasive malignant carcinoma sometimes can be challenging without a focus of typical trichilemmoma or if the biopsy specimen is too superficial.²⁹ 

Pilar cysts are common tumors that typically arise on the scalp and sometimes are proliferating. Proliferating pilar tumor should be kept on the differential when secondary changes such as ulceration occur in the primary lesion of the scalp. Microscopically, and sometimes clinically, PPT can be difficult to differentiate from other mimickers.  

The Diagnosis: Proliferating Pilar Tumor  

Proliferating pilar tumor (PPT), or cyst, is a neoplasm of trichilemmal keratinization first described by Wilson-Jones¹ in 1966. Proliferating pilar tumors lie on a spectrum with malignant PPT, which is a rare adnexal neoplasm first described by Saida et al² in 1983. The incidence of PPT is unknown given the paucity of cases and the possible misdiagnosis as squamous cell carcinoma (SCC). Proliferating pilar tumors tend to present on the head and neck of older females as a multilobular and sometimes ulcerating nodule.³ Although PPT can occur de novo, the majority of cases are thought to develop progressively from a benign pilar cyst. Histopathologically, PPT is characterized by cords and nests of squamous cells that display trichilemmal keratinization (quiz images).  

Classification of PPT as benign or malignant is challenging, though criteria have been proposed.^3-7 Lesions with minimal infiltration into the surrounding dermis and scant mitosis typically behave in a benign manner, while lesions showing nuclear atypia, atypical mitosis, and irregular infiltration into the surrounding dermis can have up to a 50% locoregional recurrence rate.³ In addition, distinguishing a PPT from an SCC or trichilemmal carcinoma also can be difficult; however, SCC is favored when there is a lack of trichilemmal keratinization or when squamous atypia is present in the adjacent epidermis.⁸ Trichilemmal carcinoma is a rare tumor that has been questioned as a distinct entity.^9-12  

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign pilar tumor that presents as a slowly growing nodule on the head or neck area or arms.^13,14 Most pilomatricomas develop by the second decade of life. Multiple lesions may be present in association with myotonic dystrophy or Gardner syndrome among other syndromes.^15-17 Similar to PPT, pilomatricomas present as large dermal nodules; however, they tend to be circumscribed and have a trabecular network that consists of basophilic cells and eosinophilic keratinized shadow cells (Figure 1).¹⁸ Calcification may be seen and bone formation subsequently may occur.¹⁹  

Most sources now consider keratoacanthoma (KA) as a well-differentiated SCC.²⁰ The typical presentation consists of a rapidly growing erythematous to flesh-colored nodule with a central keratinous plug that develops over a period of weeks. If untreated, KAs may resolve over a period of months and leave a depressed scar. Local destruction can result from KAs, and they have the potential to transform into a more aggressive SCC. Accordingly, most clinicians use tissue destructive methods, excision, or Mohs micrographic surgery for treatment based on location. Histologically, a well-circumscribed proliferation of glassy cytoplasm is noted. A depressed keratin-filled center is surrounded by a lip of epithelium extending over the lesion (Figure 2).^20,21 Pseudoepitheliomatous hyperplasia accompanied by hypergranulosis is seen in the center of KAs rather than at the periphery, which is typical of non-KA SCCs. Typical KAs lack acantholysis, a feature suggesting a non-KA type of SCC. Neutrophilic microabscesses and eosinophils commonly are seen in KAs.^20,21  

Inverted follicular keratosis is a benign tumor that gained traction as its own entity in the 1960s.²² These lesions typically develop from the follicular infundibulum, but some consider them a version of a wart or seborrheic keratosis.²³ They generally are flesh-colored nodules on the upper cutaneous lip or face. Treatment usually consists of complete excision. There are many different growth patterns described, but they typically are endophytic tumors with eosinophilic squamous cells in the center and more basophilic cells at the periphery (Figure 3).²⁴ Characteristically, there are squamous eddies throughout the tumor (Figure 3 [inset]). There also may be a scant lymphohistiocytic infiltrate within the dermis surrounding the lesion.  

Trichilemmomas are flesh-colored adnexal neoplasms that may present as a solitary lesion or in clusters on the face. They have been reported to occur on all nonglabrous skin sites.²⁵ Multiple lesions may occur in association with Cowden syndrome or with nevus sebaceous.²⁶ A desmoplastic variant of trichilemmomas has been reported.²⁷ Desmoplastic trichilemmomas appear as well-circumscribed tumors of outer root sheath differentiation with lobules extending down into the dermis.²⁸ Vacuolated glycogen-filled keratinocytes are scattered throughout the lesion but are most prominent at the base. At the periphery of the lobules, peripheral palisading of basaloid cells is accompanied by a thickened eosinophilic basement membrane that is periodic acid-Schiff positive. Typical trichilemmomas also can display these features; however, the main differentiating feature of a desmoplastic trichilemmoma is the pink hyalinized stroma separating small islets of basophilic cells (Figure 4). Differentiation from an invasive malignant carcinoma sometimes can be challenging without a focus of typical trichilemmoma or if the biopsy specimen is too superficial.²⁹ 

Pilar cysts are common tumors that typically arise on the scalp and sometimes are proliferating. Proliferating pilar tumor should be kept on the differential when secondary changes such as ulceration occur in the primary lesion of the scalp. Microscopically, and sometimes clinically, PPT can be difficult to differentiate from other mimickers.  

LAS VEGAS – U.S. patients with diabetes who underwent bariatric surgery during 2015-2017 had a 49% higher rate of deep surgical-site infections and a 31% higher rate of 30-day ICU admissions, compared with patients without diabetes, in an analysis of more than 550,000 patients who underwent this surgery.

Mitchel L. Zoler/MDedge News

The analysis also showed that among patients with diabetes undergoing bariatric surgery, those with insulin-dependent diabetes had significantly higher rates of these and other complications, compared with patients with diabetes but no insulin dependence, Andrew A. Wheeler, MD, said at a meeting presented by The Obesity Society and the American Society for Metabolic and Bariatric Surgery.

The specific factors driving these observations remain unknown, but may relate at least in part to the efficacy of glycemic control in patients during the months and weeks before surgery, said Dr. Wheeler, chief of metabolic and bariatric surgery at the University of Missouri in Columbia.

“Perioperative blood glucose control reflected in hemoglobin A_1c may help us understand if certain patients with diabetes are at increased risk of surgical complications,” Dr. Wheeler said during his talk. “We need to see whether preoperative hemoglobin A_1c tracks with the rate of complications,” he added in an interview. “Some surgeons will defer surgery until the level goes down, but right now, everyone uses a different level.”

The study by Dr. Wheeler and associates used data collected from essentially all the bariatric surgeries done at the roughly 840 U.S. centers accredited to do the surgery during 2015-2017 – a total of 555,239 patients – in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program run by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. The cohort included 413,239 patients without diabetes and 136,010 with diabetes, with the remainder having an unknown status. Nearly all patients underwent either sleeve gastrectomy or gastric bypass, with significantly more patients, 74%, having sleeve gastrectomy in the group without diabetes, and 62% of those with diabetes undergoing sleeve gastrectomy.

Patients with diabetes uniformly had significantly higher rates of complications as measured by several parameters, and among those with diabetes, the complication rates were highest in those with insulin dependence. The researchers ran a multivariate analysis that controlled for many demographic and clinical variables, and found that despite these corrections, patients with diabetes, and especially those with insulin dependence, had higher relative rates of many complications that were statistically significant. In addition to the increased rates of deep surgical-site infections and 30-day ICU admissions, patients with diabetes had a 54% relatively increased rate of wound disruption, and a 29% increased relative rate of superficial surgical-site infections, compared with those without diabetes. And among patients with diabetes, those with insulin dependence had a 40% increased rate of surgical-site infections, a 74% increase in progressive renal failure, and a 39% increased rate of hospital readmission relative to patients with diabetes that was not insulin dependent, Dr. Wheeler reported.

The absolute complication rates were, in general, low. For example, the total rate of superficial plus deep surgical-site infections was less than 1% both in patients with diabetes and those without, although the rate rose above 1% in patients with insulin-dependent diabetes. The most common complication reported by Dr. Wheeler was 30-day hospital readmission, which was 4.0% in patients without diabetes, 4.8% in those with diabetes, and 6.4% in patients with insulin-dependent diabetes. The data also showed that gastric bypass led to more complications than did sleeve gastrectomy, but complications with both types of surgeries increased in patients with diabetes, compared with those without diabetes.

Dr. Wheeler had no disclosures.

mzoler@mdedge.com

SOURCE: Wheeler AA et al. Obesity Week 2019, Abstract A133.

LAS VEGAS – U.S. patients with diabetes who underwent bariatric surgery during 2015-2017 had a 49% higher rate of deep surgical-site infections and a 31% higher rate of 30-day ICU admissions, compared with patients without diabetes, in an analysis of more than 550,000 patients who underwent this surgery.

Mitchel L. Zoler/MDedge News

The analysis also showed that among patients with diabetes undergoing bariatric surgery, those with insulin-dependent diabetes had significantly higher rates of these and other complications, compared with patients with diabetes but no insulin dependence, Andrew A. Wheeler, MD, said at a meeting presented by The Obesity Society and the American Society for Metabolic and Bariatric Surgery.

The specific factors driving these observations remain unknown, but may relate at least in part to the efficacy of glycemic control in patients during the months and weeks before surgery, said Dr. Wheeler, chief of metabolic and bariatric surgery at the University of Missouri in Columbia.

“Perioperative blood glucose control reflected in hemoglobin A_1c may help us understand if certain patients with diabetes are at increased risk of surgical complications,” Dr. Wheeler said during his talk. “We need to see whether preoperative hemoglobin A_1c tracks with the rate of complications,” he added in an interview. “Some surgeons will defer surgery until the level goes down, but right now, everyone uses a different level.”

The study by Dr. Wheeler and associates used data collected from essentially all the bariatric surgeries done at the roughly 840 U.S. centers accredited to do the surgery during 2015-2017 – a total of 555,239 patients – in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program run by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. The cohort included 413,239 patients without diabetes and 136,010 with diabetes, with the remainder having an unknown status. Nearly all patients underwent either sleeve gastrectomy or gastric bypass, with significantly more patients, 74%, having sleeve gastrectomy in the group without diabetes, and 62% of those with diabetes undergoing sleeve gastrectomy.

Patients with diabetes uniformly had significantly higher rates of complications as measured by several parameters, and among those with diabetes, the complication rates were highest in those with insulin dependence. The researchers ran a multivariate analysis that controlled for many demographic and clinical variables, and found that despite these corrections, patients with diabetes, and especially those with insulin dependence, had higher relative rates of many complications that were statistically significant. In addition to the increased rates of deep surgical-site infections and 30-day ICU admissions, patients with diabetes had a 54% relatively increased rate of wound disruption, and a 29% increased relative rate of superficial surgical-site infections, compared with those without diabetes. And among patients with diabetes, those with insulin dependence had a 40% increased rate of surgical-site infections, a 74% increase in progressive renal failure, and a 39% increased rate of hospital readmission relative to patients with diabetes that was not insulin dependent, Dr. Wheeler reported.

