U.S. hospitalists could learn a lesson from a new report that shows patients treated at higher-spending hospitals in Ontario, Canada, had associated drops in death rates and readmissions, says one of the study's authors.

Theresa Stukel, PhD, of the Institute for Clinical Evaluative Sciences in Toronto says that while direct comparisons between Canadian and U.S. healthcare delivery systems can be misleading because the U.S. spends more on healthcare, and this study deals with the universal healthcare system in Canada, "one of the important policy lessons is that it's very important to manage one's resources—to think about the fact that more resources may not lead to better care and to think about where to put the next healthcare dollar."

The report, "Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals," found that in the highest- versus lowest-spending hospitals, respectively, the age- and sex-adjusted relative 30-day mortality rate was 12.7% vs. 12.8% for acute myocardial infarction patients; 10.2% vs. 12.4% for congestive heart failure patients; 7.7% vs. 9.7% for hip fracture cases; and 3.3% vs. 3.9% for colon cancer patients.

And while higher-spending hospitals showed better outcomes, Dr. Stukel says, more money does not correlate directly to better care. She suggests U.S. physicians look for guidance from domestic health systems, such as Kaiser Permanente, Geisenger Health System, and Intermountain Healthcare, which she says outperform the U.S. averages for quality while spending less than the average costs.

The lesson to hospitalists: be careful what you ask for, Dr. Stukel explains. Physicians always want the latest "testing equipment and therapies," she says. "I think there's a point where having access to these resources means you have to use them; otherwise, you can't amortize them. There's a point where physicians think that if they are not doing a service to the patients, they’re not providing better care."

U.S. hospitalists could learn a lesson from a new report that shows patients treated at higher-spending hospitals in Ontario, Canada, had associated drops in death rates and readmissions, says one of the study's authors.

Theresa Stukel, PhD, of the Institute for Clinical Evaluative Sciences in Toronto says that while direct comparisons between Canadian and U.S. healthcare delivery systems can be misleading because the U.S. spends more on healthcare, and this study deals with the universal healthcare system in Canada, "one of the important policy lessons is that it's very important to manage one's resources—to think about the fact that more resources may not lead to better care and to think about where to put the next healthcare dollar."

The report, "Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals," found that in the highest- versus lowest-spending hospitals, respectively, the age- and sex-adjusted relative 30-day mortality rate was 12.7% vs. 12.8% for acute myocardial infarction patients; 10.2% vs. 12.4% for congestive heart failure patients; 7.7% vs. 9.7% for hip fracture cases; and 3.3% vs. 3.9% for colon cancer patients.

And while higher-spending hospitals showed better outcomes, Dr. Stukel says, more money does not correlate directly to better care. She suggests U.S. physicians look for guidance from domestic health systems, such as Kaiser Permanente, Geisenger Health System, and Intermountain Healthcare, which she says outperform the U.S. averages for quality while spending less than the average costs.

The lesson to hospitalists: be careful what you ask for, Dr. Stukel explains. Physicians always want the latest "testing equipment and therapies," she says. "I think there's a point where having access to these resources means you have to use them; otherwise, you can't amortize them. There's a point where physicians think that if they are not doing a service to the patients, they’re not providing better care."

U.S. hospitalists could learn a lesson from a new report that shows patients treated at higher-spending hospitals in Ontario, Canada, had associated drops in death rates and readmissions, says one of the study's authors.

Theresa Stukel, PhD, of the Institute for Clinical Evaluative Sciences in Toronto says that while direct comparisons between Canadian and U.S. healthcare delivery systems can be misleading because the U.S. spends more on healthcare, and this study deals with the universal healthcare system in Canada, "one of the important policy lessons is that it's very important to manage one's resources—to think about the fact that more resources may not lead to better care and to think about where to put the next healthcare dollar."

The report, "Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals," found that in the highest- versus lowest-spending hospitals, respectively, the age- and sex-adjusted relative 30-day mortality rate was 12.7% vs. 12.8% for acute myocardial infarction patients; 10.2% vs. 12.4% for congestive heart failure patients; 7.7% vs. 9.7% for hip fracture cases; and 3.3% vs. 3.9% for colon cancer patients.

And while higher-spending hospitals showed better outcomes, Dr. Stukel says, more money does not correlate directly to better care. She suggests U.S. physicians look for guidance from domestic health systems, such as Kaiser Permanente, Geisenger Health System, and Intermountain Healthcare, which she says outperform the U.S. averages for quality while spending less than the average costs.

The lesson to hospitalists: be careful what you ask for, Dr. Stukel explains. Physicians always want the latest "testing equipment and therapies," she says. "I think there's a point where having access to these resources means you have to use them; otherwise, you can't amortize them. There's a point where physicians think that if they are not doing a service to the patients, they’re not providing better care."

Clinical question: Is the risk of recurrence of Clostridium difficile infection (CDI) increased by the use of "non-CDI" antimicrobial agents (inactive against C. diff) during or after CDI therapy?

Background: Recurrence of CDI is expected to increase with use of non-CDI antimicrobials. Previous studies have not distinguished between the timing of non-CDI agents during and after CDI treatment, nor examined the effect of frequency, duration, or type of non-CDI antibiotic therapy.

