Madhu Rajaraman

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

Information obtained from computed tomography (CT) scans may help predict reherniation and surgical site infection (SSI) in patients who had complex ventral hernia repair with the component separation technique (CST), according to findings published in Hernia.

jacoblund/Thinkstock

In a study of 65 adults who had a CT performed before CST, visceral fat volume was a significant predictor of reherniation (P = .025, odds ratio 1.65), reported Harm Winters of the department of plastic and reconstructive surgery at Radboud University Medical Center, Nijmegen, the Netherlands, and coauthors.

Patients were 18-75 years of age, and had complex ventral hernia repair via CST between 2000 and 2013. Patients were excluded if the CT scan was performed earlier than 6 months before hernia repair, or if the scan did not cover the full abdomen.

Visceral fat volume, subcutaneous fat volume, loss of domain, rectus thickness and width, abdominal volume, hernia sac volume, total fat volume, sagittal distance, and waist circumference were measured. Mesh reinforcement during surgery was used in 45 patients (69.2%), the authors noted.

Hernia sac volume and subcutaneous fat volume per 1,000 cm³ were significant predictors of surgical site infection (P = .020, OR 2.10 and P = .034, OR 0.26, respectively).

“These findings suggest that CT measurements are a valuable tool for preoperative risk assessment in patients undergoing complex ventral hernia repair using the CST,” the researchers wrote. Future trials should “further identify the role of these CT scan-derived body morphometrics for patient-tailored risk assessment,” they concluded.

No conflicts of interest were reported.

SOURCE: Winters H et al. Hernia. 2019 Mar 7. doi: 10.1007/s10029-019-01899-8.

Information obtained from computed tomography (CT) scans may help predict reherniation and surgical site infection (SSI) in patients who had complex ventral hernia repair with the component separation technique (CST), according to findings published in Hernia.

jacoblund/Thinkstock

In a study of 65 adults who had a CT performed before CST, visceral fat volume was a significant predictor of reherniation (P = .025, odds ratio 1.65), reported Harm Winters of the department of plastic and reconstructive surgery at Radboud University Medical Center, Nijmegen, the Netherlands, and coauthors.

Patients were 18-75 years of age, and had complex ventral hernia repair via CST between 2000 and 2013. Patients were excluded if the CT scan was performed earlier than 6 months before hernia repair, or if the scan did not cover the full abdomen.

Visceral fat volume, subcutaneous fat volume, loss of domain, rectus thickness and width, abdominal volume, hernia sac volume, total fat volume, sagittal distance, and waist circumference were measured. Mesh reinforcement during surgery was used in 45 patients (69.2%), the authors noted.

Hernia sac volume and subcutaneous fat volume per 1,000 cm³ were significant predictors of surgical site infection (P = .020, OR 2.10 and P = .034, OR 0.26, respectively).

“These findings suggest that CT measurements are a valuable tool for preoperative risk assessment in patients undergoing complex ventral hernia repair using the CST,” the researchers wrote. Future trials should “further identify the role of these CT scan-derived body morphometrics for patient-tailored risk assessment,” they concluded.

No conflicts of interest were reported.

SOURCE: Winters H et al. Hernia. 2019 Mar 7. doi: 10.1007/s10029-019-01899-8.

Information obtained from computed tomography (CT) scans may help predict reherniation and surgical site infection (SSI) in patients who had complex ventral hernia repair with the component separation technique (CST), according to findings published in Hernia.

jacoblund/Thinkstock

In a study of 65 adults who had a CT performed before CST, visceral fat volume was a significant predictor of reherniation (P = .025, odds ratio 1.65), reported Harm Winters of the department of plastic and reconstructive surgery at Radboud University Medical Center, Nijmegen, the Netherlands, and coauthors.

Patients were 18-75 years of age, and had complex ventral hernia repair via CST between 2000 and 2013. Patients were excluded if the CT scan was performed earlier than 6 months before hernia repair, or if the scan did not cover the full abdomen.

Visceral fat volume, subcutaneous fat volume, loss of domain, rectus thickness and width, abdominal volume, hernia sac volume, total fat volume, sagittal distance, and waist circumference were measured. Mesh reinforcement during surgery was used in 45 patients (69.2%), the authors noted.

Hernia sac volume and subcutaneous fat volume per 1,000 cm³ were significant predictors of surgical site infection (P = .020, OR 2.10 and P = .034, OR 0.26, respectively).

“These findings suggest that CT measurements are a valuable tool for preoperative risk assessment in patients undergoing complex ventral hernia repair using the CST,” the researchers wrote. Future trials should “further identify the role of these CT scan-derived body morphometrics for patient-tailored risk assessment,” they concluded.

No conflicts of interest were reported.

SOURCE: Winters H et al. Hernia. 2019 Mar 7. doi: 10.1007/s10029-019-01899-8.

Giant incisional hernia repair outcomes were similar for full thickness skin graft (FTSG) and synthetic mesh, according to findings published in Hernia.

castillodominici/Thinkstock

In a prospective, randomized study of 52 patients (24 who received FTSG and 28 who received synthetic mesh), two recurrences were found at 1-year follow up in each group. Results for pain, patient satisfaction, and aesthetic outcome did not differ significantly between the groups, reported Viktor Holmdahl of the department of surgery and perioperative sciences at Umeå (Sweden) University and his coauthors.

Patients were aged 18 years or older, with symptomatic giant (greater than 10 cm) ventral incisional hernia. All patients had computerized tomography (CT) imaging of the abdominal wall, and were assessed for abdominal wall muscle strength via the Biodex Multi-Joint System-4.

The synthetic mesh used was a polypropylene mesh overlapping the repaired hernia defect by at least 5 cm. The FTSG was always placed in an onlay position, and was taken from excess skin adjacent to the midline incision made for the hernia repair. Postoperative care was identical for both groups, Dr. Holmdahl and his colleagues reported.

At 1 year, all patients received a follow-up Biodex assessment and were evaluated for recurrence. Aesthetic outcomes such as scar appearance and wound healing were assessed. Patients self-reported pain levels using a visual analogue scale.

Two patients in both the FTSG group (8.3%) and the synthetic mesh group (7.1%) had recurrence (P = 1.000). Differences between groups for the other measures were not significant, including for well-healed scars (91.3% for FTSG vs. 96.4% for synthetic mesh) and excess skin (60.9% vs. 57.1%). Biodex results also did not differ significantly between the groups.

The similarities in results between the two techniques “indicate that FTSG possibly has a future role in hernia repair, but more research is needed,” the authors concluded.

The study was supported by the Swedish Research Council and by a regional agreement between Umeå University and Västerbotten County Council. The investigators declared no conflicts of interest.

SOURCE: Holmdahl V et al. Hernia 2019 Feb 8. doi: 10.1007/s10029-019-01900-4.

Giant incisional hernia repair outcomes were similar for full thickness skin graft (FTSG) and synthetic mesh, according to findings published in Hernia.

castillodominici/Thinkstock

In a prospective, randomized study of 52 patients (24 who received FTSG and 28 who received synthetic mesh), two recurrences were found at 1-year follow up in each group. Results for pain, patient satisfaction, and aesthetic outcome did not differ significantly between the groups, reported Viktor Holmdahl of the department of surgery and perioperative sciences at Umeå (Sweden) University and his coauthors.

Patients were aged 18 years or older, with symptomatic giant (greater than 10 cm) ventral incisional hernia. All patients had computerized tomography (CT) imaging of the abdominal wall, and were assessed for abdominal wall muscle strength via the Biodex Multi-Joint System-4.

The synthetic mesh used was a polypropylene mesh overlapping the repaired hernia defect by at least 5 cm. The FTSG was always placed in an onlay position, and was taken from excess skin adjacent to the midline incision made for the hernia repair. Postoperative care was identical for both groups, Dr. Holmdahl and his colleagues reported.