The absolute complication rates were, in general, low. For example, the total rate of superficial plus deep surgical-site infections was less than 1% both in patients with diabetes and those without, although the rate rose above 1% in patients with insulin-dependent diabetes. The most common complication reported by Dr. Wheeler was 30-day hospital readmission, which was 4.0% in patients without diabetes, 4.8% in those with diabetes, and 6.4% in patients with insulin-dependent diabetes. The data also showed that gastric bypass led to more complications than did sleeve gastrectomy, but complications with both types of surgeries increased in patients with diabetes, compared with those without diabetes.

Dr. Wheeler had no disclosures.

mzoler@mdedge.com

SOURCE: Wheeler AA et al. Obesity Week 2019, Abstract A133.

LAS VEGAS – U.S. patients with diabetes who underwent bariatric surgery during 2015-2017 had a 49% higher rate of deep surgical-site infections and a 31% higher rate of 30-day ICU admissions, compared with patients without diabetes, in an analysis of more than 550,000 patients who underwent this surgery.

Mitchel L. Zoler/MDedge News

The analysis also showed that among patients with diabetes undergoing bariatric surgery, those with insulin-dependent diabetes had significantly higher rates of these and other complications, compared with patients with diabetes but no insulin dependence, Andrew A. Wheeler, MD, said at a meeting presented by The Obesity Society and the American Society for Metabolic and Bariatric Surgery.

The specific factors driving these observations remain unknown, but may relate at least in part to the efficacy of glycemic control in patients during the months and weeks before surgery, said Dr. Wheeler, chief of metabolic and bariatric surgery at the University of Missouri in Columbia.

“Perioperative blood glucose control reflected in hemoglobin A_1c may help us understand if certain patients with diabetes are at increased risk of surgical complications,” Dr. Wheeler said during his talk. “We need to see whether preoperative hemoglobin A_1c tracks with the rate of complications,” he added in an interview. “Some surgeons will defer surgery until the level goes down, but right now, everyone uses a different level.”

The study by Dr. Wheeler and associates used data collected from essentially all the bariatric surgeries done at the roughly 840 U.S. centers accredited to do the surgery during 2015-2017 – a total of 555,239 patients – in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program run by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. The cohort included 413,239 patients without diabetes and 136,010 with diabetes, with the remainder having an unknown status. Nearly all patients underwent either sleeve gastrectomy or gastric bypass, with significantly more patients, 74%, having sleeve gastrectomy in the group without diabetes, and 62% of those with diabetes undergoing sleeve gastrectomy.

Patients with diabetes uniformly had significantly higher rates of complications as measured by several parameters, and among those with diabetes, the complication rates were highest in those with insulin dependence. The researchers ran a multivariate analysis that controlled for many demographic and clinical variables, and found that despite these corrections, patients with diabetes, and especially those with insulin dependence, had higher relative rates of many complications that were statistically significant. In addition to the increased rates of deep surgical-site infections and 30-day ICU admissions, patients with diabetes had a 54% relatively increased rate of wound disruption, and a 29% increased relative rate of superficial surgical-site infections, compared with those without diabetes. And among patients with diabetes, those with insulin dependence had a 40% increased rate of surgical-site infections, a 74% increase in progressive renal failure, and a 39% increased rate of hospital readmission relative to patients with diabetes that was not insulin dependent, Dr. Wheeler reported.

The absolute complication rates were, in general, low. For example, the total rate of superficial plus deep surgical-site infections was less than 1% both in patients with diabetes and those without, although the rate rose above 1% in patients with insulin-dependent diabetes. The most common complication reported by Dr. Wheeler was 30-day hospital readmission, which was 4.0% in patients without diabetes, 4.8% in those with diabetes, and 6.4% in patients with insulin-dependent diabetes. The data also showed that gastric bypass led to more complications than did sleeve gastrectomy, but complications with both types of surgeries increased in patients with diabetes, compared with those without diabetes.

Dr. Wheeler had no disclosures.

mzoler@mdedge.com

SOURCE: Wheeler AA et al. Obesity Week 2019, Abstract A133.

AGA’s flagship research grant goes to ...

The AGA Research Scholar Award, funded by the AGA Research Foundation, is our premier funding mechanism, providing $100,000 per year for 3 years to early-career faculty working toward independent careers in digestive disease research. Our AGA Research Scholar Award recipients have a proven track record of receiving substantial funding and leadership roles in GI following the receipt of their AGA award. Read about our most recent class of RSA recipients – we’re confident they are future leaders in our field. Learn more about the AGA Research Foundation at www.gastro.org/foundation.



Parambir Dulai, MD
University of California, San Diego

Project title: Development and validation of machine learning optimized predictive models for response to different biologic agents in patients with Crohn’s disease and ulcerative colitis.

Dr. Dulai is using his grant to build and refine a decision-support platform to help providers and patients navigate the complex landscape of choosing between available biologics for the treatment of inflammatory bowel disease (IBD).
 

Amy Hemperly, DO
University of California, San Diego
AGA-Rady Children’s Institute for Genomic Medicine Research Scholar Award in Pediatric Genomics

Project title: Integration of pharmacogenomics and pharmacometabolomics with pharmacokinetics for biomarker discovery in pediatric inflammatory bowel disease

Dr. Hemperly’s research assesses the influence of genetic variations and metabolic and microbial changes on response to anti–tumor necrosis factor (anti-TNF) therapy in pediatric IBD patients. This work will ultimately elucidate factors that improve a patient’s response to therapy.
 

Rodney Infante, MD, PhD
University of Texas Southwestern Medical Center, Dallas

Project title: Regulation of gastrointestinal cancer cachexia by a tumor-adipose-hypothalamic axis

Dr. Infante and his lab will use the AGA grant to improve our understanding of the mechanism and clinical relevance of cachexia-associated anorexia and tissue wasting in order to identify effective therapeutic targets.
 

Suraj Patel, MD, PhD
Massachusetts General Hospital, Boston

Project title: Hepatic IRF3 is a transcriptional regulator of steatosis and insulin resistance in NAFLD

Dr. Patel’s research focuses on the role of innate immunity in cellular metabolism and insulin resistance. Specifically, he’s interested in determining how chronic inflammation fuels the genetic and epigenetic changes we see in overnutritional states such as nonalcoholic fatty liver disease (NAFLD).
 

Jason Pitarresi, PhD
University of Pennsylvania Health System, Philadelphia
AGA-Bern Schwartz Family Fund Research Scholar Award in Pancreatic Cancer

Project title: PTHLH drives epithelial-to-mesenchymal transition and metastasis in pancreatic cancer

With this funding, Dr. Pitarresi will continue on his quest to identify novel drivers of pancreatic cancer development and metastasis with use of genetically engineered mouse models and patient-derived 3D organoids. Dr. Pitarresi is hoping that anti-PTHLH may fill a treatment void and ultimately increase the quality of life in these patients.
 

Eric Shah, MD, MBA
Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
AGA-Shire Research Scholar Award in Functional GI and Motility Disorders*

Project title: Office-based anorectal testing to diagnose evacuation disorders and predict outcomes with biofeedback therapy: The rectal expulsion device (RED)

Dr. Shah’s research aims to validate a diagnostic test to triage patients with chronic constipation to the most effective treatment in general GI practice. This work will ultimately help patients with motility and functional bowel conditions and their providers reach a confident diagnosis and understand their treatment options.

*Funded by Shire Plc, now part of Takeda

Shailja Shah, MD, MPH
Vanderbilt University Medical Center, Nashville, Tenn.

Project title: Defining host-specific genetic and non-genetic determinants of Helicobacter pylori eradication failure using a large prospective cohort and genomic biobank

Dr. Shah’s research is focused on personalizing the clinical management of H. pylori such that eradication efforts can be optimized and targeted to the less than 1-3% of the estimated 4.4 billion individuals infected with H. pylori who are most at risk for complications, such as gastric cancer, and avoided in those who are unlikely to benefit and may even experience harm from eradication therapy.
 

Xiao Tan, MD, PhD
Massachusetts General Hospital, Boston
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease

Project title: Paper-based diagnostics of microbial and host biomarkers to predict responsiveness to IBD therapy

Dr. Tan will develop low-cost, point-of-care microbiome diagnostics to ultimately help physicians’ make diagnoses, monitor, and select treatment for patients with IBD.
 

Michael Thompson, MD, PhD
Washington University, Saint Louis, Mo.
Project title: Mechanisms of altered bile acid homeostasis and non-alcoholic fatty liver disease in offspring exposed to maternal obesity

Dr. Thompson’s research is focused on how perinatal exposures impact risk for metabolic liver disease in offspring.

My day on Capitol Hill

By Richard K. Sterling, MD, MSC, AGAF

When initially asked to represent AGA on Capitol Hill for the Global Liver Institute (GLI) congressional briefing on liver cancer and the LIVER Act on Oct. 31, I felt both honored and somewhat frightened. Honored that AGA thought enough of me as a hepatologist to represent them and frightened, not because it was Halloween, but because I would be speaking to members of Congress and their staff on issues that may impact policy and thousands if not millions of Americans. Along with myself, were Donna Cryer, founder and CEO of the GLI; John Groopman, PhD, an epidemiologist from Johns Hopkins focusing on liver disease; and two patients with liver disease who had a compelling story to tell. In addition, our briefing and Capitol Hill advocacy day included patients with a history of liver cancer and members of the Hepatitis B Foundation.

In preparation, Andrew Scott from the GLI helped me in identifying the target audience and in developing slides to present to Congress members and their aides that would show those at risk for liver cancer, the increasing incidence of the disease, and the importance of diagnosis at an early stage when curative treatment options are readily available. Travel and hotel logistics were taken care of by Kathleen Teixeira and AGA staff, and it was comforting to see them in the audience.

The briefing took place in the Cannon office building and was standing room only. After a brief introduction by Andrew Scott, I was the first speaker followed by our patient advocates and Dr. Groopman. The LIVER Act (H.R. 3016) is sponsored by Congresswomen Nydia Velazquez (D-NY) and would drive several public health initiatives that would help people of all ages, lifestyles, and ethnic backgrounds to reduce their risk for liver cancer and related illnesses by enhancing the federal government’s prevention, education, and disease surveillance capabilities while empowering local entities to promote treatment and raise awareness. It also supports increased funding to both the Centers for Disease Control and Prevention and the National Institutes of Health for liver disease and liver cancer research.

We had plenty of time for questions from the audience and I saw a lot of nodding from many present acknowledging that they had friends or family who had liver disease. Although our briefing was happening at the same time as the vote on formalizing the impeachment inquiry (you can hear the buzzing going off and the red lights flashing that the vote was about to happen; see Facebook; HepBFoundation video), congressional staff did not leave.

After the meeting, the patient advocates along with members of the GLI, Hepatitis B Foundation, and others met one-on-one with additional members of congress and their staff. While on the train home, I had time to reflect on the day and hoped that our message would be advanced through congress.

AGA, along with our sister societies (American Association for the Study of Liver Diseases and American College of Gastroenterology) are our voice and advocates for advancing legislation through congress. Days like today allow our members to get involved. It is an exciting way to help our congressional representatives take action on what matters most to us: improved patient care, supporting research, promoting education, and reducing the overall burden to accomplish these important goals.

