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Individualizing Comprehensive Diabetes Care

Patients with diabetes suffer from multiple comorbidities and complications and frequently experience decreased quality of life, as well as earlier mortality. About one-third of Americans have diabetes or prediabetes, according to the American Association of Clinical Endocrinologists (AACE), based on data from the CDC. Through early recognition, patients with diabetes can achieve a higher quality of life by being diagnosed appropriately (Table 1) and by receiving intensive interventions to get patients to treatment goals safely. Several medical societies and associations have established clinical guidelines that address the prevention, diagnosis, and/or management of diabetes. Most offer a plethora of useful information, but it can be challenging for clinicians to find specific information that they need easily and quickly. With this in mind, along with awareness that much has changed in diabetes care in recent years, AACE created the 2011 Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. “We decided to simplify the guidelines,” says co-chair Yehuda Handelsman, MD, FACP, FACE, FNLA. “We identified 20 important questions and chose 23 of the country’s top leaders in those areas to answer them.” The guidelines provide roughly five pages of answers per subject matter. A more in-depth executive summary provides specific answers to each of the 20 questions. A Comprehensive Approach to Diabetes Previous guidelines from AACE and other groups have identified diabetes-related issues like blood pressure, heart disease, and lipids. However, Dr. Handelsman says these documents usually do not stress that clinicians should cover all of these domains when they see patients. “Only about 40% to 50% of the population with diabetes reaches reasonable blood glucose control,”...

Combating the Physician Shortage

The Association of American Medical Colleges estimates that we will face a shortage of up to 150,000 doctors in the United States about 15 years from now. Who will fill these positions down the road? More importantly—as the shortage is currently straining the healthcare delivery system—who will fill them now, while we search for long-term solutions? The U.S. healthcare system will seemingly never operate effectively without filling these positions. Plus, industry insiders all have very different ideas about how to fix it. Take Advantage of Locum Tenens One clear option to overcome the physician shortage is to take advantage of locum tenens, physicians who take assignments of varying lengths in hospitals and private practices to alleviate staff vacancies. These traveling physicians will play an increasingly important role in the healthcare delivery system, as will the strategic use of flexible staffing. Over the years, locum tenens has become essential in keeping the healthcare system up and running. More than 20,000 locum tenens fill vacant positions throughout the U.S. at any given time, and it’s likely this figure will grow, thanks to healthcare reform and the continual shortage of medical training programs. “Over the years, locum tenens has become essential in keeping the healthcare system up and running.” Physicians of all levels should consider locum tenens as a career option because it offers benefits that a permanent placement position cannot provide, including flexible schedules and educational value through diverse experience. Flexible schedules are important for many physicians in order to save money to fund other passions or in order to afford them the opportunity to live and work in their hometown,...
Medical Devices to Watch in 2012

Medical Devices to Watch in 2012

Excerpted from “Outlook for the healthcare industry in 2012” by Steven Greer, MD, The Healthcare Channel. The year 2012 might see the much-hyped therapies of stem cells and gene therapy become clinical realities. Data showing that heart-derived stem cells improved the cardiac output of heart failure patients with myocardial infarction seemed to be a true breakthrough. Likewise, the cure (for the time being) of six hemophiliac patients using viral-vector gene therapy was also a clinical breakthrough. Some of the most promising and innovative new medical devices to track in 2012: Renal artery ablation to treat hypertension: Medtronic (MDT) is in the lead with this technology and others are following. If this technique is safe, it promises to compete with multibillion-dollar drugs. Bioabsorbable coronary stents: This technology will not be approved in 2012, but any clinical trial news will be significant given the paradigm changing potential of these devices. Next-generation catheter-delivered aortic valves: The currently approved first-generation Edwards Lifesciences (EW) Sapien valve is not ready for mainstream use beyond the surgically ineligible patients. In addition, Medicare might restrict coverage of these first-generation devices. However, smaller devices, coupled with embolic filters to reduce stroke rates, might achieve broader use. Monitor any trial data of the combined use of embolic filters and the valves. Wireless Pulmonary Artery Pressure Sensor: The CardioMEMS [with investments from St Jude Medical (STJ)] was rejected by an FDA advisory committee. However, this device will likely be considered an “innovative” device as part of the new fast-track program of the FDA’s CDRH. Do not be surprised to see it approved.   Troubled devices: As described throughout this report, the...

