Is a rigid HPV vaccination schedule really necessary? Story by Bruce Jancin, reporting from the annual meeting of the European Society for Pediatric Infectious Diseases. Delayed administration of the second dose of an HPV vaccine had no negative impact on the magnitude of the immune response. Other top stories: Women are underrepresented as lead authors in oncology trials  The proportion has been increasing but still lags behind the proportion of female oncologists in the United States. Dupilumab found effective for adolescents with moderate to severe AD  Rates of skin infections were higher in the placebo group, compared with the treatment groups. Exposure to outdoor air pollutants linked to increased emphysema  Being exposed to outdoor air pollutants was associated with increases in emphysema as assessed via CT imaging. Favorable Ebola results lead to drug trial termination, new focus  Two of four therapeutics showed greater survival, prompting termination of the initial trial and randomization of new patients to these two drugs. You can contact the MDedge Daily Medical News team by emailing us at [email protected] or by following us on Twitter @MDedgeTweets.

SPECIAL Crossover with Blood & Cancer, the official podcast of MDedge HematologyOncology.  You can learn more about Blood & Cancer at http://www.mdedge.com/podcasts/blood-cancer   SHOW NOTES: Alan P. Lyss, MD, a medical oncologist in community practice at Missouri Baptist Medical Center in St. Louis, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, to break down the most interesting and practice-changing studies at the recent 2019 annual meeting of the American Society of Clinical Oncology. Complete show notes by Ronak H. Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia, are available online here. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: [email protected] Interact with us on Twitter: @mdedgehemonc David Henry on Twitter: @DavidHenryMD     Relevant links: Big Data Abstract LBA1 Abstract LBA5563 Abstract 110 CancerLinQ Database Colorectal Cancer Abstract 3500 Abstract 3501 Pancreatic Cancer Abstract 4000 Abstract LBA4 Prostate Cancer Abstract LBA2 Lung Cancer Abstract 8504 Breast Cancer Abstract 500 Abstract 502 TAILORx Abstract 503 Health Informatics Abstract 6509 Abstract 6510 Multiple Myeloma Multiple Myeloma Abstracts Smoldering Myeloma Abstract 8000 Myeloma Abstract 8002 Abstract 8007

Today's top stories in clinical medicine.  Medical cannabis laws appear no longer tied to drop in opioid overdose mortality EULAR revises its RA management recommendations Aggressive lowering of LDL cholesterol: Is it a good thing? Residents are drowning in job offers -- and debt You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets

Today's top stories in clinical medicine.  Treat insomnia as a full-fledged disorder. Illinois law expands abortion rights. Consider iatrogenesis in patients with new psychiatric symptoms. Foot osteoarthritis: forgotten no longer. You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Today's top stories in clinical medicine: Modest changes deemed inherent in 'normal' aging COPD exacerbations associated with poor sleep quality Genetic analysis links PCSK9 inhibition and CV mortality Obesity and overweight declined among lower-income kids You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.  

Today's top stories: Chronic opioid use may be common in patients with ankylosing spondylitis Reducing pediatric RSV burden is top priority Less reactogenic acellular pertusses vaccine has waning immunity Nearly two-thirds of gynecologic oncology respondents experienced sexual harassment You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.  

You can find more of our podcasts at http://www.mdedge.com/podcasts. Today's top stories in clinical medicine: Updated systematic review of aspirin for primary prevention shows benefits, risks. Estimated prevalence of OSA in the Americas stands at 170 million. How to reverse type 2 diabetes with a crash diet the DiRECT approach. Zeroing in on a key issue: SGLT2s or GLP-1s for elderly T2D? You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

You can find more of our podcasts on our website: http://www.mdedge.com/podcasts Today's top stories in clinical medicine: Coffee, tea, and soda all up GERD risk Warfarin boosts OS risk in Rotterdam Study mTORC1 inhibitor protects elderly asthmatics from viral respiratory infections NJ law, EMR alerts appear effective at reducing opioid prescriptions You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Today in clinical medicine: Most measles cases in 25 years prompts government pleas to vaccinate Positive psoriatic arthritis screens occur often in psoriasis patients Sleep apnea is linked with tau accumulation in the brain Patients say primary care video visits are convenient, high quality You can contact the MDedge Daily News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.  