While some say Virginia is for Lovers, I say Virginia is for Livers (#LoveYourLiver). For more on this and the Liver Biliary Council offerings at Digestive Disease Week, follow me on twitter (@RichSterlingMD).
 

Dr. Sterling is professor of medicine, chief of hepatology, division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University, Richmond; vice-chair, AGA Liver Biliary Section, DDW Council.

New AGA guideline: Management of GIM

AGA released a new clinical practice guideline in Gastroenterology with recommendations for the management of patients with gastric intestinal metaplasia (GIM) detected as part of routine upper endoscopy for reasons including work up of endoscopically identified gastropathy/presumed gastritis, dyspepsia, or exclusion of Helicobacter pylori.

Guideline recommendations

1. In patients with GIM, AGA recommends testing for H. pylori followed by eradication over no testing and eradication. (Strong recommendation: moderate-quality evidence)

2. In patients with GIM, AGA suggests against routine use of endoscopic surveillance. (Conditional recommendation: very-low-quality evidence)

Comment: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance.

Patients with GIM specifically at higher risk of gastric cancer include those with the following:

• Incomplete versus complete GIM.
• Extensive versus limited GIM.
• Family history of gastric cancer.

Patients at overall increased risk for gastric cancer include the following:

• Racial/ethnic minorities.
• Immigrants from high incidence regions.

3. In patients with GIM, AGA suggests against routine repeat short-interval endoscopy with biopsies for the purpose of risk stratification. (Conditional recommendation: very-low-quality evidence)

Comment: Based on shared decision making, patients with GIM and high-risk stigmata, those with concerns about completeness of baseline endoscopy, and/or those who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within 1 year for risk stratification.

This guideline will be published in the February print issue of Gastroenterology with additional resources to help you implement in your practice.
 

A GI society update on MOC reform

Our work was suspended when American Board of Internal Medicine (ABIM) announced the creation of a new longitudinal assessment option for maintenance of certification across all specialties.

GI society leaders are in touch with ABIM. Here’s an update on what we know: The ABIM board of directors committed to evolve its program to provide a longitudinal assessment option for Maintenance of Certification (MOC), offering a self-paced pathway for physicians to acquire and demonstrate ongoing knowledge. The traditional, long-form assessment will also remain an option because some physicians have expressed a preference for a point-in-time exam taken less frequently.

Our next steps include seeking clarity from ABIM including the following:

1. The milestones in the process to create the new pathway.

2. When the new pathway will be available to diplomates.

3. Consideration and integration of the GI societies’ principles in the development of the new pathway for recertification, including these considerations:

• MOC needs to be simpler, less intrusive, and less expensive.
• We continue to support alternatives to the high-stakes, every-10-year recertification exam.
• We do not support single source or time-limited assessments because they do not represent the current realities of medicine in the digital age.
• We support the concept that, for the many diplomates who specialize within certain areas of gastroenterology and hepatology, MOC should not include high-stakes assessments of areas in which the diplomate may not practice.
• We support the principles of lifelong learning, as evidenced by ongoing CME activities, rather than lifelong testing.

4. The role the GI societies, as representatives for thousands of U.S. members who are ABIM diplomates, play in the creation and implementation of the new pathway.

AASLD, ACG, AGA, and American Society for Gastrointestinal Endoscopy want to be fully informed and fully respected partners in an endeavor that touches upon one of the toughest challenges facing our members and the single issue we hear about most often requesting our help.

We will continue to update our members as we learn the answers to these questions from ABIM.

Together, our first priority on the MOC issue remains ensuring that GI diplomates have a pathway for recertification that meets your needs.

Watch your step (therapy) – understanding ‘fail first’

Sometimes known as “fail first,” step therapy is a tool used by insurance companies that requires patients to fail medications before agreeing to cover a health care provider’s initial treatment recommendation.

Often affecting patients with inflammatory bowel disease (IBD), step therapy focuses on the use of insurer-preferred treatments rather than effective, patient-centric therapies. In addition to causing many patient hardships, this protocol allows insurance companies to come between the provider-patient relationship and dictate a patient’s course of treatment.

To help clinicians navigate this challenging landscape, AGA is pleased to offer a new step therapy webpage that details the step therapy protocol and opportunities to advocate for patient protections.

Additional education modules – including videos, podcasts and other resources – are also available for several states that have implemented safe step therapy laws, including Illinois, New York, and Texas.

Visit the Navigating State Step Therapy Laws program page to learn more about the following:

• What is the step therapy protocol?
• How does step therapy impact a health care provider’s ability to provide patient care?
• Which states have implemented step therapy laws?
• How do state step therapy laws provide physician rights and patient protection?
• Tips to share with your patients.
• What are AGA’s advocacy efforts – and how can I help?

Education modules for additional states will be available in early 2020.

AGA’s Navigating State Step Therapy Laws program is funded by an unrestricted educational grant from Takeda and Pfizer.

AGA’s flagship research grant goes to ...

The AGA Research Scholar Award, funded by the AGA Research Foundation, is our premier funding mechanism, providing $100,000 per year for 3 years to early-career faculty working toward independent careers in digestive disease research. Our AGA Research Scholar Award recipients have a proven track record of receiving substantial funding and leadership roles in GI following the receipt of their AGA award. Read about our most recent class of RSA recipients – we’re confident they are future leaders in our field. Learn more about the AGA Research Foundation at www.gastro.org/foundation.



Parambir Dulai, MD
University of California, San Diego

Project title: Development and validation of machine learning optimized predictive models for response to different biologic agents in patients with Crohn’s disease and ulcerative colitis.

Dr. Dulai is using his grant to build and refine a decision-support platform to help providers and patients navigate the complex landscape of choosing between available biologics for the treatment of inflammatory bowel disease (IBD).
 

Amy Hemperly, DO
University of California, San Diego
AGA-Rady Children’s Institute for Genomic Medicine Research Scholar Award in Pediatric Genomics

Project title: Integration of pharmacogenomics and pharmacometabolomics with pharmacokinetics for biomarker discovery in pediatric inflammatory bowel disease

Dr. Hemperly’s research assesses the influence of genetic variations and metabolic and microbial changes on response to anti–tumor necrosis factor (anti-TNF) therapy in pediatric IBD patients. This work will ultimately elucidate factors that improve a patient’s response to therapy.
 

Rodney Infante, MD, PhD
University of Texas Southwestern Medical Center, Dallas

Project title: Regulation of gastrointestinal cancer cachexia by a tumor-adipose-hypothalamic axis

Dr. Infante and his lab will use the AGA grant to improve our understanding of the mechanism and clinical relevance of cachexia-associated anorexia and tissue wasting in order to identify effective therapeutic targets.
 

Suraj Patel, MD, PhD
Massachusetts General Hospital, Boston

Project title: Hepatic IRF3 is a transcriptional regulator of steatosis and insulin resistance in NAFLD

Dr. Patel’s research focuses on the role of innate immunity in cellular metabolism and insulin resistance. Specifically, he’s interested in determining how chronic inflammation fuels the genetic and epigenetic changes we see in overnutritional states such as nonalcoholic fatty liver disease (NAFLD).
 

Jason Pitarresi, PhD
University of Pennsylvania Health System, Philadelphia
AGA-Bern Schwartz Family Fund Research Scholar Award in Pancreatic Cancer

Project title: PTHLH drives epithelial-to-mesenchymal transition and metastasis in pancreatic cancer

With this funding, Dr. Pitarresi will continue on his quest to identify novel drivers of pancreatic cancer development and metastasis with use of genetically engineered mouse models and patient-derived 3D organoids. Dr. Pitarresi is hoping that anti-PTHLH may fill a treatment void and ultimately increase the quality of life in these patients.
 

Eric Shah, MD, MBA
Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
AGA-Shire Research Scholar Award in Functional GI and Motility Disorders*

Project title: Office-based anorectal testing to diagnose evacuation disorders and predict outcomes with biofeedback therapy: The rectal expulsion device (RED)

Dr. Shah’s research aims to validate a diagnostic test to triage patients with chronic constipation to the most effective treatment in general GI practice. This work will ultimately help patients with motility and functional bowel conditions and their providers reach a confident diagnosis and understand their treatment options.

*Funded by Shire Plc, now part of Takeda

Shailja Shah, MD, MPH
Vanderbilt University Medical Center, Nashville, Tenn.

Project title: Defining host-specific genetic and non-genetic determinants of Helicobacter pylori eradication failure using a large prospective cohort and genomic biobank

Dr. Shah’s research is focused on personalizing the clinical management of H. pylori such that eradication efforts can be optimized and targeted to the less than 1-3% of the estimated 4.4 billion individuals infected with H. pylori who are most at risk for complications, such as gastric cancer, and avoided in those who are unlikely to benefit and may even experience harm from eradication therapy.
 

Xiao Tan, MD, PhD
Massachusetts General Hospital, Boston
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease

Project title: Paper-based diagnostics of microbial and host biomarkers to predict responsiveness to IBD therapy

Dr. Tan will develop low-cost, point-of-care microbiome diagnostics to ultimately help physicians’ make diagnoses, monitor, and select treatment for patients with IBD.
 

Michael Thompson, MD, PhD
Washington University, Saint Louis, Mo.
Project title: Mechanisms of altered bile acid homeostasis and non-alcoholic fatty liver disease in offspring exposed to maternal obesity

Dr. Thompson’s research is focused on how perinatal exposures impact risk for metabolic liver disease in offspring.

My day on Capitol Hill

By Richard K. Sterling, MD, MSC, AGAF

When initially asked to represent AGA on Capitol Hill for the Global Liver Institute (GLI) congressional briefing on liver cancer and the LIVER Act on Oct. 31, I felt both honored and somewhat frightened. Honored that AGA thought enough of me as a hepatologist to represent them and frightened, not because it was Halloween, but because I would be speaking to members of Congress and their staff on issues that may impact policy and thousands if not millions of Americans. Along with myself, were Donna Cryer, founder and CEO of the GLI; John Groopman, PhD, an epidemiologist from Johns Hopkins focusing on liver disease; and two patients with liver disease who had a compelling story to tell. In addition, our briefing and Capitol Hill advocacy day included patients with a history of liver cancer and members of the Hepatitis B Foundation.

In preparation, Andrew Scott from the GLI helped me in identifying the target audience and in developing slides to present to Congress members and their aides that would show those at risk for liver cancer, the increasing incidence of the disease, and the importance of diagnosis at an early stage when curative treatment options are readily available. Travel and hotel logistics were taken care of by Kathleen Teixeira and AGA staff, and it was comforting to see them in the audience.

The briefing took place in the Cannon office building and was standing room only. After a brief introduction by Andrew Scott, I was the first speaker followed by our patient advocates and Dr. Groopman. The LIVER Act (H.R. 3016) is sponsored by Congresswomen Nydia Velazquez (D-NY) and would drive several public health initiatives that would help people of all ages, lifestyles, and ethnic backgrounds to reduce their risk for liver cancer and related illnesses by enhancing the federal government’s prevention, education, and disease surveillance capabilities while empowering local entities to promote treatment and raise awareness. It also supports increased funding to both the Centers for Disease Control and Prevention and the National Institutes of Health for liver disease and liver cancer research.

