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COPD & Cognitive Issues

COPD & Cognitive Issues

As the third leading cause of death in the United States, COPD affects about 13.7 million patients. Recent research has suggested that as many as 77% of patients with COPD and hypoxemia have some form of cognitive impairment. Despite this association, the link between COPD and mild cognitive impairment (MCI) has not been established in well-designed, population-based studies. Investigating the Link In a study published in Mayo Clinic Proceedings, Balwinder Singh, MD, MS, and colleagues analyzed data from 1,927 individuals aged 70 to 89 who participated in the Mayo Clinic Study of Aging to see if there was an association between COPD and MCI. Patients underwent a nurse assessment, neurological evaluation, and neuropsychological testing when they entered the study. A panel diagnosed MCI using standardized criteria and then reviewed medical records to identify people with COPD who developed MCI. According to the analysis, patients with COPD had a higher prevalence of MCI than those without COPD (27% vs 15%). Findings were similar for both men and women involved in the study. “In addition, COPD was associated with almost two-fold higher odds of MCI,” says Dr. Singh. The associations of COPD with overall MCI and amnestic MCI were independent of age, sex, education, apolipoprotein E genotype, BMI, depression, and a history of coronary artery disease, diabetes, hypertension, and stroke. The investigation also revealed that there appears to be a dose-response effect for COPD duration. “We observed a 1.60 odds ratio for MCI in patients who had COPD for 5 years or less, but this ratio jumped to 2.10 in patients who had a COPD duration that exceeded 5 years,” Dr....
The Economic Burden of Cancer Survivors

The Economic Burden of Cancer Survivors

According to recent estimates, about 13.7 million people in the United States with a history of cancer were still living in 2012. “The prevalence of cancer survivors has increased substantially over time,” says Gery P. Guy Jr., PhD, MPH. “Even more cancer survivors are expected as advances are made in treatment and early detection and as life expectancy continues to increase.” As the number of cancer survivors grows, it is important to understand how medical expenditures and lost productivity affect these individuals. This includes exploring the role of employment disability, hours worked, and missed work days. In the past, studies of medical expenditures used cancer registry data, administrative claims, and other sources to describe the economic burden of patients who have survived cancer. However, analyses of expenditures on a national level tend to only include cancer survivors who are receiving cancer-related healthcare. Few studies have assessed multiple components of the economic burden of cancer survivorship, and most of these were conducted in a single state. “To gain a better perspective on this issue,” says Dr. Guy, “we need to quantify medical expenditures and the indirect morbidity cost of lost productivity among adult cancer survivors of all ages on a national level.” To address this need, Dr. Guy and colleagues conducted a study using the 2008 to 2010 Medical Expenditure Panel Survey to compare the economic burden of adult cancer survivors with individuals who did not have a history of cancer. The study, published in the Journal of Clinical Oncology, looked at the lost productivity that is associated with employment disability, missed work days, and lost household productivity. Considerable Costs...
Binge Drinking & Fatalities: EDs at the Forefront

Binge Drinking & Fatalities: EDs at the Forefront

Substantial progress has been made over the last 20 years in the United States to curb drinking and driving among teenagers. Since 1991, there has been about a 54% decrease in the prevalence of drinking and driving among high school students aged 16 and older. However, about 10% of adolescents in this age range report that they have driven after consuming an alcoholic beverage (Figure 1). Although progress has been made, the overall prevalence of drinking and driving still affects about 950,000 high school students, killing more than 800 each year. National data have illustrated significant differences in drinking and driving among genders, races, ages, and patterns of binge drinking. Male students are more likely than female students to drink and drive. Hispanics have the highest prevalence of drinking and driving when compared with Caucasians and African Americans. Drinking and driving rates increase with age throughout the teenage years. These rates are more than three times higher among students who report binge drinking when compared with those reporting they use alcohol but do not binge drink. The prevalence of drinking and driving per state also varies significantly, ranging from a low of about 5% in Utah to a high of nearly 15% in North Dakota (Figure 2). Making Efforts: Alcohol Screening & Intervention To reduce the prevalence of alcohol-related injuries, the CDC has worked with EDs and trauma centers to implement alcohol screening and brief intervention (SBI) programs. “Currently, major trauma centers are required by the American College of Surgeons to use SBI programs to screen all incoming patients for alcohol use in an effort to identify risky drinking...
Enhancing Outcomes in Bariatric Surgery

Enhancing Outcomes in Bariatric Surgery

In 2008, the Obesity Society, the American Association of Clinical Endocrinologists, and the American Society for Metabolic & Bariatric Surgery published a joint clinical practice guideline on the perioperative nutritional, metabolic, and non-surgical support of bariatric surgery patients. Since that time, a significant increase in the amount and strength of data has emerged. In 2013, the guidelines were updated to reflect these changes. Key Changes to the Bariatric Surgery Guideline For the 2013 updated guidelines, experts revised 56 of the 72 recommendations that were made in the 2008 document and added just two. These revisions represent such changes as the FDA approval of sleeve gastrectomy, which was considered an investigative procedure in 2008, says Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU, who served as lead author of the updated guideline that was published in Endocrine Practice, Surgery for Obesity and Related Diseases, and Obesity. Over the past 5 years, the role of bariatric surgery in patients with type 2 diabetes has become clearer, says Dr. Mechanick. “We still are not recommending bariatric surgery for patients with diabetes who are not obese. Instead, bariatric surgery should be considered in patients with diabetes who are obese and who have not responded to conventional methods for controlling their disease.” The use of bariatric surgery in patients with mild obesity was a new addition to the guideline. With the FDA approval of the Lap-Band® (Apollo Endosurgery, Inc) device for patients with mild obesity, the expert writing committee made the recommendation for considering gastric banding in select patients with a BMI of 30 kg/m2 to 35 kg/m2 and at least one obesity-related comorbidity....
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