The 2019 annual Internal Medicine meeting of the American College of Physicians took place beginning April 10 in Philadelphia. MDedge Podcast host and producer Nick Andrews joined Internal Medicine News editor Katie Lennon to discuss a few of the biggest topics.  ACP 2019 highlights: Telemedicine update. Neuropathic pain update. Negotiating a strong contract. ACP launches quality improvement tools. You can contact the MDedge Daily news by emailing [email protected] or by following us on Twitter at @MDedgeTweets.  

Today, we’re bringing you a special episode featuring exclusive coverage from the annual meeting of the American Academy of Dermatology in Washington. 1. Food allergies and atopic dermatitis: What is the evidence? https://bit.ly/2CayGcp 2. Many common dermatologic drugs can be safely used during pregnancy. https://bit.ly/2HmZLfY 3. 31-GEP test predicts likelihood of metastasis for cutaneous melanoma. https://bit.ly/2NO3dkK 4. Bermekimab reduces lesions, cuts pain in patients with hidradenitis suppurativa. https://bit.ly/2H6NuNe Contact us: [email protected]

Contact us: [email protected] 1. CDC: United States has hit a plateau with HIV. https://bit.ly/2TokV3E 2. Fauci, Messonnier testify on measles outbreaks. https://bit.ly/2XqP3KO 3. Big pharma says it can’t drop drug list prices alone. https://bit.ly/2Xs92Zy 4. Barrett’s esophagus uncommon in patients with uncomplicated GERD. https://bit.ly/2VqKRJd

Contact us: [email protected] FDA panels back intranasal esketamine for refractory depression. http://bit.ly/2TOKrfp ONC aims to help doctors, patients with information sharing in proposed rule. http://bit.ly/2X3SVkP Survey: Health care costs unlikely to improve in 2019. http://bit.ly/2SwSIYJ Vaccination and antiviral treatment don't lower stroke risk after shingles. http://bit.ly/2tjYQVa

Contact us: podcasts@mdedge Automated office BP readings best routine measures https://www.mdedge.com/internalmedicinenews/article/193804/hypertension/automated-office-bp-readings-best-routine-measures   Positive FIT test should prompt colonoscopy https://www.mdedge.com/internalmedicinenews/article/193798/gastroenterology/positive-fit-test-should-prompt-colonoscopy   Mild aerobic exercise speeds sports concussion recovery https://www.mdedge.com/internalmedicinenews/article/193748/injuries/mild-aerobic-exercise-speeds-sports-concussion-recovery   Phase 3 studies of antiamyloid Alzheimer’s drug crenezumab stopped https://www.mdedge.com/psychiatry/article/193578/alzheimers-cognition/phase-3-studies-antiamyloid-alzheimers-drug  

Contact us: [email protected] Follow MDedge on Twitter: @MDedgeTweets In this special edition of the MDedge Daily News, Nick Andrews and Terry Rudd report the latest news from the 2018 annual San Antonio Breast Cancer Symposium. Stories include: using low-dose tamoxifen, the latest findings fro KATHERINE trial, results of a meta-analysis of neoadjuvant chemotherapy, and capecitabine in early stage triple negative breast cancer

Contact us: [email protected] The Postcall Podcast is available here: http://bit.ly/2QxXAHh Today's stories: Asking about a family's military service can improve pediatric care. http://bit.ly/2LYC91k Knee pathologies, including multiple meniscal tears, predict accelerated osteoarthritis. http://bit.ly/2TySGvt Poor-prognosis cancers linked to highest suicide risk in first year.  http://bit.ly/2CWavzh Nuedexta mainly prescribed for dementia, Parkinson's. http://bit.ly/2Rddrju  