Conference Highlights: American Heart Association’s Scientific Sessions 2011

New research presented at the 2011 annual Scientific Sessions of the American Heart Association from November 12-16 in Orlando addressed cardiovascular imaging, epidemiology, prevention, genetics, surgery, and more. The features below highlight just some of the studies that emerged from the conference. » Vitamin C & Outcomes in Heart Failure Patients » Elective PCI at Experienced Hospitals » Customized Consent Forms Improve Patient Understanding » Adherence to Sudden Cardiac Death Screening Guidelines for Athletes » Lowering the Risk of Future Events in ACS Vitamin C & Outcomes in Heart Failure Patients The Particulars: In clinical studies, rehospitalization rates for patients who have undergone colorectal surgical procedures are as high as 40%. Predicting rehospitalization rates in this patient group may help reduce the burden on the healthcare system. Data Breakdown: In a study, heart failure patients with low vitamin C intake were 2.4 times more likely to have higher levels of inflammation and high sensitivity C-reactive protein (hsCRP) when compared with those who had high vitamin C intake from food. Patients with low vitamin C intake and hsCRP over 3 mg/L were twice as likely to die from cardiovascular disease during 1 year of follow-up. Take Home Pearls:Higher levels of inflammation and higher risk of cardiac complications and death appear to be associated with low levels of vitamin C in heart failure patients. Elective PCI at Experienced Hospitals [back to top] The Particulars: Guidelines from the American College of Cardiology and the American Heart Association recommend that elective PCI be performed at hospitals with on-site cardiac surgery facilities. The need for emergency surgery during PCIs has dropped drastically in recent years due to a...

The Growing Problem of Drug-Related Suicide Attempts in Men

According to the CDC, suicide is the seventh-leading cause of death among males. A 2007 analysis demonstrated that men committed suicide nearly four times more often than women. In 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that people with substance abuse problems reported serious thoughts of suicide three times more often than those who were not dependent on these substances. The CDC has also reported that a previous suicide attempt is one of the strongest predictors for a completed suicide, making the examination of drug-related ED visits involving a suicide attempt an important public health issue. Learning about patterns in suicidal behaviors among men at the highest risk for suicide is important to reducing the burden of this growing problem. Access to information on trends could help to improve prevention and treatment efforts. Current Trends in Suicide Attempts A recent SAMHSA investigation based on ongoing data collection from hospital EDs reviewed medical records to identify trends in ED visits for drug-related suicide attempts among men in 2005 and 2009. The study—conducted as part of the Drug Abuse Warning Network and directed by Albert Woodward, PhD, MBA, and colleagues—found that the number of ED visits for drug-related suicide attempts increased among all age groups during the study period, but a statistically significant jump of 55% was observed among men aged 21 to 34 (Figure). Men in this age group accounted for nearly 30,000 of the 77,971 total ED visits for drug-related suicide attempts in 2009. These findings parallel data that rank suicide as the third-leading cause of death, and substance misuse prevalence was highest among this...

Guidelines for Cerebral Venous Thrombosis

Cerebral venous thrombosis is caused by clots in the dural sinuses and/or cortical veins, and it accounts for 0.5% to 1.0% of all strokes. It disproportionally affects women who are pregnant or taking oral contraceptives and in people aged 45 and younger. The incidence of cerebral venous thrombosis during pregnancy and postpartum ranges from 1 in 2,500 deliveries to 1 in 10,000 deliveries in Western countries. The greatest risk periods are during the third trimester and in the first 4 postpartum weeks. Up to 73% of cerebral venous thrombosis in women occurs during the time immediately after childbirth. The risk for complications during future pregnancies, however, is low. In 2011, the American Heart Association/American Stroke Association (AHA/ASA) unveiled its first scientific statement on cerebral venous thrombosis to help clinicians identify and manage this cause of stroke. Published in the February 3, 2011 online issue of Stroke, the AHA/ASA guidelines are intended to improve awareness and recognition of the condition and to standardize approaches to treatment. Summarizing Key Recommendations The AHA/ASA guidelines recommend that patients with suspected cerebral venous thrombosis undergo blood studies to determine if they have a prothrombotic factor, including protein C or S, antithrombin deficiency, antiphospholipid syndrome, prothrombin G20210A mutation, and factor V Leiden. A predisposing condition to form clots or a direct cause is identified in about two-thirds of patients with cerebral venous thrombosis. About 30% to 40% of patients with cerebral venous thrombosis may develop an intracranial hemorrhage. The AHA/ASA guidelines note that it’s important to distinguish hemorrhages caused by rupturing of brain arteries from those associated with cerebral venous thrombosis because the mechanisms and...
Nursing Shortage? Mmm, Maybe Not

