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Combination Therapy Improves Meningitis Outcomes

Among HIV patients with cryptococcal meningitis, therapy with amphotericin B plus flucytosine appears to improve survival when compared with using amphotericin B alone. The combination was also associated with significantly higher rates of yeast clearance from cerebrospinal fluid. Abstract: New England Journal of Medicine, April 4,...

Allergies Common Among Asthmatics

Allergies appear to be common among adults with asthma, according to findings from a national survey. The study found that 75.4% of people with asthma aged 20 to 40 and 65.2% of those aged 55 and older reported sensitization to at least one allergen. Abstract: Annals of Allergy, Asthma & Immunology, April...

Analyzing Mortality in Critical Access Hospitals

The 30-day mortality rates among patients with acute myocardial infarction, congestive heart failure, or pneumonia appear to be comparable at critical access hospitals (CAHs) and non-CAHs. Results of a retrospective study showed that 30-day mortality rates were 13.3% at CAHs and 11.4% at non-CAHs in 2010. Abstract: JAMA, April 3,...

Prediabetes in the United States

About one-third of American adults aged 20 or older had prediabetes in 2010, according to a report from the CDC. The report, available at www.cdc.gov/mmwr, notes that only 11% of adults in the United States with prediabetes were aware of their condition during 2009-2010. Abstract: Morbidity & Mortality Weekly Report, March 22,...

Cancer Survivorship Rates Predicted to Soar

A National Cancer Institute study has found that approximately 13.7 million cancer survivors were living in the United States as of 2012, a figure which is expected to approach 18 million by 2022. About two-thirds of cancer survivors have survived 5 or more years while 40% have survived 10 or more. Another 15% have survived 20 years or longer after a cancer diagnosis. Abstract: Cancer Epidemiology, Biomarkers, & Prevention, March 27, 2013...

Brisdelle – First Non-hormonal Treatment for Hot Flashes Associated With Menopause

The U.S. Food and Drug Administration today approved Brisdelle (paroxetine)to treat moderate to severe hot flashes (vasomotor symptoms) associated with menopause. Brisdelle, which contains the selective serotonin reuptake inhibitor paroxetine mesylate, is currently the only non-hormonal treatment for hot flashes approved by the FDA. There are a variety of FDA-approved treatments for hot flashes, but all contain either estrogen alone or estrogen plus a progestin. Hot flashes associated with menopause occur in up to 75 percent of women and can persist for up to five years, or even longer in some women. Hot flashes are not life-threatening, but the symptoms can be very bothersome, causing discomfort, embarrassment and disruption of sleep. “There are a significant number of women who suffer from hot flashes associated with menopause and who cannot or do not want to use hormonal treatments,” said Hylton V. Joffe, M.D., M.M.Sc., director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research. “Today’s approval provides women with the first FDA-approved, non-hormonal therapeutic option to help ease the hot flashes that are so common in menopause.” The safety and effectiveness of Brisdelle were established in two randomized, double-blind, placebo-controlled studies in a total of 1,175 postmenopausal women with moderate to severe hot flashes (a minimum of seven to eight per day or 50-60 per week). The treatment period lasted 12 weeks in one study and 24 weeks in the other study. The results showed that Brisdelle reduced hot flashes compared to placebo. The mechanism by which Brisdelle reduces hot flashes is unknown. The most common side effects in patients treated...
A Different Approach to Delivering Smoking Cessation

A Different Approach to Delivering Smoking Cessation

Although the health benefits of smoking cessation are well documented, only about 6% of smokers successfully quit each year. Quitlines deliver highly effective telephone-based smoking cessation services, but this intervention reaches only 1% to 2% of smokers each year. “Most households in the United States have phones, making quitlines one of the few modalities with the potential to have broad enough reach to make a significant impact,” says Jennifer Irvin Vidrine, PhD. “Quitlines could serve a much larger smoking population, but they generally have not been well integrated or institutionalized within healthcare systems.” The formalization of partnerships with healthcare providers has been identified as a key strategy for increasing the impact of quitlines. Several national initiatives have been developed to facilitate the delivery of smoking cessation treatment in medical settings, most notably “Ask-Advise-Refer,” or AAR. “The AAR program was designed to help clinicians routinely assess smoking status among all patients,” explains Dr. Vidrine. “It’s also intended to help clinicians deliver brief advice to quit smoking and refer smokers to guideline-recommended cessation treatments. Unfortunately, referrals to quitlines are low, and most smokers passively referred to quitlines fail to call for assistance.” Testing a Quitline New Method with EHR Dr. Vidrine and colleagues conducted a group randomized trial designed to evaluate a new approach to disseminating quitline-delivered cessation treatment through a healthcare system partnership. The study, published in JAMA Internal Medicine, evaluated Ask-Advise-Connect (AAC), an approach designed to address clinic- and patient-level barriers to linking smokers to treatment through the help of an automated connection system within electronic health records (EHRs). Click here for a video presentation released by JAMA Internal...
National HIV Testing Day 2013