U.S. life expectancy down; drug overdose, suicide up sharply http://bit.ly/2Sfcx2a Less-distressed patients are driving an increase in outpatient services. http://bit.ly/2QvSoYe ASH releases new VTE guidelines. http://bit.ly/2TVCy8n Commentary: NIH director expresses concern over CRISPR-cas9 baby claim. http://bit.ly/2QvSoYe

The MDedge Psychcast is new with Dr. John Rozel and a conversation on gun violence. ( TENS cuts fibromyalgia pain in large, randomized controlled trial.  Brisk walking may decrease total knee replacement risk in osteoarthritis.  Smoking neglected in patients with peripheral arterial disease. The American College of Physicians beefs up firearms policy.

MedPAC eyes 'incident to' billing.  (http://bit.ly/2AbQBP3) Stepdown to oral ciprofloxacin looks safe in gram-negative bloodstream infections. (http://bit.ly/2CKC0wx) Nasal cannula device may be an option for severe COPD. (http://bit.ly/2IX5aZR) Brexanolone injection quickly improves postpartum depression. (http://bit.ly/2CLuLVs)

Postcall Podcast: (http://bit.ly/2CfnY52) Suicide risk doubles in COPD patients who are taking benzodiazepines. (http://bit.ly/2yGVIVt) Feds say ACA's silver plan premiums will drop in 2019. (http://bit.ly/2ygRQLt) Bias in the clinical setting can impact patient care. (http://bit.ly/2CIqH89) Managing asthma in children: PEts don't always have to go.  (http://bit.ly/2IVYD1m)

Postcall Podcast: https://apple.co/2IeKD2y GARFIELD-AF registry: DOACs cut mortality 19% http://bit.ly/2CFwmfe Obesity paradox extends to PE patients http://bit.ly/2yvOILf Adjuvanted flu vaccine reduces hospitalizations in oldest old http://bit.ly/2ITnnHq Third trimester Tdap vaccination raises antibodies in newborns http://bit.ly/2Cb1Jx8

Guidelines outlines patient-centered approach to type 2 diabetes. (http://bit.ly/2Przga9) With more mindfulness, menopausal symptoms wane.  (http://bit.ly/2ybN2Hk) Employer health insurance: Deductibles rising faster than wages.  (http://bit.ly/2ybN2Hk) Delayed pushing during labor does not benefit mother or baby.  (http://bit.ly/2QC8sEq)

Bisphosphonate holiday may help reduce atypical femur fracture risk. (http://bit.ly/2QFvMkF) Most dermatologic drugs safe for breastfeeding mothers. (http://bit.ly/2C7VLgn) 'Twincreatin' produces 'impressive' HbA1c, weight control in T2DM. (http://bit.ly/2RBRIyp) Short-term NSAIDs appear safe for high-risk patients.(http://bit.ly/2ONpv9e)

Half of outpatient antibiotics prescribed with no infectious disease code.https://www.mdedge.com/internalmedicinenews/article/176602/practice-management/half-outpatient-antibiotics-prescribed-no How to vaccinate patients on biologics.https://www.mdedge.com/internalmedicinenews/article/176611/vaccines/how-vaccinate-patients-biologics Opiate use tied to hepatitis C risk in youth.https://www.mdedge.com/internalmedicinenews/article/176570/hepatitis/opiate-use-tied-hepatitis-c-risk-youth In rosacea, a single treatment may not be enough.https://www.mdedge.com/internalmedicinenews/article/176604/rosacea/rosacea-single-treatment-may-not-be-enough

FDA expands approval of 9-valent HPV vaccine to include men and women aged 27 - 45.  http://bit.ly/2zYfcHj Allergen of the year may be closer than you think.  http://bit.ly/2y6FllH Encourage influenza vaccination in pregnant women. http://bit.ly/2NtitBC Sunscreens: Misleading labels, poor performance, and more. http://bit.ly/2y50M6G 

PCV13 shows moderate overall effectiveness for preventing invasive pneumococcal disease caused by PCV13 vaccine serotypes in adults 65 years and older (http://bit.ly/2QtUXGW). Also today, ED visits that are related to psychiatric complaints are up 20 among elderly (http://bit.ly/2xVmmus), nonobstructive angina should trigger functional testing (http://bit.ly/2Nk6TJk), and antibiotics trigger proteolytic activity that leads to chronic colitis (http://bit.ly/2zP0n9P).

