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Statin Adherence a Major Issue in Most At-Risk Patients

Statin Adherence a Major Issue in Most At-Risk Patients

First, the good news: Patients with high adherence to statin therapy can increase their expected quality-adjusted life years (QALYs) by as many as 1.5 compared with patients with low adherence, and by as many as 2 years compared with those who do not take any statins, according to a new study in the journal Medical Decision Making. Now, the bad news: The same study found that just 48% of patients who have been prescribed statins take the prescribed dose on a regular basis a year after being prescribed the medication, with only 27% doing so after 10 years. Looking specifically at patients with type 2 diabetes—because of their higher risk for heart disease, heart attack, and stroke, compared with the general population—the investigators found that adherence-improving interventions can help. Indeed, quality and length of life can significantly improve among patients who receive patient education or electronic reminders to take their statins. But the benefits of adherence don’t end there: Healthcare costs for type 2 diabetic men who take generic statins are lower than for those who take none of the medication, while there is just an incremental cost increase for women with type 2 diabetes. The study authors concluded that “given suboptimal adherence to statins, it is optimal to delay the start time for statins; however, changing the start time alone does not lead to significant changes in costs or QALYs.” Physician’s Weekly wants to know… What have your experiences been with adherence to statins among patients with type 2 diabetes? What about among other patients on statins? Do you feel the issue is adherence to statins, or adherence...
Fears About Discussing Patients’ Suicidal Thoughts Unfounded, Study Says

Fears About Discussing Patients’ Suicidal Thoughts Unfounded, Study Says

Despite some physicians’ reluctance to discuss suicide with depressed patients for fear it could foster feelings of completing or thinking about the act, a study published in the May issue of the British Journal of Psychiatry indicates that fear is unwarranted. An initial survey found that 100 family practitioners didn’t like to ask patients about suicide because they felt doing so might make the patients feel worse. The researchers sought to determine if screening for suicidal ideation in patients with signs of depression increases the incidence of feelings that “life is not worth living” in the short term. More than 440 patients with signs of depression were randomized to screening for suicidal ideation or questions about health and lifestyle. After waiting 2 weeks, the investigators asked patients whether they had, during the previous 2 weeks, felt that life was not worth living. Those who did were encouraged to discuss their feelings with healthcare staff and take advantage of available resources designed at helping such patients. Among those who were randomized to initial screening compared with those who only underwent screening at 2 weeks, the adjusted odds of experiencing thoughts that life was not worth living at followup was 0.88. The team found that the number of patients who reported thoughts of suicide dropped from 22.3% at baseline to 14.6% at 2-week followup. Although this was a relatively small study, it seems to indicate that physicians should not hesitate to screen patients for suicidal thoughts for fear it may encourage the act. Physician’s Weekly wants to know… Would you agree that asking about suicidal thoughts can help bring to light...

Choosing the Right EHR System

There are many challenges that keep physicians awake at night, and one of the most current is tackling the emerging world of electronic health records (EHRs). Financial incentives coupled with the rapid acceptance of communication technology have made this conversion essential. For healthcare providers, a key question persists: can EHR adoption be done in a way that achieves fiscal sense and administrative ease? Despite the inherent complexities that are involved with this undertaking, the answer, fortunately, is yes, but it takes proper planning, focused execution, and patience. Getting Started To start, physicians need to find an EHR system at a price point that is acceptable. Until now, that hasn’t been easy as few “single-shingle” doctors were enthusiastic to pay the costs associated with these systems. However, considerable progress has been made, and there are now products on the market that are quite affordable both in initial cost and ongoing commitment. When choosing a system, it’s essential to remember that not all physicians who convert to EHRs will receive the stimulus dollars set forth in the 2009 economic stimulus package. Only those providers who use EHR technology that has been certified to allow providers to achieve “meaningful use” will be eligible for these financial rewards. The term “meaningful use” is categorized as technology that improves care coordination, reduces healthcare disparities, engages patients and their families, improves population and public health, and ensures adequate privacy and security. In other words, providers must choose wisely when selecting their EHR systems. Gaining Support Having the correct EHR system in place is a good place to start, but providers also need to obtain the...

