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  • July 19, 2016 9:40 AM | Deleted user

    New research shows that the Zika virus has two routes by which it can infect a developing fetus, depending on when during a pregnancy the infection occurs. It also shows an existing drug might be able to limit the damage wreaked by the virus.

    The new study, by scientists at the University of California at San Francisco and the University of California at Berkeley, suggests that an antibiotic called duramycin seems to be able to block Zika’s ability to latch onto the cells it wants to affect.

    “It was day and night. There was either infection or no infection, depending on how much drug you used,” Lenore Pereira, one of two contributing authors of the study, said in an interview.

    Read full article here.

  • July 19, 2016 9:37 AM | Deleted user

    Media Statement

    For immediate release: Monday, July 18, 2016
    Contact: Media Relations,
    (404) 639-3286

    CDC is assisting in the investigation of a case of Zika in a Utah resident who is a family contact of the elderly Utah resident who died in late June. The deceased patient had traveled to an area with Zika and lab tests showed he had uniquely high amounts of virus—more than 100,000 times higher than seen in other samples of infected people—in his blood. Laboratories in Utah and at the Centers for Disease Control and Prevention (CDC) reported evidence of Zika infection in both Utah residents.

    State and local public health disease control specialists, along with CDC, are investigating how the second resident became infected. The investigation includes additional interviews with and laboratory testing of family members and health care workers who may have had contact with the person who died and trapping mosquitoes and assessing the risk of local spread by mosquitoes.

    A CDC Emergency Response Team (CERT) is in Utah at the request of the Utah Department of Health. The team includes experts in infection control, virology, mosquito control, disease investigation, and health communications.

    “The new case in Utah is a surprise, showing that we still have more to learn about Zika," said Erin Staples, MD, PhD, CDC’s Medical Epidemiologist on the ground in Utah. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, non-sexual spread from one person to another does not appear to be common."

    As of July 13, 2016, 1,306 cases of Zika have been reported in the continental United States and Hawaii; none of these have been the result of local spread by mosquitoes. These cases include 14 believed to be the result of sexual transmission and one that was the result of a laboratory exposure.

    Since early 2016, CDC has worked with state, local, and territorial public health officials to protect pregnant women from Zika infection, through these activities:

    • Alerts to pregnant women to avoid travel to an area with active Zika transmission, to women in these areas to take steps to prevent mosquito bites, and to partners of pregnant women to use a condom to prevent sexual transmission during pregnancy.
    • Development and distribution of PCR and IgM testing kits to confirm Zika virus infection.
    • Establishment of CDC Emergency Response Teams to rapidly deploy to assist with Zika-related preparedness and response activities in the United States.
    • Deployment of experts to assist in enhancement of mosquito surveillance and testing.
    • Collaboration with FDA, blood collection centers, and other entities in the public and private sectors on enhancement of surveillance of blood donations.
    • Guidance to prevent sexual transmission, particularly to women who are pregnant.
    • Guidance for clinicians on the care of pregnant women who may have been exposed to Zika.
      Studies in collaboration with Brazil, Colombia, and other countries to better understand the link between Zika infection and birth defects, including microcephaly.

    For more information about Zika: http://www.cdc.gov/zika/.

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    U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


  • July 19, 2016 9:05 AM | Deleted user

    MADISON, Wis. — Of the hundreds of monkeys in the University of Wisconsin’s primate center, a few — including rhesus macaque 827577 — are now famous, at least among scientists tracking the Zika virus.

    Since February, a team led by David H. O’Connor, the chairman of the center’s global infectious diseases department, has been conducting a unique experiment in scientific transparency. The tactic may presage the evolution of new ways to respond to fast-moving epidemics.

    Dr. O’Connor and his colleagues have been infecting pregnant female macaques with the Zika virus, minutely recording their symptoms, and giving them blood tests and ultrasounds. But then, instead of saving their data for academic journals, the researchers have posted it almost immediately on a website anyone can visit.

    The openness of the process thrills scientists, who say it fosters collaboration and speeds research.

    “David’s work is very useful,” said Dr. Koen Van Rompay, a virologist at theCalifornia National Primate Research Center at the University of California, Davis. “We all learn from each other and make sure we don’t duplicate each other’s work.”

    Back-to-back epidemics of Ebola and Zika have driven some infectious disease specialists to embrace greater speed and openness. Until now, they felt forced to hoard data and tissue samples: Careers depend on being published in prestigious journals, which often refuse to publish work that has previously been released and may take months to edit papers.

    At the same time, Dr. O’Connor’s openness has exposed some of the more macabre requirements of scientific research.

    Animal rights activists are upset at the brutal reality of infecting female monkeys and dissecting their babies. They argue that the work is unnecessary because scientists have already learned a lot by drawing blood from Zika-infected human mothers and dissecting some human fetuses that have died in the womb or were aborted.