At 1 year, all patients received a follow-up Biodex assessment and were evaluated for recurrence. Aesthetic outcomes such as scar appearance and wound healing were assessed. Patients self-reported pain levels using a visual analogue scale.

Two patients in both the FTSG group (8.3%) and the synthetic mesh group (7.1%) had recurrence (P = 1.000). Differences between groups for the other measures were not significant, including for well-healed scars (91.3% for FTSG vs. 96.4% for synthetic mesh) and excess skin (60.9% vs. 57.1%). Biodex results also did not differ significantly between the groups.

The similarities in results between the two techniques “indicate that FTSG possibly has a future role in hernia repair, but more research is needed,” the authors concluded.

The study was supported by the Swedish Research Council and by a regional agreement between Umeå University and Västerbotten County Council. The investigators declared no conflicts of interest.

SOURCE: Holmdahl V et al. Hernia 2019 Feb 8. doi: 10.1007/s10029-019-01900-4.

Giant incisional hernia repair outcomes were similar for full thickness skin graft (FTSG) and synthetic mesh, according to findings published in Hernia.

castillodominici/Thinkstock

In a prospective, randomized study of 52 patients (24 who received FTSG and 28 who received synthetic mesh), two recurrences were found at 1-year follow up in each group. Results for pain, patient satisfaction, and aesthetic outcome did not differ significantly between the groups, reported Viktor Holmdahl of the department of surgery and perioperative sciences at Umeå (Sweden) University and his coauthors.

Patients were aged 18 years or older, with symptomatic giant (greater than 10 cm) ventral incisional hernia. All patients had computerized tomography (CT) imaging of the abdominal wall, and were assessed for abdominal wall muscle strength via the Biodex Multi-Joint System-4.

The synthetic mesh used was a polypropylene mesh overlapping the repaired hernia defect by at least 5 cm. The FTSG was always placed in an onlay position, and was taken from excess skin adjacent to the midline incision made for the hernia repair. Postoperative care was identical for both groups, Dr. Holmdahl and his colleagues reported.

At 1 year, all patients received a follow-up Biodex assessment and were evaluated for recurrence. Aesthetic outcomes such as scar appearance and wound healing were assessed. Patients self-reported pain levels using a visual analogue scale.

Two patients in both the FTSG group (8.3%) and the synthetic mesh group (7.1%) had recurrence (P = 1.000). Differences between groups for the other measures were not significant, including for well-healed scars (91.3% for FTSG vs. 96.4% for synthetic mesh) and excess skin (60.9% vs. 57.1%). Biodex results also did not differ significantly between the groups.

The similarities in results between the two techniques “indicate that FTSG possibly has a future role in hernia repair, but more research is needed,” the authors concluded.

The study was supported by the Swedish Research Council and by a regional agreement between Umeå University and Västerbotten County Council. The investigators declared no conflicts of interest.

SOURCE: Holmdahl V et al. Hernia 2019 Feb 8. doi: 10.1007/s10029-019-01900-4.

Elective hernia repair in patients with chronic liver disease was far safer than emergent repair and carried an acceptable level of morbidity and mortality, according to an analysis of all cases performed at the Cleveland Clinic from 2001-2015.

In a chart review of 253 patients with chronic liver disease (CLD) who underwent hernia repair between January 2001 and December 2015, the rate of postoperative 30-day morbidity and mortality was 27% for nonemergent repairs, compared with 60% in emergent repairs.

The 90-day mortality rate also was higher for emergent repairs (10%) than for nonemergent repairs (3.7%), reported Clayton C. Petro, MD, of the Cleveland Clinic, and his coauthors.

Thirty-day morbidity and mortality was defined as incidence of surgical-site infection (SSI), wound dehiscence, bacterial peritonitis, decompensated liver failure, postoperative admission to the intensive care unit, unplanned hospital readmission, unplanned reoperation, and 30-day mortality. CLD severity was determined using the Charlson Comorbidity Index (CCI), age-adjusted CCI, Child-Turcott-Pugh Score, laboratory values, and Model for End-Stage Liver Disease (MELD) Score.

Of the 253 patients, 186 (74%) had nonemergent repairs and 67 (26%) had emergent repairs; 91 patients (36%) experienced a total of 159 morbidity and mortality events, Dr. Petro and coauthors said.

Emergent repairs had significantly higher rates of postoperative ICU admission than nonemergent repairs (27% vs. 5%; P less than .0001). Emergent repairs also had higher rates of bacterial peritonitis (10% vs 3%; P = .02), unplanned reoperation (9% vs 1%; P = .005), and unplanned readmission (27% vs 14%, P = .02).

“This large single-center cohort of 253 CLD patients suggests that non-emergent hernia repairs have relatively acceptable rates of [morbidity and mortality], even with advanced liver disease,” the authors wrote. “The dramatic increase in postoperative complications and 90-day mortality in the emergent setting supports the practice of elective repair when possible.”

No disclosures or conflicts of interest were reported.

SOURCE: Petro C et al. Am J Surg. 2019:217;59-65.

Elective hernia repair in patients with chronic liver disease was far safer than emergent repair and carried an acceptable level of morbidity and mortality, according to an analysis of all cases performed at the Cleveland Clinic from 2001-2015.

In a chart review of 253 patients with chronic liver disease (CLD) who underwent hernia repair between January 2001 and December 2015, the rate of postoperative 30-day morbidity and mortality was 27% for nonemergent repairs, compared with 60% in emergent repairs.

The 90-day mortality rate also was higher for emergent repairs (10%) than for nonemergent repairs (3.7%), reported Clayton C. Petro, MD, of the Cleveland Clinic, and his coauthors.

Thirty-day morbidity and mortality was defined as incidence of surgical-site infection (SSI), wound dehiscence, bacterial peritonitis, decompensated liver failure, postoperative admission to the intensive care unit, unplanned hospital readmission, unplanned reoperation, and 30-day mortality. CLD severity was determined using the Charlson Comorbidity Index (CCI), age-adjusted CCI, Child-Turcott-Pugh Score, laboratory values, and Model for End-Stage Liver Disease (MELD) Score.

Of the 253 patients, 186 (74%) had nonemergent repairs and 67 (26%) had emergent repairs; 91 patients (36%) experienced a total of 159 morbidity and mortality events, Dr. Petro and coauthors said.

Emergent repairs had significantly higher rates of postoperative ICU admission than nonemergent repairs (27% vs. 5%; P less than .0001). Emergent repairs also had higher rates of bacterial peritonitis (10% vs 3%; P = .02), unplanned reoperation (9% vs 1%; P = .005), and unplanned readmission (27% vs 14%, P = .02).

“This large single-center cohort of 253 CLD patients suggests that non-emergent hernia repairs have relatively acceptable rates of [morbidity and mortality], even with advanced liver disease,” the authors wrote. “The dramatic increase in postoperative complications and 90-day mortality in the emergent setting supports the practice of elective repair when possible.”

No disclosures or conflicts of interest were reported.

SOURCE: Petro C et al. Am J Surg. 2019:217;59-65.

Elective hernia repair in patients with chronic liver disease was far safer than emergent repair and carried an acceptable level of morbidity and mortality, according to an analysis of all cases performed at the Cleveland Clinic from 2001-2015.

In a chart review of 253 patients with chronic liver disease (CLD) who underwent hernia repair between January 2001 and December 2015, the rate of postoperative 30-day morbidity and mortality was 27% for nonemergent repairs, compared with 60% in emergent repairs.

The 90-day mortality rate also was higher for emergent repairs (10%) than for nonemergent repairs (3.7%), reported Clayton C. Petro, MD, of the Cleveland Clinic, and his coauthors.