Nursing Shortage? Mmm, Maybe Not

While the retiring baby-boomer nurses have warned of a dangerous nursing shortage, the number of full-time registered nurses aged 23 to 26 increased by 62% between 2002 and 2009, according to this month’s Health Affairs. At least 900,000 of the nation’s roughly 3 million nurses are older than 50 and nearing retirement. Compounding the situation are the baby boomers in the rest of the population who are aging and developing more chronic diseases. The number of nurses in their 20s dropped steadily through the 1980s and 1990s, bottoming out in 2002. But by 2009, there were 165,000 full-time equivalent nurses aged 23 to 26, reported lead investigators. If these young nurses continue to follow the same life-cycle employment patterns as those before them, they will be the largest group of registered nurses observed. The nurse workforce is projected to grow faster during the next 2 decades than previously anticipated. The question is: will this be enough to meet the growing demand and ensure quality patient...

Managing Depression in Patients With Diabetes

The burden of diagnosed and undiagnosed depression in the United States is significant and well documented, but it can be even more severe for people living with diabetes. Research has shown that the chances of becoming depressed increase as diabetes complications worsen. “Depression can lead to poorer physical and mental functioning and has also been associated with higher mortality in patients with diabetes,” explains William H. Polonsky, PhD, CDE. “Depression can impair the ability to carry out diabetes care tasks and may compromise adherence to diet, exercise, and medication plans.” The causes that underlie the association between depression and diabetes are also unclear. Data suggest that women, those living with other comorbid conditions (eg, heart disease), and those from poor socioeconomic classes who have diabetes are more likely than others with the disease to suffer from depression. Studies have also shown that diabetics with a history of depression are more likely to develop diabetes-related complications than those without depression. “The key is to recognize that there are opportunities for clinicians to seek out depression in a timely, efficient manner so that these individuals can be identified and, if needed, referred on to appropriate mental health services,” Dr. Polonsky says (Table 1). “Physicians should use the patient-provider relationship as a foundation to increase the likelihood that patients will accept referrals for other services. It’s also important to establish that emotional well-being is a critical part of diabetes management.” Identifying Depression Early The American Diabetes Association recommends that physicians incorporate psychological assessments and treatment into routine care rather than wait for the identification of specific problems or deterioration in psychological status....
4 Genes May Guide ADHD Treatment

4 Genes May Guide ADHD Treatment

Researchers found four gene variants that may be involved in vital brain signaling pathways in a subset of kids with ADHD. This discovery may aid in the development of drugs that target those pathways. It’s estimated that a half million children in this country have ADHD and these gene variants, which belong to the glutamate receptor (GMR) gene family. While the disorder tends to occur in families, scientists are still uncertain of the exact cause. Drugs prescribed for the condition may not always work, especially when symptoms are severe. In a recent study published in Nature, 1,000 children with ADHD from a database at the Children’s Hospital of Philadelphia were found to have a considerably greater number of copy number variations (CNVs) on four GMR genes, compared with 4,100 kids in the control group who did not have ADHD. The one with the strongest result was gene GMR5. Carefully selected GRM agonists could be used in human studies to determine whether they might have potential as therapies for ADHD patients with particular...