National HIV Testing Day 2013

June 27th is National HIV Testing Day, an annual campaign to encourage people of all ages to “Take the Test, Take Control.” Nearly 1.1 million people in the United States are living with HIV, and an estimated 1 in 5 don’t know they are infected. Although HIV testing rates have steadily increased, more than half of Americans have not been tested for HIV in their lifetime. The CDC recommends that all adolescents and adults get tested at least once for HIV as a routine part of medical care. Encouraging your patients to get tested will help guide them to treatment and care that can not only help them lead a long, healthy life, but reduce the spread of HIV. Download the CDC fact sheet, HIV Testing in the United States to hand out to your patients. For more resources on HIV, read related articles from Physician’s Weekly: HIV & Injection Drug Use: Trends & Learning Lessons Comparing Rural and Urban in HIV Care Guidelines: Improving Retention & Treatment Adherence in HIV Making the Case for Earlier ART in...
Collaboration is Key When Treating PAD

Collaboration is Key When Treating PAD

In the United States, only about 25% of the general population is aware of peripheral arterial disease (PAD), a strikingly low percentage considering that the disease impacts an estimated 8 to 12 million Americans. Studies show that many cases of PAD go undiagnosed each year, reflecting that management of the disease remains suboptimal. Increasing physician awareness and adherence to guideline recommendations could potentially reduce the high rate of mortality and morbidity seen with PAD. Primary care physicians (PCPs) play an extremely critical role in the early diagnosis of PAD, often serving as the first point of contact for patients suffering from its symptoms. Unfortunately, time is at a premium for these general practitioners; they face increasing patient demands and greater time constraints, making it challenging for them to always give enough attention to holistic health issues. Simple PAD warning signs (eg, leg cramping or pain) are frequently attributed to other common, more benign, factors. Complicating matters is that about half of people with PAD do not show any major symptoms at all. As such, the partnership between PCPs and vascular surgeons is essential to making a swift diagnosis and developing an effective treatment plan. We owe it to each other and our patients to educate and collaborate as we care for PAD patients. Making a Concerted Effort My colleagues and I are committed to this partnership. Our vascular surgeons work closely with the PCPs throughout our network to identify PAD risk factors and symptoms as early as possible so that we can collaboratively determine the best course of treatment. To enhance this partnership, we’ve enabled real-time communication between providers...
Enhancing Communication About Newly Prescribed Medications

Enhancing Communication About Newly Prescribed Medications

When physicians prescribe a new medication, there are many instances when basic information about the drug is not discussed with patients. Guidelines recommend that older adults be educated about the reason physicians prescribe medications, how to take them, and their potential side effects. “It has been postulated that better patient knowledge about medications may lead to better adherence,” says Derjung M. Tarn, MD, PhD. It has been reported that patients who have better and more discussions with their doctors about prescription medications are more adherent to them than those receiving less information. Many interventions have been launched in clinical studies to improve patient education and counseling about medications, but few have targeted the content of physician communication. “Physician-targeted interventions vary, but research shows that the information doctors provide to patients tends to be lacking in many cases,” Dr. Tarn explains. “They rarely address the cost of medications and oftentimes don’t adequately monitor adherence.” Greater exploration is needed into the information exchange during conversations with patients after prescribing medications. Prescription Medication Intervention In a study published in the Annals of Family Medicine, Dr. Tarn and colleagues tested an intervention that involved training physicians to discuss five basic facts about a prescribed medication with patients: 1) the medication’s name, 2) its purpose, 3) directions for its use, 4) duration of use, and 5) potential side effects. How well physicians communicated these facts to patients was measured using the Medication Communication Index (MCI), a previously developed, 5-point index in which 1 point is given for discussion about each of five topics relating to a new prescription. Training consisted of a 1-hour interactive...