Thirty-day morbidity and mortality was defined as incidence of surgical-site infection (SSI), wound dehiscence, bacterial peritonitis, decompensated liver failure, postoperative admission to the intensive care unit, unplanned hospital readmission, unplanned reoperation, and 30-day mortality. CLD severity was determined using the Charlson Comorbidity Index (CCI), age-adjusted CCI, Child-Turcott-Pugh Score, laboratory values, and Model for End-Stage Liver Disease (MELD) Score.

Of the 253 patients, 186 (74%) had nonemergent repairs and 67 (26%) had emergent repairs; 91 patients (36%) experienced a total of 159 morbidity and mortality events, Dr. Petro and coauthors said.

Emergent repairs had significantly higher rates of postoperative ICU admission than nonemergent repairs (27% vs. 5%; P less than .0001). Emergent repairs also had higher rates of bacterial peritonitis (10% vs 3%; P = .02), unplanned reoperation (9% vs 1%; P = .005), and unplanned readmission (27% vs 14%, P = .02).

“This large single-center cohort of 253 CLD patients suggests that non-emergent hernia repairs have relatively acceptable rates of [morbidity and mortality], even with advanced liver disease,” the authors wrote. “The dramatic increase in postoperative complications and 90-day mortality in the emergent setting supports the practice of elective repair when possible.”

No disclosures or conflicts of interest were reported.

SOURCE: Petro C et al. Am J Surg. 2019:217;59-65.

Smoking before elective clean open ventral hernia repair (OVHR) was not associated with significant differences in postoperative wound morbidity or all 30-day morbidity, according to results published in Surgery.

castillodominici/Thinkstock

The question of the impact of smoking on infection risk and wound healing has been studied in a variety of surgical procedures. While some associations have been established (JAMA Surg. 2017;152[5]:476-83; Infect Immun. 2015;83[6]:2443-52), the data have not been strong enough to lead to recommendations that surgeons delay procedures until a patient stops smoking.

In a study of 418 active smokers and 418 matched patients who had never smoked, the rate of surgical site infection (SSI) was 4.1% in both groups (P = .98). The total 30-day complication rates were 7.5% for current smokers and 6.6% for nonsmokers (P = .60), reported Clayton C. Petro, MD, of the department of general surgery at the Cleveland Clinic Comprehensive Hernia Center, and his coauthors.

Patient data were obtained from the Americas Hernia Society Quality Collaborative (AHSQC), and included those who had undergone OVHR in a Centers for Disease Control and Prevention class 1 wound with 30-day follow-up.

Participants were grouped according to smoking status: those who had never smoked, those who had smoked within 30 days of operation (“current smokers”), and patients who had quit smoking more than 1 month before operation (“former smokers”). Current smokers were matched with never smokers by characteristics including age, sex, and body mass index, and conditions such as diabetes and hypertension. Former smokers were excluded.

The investigators collected data from both groups on SSI, surgical site occurrence (SSO), surgical site occurrence requiring a procedural intervention (SSOPI), and all 30-day morbidity (any morbidity event entered into the AHSQC database within 30 days of operation), the authors said.

Rates of SSI were 4.1% for both smokers and nonsmokers (P = .98). Rates of SSO were greater in current smokers (12.0% vs. 7.4%, P = .03). SSOPI and reoperation rates were similar in current and never smokers (6.2% vs. 5.0%, P = .43; 1.9% vs. 1.2%, P = .39, respectively).

The results suggest that “active smoking before an elective OVHR in a CDC class I wound has a clinically negligible impact on postoperative wound morbidity and all 30-day morbidity,” wrote Dr. Petro and his colleagues.

“Surgeons allowing perioperative smoking should monitor their outcomes to [ensure that] these findings are replicable in their own practice,” they concluded.

The study authors disclosed financial relationships with Medtronic, Ariste Medical, and other companies.

SOURCE: Petro CC et al. Surgery. 2019 Feb;165(2):406-11.

Smoking before elective clean open ventral hernia repair (OVHR) was not associated with significant differences in postoperative wound morbidity or all 30-day morbidity, according to results published in Surgery.

castillodominici/Thinkstock

The question of the impact of smoking on infection risk and wound healing has been studied in a variety of surgical procedures. While some associations have been established (JAMA Surg. 2017;152[5]:476-83; Infect Immun. 2015;83[6]:2443-52), the data have not been strong enough to lead to recommendations that surgeons delay procedures until a patient stops smoking.

In a study of 418 active smokers and 418 matched patients who had never smoked, the rate of surgical site infection (SSI) was 4.1% in both groups (P = .98). The total 30-day complication rates were 7.5% for current smokers and 6.6% for nonsmokers (P = .60), reported Clayton C. Petro, MD, of the department of general surgery at the Cleveland Clinic Comprehensive Hernia Center, and his coauthors.

Patient data were obtained from the Americas Hernia Society Quality Collaborative (AHSQC), and included those who had undergone OVHR in a Centers for Disease Control and Prevention class 1 wound with 30-day follow-up.

Participants were grouped according to smoking status: those who had never smoked, those who had smoked within 30 days of operation (“current smokers”), and patients who had quit smoking more than 1 month before operation (“former smokers”). Current smokers were matched with never smokers by characteristics including age, sex, and body mass index, and conditions such as diabetes and hypertension. Former smokers were excluded.

The investigators collected data from both groups on SSI, surgical site occurrence (SSO), surgical site occurrence requiring a procedural intervention (SSOPI), and all 30-day morbidity (any morbidity event entered into the AHSQC database within 30 days of operation), the authors said.

Rates of SSI were 4.1% for both smokers and nonsmokers (P = .98). Rates of SSO were greater in current smokers (12.0% vs. 7.4%, P = .03). SSOPI and reoperation rates were similar in current and never smokers (6.2% vs. 5.0%, P = .43; 1.9% vs. 1.2%, P = .39, respectively).

The results suggest that “active smoking before an elective OVHR in a CDC class I wound has a clinically negligible impact on postoperative wound morbidity and all 30-day morbidity,” wrote Dr. Petro and his colleagues.

“Surgeons allowing perioperative smoking should monitor their outcomes to [ensure that] these findings are replicable in their own practice,” they concluded.

The study authors disclosed financial relationships with Medtronic, Ariste Medical, and other companies.

SOURCE: Petro CC et al. Surgery. 2019 Feb;165(2):406-11.

Smoking before elective clean open ventral hernia repair (OVHR) was not associated with significant differences in postoperative wound morbidity or all 30-day morbidity, according to results published in Surgery.

castillodominici/Thinkstock

The question of the impact of smoking on infection risk and wound healing has been studied in a variety of surgical procedures. While some associations have been established (JAMA Surg. 2017;152[5]:476-83; Infect Immun. 2015;83[6]:2443-52), the data have not been strong enough to lead to recommendations that surgeons delay procedures until a patient stops smoking.

In a study of 418 active smokers and 418 matched patients who had never smoked, the rate of surgical site infection (SSI) was 4.1% in both groups (P = .98). The total 30-day complication rates were 7.5% for current smokers and 6.6% for nonsmokers (P = .60), reported Clayton C. Petro, MD, of the department of general surgery at the Cleveland Clinic Comprehensive Hernia Center, and his coauthors.

Patient data were obtained from the Americas Hernia Society Quality Collaborative (AHSQC), and included those who had undergone OVHR in a Centers for Disease Control and Prevention class 1 wound with 30-day follow-up.

Participants were grouped according to smoking status: those who had never smoked, those who had smoked within 30 days of operation (“current smokers”), and patients who had quit smoking more than 1 month before operation (“former smokers”). Current smokers were matched with never smokers by characteristics including age, sex, and body mass index, and conditions such as diabetes and hypertension. Former smokers were excluded.

