One thousand patients with primary myelofibrosis: The Mayo Clinic experience

Ayalew Tefferi, M.D., with the Department of Hematology at Mayo Clinic in Rochester, Minn., discusses the results of a study of 1,000 patients who have primary myelofibrosis.

Key findings
Researchers found that when patients with myelofibrosis present, their clinical features are not at a steady state and usually progress within the first few months of the diagnosis. It is best to wait a several months before providing a prognostic score.

Many patients with primary myelofibrosis can live a long life (exceeding 15 years) and patients who won’t live that long can be identified.

The most recent version of DIPSS-plus scoring system performed much better than prior versions, helping researchers to determine what proportion of patients with myelofibrosis are suitable for therapies. More than 50 percent of patients require observation alone.

A description of the study is included in the January 2012 issue of Mayo Clinic Proceedings.

ABSTRACT
Objective
To share our decades of experience with primary myelofibrosis and underscore the importance of outcomes research studies in designing clinical trials and interpreting their results.

Patients and methods
One thousand consecutive patients with primary myelofibrosis seen at Mayo Clinic between Nov. 4, 1977, and Sept. 1, 2011, were considered.

The International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus were applied for risk stratification. Separate analyses were included for patients seen at time of referral (N=1000), at initial diagnosis (N=340), and within or after 1 year of diagnosis (N=660).

Results

To date, 592 deaths and 68 leukemic transformations have been documented. Parameters at initial diagnosis vs time of referral included: 

• Median age (66 vs 65 years)
• Male sex (61% vs 62%)
• Red cell transfusion need (24% vs 38%)
• Hemoglobin level less than 10 g/dL (38% vs 54%)
• Platelet count less than 100 × 10⁹/L (18% vs 26%)
• Leukocyte count more than 25 × 10⁹/L (13% vs 16%)
• Marked splenomegaly (21% vs 31%)
• Constitutional symptoms (29% vs 34%)
• Abnormal karyotype (31% vs 41%)

Mutational frequencies were 61% for JAK2V617F, 8% for MPLW515, and 4% for IDH1/2.

DIPSS-plus risk distributions at time of referral were 10% low, 15% intermediate-1, 37% intermediate-2, and 37% high. The corresponding median survivals were 17.5, 7.8, 3.6, and 1.8 years vs 20.0, 14.3, 5.3, and 1.7 years for patients younger than 60 years of age.

Compared with both DIPSS and IPSS, DIPSS-plus showed better discrimination among risk groups. Five-year leukemic transformation rates were 6% and 21% in low- and high-risk patients, respectively.

Conclusion
The current document should serve as a valuable resource for patients and physicians and provides context for the design and interpretation of clinical trials.

AUTHORS
Ayalew Tefferi, M.D.,  Terra L. Lasho, M.T., Thitina Jimma, M.D., Christy M. Finke, B.S., Naseema Gangat, MBBS, Rakhee Vaidya, MBBS , Kebede Hussein Begna, M.D., Aref Al-Kali, M.D., Rhett P. Ketterling, M.D., Curtis A. Hanson, M.D., Animesh Pardanani, MBBS, Ph.D.

Source: http://physicianupdate.mayoclinic.org/2012/03/15/one-thousand-patients-with-primary-myelofibrosis-the-mayo-clinic-experience/

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A nurse practitioner-directed intervention improves the quality of life of patients with metastatic cancer

Gerardo Colon-Otero, M.D., with the Department of Hematology/Oncology at Mayo Clinic in Florida, discusses results of a randomized pilot study that show that an intervention that explains the benefits of hospice and addresses advanced directives early in the course of treatment leads to measurable improvement in the patient’s emotional and mental quality of life (QoL).

The study was published in the Journal of Palliative Medicine online ahead of print on May 4, 2012.

ABSTRACT
Background
There is a paucity of randomized studies evaluating the value of palliative interventions on a prospective basis in newly diagnosed oncology patients. We sought to prospectively evaluate quality of life (QoL) outcomes in advanced cancer patients who received discussion-based palliative care interventions from an advanced registered nurse practitioner (ARNP) integrated into the oncology team, and compare these outcomes with a control population.

Methods
Patients with metastatic cancer were randomized to standard care or an ARNP-directed intervention that included discussions of the benefits of hospice, discussions on living wills and advanced directives (Five Wishes document) along with an assessment of QoL. Relevant endpoints included change from baseline QoL and improvement in hospice knowledge.