We had plenty of time for questions from the audience and I saw a lot of nodding from many present acknowledging that they had friends or family who had liver disease. Although our briefing was happening at the same time as the vote on formalizing the impeachment inquiry (you can hear the buzzing going off and the red lights flashing that the vote was about to happen; see Facebook; HepBFoundation video), congressional staff did not leave.

After the meeting, the patient advocates along with members of the GLI, Hepatitis B Foundation, and others met one-on-one with additional members of congress and their staff. While on the train home, I had time to reflect on the day and hoped that our message would be advanced through congress.

AGA, along with our sister societies (American Association for the Study of Liver Diseases and American College of Gastroenterology) are our voice and advocates for advancing legislation through congress. Days like today allow our members to get involved. It is an exciting way to help our congressional representatives take action on what matters most to us: improved patient care, supporting research, promoting education, and reducing the overall burden to accomplish these important goals.

While some say Virginia is for Lovers, I say Virginia is for Livers (#LoveYourLiver). For more on this and the Liver Biliary Council offerings at Digestive Disease Week, follow me on twitter (@RichSterlingMD).
 

Dr. Sterling is professor of medicine, chief of hepatology, division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University, Richmond; vice-chair, AGA Liver Biliary Section, DDW Council.

New AGA guideline: Management of GIM

AGA released a new clinical practice guideline in Gastroenterology with recommendations for the management of patients with gastric intestinal metaplasia (GIM) detected as part of routine upper endoscopy for reasons including work up of endoscopically identified gastropathy/presumed gastritis, dyspepsia, or exclusion of Helicobacter pylori.

Guideline recommendations

1. In patients with GIM, AGA recommends testing for H. pylori followed by eradication over no testing and eradication. (Strong recommendation: moderate-quality evidence)

2. In patients with GIM, AGA suggests against routine use of endoscopic surveillance. (Conditional recommendation: very-low-quality evidence)

Comment: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance.

Patients with GIM specifically at higher risk of gastric cancer include those with the following:

• Incomplete versus complete GIM.
• Extensive versus limited GIM.
• Family history of gastric cancer.

Patients at overall increased risk for gastric cancer include the following:

• Racial/ethnic minorities.
• Immigrants from high incidence regions.

3. In patients with GIM, AGA suggests against routine repeat short-interval endoscopy with biopsies for the purpose of risk stratification. (Conditional recommendation: very-low-quality evidence)

Comment: Based on shared decision making, patients with GIM and high-risk stigmata, those with concerns about completeness of baseline endoscopy, and/or those who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within 1 year for risk stratification.

This guideline will be published in the February print issue of Gastroenterology with additional resources to help you implement in your practice.
 

A GI society update on MOC reform

Our work was suspended when American Board of Internal Medicine (ABIM) announced the creation of a new longitudinal assessment option for maintenance of certification across all specialties.

GI society leaders are in touch with ABIM. Here’s an update on what we know: The ABIM board of directors committed to evolve its program to provide a longitudinal assessment option for Maintenance of Certification (MOC), offering a self-paced pathway for physicians to acquire and demonstrate ongoing knowledge. The traditional, long-form assessment will also remain an option because some physicians have expressed a preference for a point-in-time exam taken less frequently.

Our next steps include seeking clarity from ABIM including the following:

1. The milestones in the process to create the new pathway.

2. When the new pathway will be available to diplomates.

3. Consideration and integration of the GI societies’ principles in the development of the new pathway for recertification, including these considerations:

• MOC needs to be simpler, less intrusive, and less expensive.
• We continue to support alternatives to the high-stakes, every-10-year recertification exam.
• We do not support single source or time-limited assessments because they do not represent the current realities of medicine in the digital age.
• We support the concept that, for the many diplomates who specialize within certain areas of gastroenterology and hepatology, MOC should not include high-stakes assessments of areas in which the diplomate may not practice.
• We support the principles of lifelong learning, as evidenced by ongoing CME activities, rather than lifelong testing.

4. The role the GI societies, as representatives for thousands of U.S. members who are ABIM diplomates, play in the creation and implementation of the new pathway.

AASLD, ACG, AGA, and American Society for Gastrointestinal Endoscopy want to be fully informed and fully respected partners in an endeavor that touches upon one of the toughest challenges facing our members and the single issue we hear about most often requesting our help.

We will continue to update our members as we learn the answers to these questions from ABIM.

Together, our first priority on the MOC issue remains ensuring that GI diplomates have a pathway for recertification that meets your needs.

Watch your step (therapy) – understanding ‘fail first’

Sometimes known as “fail first,” step therapy is a tool used by insurance companies that requires patients to fail medications before agreeing to cover a health care provider’s initial treatment recommendation.

Often affecting patients with inflammatory bowel disease (IBD), step therapy focuses on the use of insurer-preferred treatments rather than effective, patient-centric therapies. In addition to causing many patient hardships, this protocol allows insurance companies to come between the provider-patient relationship and dictate a patient’s course of treatment.

To help clinicians navigate this challenging landscape, AGA is pleased to offer a new step therapy webpage that details the step therapy protocol and opportunities to advocate for patient protections.

Additional education modules – including videos, podcasts and other resources – are also available for several states that have implemented safe step therapy laws, including Illinois, New York, and Texas.

Visit the Navigating State Step Therapy Laws program page to learn more about the following:

• What is the step therapy protocol?
• How does step therapy impact a health care provider’s ability to provide patient care?
• Which states have implemented step therapy laws?
• How do state step therapy laws provide physician rights and patient protection?
• Tips to share with your patients.
• What are AGA’s advocacy efforts – and how can I help?

Education modules for additional states will be available in early 2020.

AGA’s Navigating State Step Therapy Laws program is funded by an unrestricted educational grant from Takeda and Pfizer.

AGA’s flagship research grant goes to ...

The AGA Research Scholar Award, funded by the AGA Research Foundation, is our premier funding mechanism, providing $100,000 per year for 3 years to early-career faculty working toward independent careers in digestive disease research. Our AGA Research Scholar Award recipients have a proven track record of receiving substantial funding and leadership roles in GI following the receipt of their AGA award. Read about our most recent class of RSA recipients – we’re confident they are future leaders in our field. Learn more about the AGA Research Foundation at www.gastro.org/foundation.



Parambir Dulai, MD
University of California, San Diego

Project title: Development and validation of machine learning optimized predictive models for response to different biologic agents in patients with Crohn’s disease and ulcerative colitis.

Dr. Dulai is using his grant to build and refine a decision-support platform to help providers and patients navigate the complex landscape of choosing between available biologics for the treatment of inflammatory bowel disease (IBD).
 

Amy Hemperly, DO
University of California, San Diego
AGA-Rady Children’s Institute for Genomic Medicine Research Scholar Award in Pediatric Genomics

Project title: Integration of pharmacogenomics and pharmacometabolomics with pharmacokinetics for biomarker discovery in pediatric inflammatory bowel disease

Dr. Hemperly’s research assesses the influence of genetic variations and metabolic and microbial changes on response to anti–tumor necrosis factor (anti-TNF) therapy in pediatric IBD patients. This work will ultimately elucidate factors that improve a patient’s response to therapy.
 

Rodney Infante, MD, PhD
University of Texas Southwestern Medical Center, Dallas

Project title: Regulation of gastrointestinal cancer cachexia by a tumor-adipose-hypothalamic axis

Dr. Infante and his lab will use the AGA grant to improve our understanding of the mechanism and clinical relevance of cachexia-associated anorexia and tissue wasting in order to identify effective therapeutic targets.
 

Suraj Patel, MD, PhD
Massachusetts General Hospital, Boston

Project title: Hepatic IRF3 is a transcriptional regulator of steatosis and insulin resistance in NAFLD

Dr. Patel’s research focuses on the role of innate immunity in cellular metabolism and insulin resistance. Specifically, he’s interested in determining how chronic inflammation fuels the genetic and epigenetic changes we see in overnutritional states such as nonalcoholic fatty liver disease (NAFLD).
 

Jason Pitarresi, PhD
University of Pennsylvania Health System, Philadelphia
AGA-Bern Schwartz Family Fund Research Scholar Award in Pancreatic Cancer

Project title: PTHLH drives epithelial-to-mesenchymal transition and metastasis in pancreatic cancer

With this funding, Dr. Pitarresi will continue on his quest to identify novel drivers of pancreatic cancer development and metastasis with use of genetically engineered mouse models and patient-derived 3D organoids. Dr. Pitarresi is hoping that anti-PTHLH may fill a treatment void and ultimately increase the quality of life in these patients.
 

Eric Shah, MD, MBA
Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
AGA-Shire Research Scholar Award in Functional GI and Motility Disorders*

Project title: Office-based anorectal testing to diagnose evacuation disorders and predict outcomes with biofeedback therapy: The rectal expulsion device (RED)

Dr. Shah’s research aims to validate a diagnostic test to triage patients with chronic constipation to the most effective treatment in general GI practice. This work will ultimately help patients with motility and functional bowel conditions and their providers reach a confident diagnosis and understand their treatment options.

*Funded by Shire Plc, now part of Takeda

Shailja Shah, MD, MPH
Vanderbilt University Medical Center, Nashville, Tenn.

Project title: Defining host-specific genetic and non-genetic determinants of Helicobacter pylori eradication failure using a large prospective cohort and genomic biobank

Dr. Shah’s research is focused on personalizing the clinical management of H. pylori such that eradication efforts can be optimized and targeted to the less than 1-3% of the estimated 4.4 billion individuals infected with H. pylori who are most at risk for complications, such as gastric cancer, and avoided in those who are unlikely to benefit and may even experience harm from eradication therapy.
 

Xiao Tan, MD, PhD
Massachusetts General Hospital, Boston
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease

Project title: Paper-based diagnostics of microbial and host biomarkers to predict responsiveness to IBD therapy

Dr. Tan will develop low-cost, point-of-care microbiome diagnostics to ultimately help physicians’ make diagnoses, monitor, and select treatment for patients with IBD.
 

Michael Thompson, MD, PhD
Washington University, Saint Louis, Mo.
Project title: Mechanisms of altered bile acid homeostasis and non-alcoholic fatty liver disease in offspring exposed to maternal obesity

Dr. Thompson’s research is focused on how perinatal exposures impact risk for metabolic liver disease in offspring.

My day on Capitol Hill

By Richard K. Sterling, MD, MSC, AGAF

When initially asked to represent AGA on Capitol Hill for the Global Liver Institute (GLI) congressional briefing on liver cancer and the LIVER Act on Oct. 31, I felt both honored and somewhat frightened. Honored that AGA thought enough of me as a hepatologist to represent them and frightened, not because it was Halloween, but because I would be speaking to members of Congress and their staff on issues that may impact policy and thousands if not millions of Americans. Along with myself, were Donna Cryer, founder and CEO of the GLI; John Groopman, PhD, an epidemiologist from Johns Hopkins focusing on liver disease; and two patients with liver disease who had a compelling story to tell. In addition, our briefing and Capitol Hill advocacy day included patients with a history of liver cancer and members of the Hepatitis B Foundation.