Signs point to growing abuse of gabapentinoids in the United States. Short sleep is linked to elevated blood pressure. Another large trial shows CT screening reduces lung cancer deaths. And atrial fibrillation guidelines may miss the mark with oral anticoagulation.

Dr. Joseph Murray of the Mayo Clinic points out that you might know as much about celiac as you think (http://bit.ly/2preFr4). Also today, a novel agent shows unprecedented efficacy in psoriasis (http://bit.ly/2MLLE2I), IgA vasculitis may be more common in adults than you think (http://bit.ly/2DeXTFC), and one-step gestational diabetes screening doesn’t improve outcomes (http://bit.ly/2xy7VLM).

The U.S. Preventative Services Task Force advises clinicians to refer or offer intensive behavioral weight-loss interventions to obese adults (http://bit.ly/2DbYO9F). Also today, stop treating gout and start curing it (http://bit.ly/2QIhaBO) the FDA has a new risk evaluation mitigation strategy for immediate-release opioids (http://bit.ly/2Df9AvY), and the United Nations aims to eradicate tuberculosis by the year 2030 (http://bit.ly/2DenEFN).

More than half of patients who were tested for prescription drug compliance last year misused their medications (http://bit.ly/2xpqou1). Also today, obesity prevalence is now at least 35% in 7 states(http://bit.ly/2NLI3WW), the FDA has a new plan to combat antibiotic resistance (http://bit.ly/2MCBykL), and what will come of all the comments about the new E/M payment proposals (http://bit.ly/2xryMZM).

Physician burnout may jeopardize patient care. The FDA cracks down on companies selling an increasingly popular, unproven alternative to opioids. Multiday seizure cycles in epilepsy may be quite common. And new stroke guidelines raise the bar on mechanical thrombectomy procedures.

One-quarter of emergency department sprained ankle diagnoses result in an opioid prescription. How secondhand smoke in childhood leads to COPD deaths in adulthood. A potential contender to treat antibiotic-resistant blood poisoning falls flat. And be on the lookout for a nasty skin souvenir on international travelers.

Tai chi tempers the risk of falls in older adults. Rosacea’s global reach may be greater than expected. How an MRI at prostate cancer diagnosis shapes disease management. And new guidelines debut for diagnosing and treating mild traumatic brain injury in children.

Why composite risk, not age, is key for timing a patient’s first colorectal cancer screening. EULAR updates its hand osteoarthritis management recommendations for the first time in more than a decade. Why the right medication starting dose shapes success in treating anxiety disorders. And how to avoid fraud and abuse hot spots in your telemedicine ventures.

Researchers interviewed injection drug users and identified 5 themes that capture how having HCV impacts their care. Also today, the FDA proposes broader outcomes for opioid user disorder treatment drug approvals, there’s a new state on top of WalletHub’s healthcare rankings, and there is new guidance for men who want to start a family on how to protect against Zika.

Over the last decade, opioid use has not significantly declined, despite efforts to educate physicians about the risk of abuse. Also today, the Fitbit Flex is feasible and provides nuanced step-count data in patients with MS, even moderate alcohol use could worsen outcomes in nonalcoholic fatty liver disease, and a new study supports meningococcal B vaccine in children with rare diseases.

An experimental agent slowed cognitive decline and cleared Alzheimer’s plaques. Can meteorology predict migraines? Why closing a patent foramen ovale is the right approach to prevent recurring ischemic stroke. And claims that cannabis relieves noncancer pain go up in smoke.