    Read the full article here.


  • July 18, 2016 9:16 AM | Deleted user

    by Kristin Jenkins 
    Contributing Writer, MedPage Today

    The first randomized phase III clinical trial to compare irinotecan (Camptosar, Camptothecin-11, CPT-11) and cisplatin (Platinol, Platinol-AQ, CDDP) with standard of care -- paclitaxel (Taxol, Onxal) plus carboplatin (Paraplatin) -- in patients with clear cell carcinoma (CCC) of the ovary found no significant survival benefit between the groups.

    With a median follow-up of 44.3 months, 2-year progression-free survival rates were 73.0% in the irinotecan-plus-cisplatin (CPT-P) group and 77.6% in the paclitaxel-plus-carboplatin (TC) group (HR 1.17; 95% CI 0.87 to 1.58). Two-year overall survival rates were 85.5% with CPT-P and 87.4% with TC (HR 1.13; 95% CI 0.80 to 1.61).

    Both regimens were well tolerated, although the toxicity profiles differed significantly, Aikou Okamoto, MD, of Jikei University School of Medicine in Tokyo and colleagues in the Japanese Gynecologic Oncology Group reported online in theJournal of Clinical Oncology.

    "The previous randomized phase II study[JGOG3014] showed a tendency of progression-free survival superiority of the CPT-P arm in a subset analysis of patients without residual disease or with residual disease of less than 2 cm," the researchers wrote. "However, we could not identify the survival advantage of CPT-P in any subgroup analyses by region, stage, and size of the residual disease in the current phase III randomized trial."

    The study also revealed the limitations of existing anticancer agents to improve prognosis in patients with ovarian CCC. Identification of driver mutations "is a crucial first step toward personalizing treatment of CCC," Okamoto and colleagues emphasized.

    Studies of metastatic clear cell renal cancer have demonstrated the effectiveness of using a combination of targeted treatments such as a PI3K-Akt-mTOR pathway inhibitor as well as anti-angiogenic agents and new immunotherapy drugs, the researchers said. "Therefore, we emphasize that therapeutic regimens should consider such combinations and/or target drugs to improve the prognosis of CCC of the ovary."

    The negative results of this trial highlight two major challenges in cancer research,Emese Zsiros, MD, PhD, of Roswell Park Cancer Institute in Buffalo, NY, said in an interview.

    "In vitro studies on cancer cell lines often do not translate to clinical benefit in patients given the heterogeneity and complexity of cancer in real life," she explained. "Also, if a phase II study does not show significant activity of a new drug or drug combination, it is unlikely to detect a significant clinical benefit in a large phase III study."

    Zsiros, who was not affiliated with the study, also noted that while CCC accounts for only 4-12% of all ovarian cancers in the U.S. and Europe, it is much more common in Japan, accounting for more than 20% of all ovarian cancers.

    Unlike serous ovarian cancer, CCC is often associated with a large one-sided pelvic mass and an increased incidence of hypercalcemia and vascular thromboembolic complications such as deep venous thrombosis and/or pulmonary embolism, she pointed out. The lower proliferation rate and increased resistance to traditional chemotherapeutic agents make CCC "a much more difficult disease to treat."

    Given the relatively poor prognosis and similarity to clear cell renal cancer, patients with CCC of the ovary are best treated as part of a clinical trial exploring alternative or novel agents, Zsiros suggested.

    In the international, multi-institutional study, 667 patients were recruited at 129 centers in Japan, Korea, France, and the U.K., from September 2006 to February 2011. Japanese women made up 93.5% of the study population.

    The median age in both the experimental and standard-of-care groups was 53. A total of 411 patients (66.4%) had stage I disease, and 33.6% had stage II to IV disease. Of the latter group, 23% had stage III/IV disease.

    Patients were randomly assigned to receive either:

    • irinotecan at 60 mg/m2 on days 1, 8, and 15 plus cisplatin at 60 mg/m2on day 1 every 4 weeks for six cycles (CPT-P group); or
    • paclitaxel at 175 mg/m2 plus carboplatin at an area under the curve of 6.0 mg/mL/min on day 1 every 3 weeks for six cycles (TC group).

    Of the 619 patients eligible for evaluation, the 332 in the CPT-P group experienced more grade 3/4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia. The 335 patients in the TC group had grade 3/4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain more frequently, the study showed.

    No deaths related to treatment were reported, the researchers said.

    Okamoto disclosed no conflicts of interest, but several of the other study authors disclosed relationships with industry.

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

    LAST UPDATED 07.15.2016

    • Primary Source

    Journal of Clinical Oncology

    Source Reference: Okamoto A, et al "Randomized phase III trial of irinotecan plus cisplatin compared with paclitaxel plus carboplatin as first-line chemotherapy for ovarian clear cell carcinoma: JGOG3017/GCIG trial"JCO 2016; DOI: 10.1200/JCO.2016.66.9010.