Study design: Retrospective cohort.

Setting: Academic Veterans Affairs medical center.

Synopsis: All patients with CDI over a three-year period were evaluated to determine the association between non-CDI antimicrobial during or within 30 days following CDI therapy and 90-day CDI recurrence. Of 246 patients, 57% received concurrent or subsequent non-CDI antimicrobials. CDI recurred in 40% of patients who received non-CDI antimicrobials and in 16% of those who did not (OR: 3.5, 95% CI: 1.9 to 6.5).

After multivariable adjustment (including age, duration of CDI treatment, comorbidity, hospital and ICU admission, and gastric acid suppression), those who received non-CDI antimicrobials during CDI therapy had no increased risk of recurrence. However, those who received any non-CDI antimicrobials after initial CDI treatment had an absolute recurrence rate of 48% with an adjusted OR of 3.02 (95% CI: 1.65 to 5.52). This increased risk of recurrence was unaffected by the number or duration of non-CDI antimicrobial prescriptions. Subgroup analysis by antimicrobial class revealed statistically significant associations only with beta-lactams and fluoroquinolones.

Bottom line: The risk of recurrence of CDI is tripled by exposure to non-CDI antimicrobials within 30 days after CDI treatment, irrespective of the number or duration of such exposures.

Citation: Drekonja DM, Amundson WH, DeCarolis DD, Kuskowski MA, Lederle FA, Johnson JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med. 2011;124:1081.e1-1081.e7.

Clinical question: Is the risk of recurrence of Clostridium difficile infection (CDI) increased by the use of "non-CDI" antimicrobial agents (inactive against C. diff) during or after CDI therapy?

Background: Recurrence of CDI is expected to increase with use of non-CDI antimicrobials. Previous studies have not distinguished between the timing of non-CDI agents during and after CDI treatment, nor examined the effect of frequency, duration, or type of non-CDI antibiotic therapy.

Study design: Retrospective cohort.

Setting: Academic Veterans Affairs medical center.

Synopsis: All patients with CDI over a three-year period were evaluated to determine the association between non-CDI antimicrobial during or within 30 days following CDI therapy and 90-day CDI recurrence. Of 246 patients, 57% received concurrent or subsequent non-CDI antimicrobials. CDI recurred in 40% of patients who received non-CDI antimicrobials and in 16% of those who did not (OR: 3.5, 95% CI: 1.9 to 6.5).

After multivariable adjustment (including age, duration of CDI treatment, comorbidity, hospital and ICU admission, and gastric acid suppression), those who received non-CDI antimicrobials during CDI therapy had no increased risk of recurrence. However, those who received any non-CDI antimicrobials after initial CDI treatment had an absolute recurrence rate of 48% with an adjusted OR of 3.02 (95% CI: 1.65 to 5.52). This increased risk of recurrence was unaffected by the number or duration of non-CDI antimicrobial prescriptions. Subgroup analysis by antimicrobial class revealed statistically significant associations only with beta-lactams and fluoroquinolones.

Bottom line: The risk of recurrence of CDI is tripled by exposure to non-CDI antimicrobials within 30 days after CDI treatment, irrespective of the number or duration of such exposures.

Citation: Drekonja DM, Amundson WH, DeCarolis DD, Kuskowski MA, Lederle FA, Johnson JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med. 2011;124:1081.e1-1081.e7.

Clinical question: Is the risk of recurrence of Clostridium difficile infection (CDI) increased by the use of "non-CDI" antimicrobial agents (inactive against C. diff) during or after CDI therapy?

Background: Recurrence of CDI is expected to increase with use of non-CDI antimicrobials. Previous studies have not distinguished between the timing of non-CDI agents during and after CDI treatment, nor examined the effect of frequency, duration, or type of non-CDI antibiotic therapy.

Study design: Retrospective cohort.

Setting: Academic Veterans Affairs medical center.

Synopsis: All patients with CDI over a three-year period were evaluated to determine the association between non-CDI antimicrobial during or within 30 days following CDI therapy and 90-day CDI recurrence. Of 246 patients, 57% received concurrent or subsequent non-CDI antimicrobials. CDI recurred in 40% of patients who received non-CDI antimicrobials and in 16% of those who did not (OR: 3.5, 95% CI: 1.9 to 6.5).

After multivariable adjustment (including age, duration of CDI treatment, comorbidity, hospital and ICU admission, and gastric acid suppression), those who received non-CDI antimicrobials during CDI therapy had no increased risk of recurrence. However, those who received any non-CDI antimicrobials after initial CDI treatment had an absolute recurrence rate of 48% with an adjusted OR of 3.02 (95% CI: 1.65 to 5.52). This increased risk of recurrence was unaffected by the number or duration of non-CDI antimicrobial prescriptions. Subgroup analysis by antimicrobial class revealed statistically significant associations only with beta-lactams and fluoroquinolones.

Bottom line: The risk of recurrence of CDI is tripled by exposure to non-CDI antimicrobials within 30 days after CDI treatment, irrespective of the number or duration of such exposures.