IAS 2013

New research is being presented at IAS 2013, the International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, from June 30 to July 3 in Kuala Lumpur, Malaysia. Meeting Highlights HIV Patients Have High ESRD Rate CD4 Count Linked to HIV Reservoir Level HCV Reinfection High Among Gay Men With HIV Repeat Use of Postexposure HIV Prophylaxis Positive Outcomes With HIV Prevention Program   News From the Meeting Kick, Kill, Contain – Researchers Examine Three Possible Steps in a Cure for HIV Home Visits During Pregnancy Increase Number of Male Partners Tested for HIV Stem Cell Transplant Leads to HIV Remission German Researchers Report Case of “Functional Cure” After Very Early HIV Treatment Cutting Dose of Efavirenz Safe, Effective in HIV Nevirapine Toxicity May Be Linked to Race How Can Most-at-Risk Populations Be Encouraged to Seek HIV Testing? Researchers Discuss HIV and Inflammation, Prevention Research and Structural Factors including Stigma and Punitive Laws Turning Surveillance into Support for Men Who Have Sex With Men in Africa Generic Competition Pushing Down HIV Drug Prices, but Patents Keep Newer Drugs Unaffordable Experts Discuss Role of Drug Policy in HIV, Hepatitis and TB Epidemics HIV Cure Has Long Way to Go Before the Clinic High Positivity Rate and Good Linkage to Care at Barcelona Community Testing Project AbbVie Interferon-Free Hepatitis C Combo Works Well With Reduced Ribavirin Dose New HIV Treatment Guidelines to Cut Millions of Deaths High Linkage to Care After Community-Based HIV Counselling and Testing in South Africa Associated With Confidence in Drug Supplies, Depression Management of Age-related Conditions Is “the Future of HIV Care,” Says IAS Conference Keynote...

Primary Care Guidelines eBook

We are proud to present this monograph featuring several guideline-based features that are applicable to primary care. Created with the assistance of key opinion leaders and experts in their respective fields, these articles discuss challenges and opportunities in primary care and strategies to positively change current...

ADA 2013: Mixed Results With Lifestyle Intervention for Obese Diabetics

The Particulars: The effects of long-term, intensive lifestyle interventions focused on weight loss for obese adults with diabetes are not well known in regard to heart attack and stroke. Data Breakdown: Participants in a clinical trial were randomized to physical activity and weight loss interventions (lifestyle group) or diabetes support and education (controls) and followed for up to 11.5 years. Although patients in the lifestyle group maintained a weight loss of 6% of body weight, compared with a 3.5% rate among controls, the lifestyle group did not achieve reduced risks of cardiovascular morbidity or mortality, or LDL-cholesterol levels. However, the lifestyle group did experience reduced risk of kidney disease, self-reported retinopathy, depressive symptoms, and annual hospital rates and costs, as well as improved physical quality of life, and greater reductions in A1C. Take Home Pearls: Long-term, intensive lifestyle interventions focused on weight loss do not appear to reduce the risk of heart attacks or strokes among obese adults with diabetes. However, such programs do help patients maintain substantial weight loss and reduce risks of several obesity-related...
A Different Strategy to Help Prevent VTE in Trauma Patients

A Different Strategy to Help Prevent VTE in Trauma Patients

Venous thromboembolism (VTE)—consisting of pulmonary embolism (PE) and DVT—is one of the most common and deadliest complications experienced by trauma patients admitted to hospitals. According to recent estimates, trauma is the leading killer of young people in the United States. Other studies suggest that at least 100,000 people die from PE alone every year. In light of the incidence of these events, the AHRQ recently placed interventions to improve VTE prophylaxis on its top 10 list of patient safety practices that are strongly encouraged. Changing the Approach of VTE Prophylaxis “Currently, healthcare practitioners use a complex flow diagram for determining the most appropriate strategies when providing VTE prophylaxis,” explains Elliott R. Haut, MD, FACS. For a study, Dr. Haut and colleagues converted the complex algorithm into a shorter clinical decision support-enabled VTE order set that was built into a computerized provider order entry system (CPOE). The converted algorithm was used at the point of care by trauma services providers at the Johns Hopkins Hospital in the analysis. For the intervention, clinicians checked off appropriate boxes on a short checklist (Table) based on patients’ VTE risk factors and contraindications to pharmacologic VTE prophylaxis. The CPOE system integrated this information into an evidence-based algorithm to stratify patients’ VTE risk. The system then suggested the optimal decision for an appropriate VTE prophylaxis regimen. “Using the order set was mandatory for all adult trauma patients in our study,” adds Dr. Haut, whose research was published in JAMA Surgery. The study team compared compliance with guideline-appropriate VTE prophylaxis during the year prior to implementing the order set with the 3 years after implementation. Increased...