In preparation, Andrew Scott from the GLI helped me in identifying the target audience and in developing slides to present to Congress members and their aides that would show those at risk for liver cancer, the increasing incidence of the disease, and the importance of diagnosis at an early stage when curative treatment options are readily available. Travel and hotel logistics were taken care of by Kathleen Teixeira and AGA staff, and it was comforting to see them in the audience.

The briefing took place in the Cannon office building and was standing room only. After a brief introduction by Andrew Scott, I was the first speaker followed by our patient advocates and Dr. Groopman. The LIVER Act (H.R. 3016) is sponsored by Congresswomen Nydia Velazquez (D-NY) and would drive several public health initiatives that would help people of all ages, lifestyles, and ethnic backgrounds to reduce their risk for liver cancer and related illnesses by enhancing the federal government’s prevention, education, and disease surveillance capabilities while empowering local entities to promote treatment and raise awareness. It also supports increased funding to both the Centers for Disease Control and Prevention and the National Institutes of Health for liver disease and liver cancer research.

We had plenty of time for questions from the audience and I saw a lot of nodding from many present acknowledging that they had friends or family who had liver disease. Although our briefing was happening at the same time as the vote on formalizing the impeachment inquiry (you can hear the buzzing going off and the red lights flashing that the vote was about to happen; see Facebook; HepBFoundation video), congressional staff did not leave.

After the meeting, the patient advocates along with members of the GLI, Hepatitis B Foundation, and others met one-on-one with additional members of congress and their staff. While on the train home, I had time to reflect on the day and hoped that our message would be advanced through congress.

AGA, along with our sister societies (American Association for the Study of Liver Diseases and American College of Gastroenterology) are our voice and advocates for advancing legislation through congress. Days like today allow our members to get involved. It is an exciting way to help our congressional representatives take action on what matters most to us: improved patient care, supporting research, promoting education, and reducing the overall burden to accomplish these important goals.

While some say Virginia is for Lovers, I say Virginia is for Livers (#LoveYourLiver). For more on this and the Liver Biliary Council offerings at Digestive Disease Week, follow me on twitter (@RichSterlingMD).
 

Dr. Sterling is professor of medicine, chief of hepatology, division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University, Richmond; vice-chair, AGA Liver Biliary Section, DDW Council.

New AGA guideline: Management of GIM

AGA released a new clinical practice guideline in Gastroenterology with recommendations for the management of patients with gastric intestinal metaplasia (GIM) detected as part of routine upper endoscopy for reasons including work up of endoscopically identified gastropathy/presumed gastritis, dyspepsia, or exclusion of Helicobacter pylori.

Guideline recommendations

1. In patients with GIM, AGA recommends testing for H. pylori followed by eradication over no testing and eradication. (Strong recommendation: moderate-quality evidence)

2. In patients with GIM, AGA suggests against routine use of endoscopic surveillance. (Conditional recommendation: very-low-quality evidence)

Comment: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance.

Patients with GIM specifically at higher risk of gastric cancer include those with the following:

• Incomplete versus complete GIM.
• Extensive versus limited GIM.
• Family history of gastric cancer.

Patients at overall increased risk for gastric cancer include the following:

• Racial/ethnic minorities.
• Immigrants from high incidence regions.

3. In patients with GIM, AGA suggests against routine repeat short-interval endoscopy with biopsies for the purpose of risk stratification. (Conditional recommendation: very-low-quality evidence)

Comment: Based on shared decision making, patients with GIM and high-risk stigmata, those with concerns about completeness of baseline endoscopy, and/or those who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within 1 year for risk stratification.

This guideline will be published in the February print issue of Gastroenterology with additional resources to help you implement in your practice.
 

A GI society update on MOC reform

Our work was suspended when American Board of Internal Medicine (ABIM) announced the creation of a new longitudinal assessment option for maintenance of certification across all specialties.

GI society leaders are in touch with ABIM. Here’s an update on what we know: The ABIM board of directors committed to evolve its program to provide a longitudinal assessment option for Maintenance of Certification (MOC), offering a self-paced pathway for physicians to acquire and demonstrate ongoing knowledge. The traditional, long-form assessment will also remain an option because some physicians have expressed a preference for a point-in-time exam taken less frequently.

Our next steps include seeking clarity from ABIM including the following:

1. The milestones in the process to create the new pathway.

2. When the new pathway will be available to diplomates.

3. Consideration and integration of the GI societies’ principles in the development of the new pathway for recertification, including these considerations:

• MOC needs to be simpler, less intrusive, and less expensive.
• We continue to support alternatives to the high-stakes, every-10-year recertification exam.
• We do not support single source or time-limited assessments because they do not represent the current realities of medicine in the digital age.
• We support the concept that, for the many diplomates who specialize within certain areas of gastroenterology and hepatology, MOC should not include high-stakes assessments of areas in which the diplomate may not practice.
• We support the principles of lifelong learning, as evidenced by ongoing CME activities, rather than lifelong testing.

4. The role the GI societies, as representatives for thousands of U.S. members who are ABIM diplomates, play in the creation and implementation of the new pathway.

AASLD, ACG, AGA, and American Society for Gastrointestinal Endoscopy want to be fully informed and fully respected partners in an endeavor that touches upon one of the toughest challenges facing our members and the single issue we hear about most often requesting our help.

We will continue to update our members as we learn the answers to these questions from ABIM.

Together, our first priority on the MOC issue remains ensuring that GI diplomates have a pathway for recertification that meets your needs.

Watch your step (therapy) – understanding ‘fail first’

Sometimes known as “fail first,” step therapy is a tool used by insurance companies that requires patients to fail medications before agreeing to cover a health care provider’s initial treatment recommendation.

Often affecting patients with inflammatory bowel disease (IBD), step therapy focuses on the use of insurer-preferred treatments rather than effective, patient-centric therapies. In addition to causing many patient hardships, this protocol allows insurance companies to come between the provider-patient relationship and dictate a patient’s course of treatment.

To help clinicians navigate this challenging landscape, AGA is pleased to offer a new step therapy webpage that details the step therapy protocol and opportunities to advocate for patient protections.

Additional education modules – including videos, podcasts and other resources – are also available for several states that have implemented safe step therapy laws, including Illinois, New York, and Texas.

Visit the Navigating State Step Therapy Laws program page to learn more about the following:

• What is the step therapy protocol?
• How does step therapy impact a health care provider’s ability to provide patient care?
• Which states have implemented step therapy laws?
• How do state step therapy laws provide physician rights and patient protection?
• Tips to share with your patients.
• What are AGA’s advocacy efforts – and how can I help?

Education modules for additional states will be available in early 2020.

AGA’s Navigating State Step Therapy Laws program is funded by an unrestricted educational grant from Takeda and Pfizer.

For more information about upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.

UPCOMING EVENTS

Feb 20; Mar. 24, 2020
Coding and Reimbursement Solutions by McVey Associates, Inc.
Improve the efficiency and performance of your practice by staying current on the latest reimbursement, coding, and compliance changes.
Knoxville, Tenn. (2/20); Birmingham, Ala. (3/24)

Mar. 7-8, 2020
Gut Microbiota for Health World Summit 2020
The focus of the 2020 program will include dietary and nondietary factors shaping the gut microbiome, the microbiome as orchestrator for the immune system, and drug interactions and the microbiome. The summit is sponsored by the European Society for Neurogastroenterology & Motility and the American Gastroenterological Association.
Madrid, Spain

Mar. 10-11; 11-12; 25-26; Apr. 15-16; May 13-14, 2020
Two-Day, In-Depth Coding Seminar by McVey Associates, Inc.
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Orlando, Fla. (3/10-11); Novi, Mich. (3/11-12); Charlotte, N.C. (3/25-26); Columbus, Ohio (4/15-16); Chicago, Ill. (5/13-14)

Mar. 21; Apr. 15, 2020
Regional Practice Skills Workshop
AGA Regional Practice Skills workshops are free in-person, half-day courses that provide trainees and early-career gastroenterologists with practical insights about GI business issues that will shape their professional development. Faculty will discuss employment models, reimbursement strategies, health economics and policy, billing issues, contract negotiations, and other subjects to help attendees navigate the rapidly shifting GI business environment. All workshops are open to both members and nonmembers.
Ann Arbor, Mich. (3/21); Philadelphia, Penn. (4/15)

May 2-5, 2020
Digestive Disease Week^® (DDW)
Digestive Disease Week^® (DDW) is the world’s leading educational forum for academicians, clinicians, researchers, students, and trainees working in gastroenterology, hepatology, GI endoscopy, gastrointestinal surgery, and related fields. Whether you work in patient care, research, education, or administration, the DDW program offers something for you.
Chicago, Ill.

May 2-3, 2020
2020 AGA Postgraduate Course
The AGA Postgraduate Course is a comprehensive 1.5-day program highlighting groundbreaking advances in the delivery of high-quality, patient-centered GI care. Offering general and breakout sessions, learning lunches, and case-based and panel discussions, attendees will gain a deeper understanding of how to diagnose and treat a variety of disease states and digestive disorders.

June 3-6, 2020
2020 AGA Tech Summit
Visit https://techsummit.gastro.org/ for more details.
San Francisco, Calif.

Aug. 14-15, 2020
James W. Freston Single-Topic Conference: Gastrointestinal Organoids and Engineered Organ Systems
The 2020 Freston Conference will focus on GI organoids and engineered organ systems.
Chicago, Ill.

Aug. 14-16, 2020
2020 Principles of GI for the NP and PA
Principles of GI is designed by leading advanced practice providers, GI experts, and physicians to mirror real-life settings for nurse practitioners and physician assistants that lead to GI clinical success.
Denver, Colo.

AWARDS DEADLINES

AGA Fellow Abstract Award
This $500 travel award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top-scoring abstract will be designated the Fellow Abstract of the Year and receive a $1,000 award.
Application Deadline: Feb. 26, 2020

AGA Student Abstract Award
This $500 travel award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year three) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

AGA-Moti L. & Kamla Rustgi International Travel Awards
This $750 travel award supports recipients who are young (i.e., 35 years of age or younger at the time of DDW) basic, translational, or clinical investigators residing outside North America to support travel and related expenses to attend Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

For more information about upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.