Citation: Drekonja DM, Amundson WH, DeCarolis DD, Kuskowski MA, Lederle FA, Johnson JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med. 2011;124:1081.e1-1081.e7.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Counseling Techniques
• Key Counseling Messages
• Counseling and Adherence
• Case Study

Faculty/Faculty Disclosure

Versie Johnson-Mallard, PhD, MSN, MSMS
Nurse Faculty Scholar
Robert Wood Johnson
University of South Florida
Tampa, FL

Dr Johnson-Mallard has nothing to disclose.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Counseling Techniques
• Key Counseling Messages
• Counseling and Adherence
• Case Study

Faculty/Faculty Disclosure

Versie Johnson-Mallard, PhD, MSN, MSMS
Nurse Faculty Scholar
Robert Wood Johnson
University of South Florida
Tampa, FL

Dr Johnson-Mallard has nothing to disclose.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Counseling Techniques
• Key Counseling Messages
• Counseling and Adherence
• Case Study

Faculty/Faculty Disclosure

Versie Johnson-Mallard, PhD, MSN, MSMS
Nurse Faculty Scholar
Robert Wood Johnson
University of South Florida
Tampa, FL

Dr Johnson-Mallard has nothing to disclose.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Adhesiogenesis
• Adhesion Frequency in Cesarean Deliveries
• General and Obstetric Sequelae of Adhesions
• Where Are Adhesions Most Likely to Develop?
• Should We Do Peritoneal Closure?
• Adhesion Prevention
• Data on Clinical Effectiveness
• Using ORC at Cesarean Delivery

Faculty/Faculty Disclosure

Hector Chapa, MD, FACOG
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Obstetrics and Gynecology
Residency Program
Methodist Medical Center
Dallas, Texas
Dr Chapa has received clinical grant funding from Johnson & Johnson Medical Affairs for clinical trials of Interceed

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Adhesiogenesis
• Adhesion Frequency in Cesarean Deliveries
• General and Obstetric Sequelae of Adhesions
• Where Are Adhesions Most Likely to Develop?
• Should We Do Peritoneal Closure?
• Adhesion Prevention
• Data on Clinical Effectiveness
• Using ORC at Cesarean Delivery

Faculty/Faculty Disclosure

Hector Chapa, MD, FACOG
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Obstetrics and Gynecology
Residency Program
Methodist Medical Center
Dallas, Texas
Dr Chapa has received clinical grant funding from Johnson & Johnson Medical Affairs for clinical trials of Interceed

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Adhesiogenesis
• Adhesion Frequency in Cesarean Deliveries
• General and Obstetric Sequelae of Adhesions
• Where Are Adhesions Most Likely to Develop?
• Should We Do Peritoneal Closure?
• Adhesion Prevention
• Data on Clinical Effectiveness
• Using ORC at Cesarean Delivery

Faculty/Faculty Disclosure

Hector Chapa, MD, FACOG
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Obstetrics and Gynecology
Residency Program
Methodist Medical Center
Dallas, Texas
Dr Chapa has received clinical grant funding from Johnson & Johnson Medical Affairs for clinical trials of Interceed

Management of acute lymphoblastic leukemia should be driven in large part by patient age, according to new clinical practice guidelines issued by the National Comprehensive Cancer Network.

Adolescents and young adults between the ages of 15 and 39 years benefit from the intensive therapies used to treat children, while older adults are thought to be less tolerant of the high-dose pediatric regimens, explained Dr. Patrick A. Brown.

"At this point, multiple studies have indicated that young adults with acute lymphoblastic leukemia [ALL] benefit significantly from pediatric-inspired treatments, and the new guidelines reflect this," said Dr. Brown, cochair of the NCCN panel that wrote the guidelines.

The treatment of older adults, on the other hand, is compromised relative to their younger counterparts, not only by their diminished tolerance of high-dose therapies but also by the presence in many adults of cytogenic abnormalities, including the translocation that results in the Philadelphia (Ph) chromosome, said Dr. Brown, director of the Pediatric Leukemia Program at the Kimmel Comprehensive Cancer Canter, Johns Hopkins University, Baltimore.

The Ph chromosome, a common feature in adult ALL patients but rare in children, leads to formation of the BCR-ABL fusion gene that is associated with a poor prognosis independent of age, he noted in an interview.

The new guidelines were presented March 17 at the conference in Hollywood, Fla.

They call for initial patient stratification based on Ph status and treatment of Ph-positive ALL patients with regimens that incorporate BCR-ABL-targeting tyrosine kinase inhibitors, such as imatinib (Gleevec). Imatinib is FDA approved for the treatment of adult patients with relapsed or refractory Ph-positive ALL.

Regarding treatment decisions, the guidelines recommend risk stratification by age, with adolescent and young adult patients aged 15-39 years being considered separately from the adult population 40 years and older. The guidelines also advocate that those 65 years and older be considered separately as well, but caution that "chronological age alone is a poor surrogate for determining patient fitness for therapy."

Consideration of allogeneic stem cell transplantation as a consolidation option following induction therapy in ALL patients should be based on Ph status and age, Dr. Brown said, noting that the guidelines recommend it for Ph-positive patients as well as PH-negative patients younger than 65 years who have high-risk features. These include elevated white blood cell count, hypodiploidy, or rearrangements of the mixed-lineage leukemia gene, not including those adult patients with preclusive comorbidities, such as organ dysfunction.