Even More Problems With Patient Satisfaction Surveys

A paper in April’s JAMA Surgery journal noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned. They concluded that “patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.” What about patient satisfaction and the quality of medical care provided by doctors? This is only an anecdote, but it does say volumes about the subject. In April, a New York area cardiologist admitted to defrauding government and private insurers of $19 million. This was described as the largest healthcare scam by a single physician ever recorded in New York or New Jersey. Thousands of patients underwent unnecessary and possibly dangerous tests and treatments. He also employed unlicensed and unqualified personnel who treated patients. As noted by Dan Diamond, managing editor of the Daily Briefing, the Healthgrades patient satisfaction scores for Dr. Katz ranged from very good to excellent. In fact, Dr. Katz has received not one … not two … but three Healthgrades Quality Awards still in evidence on their website, which also reports no sanctions against him. I guess $19 million...

ADA 2013: Achieving Lifestyle Changes in the Unmotivated

The Particulars: Previous studies indicate that increased exercise and healthy diet can help highly motivated patients lose weight and prevent diabetes and its complications. Whether similar results are attainable in patients who are told by a healthcare provider to adopt such lifestyle behaviors, as opposed to adopting them on their own, has not been well defined. Data Breakdown: For a study, investigators analyzed the records of 400,000 patients who were directed by their healthcare providers to weekly group lifestyle intervention sessions focused on issues such as nutrition and physical activity. An average weight loss of 1.3% of body weight was maintained for 3 years among all participants, compared with a weight loss of 2.7% of body weight among those who enrolled in eight of more sessions over 6 months. Participants diagnosed with diabetes before entering the program were more likely to become active participants than those who did not have diabetes at the start of the program. Take Home Pearl: Participation in lifestyle intervention programs focused on weight loss through better nutrition and physical activity does not appear to have to be entirely voluntary to be...

ADA 2013: Wide-Ranging Benefits of Intensive Type 1 Diabetes Therapy

The Particulars: The Epidemiology of Diabetes Interventions and Complications (EDIC) study was launched in 1983 to determine the effects of intensive therapy aimed at obtaining near-normal glucose levels in type 1 diabetics. Results were released in 1993, but longer-term effects of such therapy have remained unknown. Data Breakdown: Long-term follow-up of EDIC has been conducted over the past 20 years. Researchers found that long-term, intensive therapy reduced risk for developing impaired kidney function by 50%, reduced heart disease and stroke risk by nearly 60%, and reduced the severe, vision-threatening stages of diabetic eye disease and the need for ocular surgery and procedures by 50%. Take Home Pearl: Long-term, intensive therapy for type 1 diabetes appears to help patients achieve near-normal glucose levels and substantially reduce the risk of developing severe eye disease, impaired kidney function, heart disease, and...

ADA 2013: Major Advance Toward an Artificial Pancreas

“Smart” Device That Reduces Low Blood Glucose Levels Overnight Undergoing FDA Review. Chicago (June 22, 2013) – In a major advance in the development of an artificial pancreas, researchers have shown that an insulin pump can be programmed to temporarily shut off when blood glucose levels dip too low, successfully reducing the duration and incidence of nighttime hypoglycemia, according to study results published in the New England Journal of Medicine and presented concurrently at the American Diabetes Association’s 73rd Scientific Sessions® this week. The artificial pancreas system – which includes an insulin pump, software and sensors that track blood glucose levels on a continuous basis – reduced the incidence of nocturnal hypoglycemia events by 32 percent and the duration and severity of those incidents by 38 percent, by shutting off insulin delivery for two hours once glucose levels reached a predefined threshold value (usually 70 mg/dL) the study showed. The threshold suspend feature is part of the MiniMed 530 G system, made by Medtronic and is currently undergoing review by the U.S. Food and Drug Administration. This feature is available internationally in the MiniMed Veo System, where it is called Low Glucose Suspend. Hypoglycemia is of great concern because it can lead to unconsciousness, seizures and even death. Overnight hypoglycemia is a concern for most patients and family members of those with type 1 diabetes. Overall, 247 patients with type 1 diabetes were randomized to the three month study; 121 patients in the sensor, pump and threshold suspend group, and 126 individuals in the sensor and pump group. “Our work is the first large randomized controlled trial testing the...
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