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  • November 09, 2017 1:46 PM | Ashley Monson (Administrator)

    by Molly Walker, Staff Writer, MedPage, November 06, 2017


    BALTIMORE -- More than 21 million pregnant women, or an average of 18% of women worldwide, are colonized with group B Streptococcus bacteria, or GBS, which contributes to stillbirth, preterm birth, and in some cases, death in their infants, researchers here estimated.

    While India had the largest number of pregnant women with group B Streptococcus (over 2 million), the United States was fourth after China and Nigeria, with almost 1 million women colonized with the bacteria, reported Anna Seale, BMBCh, and Joy Lawn, BMedSci, both of the London School of Hygiene & Tropical Medicine, and colleagues.

    In an 11-paper supplement published in Clinical Infectious Diseases, researchers detailed global estimates of the burden of group B Streptococcusbacteria among pregnant women, as well as the impact on infants and stillbirths, with the goal of moving closer to developing a vaccine.

    The data were presented simultaneously at the American Society of Tropical Medicine & Hygieneannual meeting here.

    While incidence of GBS previously focused mostly on infant cases in high-income countries, researchers described worldwide burden of the bacteria as "one of the great 'black holes' for public health worldwide." They added that this is the first comprehensive study of the burden of group B Streptococcus including outcomes for both pregnant women and their babies.

    Researchers also performed a series of systematic reviews and meta-analyses. To estimate colonization data for pregnant women, they analyzed 390 articles from 84 countries, for a total of almost 300,000 pregnant women. In the 188 studies that met CDC-recommended criteria, researchers found the average adjusted estimate for maternal group B Streptococcus global colonization was 18% (95% CI 17%-19%), with substantial regional variation, ranging from 11% in Eastern Asia to 35% in the Caribbean.

    Seale & Lawn and colleagues also found that out of 15 examined studies, a single study estimated the incidence of "invasive maternal GBS disease" at 0.38% per 1,000 pregnancies. Pooled estimates found that two-thirds of cases were detected during labor and delivery or post-partum. The overall case fatality risk of pregnant or postpartum women experiencing invasive GBS was 0.20% (11 studies, 2 deaths, 890 cases), researchers said.

    They then estimated the cases of group B Streptococcus colonization worldwide using a compartmental model, and found that of 140 million live births in 2015, 21.3 million infants were exposed to maternal GBS colonization at delivery. Moreover, they estimated there were 319,000 cases of infant invasive GBS disease worldwide, with 205,000 early-onset GBS disease and 114,000 late-onset GBS cases.

    Researchers estimated 90,000 infant deaths due to group B Strep disease worldwide. Notably, they estimated 51,000 infant deaths due to early-onset GBS without access to healthcare. Stillbirth attributable to GBS disease was estimated at 57,000 cases, and the range of cases of preterm birth caused by GBS disease was 0 to 3.5 million.

    Researchers noted that the treatment for pregnant women with group B Streptococcus is antibiotics prior to delivery, with 60 countries having an antibiotic policy for use in pregnancy that aims to prevent newborn GBS disease.

    While intrapartum antibiotic prophylaxis prevented an estimated 29,000 infant deaths attributable to early-onset GBS and 3,000 deaths attributable to late-onset GBS, gaps in research remain.

    "Existing recommendations should be implemented, but these are insufficient, and the number of affected families remain unacceptable," co-author Johan Vekemans, MD, of the World Health Organization, said in a statement. "It is now essential to accelerate the GBS vaccine development activities."

    Indeed, researchers estimate that with worldwide maternal vaccination, a vaccine with 80% efficacy and 50% coverage would prevent an estimated 127,000 infant and maternal cases of GBS, 23,000 stillbirths, and 37,000 infant deaths.

    Vekemans added that a "comprehensive evaluation" is needed on the cost-effectiveness of a vaccine against group B Streptococcus, and work is needed to strengthen existing maternal immunization programs worldwide.

    This supplement was supported by the Bill & Melinda Gates Foundation.

    Authors disclosed support from the Bill & Melinda Gates Foundation, Wellcome Trust, Medical Research Council UK, the Thrasher Foundation, the Meningitis Research Foundation, the NIH, Sequirus Inc, CureVac Inc, Pfizer Inc., Novartis, Belpharma Eumedica, GlaxoSmithKline and Minervax.