The guidelines also recommend:

• Central nervous system prophylaxis and treatment, including cranial irradiation, intrathecal chemotherapy, or high-dose systemic chemotherapy, throughout the course of therapy, from induction through maintenance, to clear leukemic cells from CNS sites that cannot be accessed by systemic chemotherapy because of the blood-brain barrier.

• Postinduction consolidation comprising drug combinations similar to those used during the induction phase, such as high-dose methotrexate, cytarabine, mercaptopurine, and l-asparaginase.

• Extended maintenance therapy for all patients (except those with mature B-cell ALL in whom relapses rarely occur beyond 12 months), typically comprising daily mercaptopurine and weekly methotrexate, often with periodic vincristine and corticosteroids, for 2 years in adults and 2-3 years in children.

• The possible inclusion of novel, immune-based agents that target specific genetic abnormalities, such as the BCR-ABL selective tyrosine kinase inhibitors for Ph-positive ALL, the anti-CD20 monoclonal antibody rituximab (Rituxan) for CD20-expression B-cell lineage ALL, and the adenosine deaminase substrate nelarabine (Arranon) for T-cell lineage ALL.

The NCCN guidelines also incorporate recommendations for minimal residual disease evaluation, provision of supportive care, and management of treatment-associated toxicities.

While the survival outcomes associated with ALL have improved dramatically among children in recent years – the cure rate with current treatment regimens is approximately 80% – the long-term prognosis for adults with the disease is poor, with cure rates of 30-40%, according to NCCN ALL guidelines panel member Dr. Daniel J. DeAngelo.

"ALL is the rarest form of adult leukemia, and we still have a lot of unanswered questions," said Dr. DeAngelo of the Dana-Farber Cancer Institute, Boston. "For this reason, adult patients with the disease should be referred to specialized cancer treatment centers and should be enrolled in clinical trials whenever possible."

Dr. Brown disclosed no relevant conflicts of interest. Dr. DeAngelo disclosed relationships with Bristol-Myers Squibb, Novartis, and Sigma-Tau Pharmaceuticals. The full list of disclosures for the NCCN ALL Guidelines Panel members can be found at http://www.nccn.org.

Management of acute lymphoblastic leukemia should be driven in large part by patient age, according to new clinical practice guidelines issued by the National Comprehensive Cancer Network.

Adolescents and young adults between the ages of 15 and 39 years benefit from the intensive therapies used to treat children, while older adults are thought to be less tolerant of the high-dose pediatric regimens, explained Dr. Patrick A. Brown.

"At this point, multiple studies have indicated that young adults with acute lymphoblastic leukemia [ALL] benefit significantly from pediatric-inspired treatments, and the new guidelines reflect this," said Dr. Brown, cochair of the NCCN panel that wrote the guidelines.

The treatment of older adults, on the other hand, is compromised relative to their younger counterparts, not only by their diminished tolerance of high-dose therapies but also by the presence in many adults of cytogenic abnormalities, including the translocation that results in the Philadelphia (Ph) chromosome, said Dr. Brown, director of the Pediatric Leukemia Program at the Kimmel Comprehensive Cancer Canter, Johns Hopkins University, Baltimore.

The Ph chromosome, a common feature in adult ALL patients but rare in children, leads to formation of the BCR-ABL fusion gene that is associated with a poor prognosis independent of age, he noted in an interview.

The new guidelines were presented March 17 at the conference in Hollywood, Fla.

They call for initial patient stratification based on Ph status and treatment of Ph-positive ALL patients with regimens that incorporate BCR-ABL-targeting tyrosine kinase inhibitors, such as imatinib (Gleevec). Imatinib is FDA approved for the treatment of adult patients with relapsed or refractory Ph-positive ALL.

Regarding treatment decisions, the guidelines recommend risk stratification by age, with adolescent and young adult patients aged 15-39 years being considered separately from the adult population 40 years and older. The guidelines also advocate that those 65 years and older be considered separately as well, but caution that "chronological age alone is a poor surrogate for determining patient fitness for therapy."

Consideration of allogeneic stem cell transplantation as a consolidation option following induction therapy in ALL patients should be based on Ph status and age, Dr. Brown said, noting that the guidelines recommend it for Ph-positive patients as well as PH-negative patients younger than 65 years who have high-risk features. These include elevated white blood cell count, hypodiploidy, or rearrangements of the mixed-lineage leukemia gene, not including those adult patients with preclusive comorbidities, such as organ dysfunction.

The guidelines also recommend:

• Central nervous system prophylaxis and treatment, including cranial irradiation, intrathecal chemotherapy, or high-dose systemic chemotherapy, throughout the course of therapy, from induction through maintenance, to clear leukemic cells from CNS sites that cannot be accessed by systemic chemotherapy because of the blood-brain barrier.

• Postinduction consolidation comprising drug combinations similar to those used during the induction phase, such as high-dose methotrexate, cytarabine, mercaptopurine, and l-asparaginase.