Results
From Nov. 13, 2008, through July 28, 2009, 26 patients were accrued at the Mayo Clinic in Jacksonville, Fla. The study closed early due to published data demonstrating the benefits of early palliative care interventions in the management of metastatic cancer patients. Statistically significant improvements from baseline were noted in emotional and mental QoL assessments in the intervention group that were not seen in the control group. Patients found it useful to have the living will and Five Wishes documents offered as part of the ARNP intervention.

Conclusions
An ARNP-directed intervention that explains the benefits of hospice and addresses advanced directives early in the course of metastatic cancer patients’ treatment is well-received by the patients and their relatives and leads to measurable improvement in the patient’s emotional and mental QoL.

Authors
Gerardo Colon-Otero, M.D., Stephen H. Dyar, Jr., M.D., Mary M. Lesperance, A.R.N.P., Robert P. Shannon, M.D., Jeff A. Sloan, Ph.D.

Clinical trials at Mayo Clinic
Metastatic cancer, to bone

 

Source: http://physicianupdate.mayoclinic.org/2012/05/23/a-nurse-practitioner-directed-intervention-improves-the-quality-of-life-of-patients-with-metastatic-cancer/

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Mayo Clinic study finds that cardiac rehab reduces mortality by 45 percent

Randal J. Thomas, M.D., director of Mayo Clinic’s Cardiovascular Health Clinic, and colleagues found that patients who participate in cardiac rehabilitation after having heart interventions such as angioplasty, stents and clot-busting drugs have a 45 percent lower mortality rate.

The research team studied data from more than 2,300 patients between 1994 and 2008, and recently published the results in Circulation.  

Only about 40 percent of patients in the study participated in cardiac rehabilitation. These findings are particularly important for interventional cardiologists, Dr. Thomas says, because encouraging patients to pursue cardiac rehab after their procedure can potentially save more lives than previously thought.

Authors: Kashish Goel, M.B.B.S.; Ryan J. Lennon, M.S.; R. Thomas Tilbury, M.D.; Ray W. Squires, PhD; Randal J. Thomas, M.D., M.S.

Source: http://physicianupdate.mayoclinic.org/2012/04/03/mayo-clinic-study-finds-that-cardiac-rehab-reduces-mortality-by-45-percent/

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Fertility – a much wider issue

When people are broached with the subject of fertility, one often associates it is to an individual family’s desire to have children. However, as Professor Nargund expresses in her paper “Declining birth rate in Developed Countries: A radical re-think is required”, the subject touches society much more widely as a whole for both the developed [...]

Source: http://www.createhealthclinics.org/blog/fertility/fertility-a-much-wider-issue/

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Federal Government Questions Legality Of Certain ASC-Service Provider Arrangements

Recently, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued an advisory opinion regarding two types of Proposed Arrangements between an anesthesia provider (AP) and physician-owned ambulatory surgery centers (ASCs). This came as a result of a request for an opinion from an AP who, because of competitive market pressures, was considering one of two new business relationship models. Under the AP’s current professional arrangement, the ap offers exclusive anesthesia services to ASCs, employs personnel to meet the anesthesia needs of the ASCs, and independently bills patients and third party payors, including Medicare, for professional fees. The ASCs bill the same parties for professional services plus a facility fee for materials and ancillary staff.

• Under Proposed Arrangement A, the AP would continue to provide exclusive anesthesia services to the ASC and to bill independently. Additionally, the AP would pay a market value “management services” fee to the ASC for each non-Federally funded patient. The ASC would both collect this fee and continue to charge a facility fee to Federal and third party payors.
• Under Proposed Arrangement B, the ASC physician-owners would set up a separate subsidiary to exclusively provide anesthesia services to their patients. The subsidiary then would hire the AP as the exclusive independent anesthesia services contractor, handle all billing with the assistance of the AP and its staff, pay the AP out of fees collected, and retain any profits.

In analyzing the legality of the two arrangements, the OIG considered two questions: 1. Does either arrangement violate the Federal anti-kickback statute, and, 2. Would any safe harbor protection apply?

Under the anti-kickback statute, it is a criminal offense to offer, pay, solicit, or receive any remuneration for referrals reimbursable by a Federal health care program. This statute seeks to ensure that referrals are based on sound medical judgment and not financial or other incentives. Regarding Proposed Arrangement A, although the AP would pay a management services fee only for non-Federal health care program patients, this does not reduce the risk that the fee might be paid by the AP to induce referrals from the ASC of all types of patients. Additionally, the arrangement allows the ASC to be paid twice for the same services, and this could unduly influence the ASC to select the AP as the exclusive provider. The OIG concluded that Proposed Arrangement A could violate the anti-kickback statute. No safe harbor protections apply.