    Members of the Expert Advisory Group received reimbursement for travel expenses to attend working meetings related to this series.

    LAST UPDATED 11.07.2017

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
    Primary Source
    American Society of Tropical Medicine & Hygiene Secondary Source
    Clinical Infectious Diseases


  • November 06, 2017 11:37 AM | Ashley Monson (Administrator)

    The November 2017 ACOG Practice bulletin, entitled Long-Acting Reversible Contraception: Implants and Intrauterine Devices, summarized data regarding the extended use of levonogestrel IUDs. The bulletin stated the following: “Current data support the efficacy of the LNG-20 beyond its approved duration of use. Extended-use studies are ongoing…”. The current FDA approval for duration of use of levonogetrel IUDs is 5 years for levonogestrel-20 (Mirena®), 4 years for levonogestrel-18.6 (Liletta®), 5 years for levonogestrel-19.5 (Kyleena®), and 3 years for levonogestrel-13.5 (Skyla®) and these recommendations should be followed until studies are complete and evidence clearly outlines efficacy for longer duration of use. 


  • November 03, 2017 8:39 AM | Ashley Monson (Administrator)

    AAPA
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    Read more.

  • October 31, 2017 8:04 AM | Ashley Monson (Administrator)

    INDIANAPOLIS—The Indiana State Department of Health (ISDH) today kicked off a strategic planning effort designed to identify and reduce the state’s number of cervical cancer cases and deaths. September is National Gynecologic Cancer Awareness Month, and the ISDH marked the occasion by bringing together public health experts, medical professionals, researchers and others across the state to discuss ways to protect Hoosiers from this disease.

    “Cervical cancer is nearly 100 percent preventable, yet every year, Indiana women die from this terrible disease,” said Deputy State Health Commissioner Pamela Pontones. “By convening key leaders from all corners of our state, we can work together to reduce the burden of cervical cancer and save lives.”

    Cervical cancer is an abnormal growth of cells on, or that began in, the cervix. It is nearly 100 percent preventable through regular routine screening, avoiding tobacco products and other controllable risk factors, and vaccination against the human papillomavirus (HPV).

    In Indiana, 1,283 new cases of cervical cancer were diagnosed and 446 cervical cancer-related deaths occurred from 2011–2015, according to the Indiana State Cancer Registry. The American Cancer Society estimates that nationally in 2017, 12,820 new cases of cervical cancer will be diagnosed and 4,210 deaths will occur.

    HPV is the single greatest risk factor for cervical cancer. According to the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians and the American College of Physicians, all boys and girls ages 11 or 12 should get vaccinated against HPV. Although older teens and young adults can receive the vaccine through age 26, studies have shown that the vaccine produces a better immune response at earlier ages.

    House Bill 1278, enacted earlier this year, charged ISDH with identifying methods to increase the number of Hoosiers vaccinated for HPV, increasing regular cervical cancer screenings and creating partnerships throughout the state to reduce the number of cases.

    Visit the Indiana Cancer Consortium (ICC) at http://indianacancer.org/cervical_cancer_toolkit/ for more information on cervical cancer, risk factors and prevention.

    Follow ISDH on Twitter at @StateHealthIN and on Facebook at www.facebook.com/isdh1 for important health and safety updates.

    ###


  • October 31, 2017 8:02 AM | Ashley Monson (Administrator)

    For immediate release: September 26, 2017
    Contact: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    (404) 639-8895   |   NCHHSTPMediaTeam@cdc.gov

    Latest U.S. data reveal threat to multiple populations

    Resources

    More than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016, the highest number ever, according to the annual Sexually Transmitted Disease Surveillance Report released today by the Centers for Disease Control and Prevention (CDC).

    The majority of these new diagnoses (1.6 million) were cases of chlamydia. There were also 470,000 gonorrhea cases and almost 28,000 cases of primary and secondary syphilis – the most infectious stages of the disease. While all three of these STDs can be cured with antibiotics, if left undiagnosed and untreated, they can have serious health consequences, including infertility, life-threatening ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission.

    “Increases in STDs are a clear warning of a growing threat,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “STDs are a persistent enemy, growing in number, and outpacing our ability to respond.”