• Extended maintenance therapy for all patients (except those with mature B-cell ALL in whom relapses rarely occur beyond 12 months), typically comprising daily mercaptopurine and weekly methotrexate, often with periodic vincristine and corticosteroids, for 2 years in adults and 2-3 years in children.

• The possible inclusion of novel, immune-based agents that target specific genetic abnormalities, such as the BCR-ABL selective tyrosine kinase inhibitors for Ph-positive ALL, the anti-CD20 monoclonal antibody rituximab (Rituxan) for CD20-expression B-cell lineage ALL, and the adenosine deaminase substrate nelarabine (Arranon) for T-cell lineage ALL.

The NCCN guidelines also incorporate recommendations for minimal residual disease evaluation, provision of supportive care, and management of treatment-associated toxicities.

While the survival outcomes associated with ALL have improved dramatically among children in recent years – the cure rate with current treatment regimens is approximately 80% – the long-term prognosis for adults with the disease is poor, with cure rates of 30-40%, according to NCCN ALL guidelines panel member Dr. Daniel J. DeAngelo.

"ALL is the rarest form of adult leukemia, and we still have a lot of unanswered questions," said Dr. DeAngelo of the Dana-Farber Cancer Institute, Boston. "For this reason, adult patients with the disease should be referred to specialized cancer treatment centers and should be enrolled in clinical trials whenever possible."

Dr. Brown disclosed no relevant conflicts of interest. Dr. DeAngelo disclosed relationships with Bristol-Myers Squibb, Novartis, and Sigma-Tau Pharmaceuticals. The full list of disclosures for the NCCN ALL Guidelines Panel members can be found at http://www.nccn.org.

Management of acute lymphoblastic leukemia should be driven in large part by patient age, according to new clinical practice guidelines issued by the National Comprehensive Cancer Network.

Adolescents and young adults between the ages of 15 and 39 years benefit from the intensive therapies used to treat children, while older adults are thought to be less tolerant of the high-dose pediatric regimens, explained Dr. Patrick A. Brown.

"At this point, multiple studies have indicated that young adults with acute lymphoblastic leukemia [ALL] benefit significantly from pediatric-inspired treatments, and the new guidelines reflect this," said Dr. Brown, cochair of the NCCN panel that wrote the guidelines.

The treatment of older adults, on the other hand, is compromised relative to their younger counterparts, not only by their diminished tolerance of high-dose therapies but also by the presence in many adults of cytogenic abnormalities, including the translocation that results in the Philadelphia (Ph) chromosome, said Dr. Brown, director of the Pediatric Leukemia Program at the Kimmel Comprehensive Cancer Canter, Johns Hopkins University, Baltimore.

The Ph chromosome, a common feature in adult ALL patients but rare in children, leads to formation of the BCR-ABL fusion gene that is associated with a poor prognosis independent of age, he noted in an interview.

The new guidelines were presented March 17 at the conference in Hollywood, Fla.

They call for initial patient stratification based on Ph status and treatment of Ph-positive ALL patients with regimens that incorporate BCR-ABL-targeting tyrosine kinase inhibitors, such as imatinib (Gleevec). Imatinib is FDA approved for the treatment of adult patients with relapsed or refractory Ph-positive ALL.

Regarding treatment decisions, the guidelines recommend risk stratification by age, with adolescent and young adult patients aged 15-39 years being considered separately from the adult population 40 years and older. The guidelines also advocate that those 65 years and older be considered separately as well, but caution that "chronological age alone is a poor surrogate for determining patient fitness for therapy."

Consideration of allogeneic stem cell transplantation as a consolidation option following induction therapy in ALL patients should be based on Ph status and age, Dr. Brown said, noting that the guidelines recommend it for Ph-positive patients as well as PH-negative patients younger than 65 years who have high-risk features. These include elevated white blood cell count, hypodiploidy, or rearrangements of the mixed-lineage leukemia gene, not including those adult patients with preclusive comorbidities, such as organ dysfunction.

The guidelines also recommend:

• Central nervous system prophylaxis and treatment, including cranial irradiation, intrathecal chemotherapy, or high-dose systemic chemotherapy, throughout the course of therapy, from induction through maintenance, to clear leukemic cells from CNS sites that cannot be accessed by systemic chemotherapy because of the blood-brain barrier.

• Postinduction consolidation comprising drug combinations similar to those used during the induction phase, such as high-dose methotrexate, cytarabine, mercaptopurine, and l-asparaginase.

• Extended maintenance therapy for all patients (except those with mature B-cell ALL in whom relapses rarely occur beyond 12 months), typically comprising daily mercaptopurine and weekly methotrexate, often with periodic vincristine and corticosteroids, for 2 years in adults and 2-3 years in children.

• The possible inclusion of novel, immune-based agents that target specific genetic abnormalities, such as the BCR-ABL selective tyrosine kinase inhibitors for Ph-positive ALL, the anti-CD20 monoclonal antibody rituximab (Rituxan) for CD20-expression B-cell lineage ALL, and the adenosine deaminase substrate nelarabine (Arranon) for T-cell lineage ALL.

The NCCN guidelines also incorporate recommendations for minimal residual disease evaluation, provision of supportive care, and management of treatment-associated toxicities.