UPCOMING EVENTS

Feb 20; Mar. 24, 2020
Coding and Reimbursement Solutions by McVey Associates, Inc.
Improve the efficiency and performance of your practice by staying current on the latest reimbursement, coding, and compliance changes.
Knoxville, Tenn. (2/20); Birmingham, Ala. (3/24)

Mar. 7-8, 2020
Gut Microbiota for Health World Summit 2020
The focus of the 2020 program will include dietary and nondietary factors shaping the gut microbiome, the microbiome as orchestrator for the immune system, and drug interactions and the microbiome. The summit is sponsored by the European Society for Neurogastroenterology & Motility and the American Gastroenterological Association.
Madrid, Spain

Mar. 10-11; 11-12; 25-26; Apr. 15-16; May 13-14, 2020
Two-Day, In-Depth Coding Seminar by McVey Associates, Inc.
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Orlando, Fla. (3/10-11); Novi, Mich. (3/11-12); Charlotte, N.C. (3/25-26); Columbus, Ohio (4/15-16); Chicago, Ill. (5/13-14)

Mar. 21; Apr. 15, 2020
Regional Practice Skills Workshop
AGA Regional Practice Skills workshops are free in-person, half-day courses that provide trainees and early-career gastroenterologists with practical insights about GI business issues that will shape their professional development. Faculty will discuss employment models, reimbursement strategies, health economics and policy, billing issues, contract negotiations, and other subjects to help attendees navigate the rapidly shifting GI business environment. All workshops are open to both members and nonmembers.
Ann Arbor, Mich. (3/21); Philadelphia, Penn. (4/15)

May 2-5, 2020
Digestive Disease Week^® (DDW)
Digestive Disease Week^® (DDW) is the world’s leading educational forum for academicians, clinicians, researchers, students, and trainees working in gastroenterology, hepatology, GI endoscopy, gastrointestinal surgery, and related fields. Whether you work in patient care, research, education, or administration, the DDW program offers something for you.
Chicago, Ill.

May 2-3, 2020
2020 AGA Postgraduate Course
The AGA Postgraduate Course is a comprehensive 1.5-day program highlighting groundbreaking advances in the delivery of high-quality, patient-centered GI care. Offering general and breakout sessions, learning lunches, and case-based and panel discussions, attendees will gain a deeper understanding of how to diagnose and treat a variety of disease states and digestive disorders.

June 3-6, 2020
2020 AGA Tech Summit
Visit https://techsummit.gastro.org/ for more details.
San Francisco, Calif.

Aug. 14-15, 2020
James W. Freston Single-Topic Conference: Gastrointestinal Organoids and Engineered Organ Systems
The 2020 Freston Conference will focus on GI organoids and engineered organ systems.
Chicago, Ill.

Aug. 14-16, 2020
2020 Principles of GI for the NP and PA
Principles of GI is designed by leading advanced practice providers, GI experts, and physicians to mirror real-life settings for nurse practitioners and physician assistants that lead to GI clinical success.
Denver, Colo.

AWARDS DEADLINES

AGA Fellow Abstract Award
This $500 travel award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top-scoring abstract will be designated the Fellow Abstract of the Year and receive a $1,000 award.
Application Deadline: Feb. 26, 2020

AGA Student Abstract Award
This $500 travel award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year three) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

AGA-Moti L. & Kamla Rustgi International Travel Awards
This $750 travel award supports recipients who are young (i.e., 35 years of age or younger at the time of DDW) basic, translational, or clinical investigators residing outside North America to support travel and related expenses to attend Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

For more information about upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.

UPCOMING EVENTS

Feb 20; Mar. 24, 2020
Coding and Reimbursement Solutions by McVey Associates, Inc.
Improve the efficiency and performance of your practice by staying current on the latest reimbursement, coding, and compliance changes.
Knoxville, Tenn. (2/20); Birmingham, Ala. (3/24)

Mar. 7-8, 2020
Gut Microbiota for Health World Summit 2020
The focus of the 2020 program will include dietary and nondietary factors shaping the gut microbiome, the microbiome as orchestrator for the immune system, and drug interactions and the microbiome. The summit is sponsored by the European Society for Neurogastroenterology & Motility and the American Gastroenterological Association.
Madrid, Spain

Mar. 10-11; 11-12; 25-26; Apr. 15-16; May 13-14, 2020
Two-Day, In-Depth Coding Seminar by McVey Associates, Inc.
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Orlando, Fla. (3/10-11); Novi, Mich. (3/11-12); Charlotte, N.C. (3/25-26); Columbus, Ohio (4/15-16); Chicago, Ill. (5/13-14)

Mar. 21; Apr. 15, 2020
Regional Practice Skills Workshop
AGA Regional Practice Skills workshops are free in-person, half-day courses that provide trainees and early-career gastroenterologists with practical insights about GI business issues that will shape their professional development. Faculty will discuss employment models, reimbursement strategies, health economics and policy, billing issues, contract negotiations, and other subjects to help attendees navigate the rapidly shifting GI business environment. All workshops are open to both members and nonmembers.
Ann Arbor, Mich. (3/21); Philadelphia, Penn. (4/15)

May 2-5, 2020
Digestive Disease Week^® (DDW)
Digestive Disease Week^® (DDW) is the world’s leading educational forum for academicians, clinicians, researchers, students, and trainees working in gastroenterology, hepatology, GI endoscopy, gastrointestinal surgery, and related fields. Whether you work in patient care, research, education, or administration, the DDW program offers something for you.
Chicago, Ill.

May 2-3, 2020
2020 AGA Postgraduate Course
The AGA Postgraduate Course is a comprehensive 1.5-day program highlighting groundbreaking advances in the delivery of high-quality, patient-centered GI care. Offering general and breakout sessions, learning lunches, and case-based and panel discussions, attendees will gain a deeper understanding of how to diagnose and treat a variety of disease states and digestive disorders.

June 3-6, 2020
2020 AGA Tech Summit
Visit https://techsummit.gastro.org/ for more details.
San Francisco, Calif.

Aug. 14-15, 2020
James W. Freston Single-Topic Conference: Gastrointestinal Organoids and Engineered Organ Systems
The 2020 Freston Conference will focus on GI organoids and engineered organ systems.
Chicago, Ill.

Aug. 14-16, 2020
2020 Principles of GI for the NP and PA
Principles of GI is designed by leading advanced practice providers, GI experts, and physicians to mirror real-life settings for nurse practitioners and physician assistants that lead to GI clinical success.
Denver, Colo.

AWARDS DEADLINES

AGA Fellow Abstract Award
This $500 travel award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top-scoring abstract will be designated the Fellow Abstract of the Year and receive a $1,000 award.
Application Deadline: Feb. 26, 2020

AGA Student Abstract Award
This $500 travel award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year three) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

AGA-Moti L. & Kamla Rustgi International Travel Awards
This $750 travel award supports recipients who are young (i.e., 35 years of age or younger at the time of DDW) basic, translational, or clinical investigators residing outside North America to support travel and related expenses to attend Digestive Disease Week® (DDW).
Application Deadline: Feb. 26, 2020

In 2000, pneumococcal conjugate vaccine 7 (PCV7) was introduced in the United States, and in 2010, PCV13 was introduced. When each of those vaccines were used, they reduced acute otitis media (AOM) incidence caused by the pneumococcal types included in the vaccines. In the time frame of those vaccine introductions, about one-third of AOM cases occurred because of pneumococci and half of those cases occurred because of strains expressing the serotypes in the two formulations of the vaccines. Efficacy is about 70% for AOM prevention for PCVs. The math matches clinical trial results that have shown about an 11%-12% reduction of all AOM attributable to PCVs. However, our group continues to do tympanocentesis to track the etiology of AOM, and we have reported that elimination of strains of pneumococci expressing capsular types included in the PCVs has been followed by emergence of replacement strains of pneumococci that express non-PCV capsules. We also have shown that Haemophilus influenzae has increased proportionally as a cause of AOM and is the most frequent cause of recurrent AOM. So what else is going on?

KatarzynaBialasiewicz/Thinkstock

My colleague, Stephen I. Pelton, MD, – another ID Consult columnist – is a coauthor of a paper along with Ron Dagan, MD; Lauren Bakaletz, PhD; and Robert Cohen, MD, (all major figures in pneumococcal disease or AOM) that was published in Lancet Infectious Diseases (Dagan R et al. Lancet Infect Dis. 2016 Apr;16[4]:480-92.). They gathered evidence suggesting that prevention of early AOM episodes caused by pneumococci expressing PCV serotypes resulted in a reduction of subsequent complex cases caused by nonvaccine serotypes and other otopathogens. Thus, PCVs may have an impact on AOM indirectly attributable to vaccination.

However, the American Academy of Pediatrics made several recommendations in the 2004 and 2013 guidelines for diagnosis and management of AOM that had a remarkable impact in reducing the frequency that this infection is diagnosed and treated as well. The recommendations included:

• Stricter diagnostic criteria in 2004 that became more strict in 2013 requiring bulging of the eardrum.
• Introduction of “watchful waiting” as an option in management that possibly led to no antibiotic treatment.
• Introduction of delayed prescription of antibiotic when diagnosis was uncertain that possibly led to no antibiotic treatment.
• Endorsement of specific antibiotics with the greatest anticipated efficacy taking into consideration spectrum of activity, safety, and costs.

In the same general time frame, a second development occurred: The Centers for Disease Control and Prevention launched a national campaign to reduce unnecessary and inappropriate antibiotic use in an effort to reduce rising antibiotic resistance among bacteria. The public media and professional communication campaign emphasized that antibiotic treatment carried with it risks that should be considered by patients and clinicians.

Because of the AAP and CDC recommendations, clinicians diagnosed AOM less frequently, and they treated it less frequently. Parents of children took note of the fact that their children with viral upper respiratory infections suspected to have AOM were diagnosed with AOM less often; even when a diagnosis was made, an antibiotic was prescribed less often. Therefore, parents brought their children to clinicians less often when their child had a viral upper respiratory infections or when they suspected AOM.

In addition, guidelines endorsed specific antibiotics that had better efficacy in treatment of AOM. Therefore, when clinicians did treat the infection with antibiotics, they used more effective drugs resulting in fewer treatment failures. This gives the impression of less-frequent AOM as well.

Both universal PCV use and universal influenza vaccine use have been endorsed in recent years, and uptake of that recommendation has increased over time. Clinical trials have shown that influenza is a common virus associated with secondary bacterial AOM.

Lastly, returning to antibiotic use, we now increasingly appreciate the adverse effect on the natural microbiome of the nasopharynx and gut when antibiotics are given. Natural resistance provided by commensals is disrupted when antibiotics are given. This may allow otopathogens to colonize the nasopharynx more readily, an effect that may last for months after a single antibiotic course. We also appreciate more that the microbiome modulates our immune system favorably, so antibiotics that disrupt the microbiome may have an adverse effect on innate or adaptive immunity as well. These adverse consequences of antibiotic use on microbiome and immunity are reduced when less antibiotics are given to children, as has been occurring over the past 2 decades.

Dr. Pichichero is a specialist in pediatric infectious diseases and director of the Research Institute at Rochester (N.Y.) General Hospital. He said he had no relevent financial disclosures. Email him at pdnews@mdedge.com.

In 2000, pneumococcal conjugate vaccine 7 (PCV7) was introduced in the United States, and in 2010, PCV13 was introduced. When each of those vaccines were used, they reduced acute otitis media (AOM) incidence caused by the pneumococcal types included in the vaccines. In the time frame of those vaccine introductions, about one-third of AOM cases occurred because of pneumococci and half of those cases occurred because of strains expressing the serotypes in the two formulations of the vaccines. Efficacy is about 70% for AOM prevention for PCVs. The math matches clinical trial results that have shown about an 11%-12% reduction of all AOM attributable to PCVs. However, our group continues to do tympanocentesis to track the etiology of AOM, and we have reported that elimination of strains of pneumococci expressing capsular types included in the PCVs has been followed by emergence of replacement strains of pneumococci that express non-PCV capsules. We also have shown that Haemophilus influenzae has increased proportionally as a cause of AOM and is the most frequent cause of recurrent AOM. So what else is going on?