    Epidemic accelerating in multiple populations—impact growing in women, infants, and gay and bisexual men

    This figure shows that STDs are accelerating among men, particularly gay and bisexual men. Men accounted for more than 89 percent (24,724 cases) of all primary and secondary syphilis cases in 2016. Men who have sex with men accounted for 81 percent (16,155 cases) of male cases where the sex of the sex partner is known in 2016. Syphilis among men increased about 15 percent between 2015 and 2016, from 14 cases per 100,000 men in 2015 to 16 cases per 100,000 men in 2016.

    While young women continue to bear the greatest burden of chlamydia (nearly half of all diagnosed infections), surges in syphilis and gonorrhea are increasingly affecting new populations.

    Syphilis rates increased by nearly 18 percent overall from 2015 to 2016. The majority of these cases occur among men – especially gay, bisexual and other men who have sex with men (MSM) – however, there was a 36 percent increase in rates of syphilis among women, and a 28 percent increase in syphilis among newborns (congenital syphilis) during this period.

    More than 600 cases of congenital syphilis were reported in 2016, which has resulted in more than 40 deaths and severe health complications among newborns. The disease is preventable through routine screening and timely treatment for syphilis among pregnant women.

    “Every baby born with syphilis represents a tragic systems failure,” said Gail Bolan, director of CDC’s Division of STD Prevention. “All it takes is a simple STD test and antibiotic treatment to prevent this enormous heartache and help assure a healthy start for the next generation of Americans.”

    While gonorrhea increased among men and women in 2016, the steepest increases were seen among men (22 percent). Research suggests that a large share of new gonorrhea cases are occurring among MSM. These trends are particularly alarming in light of the growing threat of drug resistance to the last remaining recommended gonorrhea treatment.

    MSM also bear a great syphilis burden. MSM make up a majority of syphilis cases, and half of MSM diagnosed with syphilis were also living with HIV – pointing to the need to integrate STD and HIV prevention and care services.

    Essential to confront most urgent threats, upgrade prevention infrastructure

    CDC uses STD surveillance data and other tools to detect and respond to these evolving threats and new challenges, directing resources where they can have the greatest impact. Targeted efforts include:

    • Strengthening the congenital syphilis response with focused efforts to improve diagnosis and treatment of pregnant women and ensure prompt treatment of newborns at birth in the ten states hardest hit by congenital syphilis.
    • Helping state and local health departments rapidly test for drug-resistant gonorrhea and quickly find and treat affected individuals, as part of the federal government’s Combating Antibiotic Resistant Bacteria (CARB) Action Plan.
    • Assisting state health departments and health clinics integrate STD prevention into care for people living with HIV.

    Maintaining and strengthening core prevention infrastructure is also essential to mounting an effective national response to the STD epidemic. CDC provides support to state and local health departments for disease surveillance, disease investigation, and health promotion. CDC also issues and maintains testing and treatment guidelines for providers so individuals get the most effective care.

    Turning back the rise in STDs will require renewed commitment from all players:

    • State and local health departments should refocus efforts on STD investigation and clinical service infrastructure for rapid detection and treatment for people living in areas hardest hit by the STD epidemic.
    • Providers should make STD screening and timely treatment a standard part of medical care, especially for pregnant women and MSM. They should also try to seamlessly integrate STD screening and treatment into prenatal care and HIV prevention and care services.
    • Everyone should talk openly about STDs, get tested regularly, and reduce risk by using condoms or practicing mutual monogamy if sexually active.

    “CDC uses its national-level intelligence to detect and respond to STD outbreaks while supporting the nation’s on-the-ground workers who are spending each day protecting communities from STDs,” Dr. Mermin stressed.

    For more information on the new analysis and CDC’s HIV prevention efforts, visit www.cdc.gov/nchhstp/newsroom.

    ###

    U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

    CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.


  • October 27, 2017 9:07 AM | Ashley Monson (Administrator)

    Today’s Long-Acting Reversible Contraception: Practical Considerations

    Deanna Najera, MPAS, MS, PA-C, NCC; Nisha McKenzie, PA-C

    This activity is designed to equip PAs with guideline and evidence-based knowledge on several forms of birth control methods, relevant safety and efficacy data, and common concerns and priorities related to Long-Acting Reversible Contraception (LARC) that generally apply to women at various life stages. By doing so, the education aims to also improve patient counseling regarding contraceptive options, effectiveness, risks, and benefits.