While the survival outcomes associated with ALL have improved dramatically among children in recent years – the cure rate with current treatment regimens is approximately 80% – the long-term prognosis for adults with the disease is poor, with cure rates of 30-40%, according to NCCN ALL guidelines panel member Dr. Daniel J. DeAngelo.

"ALL is the rarest form of adult leukemia, and we still have a lot of unanswered questions," said Dr. DeAngelo of the Dana-Farber Cancer Institute, Boston. "For this reason, adult patients with the disease should be referred to specialized cancer treatment centers and should be enrolled in clinical trials whenever possible."

Dr. Brown disclosed no relevant conflicts of interest. Dr. DeAngelo disclosed relationships with Bristol-Myers Squibb, Novartis, and Sigma-Tau Pharmaceuticals. The full list of disclosures for the NCCN ALL Guidelines Panel members can be found at http://www.nccn.org.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Defining OC-Related Bleeding
• Differences Among OC Regimens
• Management of OC-Related Bleeding

Faculty/Faculty Disclosure

Christopher M. Estes, MD, MPH
Assistant Professor
Director, Clerkship in Obstetrics and Gynecology
Medical Director
Reproductive Health Services
University of Miami Miller, School of Medicine
Department of Obstetrics and Gynecology
Miami, FL

Mandy Gittler, MD
Medical Director
All Women's Health
Chicago, IL and Tacoma, WA

Dr Estes has nothing to disclose. Dr Gittler is a consultant to, and has received funding for clinical grants from TEVA Women's Health.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Defining OC-Related Bleeding
• Differences Among OC Regimens
• Management of OC-Related Bleeding

Faculty/Faculty Disclosure

Christopher M. Estes, MD, MPH
Assistant Professor
Director, Clerkship in Obstetrics and Gynecology
Medical Director
Reproductive Health Services
University of Miami Miller, School of Medicine
Department of Obstetrics and Gynecology
Miami, FL

Mandy Gittler, MD
Medical Director
All Women's Health
Chicago, IL and Tacoma, WA

Dr Estes has nothing to disclose. Dr Gittler is a consultant to, and has received funding for clinical grants from TEVA Women's Health.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Defining OC-Related Bleeding
• Differences Among OC Regimens
• Management of OC-Related Bleeding

Faculty/Faculty Disclosure

Christopher M. Estes, MD, MPH
Assistant Professor
Director, Clerkship in Obstetrics and Gynecology
Medical Director
Reproductive Health Services
University of Miami Miller, School of Medicine
Department of Obstetrics and Gynecology
Miami, FL

Mandy Gittler, MD
Medical Director
All Women's Health
Chicago, IL and Tacoma, WA

Dr Estes has nothing to disclose. Dr Gittler is a consultant to, and has received funding for clinical grants from TEVA Women's Health.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Total Versus Subtotal Abdominal Hysterectomy
• A Retrospective Comparison of LSH and TAH
• Two Approaches to Hysterectomy for Management of Benign Pathology

Faculty/Faculty Disclosure

Andrew I. Brill, MD
Director of Minimally Invasive Gynecology at California Pacific Medical Center
San Francisco, CA
Dr. Brill has a consulting agreement with Cephalon, Inc., Ethicon, Inc., and Karl Storz GmbH & Co. KG.

Copyright © 2010 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Total Versus Subtotal Abdominal Hysterectomy
• A Retrospective Comparison of LSH and TAH
• Two Approaches to Hysterectomy for Management of Benign Pathology

Faculty/Faculty Disclosure

Andrew I. Brill, MD
Director of Minimally Invasive Gynecology at California Pacific Medical Center
San Francisco, CA
Dr. Brill has a consulting agreement with Cephalon, Inc., Ethicon, Inc., and Karl Storz GmbH & Co. KG.

Copyright © 2010 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ethicon Women's Health & Urology.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Total Versus Subtotal Abdominal Hysterectomy
• A Retrospective Comparison of LSH and TAH
• Two Approaches to Hysterectomy for Management of Benign Pathology

Faculty/Faculty Disclosure

Andrew I. Brill, MD
Director of Minimally Invasive Gynecology at California Pacific Medical Center
San Francisco, CA
Dr. Brill has a consulting agreement with Cephalon, Inc., Ethicon, Inc., and Karl Storz GmbH & Co. KG.

Copyright © 2010 by Elsevier Inc.

CHICAGO – Bariatric surgery crushed intensive medical therapy for the management of hyperglycemia in a randomized trial involving obese patients with poorly controlled type 2 diabetes.

"The lesson of this study is that for those obese patients who also have uncontrolled diabetes, there is now another treatment option that may be very, very effective at getting them in good control," Dr. Philip R. Schauer declared in presenting the 1-year results of the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial.

STAMPEDE was a single-center prospective study involving 150 randomized patients. The primary end point – hemoglobin A_1c of 6.0% or less at 1 year – was achieved in 42% of patients in the Roux-en-Y gastric bypass group, 37% in the sleeve gastrectomy group, and 12% of patients assigned to state-of-the-art intensive medical management based upon American Diabetes Association guidelines, including a weight loss program, reported Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

At enrollment the average HbA_1c was 9.2% even though most patients were on three or more diabetes medications, and about half were taking insulin. The average baseline body mass index was 37 kg/m². More than 60% of subjects had moderate to severe fatty liver disease.