KatarzynaBialasiewicz/Thinkstock

My colleague, Stephen I. Pelton, MD, – another ID Consult columnist – is a coauthor of a paper along with Ron Dagan, MD; Lauren Bakaletz, PhD; and Robert Cohen, MD, (all major figures in pneumococcal disease or AOM) that was published in Lancet Infectious Diseases (Dagan R et al. Lancet Infect Dis. 2016 Apr;16[4]:480-92.). They gathered evidence suggesting that prevention of early AOM episodes caused by pneumococci expressing PCV serotypes resulted in a reduction of subsequent complex cases caused by nonvaccine serotypes and other otopathogens. Thus, PCVs may have an impact on AOM indirectly attributable to vaccination.

However, the American Academy of Pediatrics made several recommendations in the 2004 and 2013 guidelines for diagnosis and management of AOM that had a remarkable impact in reducing the frequency that this infection is diagnosed and treated as well. The recommendations included:

• Stricter diagnostic criteria in 2004 that became more strict in 2013 requiring bulging of the eardrum.
• Introduction of “watchful waiting” as an option in management that possibly led to no antibiotic treatment.
• Introduction of delayed prescription of antibiotic when diagnosis was uncertain that possibly led to no antibiotic treatment.
• Endorsement of specific antibiotics with the greatest anticipated efficacy taking into consideration spectrum of activity, safety, and costs.

In the same general time frame, a second development occurred: The Centers for Disease Control and Prevention launched a national campaign to reduce unnecessary and inappropriate antibiotic use in an effort to reduce rising antibiotic resistance among bacteria. The public media and professional communication campaign emphasized that antibiotic treatment carried with it risks that should be considered by patients and clinicians.

Because of the AAP and CDC recommendations, clinicians diagnosed AOM less frequently, and they treated it less frequently. Parents of children took note of the fact that their children with viral upper respiratory infections suspected to have AOM were diagnosed with AOM less often; even when a diagnosis was made, an antibiotic was prescribed less often. Therefore, parents brought their children to clinicians less often when their child had a viral upper respiratory infections or when they suspected AOM.

In addition, guidelines endorsed specific antibiotics that had better efficacy in treatment of AOM. Therefore, when clinicians did treat the infection with antibiotics, they used more effective drugs resulting in fewer treatment failures. This gives the impression of less-frequent AOM as well.

Both universal PCV use and universal influenza vaccine use have been endorsed in recent years, and uptake of that recommendation has increased over time. Clinical trials have shown that influenza is a common virus associated with secondary bacterial AOM.

Lastly, returning to antibiotic use, we now increasingly appreciate the adverse effect on the natural microbiome of the nasopharynx and gut when antibiotics are given. Natural resistance provided by commensals is disrupted when antibiotics are given. This may allow otopathogens to colonize the nasopharynx more readily, an effect that may last for months after a single antibiotic course. We also appreciate more that the microbiome modulates our immune system favorably, so antibiotics that disrupt the microbiome may have an adverse effect on innate or adaptive immunity as well. These adverse consequences of antibiotic use on microbiome and immunity are reduced when less antibiotics are given to children, as has been occurring over the past 2 decades.

Dr. Pichichero is a specialist in pediatric infectious diseases and director of the Research Institute at Rochester (N.Y.) General Hospital. He said he had no relevent financial disclosures. Email him at pdnews@mdedge.com.

In 2000, pneumococcal conjugate vaccine 7 (PCV7) was introduced in the United States, and in 2010, PCV13 was introduced. When each of those vaccines were used, they reduced acute otitis media (AOM) incidence caused by the pneumococcal types included in the vaccines. In the time frame of those vaccine introductions, about one-third of AOM cases occurred because of pneumococci and half of those cases occurred because of strains expressing the serotypes in the two formulations of the vaccines. Efficacy is about 70% for AOM prevention for PCVs. The math matches clinical trial results that have shown about an 11%-12% reduction of all AOM attributable to PCVs. However, our group continues to do tympanocentesis to track the etiology of AOM, and we have reported that elimination of strains of pneumococci expressing capsular types included in the PCVs has been followed by emergence of replacement strains of pneumococci that express non-PCV capsules. We also have shown that Haemophilus influenzae has increased proportionally as a cause of AOM and is the most frequent cause of recurrent AOM. So what else is going on?

KatarzynaBialasiewicz/Thinkstock

My colleague, Stephen I. Pelton, MD, – another ID Consult columnist – is a coauthor of a paper along with Ron Dagan, MD; Lauren Bakaletz, PhD; and Robert Cohen, MD, (all major figures in pneumococcal disease or AOM) that was published in Lancet Infectious Diseases (Dagan R et al. Lancet Infect Dis. 2016 Apr;16[4]:480-92.). They gathered evidence suggesting that prevention of early AOM episodes caused by pneumococci expressing PCV serotypes resulted in a reduction of subsequent complex cases caused by nonvaccine serotypes and other otopathogens. Thus, PCVs may have an impact on AOM indirectly attributable to vaccination.

However, the American Academy of Pediatrics made several recommendations in the 2004 and 2013 guidelines for diagnosis and management of AOM that had a remarkable impact in reducing the frequency that this infection is diagnosed and treated as well. The recommendations included:

• Stricter diagnostic criteria in 2004 that became more strict in 2013 requiring bulging of the eardrum.
• Introduction of “watchful waiting” as an option in management that possibly led to no antibiotic treatment.
• Introduction of delayed prescription of antibiotic when diagnosis was uncertain that possibly led to no antibiotic treatment.
• Endorsement of specific antibiotics with the greatest anticipated efficacy taking into consideration spectrum of activity, safety, and costs.

In the same general time frame, a second development occurred: The Centers for Disease Control and Prevention launched a national campaign to reduce unnecessary and inappropriate antibiotic use in an effort to reduce rising antibiotic resistance among bacteria. The public media and professional communication campaign emphasized that antibiotic treatment carried with it risks that should be considered by patients and clinicians.

Because of the AAP and CDC recommendations, clinicians diagnosed AOM less frequently, and they treated it less frequently. Parents of children took note of the fact that their children with viral upper respiratory infections suspected to have AOM were diagnosed with AOM less often; even when a diagnosis was made, an antibiotic was prescribed less often. Therefore, parents brought their children to clinicians less often when their child had a viral upper respiratory infections or when they suspected AOM.

In addition, guidelines endorsed specific antibiotics that had better efficacy in treatment of AOM. Therefore, when clinicians did treat the infection with antibiotics, they used more effective drugs resulting in fewer treatment failures. This gives the impression of less-frequent AOM as well.

Both universal PCV use and universal influenza vaccine use have been endorsed in recent years, and uptake of that recommendation has increased over time. Clinical trials have shown that influenza is a common virus associated with secondary bacterial AOM.

Lastly, returning to antibiotic use, we now increasingly appreciate the adverse effect on the natural microbiome of the nasopharynx and gut when antibiotics are given. Natural resistance provided by commensals is disrupted when antibiotics are given. This may allow otopathogens to colonize the nasopharynx more readily, an effect that may last for months after a single antibiotic course. We also appreciate more that the microbiome modulates our immune system favorably, so antibiotics that disrupt the microbiome may have an adverse effect on innate or adaptive immunity as well. These adverse consequences of antibiotic use on microbiome and immunity are reduced when less antibiotics are given to children, as has been occurring over the past 2 decades.

Dr. Pichichero is a specialist in pediatric infectious diseases and director of the Research Institute at Rochester (N.Y.) General Hospital. He said he had no relevent financial disclosures. Email him at pdnews@mdedge.com.

When it comes to what future hospitalists should be doing to accelerate their careers, is there such a thing as a “no-brainer” opportunity? Aram Namavar, MD, MS, thinks so.

Dr. Namavar is a first-year internal medicine resident at UC San Diego pursuing a career as an academic hospitalist. He is passionate about building interdisciplinary platforms for patient care enhancement and serving disadvantaged and underserved communities.

Membership in the Society of Hospital Medicine is free for medical students and offers a diverse array of resources specifically curated for the ever-expanding needs of the specialty and its aspiring leaders. An active member of SHM since 2015, Dr. Namavar has looked to the organization for leading career-enhancing opportunities and resources in hospital medicine to help him achieve his altruistic career goals.

For Dr. Namavar, a few of these professional development–focused opportunities include becoming an active member of the Physicians-in-Training Committee, a founding member of the Resident and Student Special Interest Group, and a recipient of the Student Hospitalist Scholar Grant.

“I applied for the Student Hospitalist Scholar Grant to have a dedicated summer of learning quality improvement through being in meetings with hospital medicine leaders and leading my research initiatives alongside my team,” Dr. Namavar said. He described the experience as pivotal to his growth within hospital medicine and as a medical student.

The key component to SHM’s Student Hospitalist Scholar Grant opportunity is the ability for first- and second-year medical students to work alongside leading hospital medicine professionals in scholarly projects to help interested students gain perspective on working within the specialty.

“As a young, interested trainee in hospital medicine, working with a mentor who is established in the field allows one to learn what steps to take in the future to become a leader,” he said. “[It allowed me to] gain insight into leadership style and develop a strong network for the future.”

In addition to the program’s mentorship benefits, grant recipients also receive complimentary registration to SHM’s Annual Conference with the added perks of funding and research support, accommodation expenses, and acceptance into SHM’s RIV Poster Competition.

“I attended the SHM Annual Conference previously,” Dr. Namavar said. “However, as a grant recipient, you have the chance to connect with faculty who will come to your poster presentation and want to learn about your project. This platform allows you to meet individuals from across the nation and connect with those interested in helping trainees thrive within hospital medicine.”

With the grant funding, Dr. Namavar completed his project, “Evaluation of Decisional Conflict as a Simple Tool to Assess Risk of Readmission.” He described this endeavor as a multidimensional project that took on a holistic view of patient-centered readmissions. “We evaluated patient conflict in posthospitalization resources as a marker of readmission, social determinants of health, and health literacy as risk factors for hospital readmission.”

Described by Dr. Namavar as a “no-brainer” opportunity, SHM’s Student Hospitalist Scholar Grant “offers some of the best benefits overall – funding for your project, automatic acceptance at the Annual Conference, the chance to have your work highlighted in blog posts, networking opportunities with faculty across the nation, and travel reimbursement for the conference.”

Building your networks or establishing your professional career path does not stop at individual networking events or scholarship programs, Dr. Namavar said. It’s about piecing together the building blocks to set yourself up for success.

“My long-term involvement in SHM through working on a committee, leading a special interest group, attending annual meetings, and receiving the grant from SHM has helped me to build new, long-lasting connections in the field,” he said. “Because of this, I plan to continue to serve within SHM in multiple capacities throughout my career in hospital medicine.”

Are you a first- or second-year medical student interested in taking the next step in your hospital medicine career? Apply to SHM’s Student Hospitalist Scholar Grant program through late January 2020 at hospitalmedicine.org/scholargrant.
 

Ms. Cowan is a marketing communications specialist at the Society of Hospital Medicine.

When it comes to what future hospitalists should be doing to accelerate their careers, is there such a thing as a “no-brainer” opportunity? Aram Namavar, MD, MS, thinks so.