    Educational Objectives

    At the conclusion of this activity, you should be able to: 
    • Evaluate safety and efficacy data on long-acting reversible contraception (LARC) options, with a focus on research and treatment guidelines related to LARC options
    • Describe common concerns and priorities related to contraception that generally apply to women at various life stages and should be considered for clinician-patient discussions

    Accreditation Statement

    This activity has been reviewed and is approved for a maximum of 1.0 AAPA Category 1 Self-Assessment CME credit by the AAPA Review Panel. Participants should only claim credit commensurate with their participation in the CME activity. This program was planned in accordance with AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs. Approval valid until July 31, 2018.

    Disclosure Policy Statement

    It is the policy of AAPA to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member has with the commercial interest of any commercial product discussed in an educational presentation. The participating faculty reported the following:

    Faculty

    Deanna Najera, MPAS, MS, PA-C, NCC
    Emergency Medical Associates, PA, PC
    Carroll Hospital Emergency Department in Westminster, MD
    True North Wellness Services, Hanover, PA
    Chair, AAPA Commission Health of the Public 2016-2017
    No commercial relationships to disclose

    Nisha McKenzie, PA-C
    Grand Rapids OB/GYN
    Center for Women's Sexual Health - Founder and Director
    Great Lakes Sexual Health Alliance - Co-Founder and Director of Finance
    Sexuality Educator
    AASECT Certified Sexuality Counselor
    No commercial relationships to disclose

    Activity Planners

    Marie-Michele Leger, MPH, PA-C
    AAPA
    Alexandria, VA
    No commercial relationships to disclose

    Wendy Scales, PhD
    The France Foundation
    Old Lyme, CT
    No commercial relationships to disclose

    Heather Tarbox, MPH
    The France Foundation
    Old Lyme, CT
    No commercial relationships to disclose

    Off-Label/Unapproved Product(s) Discussion

    There are no references to off-label/unapproved uses of products in this program. 

    Disclaimer

    The opinions and comments expressed by faculty and other experts, whose input is included in this program, are their own. This enduring material is produced for educational purposes only. Please review complete prescribing information of specific drugs mentioned in this program including indications, contraindications, warnings, and adverse effects and dosage before administering to patients.

    Acknowledgement of Commercial Support

    Supported by an educational grant from Bayer 

    AAPA offers no returns or refunds for online CME activities purchased through the AAPA store. All sales are final.


  • October 20, 2017 8:44 AM | Ashley Monson (Administrator)

    November 16, 2017
    7 PM CT/8 PM ET/5 PM PT

    Topic: Physical Therapy in Women's Health
    Speaker: Carol Figuers, MS, PT, EdD, Professor, Doctor of Physical Therapy Division, Duke University School of Medicine


    This webinar will provide potential referral information for the primary care provider working with patients who present with pregnancy and pelvic floor related concerns.  In particular, the special evaluation and treatment skills implemented by the physical therapist to manage these complex musculoskeletal and behavioral issues will be described and discussed.

    Objectives:  

    1.  Understand the roles and responsibilities of the physical therapist in working with obstetrical patients during and after pregnancy and childbirth.
    2.  Recognize physical therapist interventions for prenatal and postpartum women.
    3. Describe the types, causes and symptoms of urinary incontinence.
    4. Identify the most common types of female pelvic pain.
    5. Describe the role of the physical therapist in evaluation and intervention for pelvic floor dysfunction.

    This program has been reviewed and is approved for a maximum of 1.00 AAPA Category 1 CME credits by the PA Review Panel. PAs should claim only the credit commensurate with the extent of their participation in the activity. 

    This program was planned in accordance with AAPA's CME Standards for Live Programs and for Commercial Support of Live Programs. 


  • October 20, 2017 8:39 AM | Ashley Monson (Administrator)

    In Seattle, an increasing number of gonorrhea infections in men who have sex with men have demonstrated reduced susceptibility to azithromycin - one of two drugs recommended to treat the increasingly drug-resistant STD.  

  • October 20, 2017 8:38 AM | Ashley Monson (Administrator)

    California Governor Jerry Brown has signed first-of-its kind legislation that enables residents of the state to choose a third, non-binary gender category on California state-issued IDs, birth certificates and driver's licenses.


  • October 19, 2017 12:14 PM | Ashley Monson (Administrator)

    Every year 40,000 women die from breast cancer in the U.S. alone. When cancers are found early, they can often be cured. Mammograms are the best test available, but they're still imperfect and often result in false positive results that can lead to unnecessary biopsies and surgeries.