Particularly noteworthy was the finding that all gastric bypass patients with an HbA_1c of 6.0% or less at 1 year achieved that target despite having discontinued all diabetes medications, including insulin. So did 13 of 18 patients in the sleeve gastrectomy group who reached the primary end point.

"That’s as close to a definition of remission of diabetes as you can get to," the surgeon commented.

Improvements in secondary study end points related to cardiovascular risk were also far more impressive in the surgery arms.

Three patients in the gastric bypass group and one in the sleeve gastrectomy arm required redo operations. There were other serious complications in the surgical groups as well, but no deaths.

Follow-up of STAMPEDE participants will continue through 4 years. Dr. Schauer predicted that on the basis of the highly positive STAMPEDE findings, future studies will look at bariatric surgery versus intensive medical management in obese type 2 diabetic patients with lesser degrees of uncontrolled type 2 diabetes – say, HbA_1cs between 7% and 9%.

Reaction to STAMPEDE was cautious.

"That’s a huge intervention in order to get control of diabetes. I’m just not sure it’s ready for prime time yet," former ACC President Dr. W. Douglas Weaver said in an interview.

"I would like to see some more outcomes data in patients who’ve been managed in this way. You’d like to see that it not only keeps the weight off and the glucose levels lower over the longer term, but that it actually improves outcomes in terms of cardiovascular events and diabetic complications. Then it becomes compelling. Right now, we just have these surrogate improvements," added Dr. Weaver, head of the division of cardiovascular medicine at the Henry Ford Health System, Detroit.

Cleveland Clinic endocrinologist Dr. Sangeeta Kashyap, who headed the STAMPEDE diabetology team, said medical therapy is not to be discounted. It’s titratable, even stoppable if need be. A surgical fix is not.

"Surgery works very well, but once it’s done, it’s done. If you want to eat an extra bite of food, you’re not going to be able to without getting violently ill," she observed in an interview.

"Even though our results strongly support bariatric surgery for diabetes, I don’t think it’s going to be right for everybody. I think more studies need to be done to figure out who the best candidates are, and for which procedures," Dr. Kashyap said.

The durability of surgery’s antidiabetic effect has yet to be established, she added.

Simultaneously with Dr. Schauer’s presentation of STAMPEDE in Chicago, the study was published online by the New England Journal of Medicine (N. Engl. J. Med. 2012 March 26 [10.1056/NEJMoa1200225]).

STAMPEDE was supported by Ethicon Endo-Surgery, the National Institutes of Health, and LifeScan. Dr. Schauer and Dr. Kashyap reported serving as consultants to Ethicon, and Dr. Schauer consults for other companies as well.

CHICAGO – Bariatric surgery crushed intensive medical therapy for the management of hyperglycemia in a randomized trial involving obese patients with poorly controlled type 2 diabetes.

"The lesson of this study is that for those obese patients who also have uncontrolled diabetes, there is now another treatment option that may be very, very effective at getting them in good control," Dr. Philip R. Schauer declared in presenting the 1-year results of the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial.

STAMPEDE was a single-center prospective study involving 150 randomized patients. The primary end point – hemoglobin A_1c of 6.0% or less at 1 year – was achieved in 42% of patients in the Roux-en-Y gastric bypass group, 37% in the sleeve gastrectomy group, and 12% of patients assigned to state-of-the-art intensive medical management based upon American Diabetes Association guidelines, including a weight loss program, reported Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

At enrollment the average HbA_1c was 9.2% even though most patients were on three or more diabetes medications, and about half were taking insulin. The average baseline body mass index was 37 kg/m². More than 60% of subjects had moderate to severe fatty liver disease.

Particularly noteworthy was the finding that all gastric bypass patients with an HbA_1c of 6.0% or less at 1 year achieved that target despite having discontinued all diabetes medications, including insulin. So did 13 of 18 patients in the sleeve gastrectomy group who reached the primary end point.

"That’s as close to a definition of remission of diabetes as you can get to," the surgeon commented.

Improvements in secondary study end points related to cardiovascular risk were also far more impressive in the surgery arms.

Three patients in the gastric bypass group and one in the sleeve gastrectomy arm required redo operations. There were other serious complications in the surgical groups as well, but no deaths.

Follow-up of STAMPEDE participants will continue through 4 years. Dr. Schauer predicted that on the basis of the highly positive STAMPEDE findings, future studies will look at bariatric surgery versus intensive medical management in obese type 2 diabetic patients with lesser degrees of uncontrolled type 2 diabetes – say, HbA_1cs between 7% and 9%.

Reaction to STAMPEDE was cautious.

"That’s a huge intervention in order to get control of diabetes. I’m just not sure it’s ready for prime time yet," former ACC President Dr. W. Douglas Weaver said in an interview.

"I would like to see some more outcomes data in patients who’ve been managed in this way. You’d like to see that it not only keeps the weight off and the glucose levels lower over the longer term, but that it actually improves outcomes in terms of cardiovascular events and diabetic complications. Then it becomes compelling. Right now, we just have these surrogate improvements," added Dr. Weaver, head of the division of cardiovascular medicine at the Henry Ford Health System, Detroit.