Guidelines for Managing Patients With Shoulder Arthritis

According to data from the CDC, more than 51 million Americans have been diagnosed with some form of arthritis, and the estimated annual cost for medical care of arthritis and joint pain was $281.5 billion in 2004. Arthritis of the glenohumeral joint can be the result of primary osteoarthritis, posttraumatic deformity, inflammatory arthritis, sepsis, or avascular necrosis. Epidemiological data suggest that the incidence of glenohumeral joint osteoarthritis is more common in women and appears to increase with age. The risk of shoulder arthritis is increased by a history of injury or surgery to the shoulder. “Patients diagnosed with osteoarthritis of the shoulder experience pain, progressive loss of function, and diminished quality of life,” says Rolando Izquierdo, MD. “Shoulder replacement surgery has become the third most common joint surgery, following hip and knee replacements, due to the increasing burden of glenohumeral joint osteoarthritis. Most treatments for glenohumeral joint osteoarthritis are associated with some known risks, especially invasive and operative treatments. Contraindications can also vary widely based on the treatment administered. As such, discussion of available treatments and procedures that may be applicable to patients should rely on mutual communication with physicians. This dialogue should weigh the potential risks and benefits for each patient, based on their individual medical characteristics.” Evidence-Based Guidelines The American Academy of Orthopaedic Surgeons (AAOS) recently released an evidence-based clinical practice guideline on the treatment of glenohumeral joint osteoarthritis in adults aged 19 and older. The guideline provides information on patient management after the diagnosis of osteoarthritis of the glenohumeral joint. The final treatment guidelines contain 16 recommendations and include both operative and non-operative treatment options (Table)....

Obesity “Master” Regulator Gene Found?

Researchers from London claim to have identified a master regulator gene that causes obesity, is linked to diabetes and cholesterol, and controls the behavior of distant genes existing inside fat cells. This discovery may potentially help steer more effective treatments for obesity-related illness. The KLF14 gene is inherited from the mother (the same gene inherited from the father is not active and has no effect). Researchers surmise medications could developed to target KLF14, improving the efficiency of treatment for several metabolic diseases. The study was published in this week’s issue of Nature Genetics.Researchers of the large, multinational collaboration called the MuTHER study took subcutaneous fat biopsies of 776 female twins in the UK and analyzed over 20,000 genes in the fat cells. KLF14, a gene known to have been linked to cholesterol and diabetes type 2, was found to influence the behavior of distant genes that influence BMI (body mass index), glucose levels, insulin levels, cholesterol and obesity. These findings were also supported by an independent sample of 600 subcutaneous fat biopsies from patients in Iceland. “This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes,” writes Professor Tim Spector, study leader. “This has great therapeutic potential particularly as by studying large detailed populations such as the twins we hope to find more of these...

The 63rd American Academy of Neurology’s 2011 Annual Meeting

Highlights from the AAN 2011 Annual Meeting include the relationship between cardiovascular risk factors and cognitive decline, using a cerebrospinal fluid test to determine MS onset of disability, an experimental agent for MS, and overcoming dyskinesia in Parkinson’s. » Amphetamine Use May Increase Parkinson’s Risk » Cardiovascular Risk Factors & Cognitive Decline » Experimental Agent Promising for MS Sufferers » Overcoming Dyskinesia in Parkinson’s » CSF Test May Help Predict MS Onset of Disability Amphetamine Use May Increase Parkinson’s Risk The Particulars: Amphetamines were once recommended for treating patients with Parkinson’s disease. Recent studies, however, have suggested that this class of drugs may be linked to a higher risk of developing Parkinson’s. Data Breakdown: Researchers conducted an analysis in 66,438 individuals who did not have Parkinson’s disease at baseline and collected information on exposure to amphetamines. Through a mean follow-up of 38.8 years, 1,154 patients received a Parkinson’s diagnosis. The average age at baseline was 36, and the average age at diagnosis was 70. Individuals who reported often taking amphetamine sulfate or dextroamphetamine sulfate had a 56% greater risk of having a Parkinson’s diagnosis decades later. The magnitude of the relationship was similar for both men and women. Participants who reported taking weight-loss medication at baseline did not have an elevated risk for Parkinson’s disease through follow-up (hazard ratio, 0.95). Take Home Pearls: The use of amphetamines appears to be associated with an elevated risk for developing Parkinson’s disease later in life. Considering the wide population exposure to both legal and illegal amphetamines, more studies are needed to address this association. Cardiovascular Risk Factors & Cognitive Decline [back to top] The Particulars: The heart...