Hypertension medications slashed mild cognitive impairment risk by 19% in the SPRINT MIND study. Updated HIV guidelines recommend immediate treatment, three-drug therapy. Early antidepressant therapy after a heart attack delivers benefits years later. And HIV infection could double a patient’s risk of stroke.

Are omega-3 fatty acids' heart benefits just another fish tale? Why sustaining weight loss requires more than a bariatric procedure. How pregnancies and a longer span of reproductive years shape dementia risk. And physicians sound off on possible dramatic changes to how Medicare pays them.

Fibromyalgia should be seen as one disorder, not two. How dementia prevalence differs among sexual minorities. Why you should talk with parents about the risks of food additives. And breast cancer patients don’t get the financial counseling they want from their clinicians.

Epinephrine provided a slight 30-day survival benefit, but those patients experienced more severe brain damage. Also today, nerve growth factor inhibitor shows phase-3 efficacy in osteoarthritis, National Academies issues a 5-step plan to address infections linked to opioid use disorder, and there may be beneficial class effects of SGLT2 inhibitors, including dapagliflozin.

Medicare’s bundled pay plan didn’t deliver any cost savings per episode or care outcomes for the top five medical conditions under the program. Also today, deaths in the US from liver disease surged from 1999 to 2016, bivalent HPV vaccine brings no significant increase in any of 38 different potential adverse outcomes, and almost one-quarter of preoperative patients were already using opioids.

Federal officials are looking to expand the number of services that qualify for telemedicine payment. Also today, new PET imaging agent shows loss of synaptic density in Alzheimer’s brains, fecal transplantation suggests efficacy in IBS, and SGLT-2 inhibitor shows lower mortality and cardiovascular risk than DPP-4 inhibitor for type 2 diabetes.

Patients with HIV are living longer which means that physicians often need to factor diabetes into care strategy Also today, better communication between ICU staff and family may improve end-of-life choices, randomized clinical trials for probiotics often lack adequate safety data, and early data suggest that intranasal naloxone is promising for hypoglycemia-associated autonomic failure (HAAF).

Antibiotic prescription rates were at least twice as high in urgent care and retail clinics than at emergency departments and medical offices. Also today, overdoses from a fentanyl analog nearly doubled, a device impresses for chronic cluster headaches, and the immunogenicity of two-dose Gardasil 9 persists at 36 months,

Sweeping reductions in documentation requirements headline a new Medicare fee schedule proposal. Also today, spironolactone is safe and effective for acne in adolescent females, for smokers, the ends may not justify the ENDS (electronic nicotine delivery system), and the rare diabetes diagnosis that thrills patients.

Adoption of the new ACC/AHA hypertension guidelines would suddenly lead to 15 million more Americans and about 125 million more Chinese with hypertension. Also today, in virto fertilization and cancer risk, depression screening rates are improving, but are still not great, and the relationship between temperature, pollution and lupus flares.

Previous rulings by President Trump’s Supreme Court nominee could provide insight into the fate of the Affordable Care Act should Judge Brett M. Kavanaugh be confirmed. Also today, OnabutolinumtoxinA crushes topiramate in chronic migraine PRO benefits, antiamyloid antibody slowed Alzheimer’s progression while also clearing brain amyloid, and the USPSTF says that nontraditional CVD risk factors are not ready for primetime.

The first-ever recommendations for managing Sjogren’s Syndrome will divide the treatment targets into sicca syndrome and systemic manifestations. Also today, more than 16% of ED sepsis patients are discharged, female authorship trends in academic gastroenterology over 40 years, and the CMS holds ACA risk adjustment payments following a legal ruling.

Multiple studies based on phase 3 clinical trials of the investigational drug solriamfetol have found that it may be effective for improving next-day wakefulness and work productivity in people with narcolepsy and obstructive sleep apnea, and that the drug can maintain its effect throughout the day as well as for up to 6 months. Also today, ankylosing spondylitis progression slowed when NSAIDs were added to TNFi, chronic kidney disease more common among patients with type 2 diabetes, laws that promote drug price transparency gain ground.