  • July 18, 2016 9:13 AM | Deleted user

    A new study led by Assistant Medical Professor Philip Smith of The City College of New York's Sophie Davis Biomedical Education/CUNY School of Medicine, and conducted in collaboration with researchers at Yale University and Yeshiva University, found important differences between women and men in their ability to quit smoking when taking medications commonly prescribed to help smokers quit.

    The study, "Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis," which reviewed and analyzed evidence from over 14,000 cigarette smokers participating in 28 clinical trials for nicotine patch, varenicline and bupropion, found that across the trials women who were given varenicline were much more likely to quit smoking than women who were given nicotine patch or bupropion. By contrast, among men there were no differences in the likelihood of successfully quitting smoking when given varenicline, bupropion or nicotine patch.

    While the study found that all three medications helped both women and men quit when compared to placebo, the difference was in the relative benefit of the three medications. Clinical trial data consistently show that taking medications can help smokers quit. Some may help more than others, and for women the best choice may be varenicline.

    "Before our study, research had shown that among the choices for medications for smokers who wanted to quit, varenicline was the clear winner when it came to promoting quitting," said Smith. "Our study shows this is clearly the case for women. The story seems less clear among men, who showed less of a difference when taking any of the three medications."

    Roughly one in six adults in the United States smokes cigarettes, which contributes to over 550,000 deaths per year in the U.S. Currently, three types of medications approved by the U.S. Food and Drug Administration can be prescribed to help smokers quit: nicotine replacement therapies, which include the nicotine patch and nicotine gum; varenicline, which is manufactured by Pfizer and sold as Chantix in the United States; and bupropion, which is manufactured by GlaxoSmithKline and sold as Wellbutrin or Zyban.

    The study appears in the journal Nicotine & Tobacco Research.

    Story Source: The above post is reprinted from materials provided by City College of New York. Note: Materials may be edited for content and length.

    Journal Reference:

    Sherry A. McKee, Philip H. Smith, Mira Kaufman, Carolyn M. Mazure, Andrea H. Weinberger. Sex Differences in Varenicline Efficacy for Smoking Cessation: A Meta-Analysis. Nicotine & Tobacco Research, 2016; 18 (5): 1002 DOI: 10.1093/ntr/ntv207

    City College of New York. "Study finds differing treatment options for women smokers." ScienceDaily. ScienceDaily, 13 July 2016. <www.sciencedaily.com/releases/2016/07/160713105742.htm>.


  • July 18, 2016 8:52 AM | Deleted user

    AAPA

    In a landmark partnership, the Centers for Disease Control and Prevention and AAPA will present a free webinar on Zika and pregnancy on July 28 from 2-3 p.m. EDT. The presentation qualifies as Category 1 CME.

    The World Health Organization declared Zika virus a public health emergency of international concern after local transmission was reported in many other countries and territories. With the likelihood that the Zika virus will continue to spread to new international and domestic areas, this webinar is an opportunity for PAs to be prepared to handle Zika by knowing the facts. Pre-register (at no cost) and view the detailed agenda here

  • July 18, 2016 8:51 AM | Deleted user

    AAPA is looking for 10-15 PAs in various specialties who are willing to be interviewed and provide their thoughts and attitudes on the development of clinical apps that would be used via smartphones. The goal of the project is to learn what features and characteristics make medical apps effective and user-friendly for healthcare professionals and to gather information on using an "App Store" approach to enhancing electronic health records (EHR) functionality.

    Interviews will be conducted via phone by KLAS marketing research firm and will take no more than 15 minutes. During the interview you will also have an opportunity to provide ideas and suggest questions that will be part of a larger survey that will go out to PAs, physicians, advanced practice nurses in the future.

    The project is funded by a grant from the Office of the National Coordinator for Health Information Technology (ONC). ONC is the principal federal entity charged with coordination of nationwide efforts to implement and support the adoption of advanced health information technology within the healthcare arena.

    We would appreciate hearing from interested PAs by Friday, July 22.

    For additional information or to volunteer contact Michael Powe, AAPA's Vice President of Reimbursement & Professional Advocacy at michael@aapa.org.

  • July 18, 2016 8:50 AM | Deleted user

    July 13, 2016

    Over the past year, AAPA aggressively lobbied for PAs to be part of the solution to the nation’s opioid epidemic. As a result of our efforts, PAs will soon be eligible to become waivered to prescribe buprenorphine for the treatment of opioid addiction. On July 8, the U.S. House of Representatives overwhelmingly supported passage of the House-Senate Conference report to S524, the Comprehensive Addiction and Recovery Act (CARA) of 2016 and the U.S. Senate followed suit on July 13. The legislation amends federal law (the Drug Addiction Treatment Act of 2000 orDATA 2000) to permit PAs to become waivered to prescribe buprenorphine for the treatment of opioid addiction.  It will now be sent to the president for his expected signature.