Improving Boomeratric Care Services

The population of baby boomers and geriatric adults—the “boomeratric”™ generation—is continuing to increase in the United States. Roughly 40 million Americans are 65 or older, representing 12.9% of the total population (or one in every eight people). There will also be about 72.1 million older Americans by 2030, a growth of about 19%. As the boomeratric™ generation continues to age, they become increasingly prone to falls and fractures because of their frailty. Timely evaluation and treatment after bone fractures lead to better outcomes. At Geisinger Health System and other medical centers throughout the country, hospitals are starting to establish geriatric fracture care programs. These initiatives utilize evidence-based medicine to address the aging population and a complete team approach to provide quality comprehensive care. Using the latest research, a series of protocols is followed to deliver best practice medicine throughout the entire care process. Geriatric fracture care programs connect patients with the resources they need to expedite recovery and help them take steps to stay healthy and prevent future injury. Coordinated, Evidence-Based Care Members of the geriatric fracture care team include nurse coordinators, emergency physicians, physical and occupational therapies, orthopedic surgeons, hospitalists, pharmacists, care managers, physician assistants, rheumatologists, dietitians, blood conservation services, and nurses. Nurse coordinators play an integral role in streamlining processes—speaking with patients regularly, keeping track of their progress, and guiding them throughout the care process. It’s their job to facilitate family involvement in the care of patients to improve outcomes. They also help maintain centralized electronic medical records and order sets. These enable all members of the geriatric fracture care team to stay up to date and...
Suicidal Thoughts Plague 1 in 16 U.S. Surgeons

Suicidal Thoughts Plague 1 in 16 U.S. Surgeons

One in 16 surgeons had suicidal thoughts in the past year, according to a survey of nearly 8,000 U.S. surgeons published in a recent issue of Archives of Surgery. The prevalence among surgeons was similar to that in the general population for those aged 25 to 44; however, rates were substantially higher among surgeons aged 45 and older. “We know the lifetime risk of depression among physicians is similar to that of the general population, which suggests factors other than depression may be contributing to increased risk of suicide among physicians,” Tait D. Shanafelt, MD, tells Physician’s Weekly. “The influence of professional characteristics in forms of distress and depression, such as burnout, has been largely unexplored.” According to Dr. Shanafelt, in addition to burnout, there appear to be occupational risks for having suicidal thoughts: A three-fold increased risk for suicidal thoughts was reported for surgeons who made a recent major medical error. A further finding from the survey was that only 26% of surgeons who reported suicidal ideation sought psychiatric or psychologic help, while 60% were reluctant to seek help due to concerns about their medical license. “We need to be mindful of the organizational characteristics that may contribute to burnout as it pertains to workload, call schedule, and inefficiencies that may put physicians at risk for burnout,” says Dr. Shanafelt, lead author of the study. “Organizations should also recognize times when physicians might have a substantial increased risk, such as following a medical error or during a malpractice suit, and build into those processes support systems for physicians.” For the full interview with Dr. Shanafelt, keep an eye...

CDC Releases Statement on PCR Use for Pertussis

The CDC has issued a statement on best practices for use of polymerase chain reaction (PCR) to diagnose pertussis. The statement, available at www.cdc.gov/pertussis/clinical, provides information for clinicians on the clinical features of pertussis as well as strategies for appropriate testing with PCR, specimen collection techniques, protocols for avoiding specimen contamination, and appropriate interpretation of test...