The investigators collected data from both groups on SSI, surgical site occurrence (SSO), surgical site occurrence requiring a procedural intervention (SSOPI), and all 30-day morbidity (any morbidity event entered into the AHSQC database within 30 days of operation), the authors said.

Rates of SSI were 4.1% for both smokers and nonsmokers (P = .98). Rates of SSO were greater in current smokers (12.0% vs. 7.4%, P = .03). SSOPI and reoperation rates were similar in current and never smokers (6.2% vs. 5.0%, P = .43; 1.9% vs. 1.2%, P = .39, respectively).

The results suggest that “active smoking before an elective OVHR in a CDC class I wound has a clinically negligible impact on postoperative wound morbidity and all 30-day morbidity,” wrote Dr. Petro and his colleagues.

“Surgeons allowing perioperative smoking should monitor their outcomes to [ensure that] these findings are replicable in their own practice,” they concluded.

The study authors disclosed financial relationships with Medtronic, Ariste Medical, and other companies.

SOURCE: Petro CC et al. Surgery. 2019 Feb;165(2):406-11.

Recurrence of inguinal hernia in women was lower after laparoscopic repair, compared with open repair, according to findings published in JAMA Surgery.

Courtesy Wikimedia Commons/Samuel Bendet, US Air Force/Creative Commons License

In a systematic review of 43,870 female patients in 55 studies, the recurrence rate was 1.2% after laparoscopic repair, compared with 2.4% after open repair. The recurrent hernia was a femoral hernia in 40.9% of patients after open repair, compared with no recurrences after laparoscopic repair, reported Line Schmidt of the department of surgery at Herlev (Denmark) Hospital, and coauthors.

Patients were women aged 18 years and older who had repair of a primary unilateral or bilateral inguinal hernia. The review included all retrospective cohort studies, prospective cohort studies, prospective clinical trials, and retrospective cohort studies with 20 or more women with inguinal hernias. PubMed, Embase, and the Cochrane Library databases were searched. The primary outcome was recurrence rate after primary laparoscopic and open repairs, with or without mesh.

The overall recurrence rate among women was 2.6%. The overall crude recurrence rate for studies with low risk of bias was 3.9%, the authors wrote. A femoral hernia was found in 43% of reoperations, though in one study including both open and laparoscopic repairs in women, the rate of detection of incidental femoral hernia was only 2%.

The results “support the recommendation that women with inguinal hernias should undergo laparoscopic repair, unless there are concerns where an open repair might be more clinically appropriate,” the authors wrote. “A substantial number of recurrences after open repair were femoral hernias that may have been overlooked at the primary operation.”

Authors reported receiving personal fees from Bard and Merck. No other disclosures were reported.

SOURCE: Schmidt L et al. JAMA Surg. 2018;153(12):1135-42.

Recurrence of inguinal hernia in women was lower after laparoscopic repair, compared with open repair, according to findings published in JAMA Surgery.

Courtesy Wikimedia Commons/Samuel Bendet, US Air Force/Creative Commons License

In a systematic review of 43,870 female patients in 55 studies, the recurrence rate was 1.2% after laparoscopic repair, compared with 2.4% after open repair. The recurrent hernia was a femoral hernia in 40.9% of patients after open repair, compared with no recurrences after laparoscopic repair, reported Line Schmidt of the department of surgery at Herlev (Denmark) Hospital, and coauthors.

Patients were women aged 18 years and older who had repair of a primary unilateral or bilateral inguinal hernia. The review included all retrospective cohort studies, prospective cohort studies, prospective clinical trials, and retrospective cohort studies with 20 or more women with inguinal hernias. PubMed, Embase, and the Cochrane Library databases were searched. The primary outcome was recurrence rate after primary laparoscopic and open repairs, with or without mesh.

The overall recurrence rate among women was 2.6%. The overall crude recurrence rate for studies with low risk of bias was 3.9%, the authors wrote. A femoral hernia was found in 43% of reoperations, though in one study including both open and laparoscopic repairs in women, the rate of detection of incidental femoral hernia was only 2%.

The results “support the recommendation that women with inguinal hernias should undergo laparoscopic repair, unless there are concerns where an open repair might be more clinically appropriate,” the authors wrote. “A substantial number of recurrences after open repair were femoral hernias that may have been overlooked at the primary operation.”

Authors reported receiving personal fees from Bard and Merck. No other disclosures were reported.

SOURCE: Schmidt L et al. JAMA Surg. 2018;153(12):1135-42.

Recurrence of inguinal hernia in women was lower after laparoscopic repair, compared with open repair, according to findings published in JAMA Surgery.

Courtesy Wikimedia Commons/Samuel Bendet, US Air Force/Creative Commons License

In a systematic review of 43,870 female patients in 55 studies, the recurrence rate was 1.2% after laparoscopic repair, compared with 2.4% after open repair. The recurrent hernia was a femoral hernia in 40.9% of patients after open repair, compared with no recurrences after laparoscopic repair, reported Line Schmidt of the department of surgery at Herlev (Denmark) Hospital, and coauthors.

Patients were women aged 18 years and older who had repair of a primary unilateral or bilateral inguinal hernia. The review included all retrospective cohort studies, prospective cohort studies, prospective clinical trials, and retrospective cohort studies with 20 or more women with inguinal hernias. PubMed, Embase, and the Cochrane Library databases were searched. The primary outcome was recurrence rate after primary laparoscopic and open repairs, with or without mesh.

The overall recurrence rate among women was 2.6%. The overall crude recurrence rate for studies with low risk of bias was 3.9%, the authors wrote. A femoral hernia was found in 43% of reoperations, though in one study including both open and laparoscopic repairs in women, the rate of detection of incidental femoral hernia was only 2%.

The results “support the recommendation that women with inguinal hernias should undergo laparoscopic repair, unless there are concerns where an open repair might be more clinically appropriate,” the authors wrote. “A substantial number of recurrences after open repair were femoral hernias that may have been overlooked at the primary operation.”

Authors reported receiving personal fees from Bard and Merck. No other disclosures were reported.

SOURCE: Schmidt L et al. JAMA Surg. 2018;153(12):1135-42.

Untreated moderate or severe obstructive sleep apnea (OSA) was associated with greater odds of resistant hypertension in black patients, according to findings published in Circulation.

Participants were enrolled in the JHSS, an ancillary trial conducted during December 2012 – May 2016 as part of the Jackson Heart Study, a longitudinal study of 5,306 black adults aged 21-95 years in Jackson, Miss. Patients included in the analysis had hypertension (defined as high blood pressure, use of antihypertensive medication, or self-reported diagnosis). Those without a valid in-home sleep apnea test and with missing data on hypertension, measured blood pressure, or use of antihypertensive medications and diuretics were excluded from analysis.

Sleep apnea was assessed using measures of nasal pressure, thoracic and abdominal inductance plethysmography, finger pulse oximetry, body position, and electrocardiography with a validated Type 3 home sleep apnea device. Obstructive apneas were identified as a flat or nearly flat amplitude of the nasal pressure signal for greater than 10 seconds, accompanied by respiratory effort on the abdominal or thoracic inductance plethysmography bands. Severity was defined by the standard Respiratory Event Index (REI) categories: fewer than 5 events (unaffected), greater than or equal to 5 events to fewer than 15 events (mild), greater than or equal to 15 events to fewer than 30 events (moderate), and greater than or equal to 30 events (severe), the authors reported.

High blood pressure (BP) was defined as systolic BP greater than or equal to 130 mm Hg or diastolic BP greater than or equal to 80 mm Hg. Controlled hypertension was defined as systolic BP less than 130 mmHg and diastolic BP less than 80 mm Hg.