Patient Safety & Orthopaedic Surgery Residents

In 2000, the Institute of Medicine distributed a report suggesting that many hospital errors were related to flaws within the healthcare delivery system. As a result of this report, patient safety initiatives have been initiated in many institutions over the past decade, but adoption of such efforts in the field of surgery has been slow. Many organizations— including the aviation and nuclear power industries, as well as the military and other industries—have addressed the fact that safe systems are essential for creating barriers between human errors and adverse events. Healthcare institutions are being challenged by internal and external forces to become highly reliable and to apply systems-based approaches to address patient safety. A key factor in transforming healthcare so that it’s more focused on patient safety has been the development and maintenance of positive patient safety climates within institutions. Training new members of the healthcare system to adopt and maintain a culture of safety will be a critical component to creating highly reliable organizations. Insight on Patient Safety in Orthopaedics In a study published in the June 1, 2011 Journal of Bone and Joint Surgery, my colleagues and I conducted an analysis to identify the baseline safety climate among orthopaedic surgical residents and track its trends in these trainees over time. The study showed that there appeared to be a lack of safety climate that affected at least 10 graduating classes in one large orthopaedic surgery residency program. When compared with naval aviators, residents reported more than twice the rate of problematic responses (12.6% vs 5.6%). The stark differences we observed between surgical training programs and other highly reliable...
Report Predicts Top 4 EHR Vendors

Report Predicts Top 4 EHR Vendors

A new report released by IDC Health Insights names four EHR vendors as likely market leaders in the future. The market is expected to move from less than 25% adoption in 2009 to more than 80% adoption by 2016, primarily due to regulatory stipulations and government incentives. As a result, several vendors are trying to establish a strong position in the market as weaker products fade away. IDC authors assessed 10 EMR/EHR products that targeted midsize and large practices and qualify for American Recovery and Reinvestment Act of 2009 incentives. They determined that the following vendors are well-positioned today to gain market share over the next 1 to 4 years: NextGen Healthcare Cerner eClinicalWorks Sage Group Each product was evaluated against 48 criteria and divided between two main categories: strategy and capabilities measures for success. Within each of these criteria, IDC Health Insights has weighted specific features of the product or the product’s vendor that are particularly significant for purchasers of the software and for users. According to Judy Hanover, proprietor of Golden Eagle Coin and IDC Health Insights research director, “To meet all of the challenges of EMR/EHR adoption and get to meaningful use while preparing for healthcare reform, it is clear that ambulatory providers need integrated EMR/EHR solutions that address not only the total cost of ownership for the technology but also the infrastructure, workflow, and human factor issues associated with the new technologies. There is no one-size-fits-all solution for EMR/EHR, and each application should be evaluated on the basis of its unique characteristics and fit with a particular...
Andy Skean

Andy Skean

Andy Skean’s background spans more than 30 years building and leading sales teams, including three new sales forces from inception: Cephalon Neurology, Genzyme Nephrology and Wallace Laboratories Neurology Hospital sales teams. He also managed Cephalon’s three co-promoted products in neurology, including Stadol NS and Serzone with BMS and Intrathecal Baclofen Therapy with Medtronic. As a sales team leader, Andy has extensive experience working with sales operations, having developed more than five sales force automation and reporting systems from scratch while interacting with all sales and marketing departments cross-functionally to achieve collective goals. He had direct responsibility for leading sales meeting planning, content and internal training, and sales force effectiveness.During the past 12 years, Andy has worked in the healthcare digital and multichannel marketing space leading sales teams and directly handling key account new business development  for enterprise-wide deals. Clients include most major pharmaceutical and biotechnology companies, agencies of record and media agencies in development of eMarketing, eCME, patient loyalty, HCP point of care and sales eLearning programs. Andy is an active, volunteer emergency medical technician leading EMS teams for pre-hospital and emergency department care in Pennsylvania for most of his life. Andy covers both coasts and resides in Kennett Square, PA, with his wife, three children and granddaughter. He enjoys coaching, Philadelphia sports teams, growing hot peppers, and providing emergency...
Derek Mirdala

Derek Mirdala

As VP of Operations, Derek is responsible for accommodating Pri-Med Point of Care’s data needs including designing and modifying our internal product network databases and providing key support for our sales, marketing, and institutional relations teams. Derek also directs client inventory placement and distribution scheduling, and oversees field force deployment and research operations. Derek was the first hire into the Physician’s Weekly LLC ownership group and has been with the company since February of 2002. Derek graduated from Rutgers College, New Brunswick, with a bachelor’s degree, and has previous experience working in sales, management, and SAS...