Persistent HPV Leaves Women More Vulnerable

Women with long-term persistence of human papillomavirus (HPV) infection appear to be generally more susceptible to other HPV infections, especially longer-lasting infections, than women who have these infections cleared, according to an international investigation. In a logistic regression model, women with long-term HPV persistence were more likely than women who cleared infections to have another newly-detected HPV infection detected when assessed at three or more office visits (odds ratio,...

A Web-Based Depression Treatment

A web-based cognitive behavioral therapy (CBT) depression treatment appears to be effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes, according to a study from the Netherlands. In a randomized controlled trial, researchers found that web-based CBT effectively reduced depressive symptoms by intention-to-treat analyses and by per-protocol analyses. The intervention reduced diabetes-specific emotional distress, but had no beneficial effect on glycemic...

CHD, Heart Transplantation, & Survival

Adults with congenital heart disease (CHD) appear to have high 30-day mortality rates after heart transplantation but also have better late survival after their transplant procedure. Researchers in the United States found that early mortality among patients with CHD was high, but overall survival was equivalent by 10 years (53.8% vs 53.6%). Mechanical circulatory assistance did not improve waiting-list survival in the study. The authors theorized that this may be due to a combination of highly complex reoperative surgery and poor preoperative systemic health. CHD patients were more likely to have a BMI less than 18.5 kg/m2 at transplantation, were younger, and had fewer...

Managing VCFs in Cancer Patients

An international randomized control trial has found that kyphoplasty appears to be an effective and safe treatment that rapidly reduces pain and improves function for patients with cancer who have painful vertebral compression fractures (VCFs). The average scores on a disability scale for patients receiving kyphoplasty for VCFs changed from 17.6 at baseline to 9.1 at 1 month. Conversely, the average scores on the scale for the control group changed from 18.2 to...

Collaboration Helps When Managing CKD

Most primary care physicians (PCPs) and nephrologists appear to favor utilizing collaborative care for patients with progressive chronic kidney disease (CKD), according to a nationwide analysis. Most PCPs and nephrologists in the study desired collaboration for managing CKD, but nephrologists were more likely than PCPs to prefer collaboration that focused on pre-dialysis or renal replacement therapy preparation and electrolyte management. PCPs were more likely to desire collaboration if patients have diabetes and hypertension, if they believed the care they provide helps slow CKD disease progression, and if they did not perceive health insurance as a barrier to nephrology...

Non-Compliance High With Work-Hour Regulations

Non-compliance with work-hour regulations appears to be prevalent among surgical residents, according to survey findings from a Mount Sinai School of Medicine study. Non-compliance with the work-hour regulations was 64.6%, with 21.1% of residents working more than 90 hours per week. Investigators noted that education and continuity in patient care were the main reasons associated with...

Home Dialysis Machine Approved

The FDA has approved a home dialysis machine (2008K@home, Fresenius Medical Care) to facilitate hemodialysis treatment in the home environment. The machine offers a broad range of dialysis pre

A Look at Online Health Users

Findings from the Bupa Health Pulse survey suggest that there are more ways to access health information on the internet than ever before, but few people check the source of this information. The report, available at www.bupa.com, found that 81% of those with internet access used it to search for advice about health, drugs, or medical conditions. About 68% did so to look for information about specific medicines, and nearly 40% used it to look for other...

Post-Exercise ABI Beneficial in PAD

Use of a post-exercise ankle brachial index (ABI) appears to be a powerful independent predictor of all-cause mortality among patients with peripheral arterial disease, or PAD, and provides additional risk stratification beyond the ABI at rest, according to findings from an observational analysis. Patients with an ABI of 0.85 or higher before and after exercise had a 10-year mortality rate of 32.7%, compared with a 41.2% rate, which was observed in patients with a normal ABI at rest but an ABI of less than 0.85 after exercise. An abnormal post-exercise ABI result independently predicted mortality (hazard ratio 1.3). Additional independent predictors of mortality...

Fruits, Vegetables, & Ischemic Heart Disease

A European study has found that a higher intake of fruits and vegetables appears to be associated with a reduced risk of mortality from ischemic heart disease (IHD). Patients consuming at least eight portions (80 g each) of fruits and vegetables a day had a 22% lower risk of fatal IHD when compared with those consuming fewer than three portions a...
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