Uncontrolled BP was defined as high BP with use of one or two classes of antihypertensive medications; resistant hypertension was defined as having high BP while on greater than or equal to three classes of antihypertensive medications with one being a diuretic or as using of greater than four classes of antihypertensive medications regardless of BP control, Dr. Johnson and colleagues reported.

A total of 25.7% of hypertension patients had moderate or severe OSA, though only 6% of these patients had an OSA diagnosis from a physician. In addition, 48.2% of patients had uncontrolled hypertension, and 14.5% had resistant hypertension.

Moderate or severe OSA was associated with nearly twofold higher unadjusted odds of resistant hypertension (OR, 1.92; 95% CI, 1.15-3.20). In adjusted models, moderate or severe OSA and nocturnal hypoxemia were not associated with uncontrolled hypertension but were associated with resistant hypertension (OR, 2.04; 95% CI, 1.14-3.67; OR, 1.25; 95% CI, 1.01-1.55, respectively).

Compared with no OSA, severe OSA was associated with more than three times higher odds of resistant hypertension (OR, 3.50; 95% CI, 1.54-7.91). This association was even higher after adjustment for covariates (OR, 3.58; 95% CI, 1.39-9.19).

“These data suggest that untreated OSA may contribute to the high burden of resistant hypertension in blacks,” Dr. Johnson and coauthors wrote. “Future studies should test whether diagnosis and treatment of OSA may be interventions for improving BP control” and reducing this burden, they added.

“These findings are particularly important given that most adults with OSA are undiagnosed and untreated.”

The study was funded by grants from the National Heart, Lung, and Blood Institute. One of the authors reported receiving funding from Amgen. No other disclosures were reported.

SOURCE: Johnson D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.118.036675.

Untreated moderate or severe obstructive sleep apnea (OSA) was associated with greater odds of resistant hypertension in black patients, according to findings published in Circulation.

Participants were enrolled in the JHSS, an ancillary trial conducted during December 2012 – May 2016 as part of the Jackson Heart Study, a longitudinal study of 5,306 black adults aged 21-95 years in Jackson, Miss. Patients included in the analysis had hypertension (defined as high blood pressure, use of antihypertensive medication, or self-reported diagnosis). Those without a valid in-home sleep apnea test and with missing data on hypertension, measured blood pressure, or use of antihypertensive medications and diuretics were excluded from analysis.

Sleep apnea was assessed using measures of nasal pressure, thoracic and abdominal inductance plethysmography, finger pulse oximetry, body position, and electrocardiography with a validated Type 3 home sleep apnea device. Obstructive apneas were identified as a flat or nearly flat amplitude of the nasal pressure signal for greater than 10 seconds, accompanied by respiratory effort on the abdominal or thoracic inductance plethysmography bands. Severity was defined by the standard Respiratory Event Index (REI) categories: fewer than 5 events (unaffected), greater than or equal to 5 events to fewer than 15 events (mild), greater than or equal to 15 events to fewer than 30 events (moderate), and greater than or equal to 30 events (severe), the authors reported.

High blood pressure (BP) was defined as systolic BP greater than or equal to 130 mm Hg or diastolic BP greater than or equal to 80 mm Hg. Controlled hypertension was defined as systolic BP less than 130 mmHg and diastolic BP less than 80 mm Hg.

Uncontrolled BP was defined as high BP with use of one or two classes of antihypertensive medications; resistant hypertension was defined as having high BP while on greater than or equal to three classes of antihypertensive medications with one being a diuretic or as using of greater than four classes of antihypertensive medications regardless of BP control, Dr. Johnson and colleagues reported.

A total of 25.7% of hypertension patients had moderate or severe OSA, though only 6% of these patients had an OSA diagnosis from a physician. In addition, 48.2% of patients had uncontrolled hypertension, and 14.5% had resistant hypertension.

Moderate or severe OSA was associated with nearly twofold higher unadjusted odds of resistant hypertension (OR, 1.92; 95% CI, 1.15-3.20). In adjusted models, moderate or severe OSA and nocturnal hypoxemia were not associated with uncontrolled hypertension but were associated with resistant hypertension (OR, 2.04; 95% CI, 1.14-3.67; OR, 1.25; 95% CI, 1.01-1.55, respectively).

Compared with no OSA, severe OSA was associated with more than three times higher odds of resistant hypertension (OR, 3.50; 95% CI, 1.54-7.91). This association was even higher after adjustment for covariates (OR, 3.58; 95% CI, 1.39-9.19).

“These data suggest that untreated OSA may contribute to the high burden of resistant hypertension in blacks,” Dr. Johnson and coauthors wrote. “Future studies should test whether diagnosis and treatment of OSA may be interventions for improving BP control” and reducing this burden, they added.

“These findings are particularly important given that most adults with OSA are undiagnosed and untreated.”

The study was funded by grants from the National Heart, Lung, and Blood Institute. One of the authors reported receiving funding from Amgen. No other disclosures were reported.

SOURCE: Johnson D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.118.036675.

Untreated moderate or severe obstructive sleep apnea (OSA) was associated with greater odds of resistant hypertension in black patients, according to findings published in Circulation.

Participants were enrolled in the JHSS, an ancillary trial conducted during December 2012 – May 2016 as part of the Jackson Heart Study, a longitudinal study of 5,306 black adults aged 21-95 years in Jackson, Miss. Patients included in the analysis had hypertension (defined as high blood pressure, use of antihypertensive medication, or self-reported diagnosis). Those without a valid in-home sleep apnea test and with missing data on hypertension, measured blood pressure, or use of antihypertensive medications and diuretics were excluded from analysis.

Sleep apnea was assessed using measures of nasal pressure, thoracic and abdominal inductance plethysmography, finger pulse oximetry, body position, and electrocardiography with a validated Type 3 home sleep apnea device. Obstructive apneas were identified as a flat or nearly flat amplitude of the nasal pressure signal for greater than 10 seconds, accompanied by respiratory effort on the abdominal or thoracic inductance plethysmography bands. Severity was defined by the standard Respiratory Event Index (REI) categories: fewer than 5 events (unaffected), greater than or equal to 5 events to fewer than 15 events (mild), greater than or equal to 15 events to fewer than 30 events (moderate), and greater than or equal to 30 events (severe), the authors reported.

High blood pressure (BP) was defined as systolic BP greater than or equal to 130 mm Hg or diastolic BP greater than or equal to 80 mm Hg. Controlled hypertension was defined as systolic BP less than 130 mmHg and diastolic BP less than 80 mm Hg.

Uncontrolled BP was defined as high BP with use of one or two classes of antihypertensive medications; resistant hypertension was defined as having high BP while on greater than or equal to three classes of antihypertensive medications with one being a diuretic or as using of greater than four classes of antihypertensive medications regardless of BP control, Dr. Johnson and colleagues reported.

A total of 25.7% of hypertension patients had moderate or severe OSA, though only 6% of these patients had an OSA diagnosis from a physician. In addition, 48.2% of patients had uncontrolled hypertension, and 14.5% had resistant hypertension.

Moderate or severe OSA was associated with nearly twofold higher unadjusted odds of resistant hypertension (OR, 1.92; 95% CI, 1.15-3.20). In adjusted models, moderate or severe OSA and nocturnal hypoxemia were not associated with uncontrolled hypertension but were associated with resistant hypertension (OR, 2.04; 95% CI, 1.14-3.67; OR, 1.25; 95% CI, 1.01-1.55, respectively).

Compared with no OSA, severe OSA was associated with more than three times higher odds of resistant hypertension (OR, 3.50; 95% CI, 1.54-7.91). This association was even higher after adjustment for covariates (OR, 3.58; 95% CI, 1.39-9.19).