Cleveland Clinic endocrinologist Dr. Sangeeta Kashyap, who headed the STAMPEDE diabetology team, said medical therapy is not to be discounted. It’s titratable, even stoppable if need be. A surgical fix is not.

"Surgery works very well, but once it’s done, it’s done. If you want to eat an extra bite of food, you’re not going to be able to without getting violently ill," she observed in an interview.

"Even though our results strongly support bariatric surgery for diabetes, I don’t think it’s going to be right for everybody. I think more studies need to be done to figure out who the best candidates are, and for which procedures," Dr. Kashyap said.

The durability of surgery’s antidiabetic effect has yet to be established, she added.

Simultaneously with Dr. Schauer’s presentation of STAMPEDE in Chicago, the study was published online by the New England Journal of Medicine (N. Engl. J. Med. 2012 March 26 [10.1056/NEJMoa1200225]).

STAMPEDE was supported by Ethicon Endo-Surgery, the National Institutes of Health, and LifeScan. Dr. Schauer and Dr. Kashyap reported serving as consultants to Ethicon, and Dr. Schauer consults for other companies as well.

CHICAGO – Bariatric surgery crushed intensive medical therapy for the management of hyperglycemia in a randomized trial involving obese patients with poorly controlled type 2 diabetes.

"The lesson of this study is that for those obese patients who also have uncontrolled diabetes, there is now another treatment option that may be very, very effective at getting them in good control," Dr. Philip R. Schauer declared in presenting the 1-year results of the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial.

STAMPEDE was a single-center prospective study involving 150 randomized patients. The primary end point – hemoglobin A_1c of 6.0% or less at 1 year – was achieved in 42% of patients in the Roux-en-Y gastric bypass group, 37% in the sleeve gastrectomy group, and 12% of patients assigned to state-of-the-art intensive medical management based upon American Diabetes Association guidelines, including a weight loss program, reported Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

At enrollment the average HbA_1c was 9.2% even though most patients were on three or more diabetes medications, and about half were taking insulin. The average baseline body mass index was 37 kg/m². More than 60% of subjects had moderate to severe fatty liver disease.

Particularly noteworthy was the finding that all gastric bypass patients with an HbA_1c of 6.0% or less at 1 year achieved that target despite having discontinued all diabetes medications, including insulin. So did 13 of 18 patients in the sleeve gastrectomy group who reached the primary end point.

"That’s as close to a definition of remission of diabetes as you can get to," the surgeon commented.

Improvements in secondary study end points related to cardiovascular risk were also far more impressive in the surgery arms.

Three patients in the gastric bypass group and one in the sleeve gastrectomy arm required redo operations. There were other serious complications in the surgical groups as well, but no deaths.

Follow-up of STAMPEDE participants will continue through 4 years. Dr. Schauer predicted that on the basis of the highly positive STAMPEDE findings, future studies will look at bariatric surgery versus intensive medical management in obese type 2 diabetic patients with lesser degrees of uncontrolled type 2 diabetes – say, HbA_1cs between 7% and 9%.

Reaction to STAMPEDE was cautious.

"That’s a huge intervention in order to get control of diabetes. I’m just not sure it’s ready for prime time yet," former ACC President Dr. W. Douglas Weaver said in an interview.

"I would like to see some more outcomes data in patients who’ve been managed in this way. You’d like to see that it not only keeps the weight off and the glucose levels lower over the longer term, but that it actually improves outcomes in terms of cardiovascular events and diabetic complications. Then it becomes compelling. Right now, we just have these surrogate improvements," added Dr. Weaver, head of the division of cardiovascular medicine at the Henry Ford Health System, Detroit.

Cleveland Clinic endocrinologist Dr. Sangeeta Kashyap, who headed the STAMPEDE diabetology team, said medical therapy is not to be discounted. It’s titratable, even stoppable if need be. A surgical fix is not.

"Surgery works very well, but once it’s done, it’s done. If you want to eat an extra bite of food, you’re not going to be able to without getting violently ill," she observed in an interview.

"Even though our results strongly support bariatric surgery for diabetes, I don’t think it’s going to be right for everybody. I think more studies need to be done to figure out who the best candidates are, and for which procedures," Dr. Kashyap said.

The durability of surgery’s antidiabetic effect has yet to be established, she added.

Simultaneously with Dr. Schauer’s presentation of STAMPEDE in Chicago, the study was published online by the New England Journal of Medicine (N. Engl. J. Med. 2012 March 26 [10.1056/NEJMoa1200225]).

STAMPEDE was supported by Ethicon Endo-Surgery, the National Institutes of Health, and LifeScan. Dr. Schauer and Dr. Kashyap reported serving as consultants to Ethicon, and Dr. Schauer consults for other companies as well.

NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.

In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.

"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.

Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.

These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.

Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).

NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.

In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.

"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.

Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.

These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.

Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).

NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.

In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.

"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.

Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.

These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.

Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception

Faculty/Faculty Disclosure

David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception

Faculty/Faculty Disclosure

David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.

A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception

Faculty/Faculty Disclosure

David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.