Safe harbor protections for ASCs, employment, and personal services and management contracts were determined to not apply to Proposed Arrangement B. The Subsidiary does not qualify as a Medicare-certified ASC because it would not provide surgical services, only anesthesia services. As such, its income and the profits distributed to the ASC physician-owners would not be protected by any safe harbor provisions. Additionally, the OIG is concerned about exclusive arrangements between those who refer business (the ASC physician-owners), and those who furnish goods or services reimbursed by a Federal health care program (the AP). The AP and the ASC physician-owners both would benefit financially in Proposed Arrangement B, with the AP receiving its negotiated rate and the physician-owners receiving residual profits from the subsidiary after expenses and payment to the AP. The OIG concluded that Proposed Arrangement B would permit the physician-owners to receive compensation in the form of profits from the subsidiary from referring patients to the AP; this payment would be for services that they themselves could not provide. The more than minimal risk of fraud and abuse and the prohibited remuneration both would be in violation of the Federal anti-kickback statute.

Physicians should be aware of this development, as it may affect current and future professional relationships. A health care attorney can offer assistance in interpreting the potential impact of the OIG decision and evaluating the need to restructure business arrangements.

Source: http://www.pagingdrblog.com/2012/07/18/federal-government-questions-legality-of-certain-asc-service-provider-arrangements/

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Malaria in Greece

For the second year in a row there have been cases of Plasmosium vivax malaria reported in Greece.

There is no history of travel to malarious area in the affected patients, so the cases have been acquired locally.

These cases were in agricultural areas, and there are no reports of malaria occurring in resort areas of Greece.

It is however, recommended that travellers do take precautions against getting insect bites – West Nile virus (not as serious as malaria, but nevertheless unpleasant) is also spread by infected mosquitos and cases have been reported recently.

Source: European Centre for Disease Prevention and Control

For further advice, contact the Globe Travel Health Centre on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/malaria-in-greece-2.html?utm_source=rss&utm_medium=rss&utm_campaign=malaria-in-greece-2

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Advancing Care for Advanced Illness

Millions of Americans are dealing with advanced illness—defined as when health conditions become serious enough that general health declines, and treatment loses its impact.  A significant challenge is that the quality of care these individuals receive varies significantly.

The Coalition to Transform Advanced Care, otherwise known as C-TAC, is an organization focused on ensuring everyone, especially the sickest and most vulnerable, receive high-quality care that is consistent with their values and respects their dignity.  They hope to transform care for advanced illness through public and private policy, making changes to the care delivery system, and by empowering consumers. C-TAC is bringing together patient advocacy groups, medical teams, faith communities and individuals in an effort to bring about this change as quickly as possible.

To shed more light on these issues and explore potential solutions, C-TAC is hosting a summit on advanced illness care in Washington, D.C., January 29-30, 2013.  The summit will explore community-based approaches, cultural issues, public perspectives, and the economics of advanced care.  You can read more about the event here.

In this video, Dan Johnson, MD, FAAHPM, national physician lead for palliative care at Kaiser Permanente and a supporter of C-TAC, reflects on the quality of care for people living with advanced illness.

Source: http://centerfortotalhealth.org/2012/advancing-care-for-advanced-illness/

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This Week at the Center for Total Health

Ted Eytan, MD, gives a tour of the Kaiser Permanente Center for Total Health to Peter Levin, the chief technology officer of the Department of Veterans Affairs.  (Photo credit: Henry Wei, MD, Presidential Innovation Fellow.)  On Twitter, you can follow Levin at @pllevin and Wei at @henryweimd.

Source: http://centerfortotalhealth.org/2012/this-week-at-the-center-for-total-health/

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Fertility – a much wider issue

When people are broached with the subject of fertility, one often associates it is to an individual family’s desire to have children. However, as Professor Nargund expresses in her paper “Declining birth rate in Developed Countries: A radical re-think is required”, the subject touches society much more widely as a whole for both the developed [...]

Source: http://www.createhealthclinics.org/blog/fertility/fertility-a-much-wider-issue/

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Praise From a Visiting Former Navy Seal and Best-Selling Author

We were recently privileged to have New York Times bestselling author, and former Navy SEAL, Brandon Webb, speak at Eye Consultants of Texas in Grapevine. It was the idea of founder Phillips Kirk Labor, MD, to host this event, primarily for his staff and a group of local law enforcement officers, as well as special guests.

A highly sought-after motivational speaker, Brandon focused his talk on the importance of attention to detail and striving for excellence. His New York Times bestselling book, The Red Circle, shares his personal story of dealing with adversity in a positive and constructive way, and passes on valuable leadership lessons he learned as a Navy SEAL. Everyone in attendance at our practice was incredibly inspired, just like all of Brandon’s audiences in his speaking engagements across the U.S.