Dr. Namavar is a first-year internal medicine resident at UC San Diego pursuing a career as an academic hospitalist. He is passionate about building interdisciplinary platforms for patient care enhancement and serving disadvantaged and underserved communities.

Membership in the Society of Hospital Medicine is free for medical students and offers a diverse array of resources specifically curated for the ever-expanding needs of the specialty and its aspiring leaders. An active member of SHM since 2015, Dr. Namavar has looked to the organization for leading career-enhancing opportunities and resources in hospital medicine to help him achieve his altruistic career goals.

For Dr. Namavar, a few of these professional development–focused opportunities include becoming an active member of the Physicians-in-Training Committee, a founding member of the Resident and Student Special Interest Group, and a recipient of the Student Hospitalist Scholar Grant.

“I applied for the Student Hospitalist Scholar Grant to have a dedicated summer of learning quality improvement through being in meetings with hospital medicine leaders and leading my research initiatives alongside my team,” Dr. Namavar said. He described the experience as pivotal to his growth within hospital medicine and as a medical student.

The key component to SHM’s Student Hospitalist Scholar Grant opportunity is the ability for first- and second-year medical students to work alongside leading hospital medicine professionals in scholarly projects to help interested students gain perspective on working within the specialty.

“As a young, interested trainee in hospital medicine, working with a mentor who is established in the field allows one to learn what steps to take in the future to become a leader,” he said. “[It allowed me to] gain insight into leadership style and develop a strong network for the future.”

In addition to the program’s mentorship benefits, grant recipients also receive complimentary registration to SHM’s Annual Conference with the added perks of funding and research support, accommodation expenses, and acceptance into SHM’s RIV Poster Competition.

“I attended the SHM Annual Conference previously,” Dr. Namavar said. “However, as a grant recipient, you have the chance to connect with faculty who will come to your poster presentation and want to learn about your project. This platform allows you to meet individuals from across the nation and connect with those interested in helping trainees thrive within hospital medicine.”

With the grant funding, Dr. Namavar completed his project, “Evaluation of Decisional Conflict as a Simple Tool to Assess Risk of Readmission.” He described this endeavor as a multidimensional project that took on a holistic view of patient-centered readmissions. “We evaluated patient conflict in posthospitalization resources as a marker of readmission, social determinants of health, and health literacy as risk factors for hospital readmission.”

Described by Dr. Namavar as a “no-brainer” opportunity, SHM’s Student Hospitalist Scholar Grant “offers some of the best benefits overall – funding for your project, automatic acceptance at the Annual Conference, the chance to have your work highlighted in blog posts, networking opportunities with faculty across the nation, and travel reimbursement for the conference.”

Building your networks or establishing your professional career path does not stop at individual networking events or scholarship programs, Dr. Namavar said. It’s about piecing together the building blocks to set yourself up for success.

“My long-term involvement in SHM through working on a committee, leading a special interest group, attending annual meetings, and receiving the grant from SHM has helped me to build new, long-lasting connections in the field,” he said. “Because of this, I plan to continue to serve within SHM in multiple capacities throughout my career in hospital medicine.”

Are you a first- or second-year medical student interested in taking the next step in your hospital medicine career? Apply to SHM’s Student Hospitalist Scholar Grant program through late January 2020 at hospitalmedicine.org/scholargrant.
 

Ms. Cowan is a marketing communications specialist at the Society of Hospital Medicine.

When it comes to what future hospitalists should be doing to accelerate their careers, is there such a thing as a “no-brainer” opportunity? Aram Namavar, MD, MS, thinks so.

Dr. Namavar is a first-year internal medicine resident at UC San Diego pursuing a career as an academic hospitalist. He is passionate about building interdisciplinary platforms for patient care enhancement and serving disadvantaged and underserved communities.

Membership in the Society of Hospital Medicine is free for medical students and offers a diverse array of resources specifically curated for the ever-expanding needs of the specialty and its aspiring leaders. An active member of SHM since 2015, Dr. Namavar has looked to the organization for leading career-enhancing opportunities and resources in hospital medicine to help him achieve his altruistic career goals.

For Dr. Namavar, a few of these professional development–focused opportunities include becoming an active member of the Physicians-in-Training Committee, a founding member of the Resident and Student Special Interest Group, and a recipient of the Student Hospitalist Scholar Grant.

“I applied for the Student Hospitalist Scholar Grant to have a dedicated summer of learning quality improvement through being in meetings with hospital medicine leaders and leading my research initiatives alongside my team,” Dr. Namavar said. He described the experience as pivotal to his growth within hospital medicine and as a medical student.

The key component to SHM’s Student Hospitalist Scholar Grant opportunity is the ability for first- and second-year medical students to work alongside leading hospital medicine professionals in scholarly projects to help interested students gain perspective on working within the specialty.

“As a young, interested trainee in hospital medicine, working with a mentor who is established in the field allows one to learn what steps to take in the future to become a leader,” he said. “[It allowed me to] gain insight into leadership style and develop a strong network for the future.”

In addition to the program’s mentorship benefits, grant recipients also receive complimentary registration to SHM’s Annual Conference with the added perks of funding and research support, accommodation expenses, and acceptance into SHM’s RIV Poster Competition.

“I attended the SHM Annual Conference previously,” Dr. Namavar said. “However, as a grant recipient, you have the chance to connect with faculty who will come to your poster presentation and want to learn about your project. This platform allows you to meet individuals from across the nation and connect with those interested in helping trainees thrive within hospital medicine.”

With the grant funding, Dr. Namavar completed his project, “Evaluation of Decisional Conflict as a Simple Tool to Assess Risk of Readmission.” He described this endeavor as a multidimensional project that took on a holistic view of patient-centered readmissions. “We evaluated patient conflict in posthospitalization resources as a marker of readmission, social determinants of health, and health literacy as risk factors for hospital readmission.”

Described by Dr. Namavar as a “no-brainer” opportunity, SHM’s Student Hospitalist Scholar Grant “offers some of the best benefits overall – funding for your project, automatic acceptance at the Annual Conference, the chance to have your work highlighted in blog posts, networking opportunities with faculty across the nation, and travel reimbursement for the conference.”

Building your networks or establishing your professional career path does not stop at individual networking events or scholarship programs, Dr. Namavar said. It’s about piecing together the building blocks to set yourself up for success.

“My long-term involvement in SHM through working on a committee, leading a special interest group, attending annual meetings, and receiving the grant from SHM has helped me to build new, long-lasting connections in the field,” he said. “Because of this, I plan to continue to serve within SHM in multiple capacities throughout my career in hospital medicine.”

Are you a first- or second-year medical student interested in taking the next step in your hospital medicine career? Apply to SHM’s Student Hospitalist Scholar Grant program through late January 2020 at hospitalmedicine.org/scholargrant.
 

Ms. Cowan is a marketing communications specialist at the Society of Hospital Medicine.

Editor’s note: This is one of the many emails readers sent to Dermatology News in response to Dr. Alan Rockoff’s last “Under My Skin” column in the December issue.


Dr. Rockoff,

I was deeply heartbroken to read that this would be your last column in Dermatology News today. I am a medical dermatologist with 19 years of experience in a small town in North Carolina and have always looked forward to reading your columns. No matter what the topic for the article you chose, I would always glean something worthwhile from it, be it a poignant insight, a relevant practice tip on treatment or patient management, and nearly always a hearty laugh.

Being somewhat rural and without a lot of competition, my very busy practice consists mainly of salt of the earth patients needing straight dermatologic care, mostly skin cancer, psoriasis, acne, the general stuff. Your ability to capture the essence of what it is like to be one of us in the trenches, to expose and eloquently define the most common and frustrating issues we face, has been a source of pleasure for years. On more than one occasion, I put down the magazine and attempted to write a thank you letter for one article or another you wrote, to say that you are doing a great job and please continue to enlighten us with your insight and that your efforts are greatly valued. I am embarrassed to admit, I never could complete those emails, thinking “Why bother the man? He is clearly as busy as me, and why would he want to hear from me anyway?”

Well, at the risk of bothering you, sir, please do accept my apologies for not writing you before you retired your article, and please know that your articles have personally given me years of immense happiness. They will be sorely missed, and likely not ever replaced.


With gratitude,


Jeff Suchniak, MD

Rocky Mount, N.C.

Editor’s note: This is one of the many emails readers sent to Dermatology News in response to Dr. Alan Rockoff’s last “Under My Skin” column in the December issue.


Dr. Rockoff,

I was deeply heartbroken to read that this would be your last column in Dermatology News today. I am a medical dermatologist with 19 years of experience in a small town in North Carolina and have always looked forward to reading your columns. No matter what the topic for the article you chose, I would always glean something worthwhile from it, be it a poignant insight, a relevant practice tip on treatment or patient management, and nearly always a hearty laugh.

Being somewhat rural and without a lot of competition, my very busy practice consists mainly of salt of the earth patients needing straight dermatologic care, mostly skin cancer, psoriasis, acne, the general stuff. Your ability to capture the essence of what it is like to be one of us in the trenches, to expose and eloquently define the most common and frustrating issues we face, has been a source of pleasure for years. On more than one occasion, I put down the magazine and attempted to write a thank you letter for one article or another you wrote, to say that you are doing a great job and please continue to enlighten us with your insight and that your efforts are greatly valued. I am embarrassed to admit, I never could complete those emails, thinking “Why bother the man? He is clearly as busy as me, and why would he want to hear from me anyway?”

Well, at the risk of bothering you, sir, please do accept my apologies for not writing you before you retired your article, and please know that your articles have personally given me years of immense happiness. They will be sorely missed, and likely not ever replaced.


With gratitude,


Jeff Suchniak, MD

Rocky Mount, N.C.

Editor’s note: This is one of the many emails readers sent to Dermatology News in response to Dr. Alan Rockoff’s last “Under My Skin” column in the December issue.


Dr. Rockoff,

I was deeply heartbroken to read that this would be your last column in Dermatology News today. I am a medical dermatologist with 19 years of experience in a small town in North Carolina and have always looked forward to reading your columns. No matter what the topic for the article you chose, I would always glean something worthwhile from it, be it a poignant insight, a relevant practice tip on treatment or patient management, and nearly always a hearty laugh.

Being somewhat rural and without a lot of competition, my very busy practice consists mainly of salt of the earth patients needing straight dermatologic care, mostly skin cancer, psoriasis, acne, the general stuff. Your ability to capture the essence of what it is like to be one of us in the trenches, to expose and eloquently define the most common and frustrating issues we face, has been a source of pleasure for years. On more than one occasion, I put down the magazine and attempted to write a thank you letter for one article or another you wrote, to say that you are doing a great job and please continue to enlighten us with your insight and that your efforts are greatly valued. I am embarrassed to admit, I never could complete those emails, thinking “Why bother the man? He is clearly as busy as me, and why would he want to hear from me anyway?”

Well, at the risk of bothering you, sir, please do accept my apologies for not writing you before you retired your article, and please know that your articles have personally given me years of immense happiness. They will be sorely missed, and likely not ever replaced.


With gratitude,


Jeff Suchniak, MD

Rocky Mount, N.C.