    One common cause of false positives are so-called "high-risk" lesions that appear suspicious on mammograms and have abnormal cells when tested by . In this case, the patient typically undergoes surgery to have the lesion removed; however, the lesions turn out to be benign at surgery 90 percent of the time. This means that every year thousands of women go through painful, expensive, scar-inducing surgeries that weren't even necessary.

    How, then, can unnecessary surgeries be eliminated while still maintaining the important role of mammography in  detection? Researchers at MIT's Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts General Hospital, and Harvard Medical School believe that the answer is to turn to artificial intelligence (AI).

    As a first project to apply AI to improving detection and diagnosis, the teams collaborated to develop an AI system that uses  to predict if a high-risk lesion identified on needle biopsy after a mammogram will upgrade to cancer at surgery.

    When tested on 335 high-risk lesions, the  correctly diagnosed 97 percent of the breast cancers as malignant and reduced the number of benign surgeries by more than 30 percent compared to existing approaches.

    "Because diagnostic tools are so inexact, there is an understandable tendency for doctors to over-screen for ," says Regina Barzilay, MIT's Delta Electronics Professor of Electrical Engineering and Computer Science and a breast cancer survivor herself. "When there's this much uncertainty in data, machine learning is exactly the tool that we need to improve detection and prevent over-treatment."

    Trained on information about more than 600 existing high-risk lesions, the model looks for patterns among many different data elements that include demographics, family history, past biopsies, and pathology reports.

    A recent MacArthur "genius grant" recipient, Barzilay is a co-author of a new journal article describing the results, co-written with Lehman and Manisha Bahl of MGH, as well as CSAIL graduate students Nicholas Locascio, Adam Yedidia, and Lili Yu. The article was published today in the medical journal Radiology.How it works


    When a mammogram detects a suspicious lesion, a needle biopsy is performed to determine if it is cancer. Roughly 70 percent of the lesions are benign, 20 percent are malignant, and 10 percent are high-risk lesions.

    Doctors manage high-risk lesions in different ways. Some do surgery in all cases, while others perform surgery only for lesions that have higher cancer rates, such as "atypical ductal hyperplasia" (ADH) or a "lobular carcinoma in situ" (LCIS).

    The first approach requires that the patient undergo a painful, time-consuming, and expensive surgery that is usually unnecessary; the second approach is imprecise and could result in missing cancers in high-risk lesions other than ADH and LCIS.

    "The vast majority of patients with high-risk lesions do not have cancer, and we're trying to find the few that do," says Bahl, a fellow doctor at MGH's Department of Radiology. "In a scenario like this there's always a risk that when you try to increase the number of cancers you can identify, you'll also increase the number of  you find."

    Using a method known as a "random-forest classifier," the team's model resulted in fewer unnecessary surgeries compared to the strategy of always doing surgery, while also being able to diagnose more  than the strategy of only doing surgery on traditional "high-risk lesions." (Specifically, the new model diagnosed 97 percent of cancers compared to 79 percent.)

    "This work highlights an example of using cutting-edge machine learning technology to avoid unnecessary ," says Marc Kohli, director of clinical informatics in the Department of Radiology and Biomedical Imaging at the University of California at San Francisco. "This is the first step toward the medical community embracing machine learning as a way to identify patterns and trends that are otherwise invisible to humans."

    Lehman says that MGH radiologists will begin incorporating the model into their clinical practice over the next year.

    "In the past we might have recommended that all high-risk lesions be surgically excised," Lehman says. "But now, if the model determines that the lesion has a very low chance of being cancerous in a specific patient, we can have a more informed discussion with our patient about her options. It may be reasonable for some patients to have their  followed with imaging rather than surgically excised."

    The team says that they are still working to further hone the model.

    "In future work we hope to incorporate the actual images from the mammograms and images of the pathology slides, as well as more extensive patient information from medical records," says Bahl.

    Moving forward, the model could also easily be tweaked to be applied to other kinds of cancer and even other diseases entirely.

    "A model like this will work anytime you have lots of different factors that correlate with a specific outcome," says Barzilay. "It hopefully will enable us to start to go beyond a one-size-fits-all approach to medical diagnosis."

    Explore further: Machine learning identifies breast lesions likely to become cancer

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