 

In addition to inviting him to speak, Dr. Labor invited Brandon into the operating room to observe actual cataract procedures. Recently, Brandon wrote about his Eye Consultants of Texas visit and experiences in his blog.

 

Here is an excerpt from Brandon’s blog:

 

“The last part of September I had a chance to visit with Dr. Kirk Labor and his team at Eye Consultants of Texas. I was invited to sit in on a few Cataract procedures, and actually assisted in a minor way. I’ve been fortunate to tour plenty of U.S. companies when I was an active SEAL and after. Companies like Smith & Wesson, Nixon, ABC news, St. Martin’s Press, L-3, and many others. I can honestly say that Dr. Labor and his staff run an excellent facility and operation compared to these other organizations. They set the bar high, and are far ahead of the competition from my perspective. I’d highly recommend his facility to anyone regardless of your geographic location. For now, my own sniper eyes are good-to-go, if they start having problems I’ll have no problem flying to Texas. Excellence matters and I want only the best working on my eyes.”

 

In an email to Brandon, thanking him for coming, Dr. Labor said:

 

“The reports I have from those in attendance have been nothing but positive. I really think it helped my staff to hear about those attributes from someone other than me, and will serve the practice and my patients well going forward. I hope you enjoyed being here as much as we enjoyed having you. I know the girls in the operating room loved having you there (as did the patients; particularly the Vietnam veteran we operated on)!”

Source: http://www.eyectexas.com/blog/praise-from-navy-seal-best-selling-author/

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Tactical and Remote Medicine Classes

Source: http://adventuredoc.net/2011/08/16/tactical-and-remote-medicine-classes/

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What to expect when considering LASIK

If you’ve ever considered LASIK here in Dallas / Fort Worth, the first thought might have been, “what can I expect?” Like a lot of medical procedures, LASIK surgery has advanced and improved over the years. Today, LASIK is allowing more patients to become less dependent on glasses or contact lenses. It’s not uncommon for our patients to tell us, “my eyesight is better without glasses than it was with glasses before I had surgery.”

Here is a shortlist of the most important things to expect:

1. A thorough examination to see if you’re a LASIK candidate. First, you must be 18 or older to have it performed. People well into their 40’s can be LASIK candidates as well. Age, vision health, and overall health can make a difference.

2. For your doctor to tell you everything you need to know. LASIK has become safer, more effective, and with faster recovery times. Still, LASIK is a surgical procedure, which is why your doctor should shoot straight with you (as ours do) about the benefits and any potential complications. This includes taking the time to answer your questions and listen to your concerns.

3. Skill, experience, and advanced technology. Phillips Kirk Labor, MD is known locally here in metro Dallas, and internationally, as a LASIK innovator, but also for his devotion to each patient’s well being. He uses an advanced procedure called iLASIK, which combines the Intralase IFS Femtosecond Laser with VISX technology. iLASIK was designed to improve results, but also safety, and patient comfort (an added comfort is that we perform the entire procedure in our office).

4. Mild, temporary post-surgery discomfort. The procedure itself involves very minimal or no discomfort, and takes only a few minutes. After surgery, a mild scratchiness, burning or itching is normal, which quickly improves as the eyes adjust and heal. We tell our patients to immediately get rest and use special eye drops we prescribe to speed the healing process.

5. Better vision. Our patients generally see better right after surgery, which continually improves as the days progress. LASIK isn’t permanent, and results can vary. But most every LASIK patient can enjoy clear vision for many years. This is why every LASIK procedure starts with a thorough examination – to ensure the best outcome, but also to inform you of everything that will happen.

There is much more our doctors can tell you about what to expect. If you’re considering LASIK, please call our Metro Dallas offices in Grapevine at 877-516-4364 to learn more and read what other patients have to say.

 

Source: http://www.eyectexas.com/blog/dallas-lasik-fort-worth/

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Fertility – a much wider issue

When people are broached with the subject of fertility, one often associates it is to an individual family’s desire to have children. However, as Professor Nargund expresses in her paper “Declining birth rate in Developed Countries: A radical re-think is required”, the subject touches society much more widely as a whole for both the developed [...]

Source: http://www.createhealthclinics.org/blog/fertility/fertility-a-much-wider-issue/

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Interview With Wendy Schauer – Author of The 7 Steps To Amazing Health!