“These data suggest that untreated OSA may contribute to the high burden of resistant hypertension in blacks,” Dr. Johnson and coauthors wrote. “Future studies should test whether diagnosis and treatment of OSA may be interventions for improving BP control” and reducing this burden, they added.

“These findings are particularly important given that most adults with OSA are undiagnosed and untreated.”

The study was funded by grants from the National Heart, Lung, and Blood Institute. One of the authors reported receiving funding from Amgen. No other disclosures were reported.

SOURCE: Johnson D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.118.036675.

There was no significant difference in mortality between critically ill patients who received pantoprazole prophylaxis for gastrointestinal bleeding, and those who received placebo, new findings suggest.

In a multicenter, randomized trial of 3,298 adult patients at risk for gastrointestinal bleeding, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died at 90 days (relative risk, 1.02; 95% confidence interval, 0.91-1.13; P = .76). The results were published in the New England Journal of Medicine.

Patients were aged 18 years or older; had been admitted to the ICU for an acute condition in one of six international centers; and had at least one risk factor for gastrointestinal bleeding including shock, use of anticoagulant agents, renal replacement therapy, mechanical ventilation (expected to last more than 24 hours), any history of liver disease, or any history of or ongoing coagulopathy. A total of 1,645 patients were randomly assigned to receive 40 mg of intravenous pantoprazole once daily and 1,653 received placebo, reported Mette Krag, MD, of the department of intensive care at Rigshospitalet in Copenhagen, and her coauthors.

The primary outcome was 90-day mortality. Secondary outcomes were clinically important events in the ICU, clinically important gastrointestinal bleeding in the ICU, infectious adverse events in the ICU, and days alive without the use of life support within the 90-day period.

One or more clinically important events occurred in 21.9% of patients in the pantoprazole group and in 22.6% in the placebo group (RR, 0.96; 95% CI, 0.83-1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, compared with 4.2% in the placebo group, Dr. Krag and her coauthors wrote.

The findings are similar to other recently published results, which showed “no significant differences ... in the rates of death or infectious complications between patients receiving placebo or no prophylaxis and those receiving proton pump inhibitors,” the authors wrote.

Dr. Krag reported financial support from Innovation Fund Denmark, Ehrenreich’s Foundation, and several other organizations.

SOURCE: Krag M et al. N Engl J Med. 2018 Dec 6. doi: 10.1056/NEJMoa1714919.

This article was updated 12/6/18.

There was no significant difference in mortality between critically ill patients who received pantoprazole prophylaxis for gastrointestinal bleeding, and those who received placebo, new findings suggest.

In a multicenter, randomized trial of 3,298 adult patients at risk for gastrointestinal bleeding, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died at 90 days (relative risk, 1.02; 95% confidence interval, 0.91-1.13; P = .76). The results were published in the New England Journal of Medicine.

Patients were aged 18 years or older; had been admitted to the ICU for an acute condition in one of six international centers; and had at least one risk factor for gastrointestinal bleeding including shock, use of anticoagulant agents, renal replacement therapy, mechanical ventilation (expected to last more than 24 hours), any history of liver disease, or any history of or ongoing coagulopathy. A total of 1,645 patients were randomly assigned to receive 40 mg of intravenous pantoprazole once daily and 1,653 received placebo, reported Mette Krag, MD, of the department of intensive care at Rigshospitalet in Copenhagen, and her coauthors.

The primary outcome was 90-day mortality. Secondary outcomes were clinically important events in the ICU, clinically important gastrointestinal bleeding in the ICU, infectious adverse events in the ICU, and days alive without the use of life support within the 90-day period.

One or more clinically important events occurred in 21.9% of patients in the pantoprazole group and in 22.6% in the placebo group (RR, 0.96; 95% CI, 0.83-1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, compared with 4.2% in the placebo group, Dr. Krag and her coauthors wrote.

The findings are similar to other recently published results, which showed “no significant differences ... in the rates of death or infectious complications between patients receiving placebo or no prophylaxis and those receiving proton pump inhibitors,” the authors wrote.

Dr. Krag reported financial support from Innovation Fund Denmark, Ehrenreich’s Foundation, and several other organizations.

SOURCE: Krag M et al. N Engl J Med. 2018 Dec 6. doi: 10.1056/NEJMoa1714919.

This article was updated 12/6/18.

There was no significant difference in mortality between critically ill patients who received pantoprazole prophylaxis for gastrointestinal bleeding, and those who received placebo, new findings suggest.

In a multicenter, randomized trial of 3,298 adult patients at risk for gastrointestinal bleeding, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died at 90 days (relative risk, 1.02; 95% confidence interval, 0.91-1.13; P = .76). The results were published in the New England Journal of Medicine.

Patients were aged 18 years or older; had been admitted to the ICU for an acute condition in one of six international centers; and had at least one risk factor for gastrointestinal bleeding including shock, use of anticoagulant agents, renal replacement therapy, mechanical ventilation (expected to last more than 24 hours), any history of liver disease, or any history of or ongoing coagulopathy. A total of 1,645 patients were randomly assigned to receive 40 mg of intravenous pantoprazole once daily and 1,653 received placebo, reported Mette Krag, MD, of the department of intensive care at Rigshospitalet in Copenhagen, and her coauthors.

The primary outcome was 90-day mortality. Secondary outcomes were clinically important events in the ICU, clinically important gastrointestinal bleeding in the ICU, infectious adverse events in the ICU, and days alive without the use of life support within the 90-day period.

One or more clinically important events occurred in 21.9% of patients in the pantoprazole group and in 22.6% in the placebo group (RR, 0.96; 95% CI, 0.83-1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, compared with 4.2% in the placebo group, Dr. Krag and her coauthors wrote.

The findings are similar to other recently published results, which showed “no significant differences ... in the rates of death or infectious complications between patients receiving placebo or no prophylaxis and those receiving proton pump inhibitors,” the authors wrote.

Dr. Krag reported financial support from Innovation Fund Denmark, Ehrenreich’s Foundation, and several other organizations.

SOURCE: Krag M et al. N Engl J Med. 2018 Dec 6. doi: 10.1056/NEJMoa1714919.

This article was updated 12/6/18.

The single-item sleep quality scale (SQS) produced favorable results comparable to other complex, time-intensive assessment tools, according to findings published in the Journal of Clinical Sleep Medicine.

Silvia Jansen/iStockphoto

In a study of 70 insomnia patients and 651 depression patients, concurrent criterion validity analysis yielded strong correlations between the SQS and the morning-questionnaire insomnia (MQI) and Pittsburgh Sleep Quality Index (PSQI) in patients with insomnia and depression, respectively. The investigators wrote, “The single-item format enables a patient-reported rating of sleep quality over a 7-day recall period without greatly increasing the patient’s burden. The use of a discretizing visual analog scale (VAS) increases the potential for a more sensitive measurement.” The SQS is a quick but accurate self-reported assessment of sleep quality.

The SQS was validated based on two studies. Eligible patients in the 4-week, randomized, multicenter insomnia study were aged 30-75 years and were receiving a Food and Drug Administration–approved hypnotic agent as usual treatment for insomnia based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The MQI was used daily for the duration of the study, wrote Ellen Snyder, PhD, of Merck & Co., in Kenilworth, N.J., and her coauthors.

The depression study was a randomized, double-blind, parallel-group, 12-month international trial evaluating the safety of the substance P antagonist aprepitant, compared with paroxetine hydrochloride. Patients were aged 18 years or older, with a DSM-IV diagnosis of major depressive disorder. Patients completed the SQS and PSQI at baseline, week 1, and week 8.

In insomnia patients, a Pearson correlation of –.76 was found at week 1 for the SQS in relation to the MQI.