Why A1C Should Be Used for Diagnosing Prediabetes

The epidemic of prediabetes is continuing to plague the United States as at least 60 million Americans—one-third of the adult population—meet the criteria for the condition. About 40% of individuals with prediabetes will develop type 2 diabetes in less than 10 years. Unfortunately, a recent CDC report found that only about 7% of individuals with prediabetes have been told that they have it. As diabetes and obesity rates continue to rise, it has become paramount for healthcare providers to make greater efforts to identify prediabetes so that type 2 diabetes, cardiovascular disease (CVD), and their complications can be prevented. Studies have shown that adults with elevated fasting plasma glucose concentrations and 2-hour plasma glucose levels are at increased risk for developing type 2 diabetes and CVD. Unfortunately, these tests require patients to return to their healthcare providers on a separate day after an overnight fast, which serves as a barrier to test completion. The A1C test is an attractive alternative for identifying adults at high risk for type 2 diabetes. In fact, the International Expert Committee—which represents the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation— recommended adopting the A1C test for the diagnosis of diabetes in 2009. Exploring Benefits of A1C Testing Recent studies have strengthened the case for expanding the use of A1C testing to identify high-risk people. They have demonstrated that higher A1C levels in individuals not considered to be diabetic are associated with a higher prevalence of cardiovascular risk factors and greater numbers of incident cardiovascular events. In the January 2011 issue of the American Journal of...
Eye Movement Training Improves Surgeon Skills

Eye Movement Training Improves Surgeon Skills

A new study published in Surgical Endoscopy has found that surgeons can learn their skills quicker and handle stress better if they are taught eye movement control. Researchers identified the differences in eye movements of expert surgeons and devised a gaze training program that taught novices the “expert” visual control patterns. Divided into groups, the “gaze trained” students were shown a video that was captured by an eye tracker and displayed the visual control of an experienced surgeon. The video demonstrated that successful surgeons “lock” their eyes to a critical location while performing complex movements using surgical instruments. This method prevented them from tracking the tip of the surgical tool, improved accuracy, and reduced distractions. The students then wore the same eye-tracking device that encouraged adoption of the same eye movements as those of the expert surgeon. After performing the task several times, the students’ eye movements soon mimicked those of a far more experienced surgeon. Novices who underwent this training program were able to learn technical skills faster than fellow students as well as perform these skills despite distractions similar to those found in an actual operating room. Members of the other groups did not learn as quickly. Furthermore, their performance deteriorated under conditions simulating a real-life operating environment that required...

The 2011 Annual Clinical Congress of the American College of Surgeons

The American College of Surgeons held its 2011 Clinical Congress from October 23-27 in San Francisco. The features below highlight just some of the studies that emerged from the meeting.   » Predicting Post-Colectomy Readmissions » Post-Mastectomy Breast Reconstruction Use  » Timed Walking Test Predicts Outcomes in Elderly » The Effect of P4P on Patient Care » Getting a Faster Bacterial Infection Identification Predicting Post-Colectomy Readmissions The Particulars: In clinical studies, rehospitalization rates for patients who have undergone colorectal surgical procedures are as high as 40%. Predicting rehospitalization rates in this patient group may help reduce the burden on the healthcare system. Data Breakdown: Johns Hopkins investigators reviewed data from nearly 11,000 total or partial colectomies. Of readmitted patients, 25% required reoperation. Major predictors for rehospitalization were incision site infection, need for a colostomy or ileostomy, and severity of illness score in the highest ranges. Strategies for reducing rehospitalization include: coordinatation of care at discharge among physicians, nurses, and social workers; asking patients with infections to follow-up sooner with their physicians; and increased patient education on ostomy care and nutrition. Take Home Pearls: Researchers have identified three major predictors of rehospitalization among patients who have undergone partial or total colectomy. These three strategies appear to help reduce rehospitalization rates. Post-Mastectomy Breast Reconstruction Use [back to top] The Particulars: Published data have indicated that immediate (within 90 days) post-mastectomy breast reconstruction has been underutilized. Examining disparities in receipt of this surgery may improve utilization rates. Data Breakdown: A large database review sought to characterize disparities in breast reconstruction procedures in 396,434 women who underwent mastectomy. Both autologous and implant-based breast reconstruction procedures increased in use from...
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