Here is a link to an interview that “foodie”, health advocate, and grass fed beef rancher Lisa Wilcox recently did with author Wendy Schauer.

http://nwlocalgrassfedbeef.com/interview-with-wendy-schauer-author-speaker-chiropractor-kettlebell-trainer/

Yours In Health!

G.E. Moon II

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Source: http://www.abundanthealthcenter.com/blog/interview-with-wendy-schauer-author-of-the-7-steps-to-amazing-health

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Ivan Pavlov is alive and well, though forgotten (Essay 22)

Source: http://bernardlown.wordpress.com/2011/05/19/ivan-pavlov-is-alive-and-well-though-forgotten-essay-2/

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A Maverick’s Lonely Path in Cardiology (Essay 28)

Source: http://bernardlown.wordpress.com/2012/03/10/mavericks-lonely-path-in-cardiology/

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Baltimore Laser Eye Surgeon Dr. Grochmal Launches New Website

Dr. Jay C. Grochmal, a laser eye surgeon in Baltimore, is launching an innovative website to enhance his ability to help his vision correction patients. In collaboration with Rosemont Media™, a medical website design firm in San Diego, CA, Dr. Grochmal’s new website is a comprehensive resource of information showcasing the range of procedures he offers, including vision correction procedures such as LASIK, and treatment for eye diseases such as glaucoma and cataract surgery in Baltimore, MD and the Washington, DC area.

Dr. Grochmal’s website features detailed descriptions of both corrective and cosmetic procedures such as eyelid surgery in Baltimore, as well as a doctor biography, patient testimonials, and financing options. In addition to the in-depth breakdown of the procedures and treatments Dr. Grochmal provides, his website also includes direct links to his social media sites, such as Facebook and Twitter to foster the growth of an online community centering around his practice and his patients’ experiences. Please welcome to the web, www.grochmaleye.com!

Source: http://www.grochmaleye.com/uncategorized/baltimore-laser-eye-surgeon-dr-grochmal-launches-new-website/

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Dr. Jarob N. Mushaweh, MD, Waterbury, CT, 06708

Website Address: 

Neurosurgery, Othopedics, and Spine Specialists Website Link

Phone: 

(800) 463-8764

Source: http://www.spine-health.com/doctor/neurosurgeon/jarob-mushaweh-waterbury-ct

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Top 5 Myths of Glaucoma

Most people have heard of glaucoma, but few know the whole story.  In short, glaucoma is an eye condition where the optic nerve becomes damaged, usually as a result of increased pressure in the eye.  This damaging of the optic nerve ultimately causes a gradual but serious loss of vision.  Untreated, the disease often results in complete blindness.

Now that you have a basic understanding of glaucoma, let’s clear up a few of the most common myths surrounding this serious condition.

Here are the top 5 myths of glaucoma:

1. Myth:  Glaucoma is rare.
Fact: On the contrary, it has been estimated that over 2 million Americans are suffering from glaucoma.  Even more disturbing is the fact that glaucoma remains a leading cause of blindness in the US.

2. Myth:  Only patients with a family history can develop glaucoma.
Fact: Although certain factors like age and heredity can increase your chances of developing glaucoma, the condition can affect anyone, anywhere and at any age.

3. Myth:  Glaucoma cannot be treated.
Fact: While there is currently no cure, there are a host of Glaucoma Treatments aimed at minimizing the risk of permanent vision loss. These treatments include medications, eye drops and surgery.

4. Myth: Only patients with glaucoma symptoms should get checked out.
Fact: The majority of glaucoma patients do not experience any symptoms before the optic nerve actually becomes damaged.  For this reason, regular glaucoma screenings are vitally important.

5. Myth:  Glaucoma screenings are painful.
Fact: Glaucoma screenings test different things—visual field, pressure in the eye, etc.  Each of these tests are not only quick, but non-painful.

Get Checked!  Schedule a Glaucoma Screening Today

To schedule a glaucoma screening or to learn about any of the ophthalmology services we offer, we encourage you to contact us today.  Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.  We look forward to seeing you.

Source: http://www.seeclear.com/blog/glaucoma/top-5-myths-of-glaucoma

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Cholera in Cuba

The first outbreak of cholera in over a century has been reported by the Cuban Ministry of Public Health. The risk to travellers is low, but they should be aware that Cholera can be spread via food being prepared by a person who is ill with the disease.

Travellers are advised to take care with food and water, and to ensure they eat seafood such as crabs and crayfish only when it has been cooked through and is thoroughly hot.

Source: ProMed Newsgroup Aug 2012

For further advice, contact the Globe Travel Health Centre on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/cholera-in-cuba.html?utm_source=rss&utm_medium=rss&utm_campaign=cholera-in-cuba

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