In patients with depression, Goodman-Kruskal correlation coefficients for the SQS in relation to the Pittsburgh Sleep Quality Index (PSQI) were –.87, –.88, and –.92 at baseline, week 1, and week 8, respectively.

Correlations were negative because “better sleep quality is associated with a lower score on the MQI and PSQI, but a higher score on the SQS,” the authors noted.

The results support the use of the SQS as a “practical sleep measure that can effectively gauge sleep quality without significantly increasing the burden of clinical trial participants,” compared with lengthier assessments such as the MQI and PSQI, they added.

Funding for the study was provided by Merck Sharp & Dohme.

SOURCE: Snyder E et al. J Clin Sleep Med. 2018;14(11):1849-57.

The single-item sleep quality scale (SQS) produced favorable results comparable to other complex, time-intensive assessment tools, according to findings published in the Journal of Clinical Sleep Medicine.

Silvia Jansen/iStockphoto

In a study of 70 insomnia patients and 651 depression patients, concurrent criterion validity analysis yielded strong correlations between the SQS and the morning-questionnaire insomnia (MQI) and Pittsburgh Sleep Quality Index (PSQI) in patients with insomnia and depression, respectively. The investigators wrote, “The single-item format enables a patient-reported rating of sleep quality over a 7-day recall period without greatly increasing the patient’s burden. The use of a discretizing visual analog scale (VAS) increases the potential for a more sensitive measurement.” The SQS is a quick but accurate self-reported assessment of sleep quality.

The SQS was validated based on two studies. Eligible patients in the 4-week, randomized, multicenter insomnia study were aged 30-75 years and were receiving a Food and Drug Administration–approved hypnotic agent as usual treatment for insomnia based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The MQI was used daily for the duration of the study, wrote Ellen Snyder, PhD, of Merck & Co., in Kenilworth, N.J., and her coauthors.

The depression study was a randomized, double-blind, parallel-group, 12-month international trial evaluating the safety of the substance P antagonist aprepitant, compared with paroxetine hydrochloride. Patients were aged 18 years or older, with a DSM-IV diagnosis of major depressive disorder. Patients completed the SQS and PSQI at baseline, week 1, and week 8.

In insomnia patients, a Pearson correlation of –.76 was found at week 1 for the SQS in relation to the MQI.

In patients with depression, Goodman-Kruskal correlation coefficients for the SQS in relation to the Pittsburgh Sleep Quality Index (PSQI) were –.87, –.88, and –.92 at baseline, week 1, and week 8, respectively.

Correlations were negative because “better sleep quality is associated with a lower score on the MQI and PSQI, but a higher score on the SQS,” the authors noted.

The results support the use of the SQS as a “practical sleep measure that can effectively gauge sleep quality without significantly increasing the burden of clinical trial participants,” compared with lengthier assessments such as the MQI and PSQI, they added.

Funding for the study was provided by Merck Sharp & Dohme.

SOURCE: Snyder E et al. J Clin Sleep Med. 2018;14(11):1849-57.

The single-item sleep quality scale (SQS) produced favorable results comparable to other complex, time-intensive assessment tools, according to findings published in the Journal of Clinical Sleep Medicine.

Silvia Jansen/iStockphoto

In a study of 70 insomnia patients and 651 depression patients, concurrent criterion validity analysis yielded strong correlations between the SQS and the morning-questionnaire insomnia (MQI) and Pittsburgh Sleep Quality Index (PSQI) in patients with insomnia and depression, respectively. The investigators wrote, “The single-item format enables a patient-reported rating of sleep quality over a 7-day recall period without greatly increasing the patient’s burden. The use of a discretizing visual analog scale (VAS) increases the potential for a more sensitive measurement.” The SQS is a quick but accurate self-reported assessment of sleep quality.

The SQS was validated based on two studies. Eligible patients in the 4-week, randomized, multicenter insomnia study were aged 30-75 years and were receiving a Food and Drug Administration–approved hypnotic agent as usual treatment for insomnia based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The MQI was used daily for the duration of the study, wrote Ellen Snyder, PhD, of Merck & Co., in Kenilworth, N.J., and her coauthors.

The depression study was a randomized, double-blind, parallel-group, 12-month international trial evaluating the safety of the substance P antagonist aprepitant, compared with paroxetine hydrochloride. Patients were aged 18 years or older, with a DSM-IV diagnosis of major depressive disorder. Patients completed the SQS and PSQI at baseline, week 1, and week 8.

In insomnia patients, a Pearson correlation of –.76 was found at week 1 for the SQS in relation to the MQI.

In patients with depression, Goodman-Kruskal correlation coefficients for the SQS in relation to the Pittsburgh Sleep Quality Index (PSQI) were –.87, –.88, and –.92 at baseline, week 1, and week 8, respectively.

Correlations were negative because “better sleep quality is associated with a lower score on the MQI and PSQI, but a higher score on the SQS,” the authors noted.

The results support the use of the SQS as a “practical sleep measure that can effectively gauge sleep quality without significantly increasing the burden of clinical trial participants,” compared with lengthier assessments such as the MQI and PSQI, they added.

Funding for the study was provided by Merck Sharp & Dohme.

SOURCE: Snyder E et al. J Clin Sleep Med. 2018;14(11):1849-57.

Despite the adoption of naloxone access laws, new findings suggest that naloxone availability without a prescription still varies between states.

Two research letters published Nov. 13 in JAMA examined pharmacy availability of naloxone in California and Texas 24 and 32 months, respectively, after implementation of expanded access laws.

In California, just 23.5% of retail pharmacies were dispensing naloxone without a prescription 2 years later. In Texas, however, 83.7% of chain pharmacies with expanded access via standing order reported that they would dispense naloxone without prescription 32 months later.

In the first study, investigators conducted an anonymous telephone survey of a 20% representative sample of California pharmacies. Posing as potential customers, interviewers asked pharmacy staff whether naloxone was available at their pharmacy without a prescription. They also inquired about what formulations were available, price, and whether naloxone could be billed to insurance, wrote Talia Puzantian, PharmD, and James J. Gasper, PharmD.

Naloxone was available at 23.5% (95% confidence interval, 21.0%-26.0%) of the 1,147 pharmacies that provided data. Chain pharmacies were more likely to dispense naloxone (31.6%; 95% CI, 28.3%-35.1%) than were independent pharmacies (7.5%; 95% CI, 5.1%-10.6%; P less than .001). Of pharmacies dispensing naloxone, 50.6% had nasal naloxone in stock, and 59.9% correctly said that naloxone could be billed to insurance, reported Dr. Puzantian, of the Keck Graduate Institute School of Pharmacy in Claremont, Calif., and Dr. Gasper, of the department of family and community medicine at the University of California, San Francisco.

Reasons for low availability in California pharmacies might include lack of knowledge and training, stigma about substance use, and time, Dr. Puzantian and Dr. Gasper said.

“Whether naloxone will become more available with training of additional pharmacists and implementation of standardized policies by pharmacy chains needs to be studied,” the authors concluded.

The second study examined naloxone availability among Texas chain pharmacies with public implementation of standing orders, for a survey of 2,317 CVS, Walgreens, HEB, and Walmart pharmacies. Interviewers posed as potential overdose responders, and inquired about purchasing naloxone without a prescription, reported Kirk E. Evoy, PharmD, of the College of Pharmacy at the University of Texas at Austin, and his coauthors.

Of the pharmacies surveyed, 83.7% (95% CI, 82.2%-85.2%) said they would dispense naloxone without a prescription, and 76.4% (95% CI, 74.7%-78.1%) currently stocked naloxone.

In addition, 79.9% (95% CI, 78.3%-81.6%) would allow purchase of naloxone for someone else, though only 49.7% (95% CI, 47.8%-51.9%) would allow the purchase to be billed to a third-party buyer’s insurance, the authors noted.