    “As a PA with a background in addiction medicine and community health clinics, I am pleased Congress is bringing more resources to bear to tackle the opioid addiction crisis in this country," said AAPA President Josanne Pagel. “The inclusion of PAs in CARA is crucial to our ability to provide proven treatment options to more Americans suffering from addiction.”

    Although CARA was crafted in a bipartisan manner, funding was a contentious issue leading up to the bill’s passage and shaped many of the bill’s final provisions. This was because the Congressional Budget Office gave the bill a high cost estimate for the Medication-Assisted Treatment (MAT) Program, Section 303, of the bill. This unexpectedly high cost ultimately determined the conditions in which DATA 2000 was amended to permit PAs and nurse practitioners (NPs) to become waivered to prescribe buprenorphine for the treatment of opioid addiction. The final version of the Section 303 MAT Program:

    • Authorizes PAs and NPs to become waivered to prescribe buprenorphine in MAT for a five-year period, expiring in 2021;
    • Allows newly-waivered PAs, NPs, and physicians to prescribe buprenorphine to 30 patients, with the option to treat up to 100 patients after one year if certain conditions are met;
    • Requires PAs and NPs to obtain 24 hours in education related to the treatment of opioid addiction as a condition to be waivered; the law includes AAPA in the list of professional associations who may provide the educational requirements; additionally, the law provides the secretary of the Department of Health and Human Services (HHS) the flexibility to adjust the 24-hour educational requirement for clinicians with demonstrated experience in treating patients struggling with addiction;
    • Defers to state law regarding whether a PA or NP works with a physician through a supervisory or collaborative relationship; however, the legislation requires that a physician who supervises or collaborates with a PA or NP must also be waivered to prescribe buprenorphine to treat addiction; given the small number of waivered-physicians, particularly in rural and other medically underserved communities, AAPA is concerned this requirement will limit the number of PAs and NPs who will become waivered; fortunately, there is also a provision in the bill that provides flexibility to the HHS Secretary to review and remove the requirement.

    According to Tillie Fowler, AAPA’s senior vice president for advocacy and government relations, “Although Section 303 of CARA does not include all of AAPA’s policy recommendations; we believe it is a significant step forward in utilizing PAs to expand access to treatment for the millions of Americans who are struggling with opioid addiction. And AAPA will push to extend this authorization for PAs beyond its current 2021 expiration date.”

    In addition to MAT, CARA contains numerous programs and provisions designed to:

    • Support and provide grants for education, prevention, treatment, and recovery efforts to confront the opioid epidemic and assist individuals and communities suffering from addiction to opioids and heroin;
    • Provide grants to expand access to naloxone and prescription drug monitoring programs and to support veterans and law enforcement.

    Enactment of CARA is a significant win in AAPA’s continued efforts to ensure PAs have the ability to be part of the solution to the nation’s opioid epidemic. The Academy presented multiple statements and letters to Congress on the need to permit PAs to prescribe buprenorphine for the treatment of opioid addiction; extensively lobbied committee staff and members, as well as House and Senate leadership; and held joint lobbying visits with the American Association of Nurse Practitioners. AAPA will continue its work through the development of regulations to implement the MAT Program.

    - See more at: https://www.aapa.org/twocolumn.aspx?id=6442451389#sthash.Ev0XpXcU.hDmrNspU.dpuf


  • July 18, 2016 8:49 AM | Deleted user

    Medscape 


    Overall, adverse event rates are comparable between the two vaccines, although injection-site AEs are more common with the 9-valent human papillomavirus vaccine (9vHPV) (Gardasil 9, Merck & Co., Inc.) than with the quadrivalent HPV (qHPV) vaccine (Gardasil, Merck & Co., Inc.), and they increase with subsequent doses for both vaccines, a new analysis concludes. 


    Read more

  • July 18, 2016 8:48 AM | Deleted user

    Media Statement

    Embargoed until: Friday, July 15, 2016, 11 AM, EDT
    Contact: Media Relations,
    (404) 639-3286

    The New York City report of female-to-male sexual transmission of Zika virus infection is the first documented case of sexual transmission of Zika from a woman to her sex partner and adds to the growing body of knowledge about the sexual transmission of Zika. All previously reported cases of sexually transmitted Zika virus infection have been spread from men to their sex partners.

    CDC recommends that all pregnant women who have a sex partner who has traveled to or resides in an area with Zika use barrier methods every time they have sex or they should not have sex during the pregnancy. Although no cases of woman-to-woman Zika transmission have been reported, these recommendations now also apply to female sex partners of pregnant women.

    CDC is currently updating recommendations for sexually active people in which the couple is not pregnant or concerned about pregnancy and for people who want to reduce personal risk of Zika infection through sex.

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    U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


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