New research debunks three migraine trigger myths. Also today, the relationship between migraines and menopause, the FDA recommends pooled Zika testing of blood donations, and ICD use drops in hospitals named in a federal lawsuit.

From family practice news, women who received only a primary HPV test were 58% less likely to develop grade 3 or worse cervical intraepithelial neoplasia by 48 months than women who had the traditional pap cytology screen. Oral tecovirimat for smallpox shows efficacy in animals and safety in humans, low platelets are linked to pregnancy complications, and four new and emerging alternatives to continuous positive airway pressure are on the horizon.

Hospitals in and around St. Louis have seen a dramatic decrease in the incidence of hypoglycemia due to a new alert system. Also today, women have a higher risk for diabetes if they work more hours, the FDA reverses the warning on asthma medications that contain long-acting beta agonists, and transgender men are in need of counseling for contraceptive and reproductive choices.

The advisory committee on Immunization Practices voted to approve recommendations for the use of Anthrax Vaccine Adsorbed (AVA) in post-exposure prophylaxis (PEP) in the event of a wide-area release of Bacillus anthracis spores. Also today, the FDA approves topical anticholinergic for primary axillary hyperhidrosis, a shortage of ob.gyns. looms, and more Americans missed care in 2017 as a result of cost.

Since 2000, Medicare beneficiaries are less likely to die in hospitals and are more likely to die in their homes or in community healthcare facilities. Also today, heart failure leads to a poor prognosis for patients with rheumatoid arthritis, The Supreme Court supports anti-abortion centers in free speech case, and when confronted with contact dermatitis in toddlers, consider the potty seat.

Less than 30% of veterans who are on medication-assisted treatment for opioids have not been diagnosed with opioid use disorder and only 7% who have OUD initiated medication-assisted treatment. Also today, Buprenorphine endangers the lives and health of children, cocaine use is declining among young adults, and smoking cigarettes is an epidemic among patients with hepatitis C virus.

Opioids cannot be justified for the routine treatment for musculoskeletal pain because risks outweigh benefits. Also today, intensive treatment for type 2 diabetes pays off in the long run, diabetes patients are being pushed into high-deductible insurance plans, and obesity didn’t just happen overnight.

The FDA approved cannabidiol oral solution for the treatment of two rare pediatric seizure disorders. Also today, it’s a good idea to urge expectant parents to have a prenatal pediatrician visit, the Trump administration proposes changes to HHS and the FDA (view the complete proposal here), and after being approved for adults, the Eversense continuous glucose monitoring system is safe, durable, and accurate in children.

Nearly 25% of patients with diabetes use less insulin than prescribed because they can’t afford it. Also today, switching back to human insulin is a viable way to save money, tackling maternal obesity might prevent later CVD in offspring, and new research provides evidence of a link between diabetes and autism spectrum disorder.

A new study finds that two nearly ubiquitous herpes viruses, HHV-6a and HHV-7, are abundant in the brains of people with Alzheimer’s disease. Also today, midlife retinopathy predicts ischemic stroke, fingernails may hold a clue for relapsing scabies, and canakinumab cuts gout attacks by nearly half.

Is galectin-3 a post-MI prognostic biomarker for out times? Also today, postmenopausal estrogen use is down since 2006, watching for substance abuse risks among reservists who have never been deployed, and do free meals for physicians affect opioid prescribing?

The exogenous boosting hypothesis predicted that pediatric universal varicella vaccination would fuel a rise in adult herpes zoster cases. However, in the U.S., the 20-year experience has delivered just the opposite effect. Also today, in type 2 diabetes, healthy lifestyle lowers CVD risk and mortality, antipsychotics linked to increased body fat and insulin resistance in children, and maternal use of pot and tobacco may boost birth defect risk.