Although this study found that most pharmacies would dispense naloxone without a prescription, the findings cannot be applied to independent pharmacies, Dr. Evoy and his colleagues noted.

“Consistent naloxone supply in all pharmacies, improved pharmacist understanding of naloxone standing orders, and ubiquitous insurance coverage for third-party purchasers may further improve access,” they wrote.

Dr. Puzantian and Dr. Gasper reported no disclosures. Dr. Evoy disclosed receiving grant funding from the Institute for Integration of Medicine and Science at the UT Health in San Antonio, the Kleberg Foundation, and Texas Health and Human Services. Other authors disclosed previous receipt of donations of branded formulations of naloxone from Kaléo Pharma and Adapt Pharma.

SOURCE: Puzantian T et al. and Evoy KE et al. JAMA 2018 Nov 13.320(18):1933-7.

Despite the adoption of naloxone access laws, new findings suggest that naloxone availability without a prescription still varies between states.

Two research letters published Nov. 13 in JAMA examined pharmacy availability of naloxone in California and Texas 24 and 32 months, respectively, after implementation of expanded access laws.

In California, just 23.5% of retail pharmacies were dispensing naloxone without a prescription 2 years later. In Texas, however, 83.7% of chain pharmacies with expanded access via standing order reported that they would dispense naloxone without prescription 32 months later.

In the first study, investigators conducted an anonymous telephone survey of a 20% representative sample of California pharmacies. Posing as potential customers, interviewers asked pharmacy staff whether naloxone was available at their pharmacy without a prescription. They also inquired about what formulations were available, price, and whether naloxone could be billed to insurance, wrote Talia Puzantian, PharmD, and James J. Gasper, PharmD.

Naloxone was available at 23.5% (95% confidence interval, 21.0%-26.0%) of the 1,147 pharmacies that provided data. Chain pharmacies were more likely to dispense naloxone (31.6%; 95% CI, 28.3%-35.1%) than were independent pharmacies (7.5%; 95% CI, 5.1%-10.6%; P less than .001). Of pharmacies dispensing naloxone, 50.6% had nasal naloxone in stock, and 59.9% correctly said that naloxone could be billed to insurance, reported Dr. Puzantian, of the Keck Graduate Institute School of Pharmacy in Claremont, Calif., and Dr. Gasper, of the department of family and community medicine at the University of California, San Francisco.

Reasons for low availability in California pharmacies might include lack of knowledge and training, stigma about substance use, and time, Dr. Puzantian and Dr. Gasper said.

“Whether naloxone will become more available with training of additional pharmacists and implementation of standardized policies by pharmacy chains needs to be studied,” the authors concluded.

The second study examined naloxone availability among Texas chain pharmacies with public implementation of standing orders, for a survey of 2,317 CVS, Walgreens, HEB, and Walmart pharmacies. Interviewers posed as potential overdose responders, and inquired about purchasing naloxone without a prescription, reported Kirk E. Evoy, PharmD, of the College of Pharmacy at the University of Texas at Austin, and his coauthors.

Of the pharmacies surveyed, 83.7% (95% CI, 82.2%-85.2%) said they would dispense naloxone without a prescription, and 76.4% (95% CI, 74.7%-78.1%) currently stocked naloxone.

In addition, 79.9% (95% CI, 78.3%-81.6%) would allow purchase of naloxone for someone else, though only 49.7% (95% CI, 47.8%-51.9%) would allow the purchase to be billed to a third-party buyer’s insurance, the authors noted.

Although this study found that most pharmacies would dispense naloxone without a prescription, the findings cannot be applied to independent pharmacies, Dr. Evoy and his colleagues noted.

“Consistent naloxone supply in all pharmacies, improved pharmacist understanding of naloxone standing orders, and ubiquitous insurance coverage for third-party purchasers may further improve access,” they wrote.

Dr. Puzantian and Dr. Gasper reported no disclosures. Dr. Evoy disclosed receiving grant funding from the Institute for Integration of Medicine and Science at the UT Health in San Antonio, the Kleberg Foundation, and Texas Health and Human Services. Other authors disclosed previous receipt of donations of branded formulations of naloxone from Kaléo Pharma and Adapt Pharma.

SOURCE: Puzantian T et al. and Evoy KE et al. JAMA 2018 Nov 13.320(18):1933-7.

Despite the adoption of naloxone access laws, new findings suggest that naloxone availability without a prescription still varies between states.

Two research letters published Nov. 13 in JAMA examined pharmacy availability of naloxone in California and Texas 24 and 32 months, respectively, after implementation of expanded access laws.

In California, just 23.5% of retail pharmacies were dispensing naloxone without a prescription 2 years later. In Texas, however, 83.7% of chain pharmacies with expanded access via standing order reported that they would dispense naloxone without prescription 32 months later.

In the first study, investigators conducted an anonymous telephone survey of a 20% representative sample of California pharmacies. Posing as potential customers, interviewers asked pharmacy staff whether naloxone was available at their pharmacy without a prescription. They also inquired about what formulations were available, price, and whether naloxone could be billed to insurance, wrote Talia Puzantian, PharmD, and James J. Gasper, PharmD.

Naloxone was available at 23.5% (95% confidence interval, 21.0%-26.0%) of the 1,147 pharmacies that provided data. Chain pharmacies were more likely to dispense naloxone (31.6%; 95% CI, 28.3%-35.1%) than were independent pharmacies (7.5%; 95% CI, 5.1%-10.6%; P less than .001). Of pharmacies dispensing naloxone, 50.6% had nasal naloxone in stock, and 59.9% correctly said that naloxone could be billed to insurance, reported Dr. Puzantian, of the Keck Graduate Institute School of Pharmacy in Claremont, Calif., and Dr. Gasper, of the department of family and community medicine at the University of California, San Francisco.

Reasons for low availability in California pharmacies might include lack of knowledge and training, stigma about substance use, and time, Dr. Puzantian and Dr. Gasper said.

“Whether naloxone will become more available with training of additional pharmacists and implementation of standardized policies by pharmacy chains needs to be studied,” the authors concluded.

The second study examined naloxone availability among Texas chain pharmacies with public implementation of standing orders, for a survey of 2,317 CVS, Walgreens, HEB, and Walmart pharmacies. Interviewers posed as potential overdose responders, and inquired about purchasing naloxone without a prescription, reported Kirk E. Evoy, PharmD, of the College of Pharmacy at the University of Texas at Austin, and his coauthors.

Of the pharmacies surveyed, 83.7% (95% CI, 82.2%-85.2%) said they would dispense naloxone without a prescription, and 76.4% (95% CI, 74.7%-78.1%) currently stocked naloxone.

In addition, 79.9% (95% CI, 78.3%-81.6%) would allow purchase of naloxone for someone else, though only 49.7% (95% CI, 47.8%-51.9%) would allow the purchase to be billed to a third-party buyer’s insurance, the authors noted.

Although this study found that most pharmacies would dispense naloxone without a prescription, the findings cannot be applied to independent pharmacies, Dr. Evoy and his colleagues noted.

“Consistent naloxone supply in all pharmacies, improved pharmacist understanding of naloxone standing orders, and ubiquitous insurance coverage for third-party purchasers may further improve access,” they wrote.

Dr. Puzantian and Dr. Gasper reported no disclosures. Dr. Evoy disclosed receiving grant funding from the Institute for Integration of Medicine and Science at the UT Health in San Antonio, the Kleberg Foundation, and Texas Health and Human Services. Other authors disclosed previous receipt of donations of branded formulations of naloxone from Kaléo Pharma and Adapt Pharma.

SOURCE: Puzantian T et al. and Evoy KE et al. JAMA 2018 Nov 13.320(18):1933-7.