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The War on Doctors & Destruction of Healthcare

The War on Doctors & Destruction of Healthcare

Walking the hospital corridors, many of the comments I overhear patients and others speaking about doctors often amazes me. On this day, I took notice to the conversation of two elderly women who were none too happy with doctors, whom they stated only cared about their computers these days and not about their patients. Upon hearing this, I wanted to scream out that nothing is further from the reality of what doctors truly feel. In fact, many days, a burning desire to toss my computer out the second floor window consumes me, but I rein it in. Doctors abhor spending time during the patient visit on their computers, documenting in the electronic chart. This decision was foisted on us by governmental mandates much against our wills. EHR (or electronic health record) technology was forced upon us as well as its antecedent meaningful use requirements. If we do not comply, we will be financially penalized, so we have little choice. I have published many articles on the topic. Patients do not see this, however. They want our time, they need our eye contact, they need to know we care about their health. They do not want us keyboarding away while they open their hearts to us. It makes them feel insecure. It lets mistrust sneak in. This lack of trust is very harmful to the doctor-patient relationship in many ways. Perhaps, most important is that patients are less likely to follow our medical advice when the trust is not there. And, this can lead to unfavorable medical outcomes. “The doctor is no longer center stage, unless you are watching a...
Assessing Aspirin Use for CVD Prevention

Assessing Aspirin Use for CVD Prevention

Aspirin is used as a primary strategy to help prevent a first occurrence of cardiovascular disease (CVD). It can also be used as secondary prevention for survivors of heart attacks and strokes to prevent additional cardiovascular events. The American Heart Asso­ciation recommends daily low-dose aspirin for people at high risk of heart attacks and regular use of low-dose aspirin for heart attack survivors. “Preventing CVD events is particularly important,” says Arch G. Mainous, PhD. “Understanding physician recommendations for aspirin therapy is critical to the delivery of quality care.” Few studies, however, have evaluated patient use of aspirin and reported physician recommendations of aspirin therapy for CVD prevention. Suboptimal Use In a study published in the Journal of the American Heart Association, Dr. Mainous and colleagues analyzed data from the National Health and Nutrition Examination Survey, 2011–2012 and examined aspirin use for preventing CVD. The study showed that only about 41% of high-risk individuals reported being told by their physician to take aspirin, and just 79% of these patients actually complied with the recommendation. Among low-risk patients, 26% were told by their physician to take aspirin, with nearly 77% complying. Age, access to a regular source of care, education, and insurance status were identified as significant predictors of a physician recommendation for aspirin use as primary prevention. Among high-risk patients, significant predictors were age, race, and insurance status. Age, education, obesity, and insurance status were significant predictors among low-risk patients. Overall, the analysis indicated that there were persistent problems with access to care. The rates of patients being recommended to take aspirin to prevent CVD are not ideal, says Dr....
Social Support After AMI

Social Support After AMI

Studies have shown that social support is an important prognostic predictor in older people who have suffered an acute myocardial infarction (AMI). Patients with low perceived social support have worse outcomes after their AMI, including higher mortality, more cardiac events, and lower quality of life (QOL). However, most studies have focused on older men, and few analyses have looked at the role of social support in younger AMI patients, especially women. “Younger AMI survivors are at an entirely different stage of life and often have different social connections and support structures,” says Emily M. Bucholz, MD, PhD MPH. “While older people tend to rely on their immediate family for help, younger individuals are more likely to include fewer family members and more friends and coworkers in their support networks. Younger people may also experience more stress from work, raising their family, or social obligations, which can compromise their support structures. As a result, social support may be a particularly important predictor of AMI prognosis in these patients.” Examining Younger AMI Patients In a study published in the Journal of the American Heart Association, Bucholz and colleagues used data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study to examine social support in younger patients after they had an AMI, particularly women, from the United States and Spain. VIRGO contains detailed socio-demographic and psychosocial information as well as data on mental health, depression symptoms, and QOL during follow-up. Data from VIRGO were used to investigate both the physical and mental health consequences of low social support after AMI. The investigators evaluated self-reported social...
Outlaw Motorcycle Gangs: Lessons for ED Personnel

Outlaw Motorcycle Gangs: Lessons for ED Personnel

Outlaw motorcycle gangs (OMGs) are an iconic element of the criminal landscape in the United States. “When an injured member of an OMG is brought to the ED, other members and associates are likely to come to the ED to support him,” say Anand N. Bosmia and colleagues. “The arrival of injured outlaw bikers and their associates can be concerning to ED personnel because of their potential for aggression and violence. Increasing knowledge on the symbols, values, and hierarchy of OMGs may help ED personnel understand the mentality of outlaw bikers and thereby optimize management strategies.” In a study published in the Western Journal of Emergency Medicine, Bosmia and colleagues discuss various aspects of the culture of OMGs to inform ED personnel about outlaw bikers. The study notes that OMGs pose a challenge for ED personnel because they are well-organized, have an intricate intelligence network, and are capable of mobilizing members quickly to assist injured comrades. Important Characteristics Many outlaw bikers refer to their organizations as “one-percenter” motorcycle clubs (MCs) rather than gangs. The term “one-percenter” originated from a statement made in 1947 by the American Motorcycle Association, which proclaimed that 99% of the motorcycling public abides by the law and the remaining 1% does not. Outlaw bikers wear the diamond-shaped “1%” patch if their MC is immersed in criminality and large enough to defend itself against all rivals. OMGs are divided into four categories (Table 1), with the larger one-percenter MCs topping the criminal hierarchy. Almost all OMGs in the United States are entirely Caucasian, and many of these one-percenter MCs are racist and have strong links to...
Guidelines for Metastatic Castration-Resistant Prostate Cancer

Guidelines for Metastatic Castration-Resistant Prostate Cancer

According to current estimates, prostate cancer is the second leading cause of cancer deaths among North American men, with more than 33,000 dying from the disease in 2013. For men with androgen-sensitive metastatic disease, continuous androgen-deprivation therapy is considered the current standard of care, but many of these individuals will go on to develop castration-resistant prostate cancer (CRPC). When this occurs, patients will need additional lines of treatments to support their androgen-deprivation therapy. These additional therapies have the potential to improve survival and quality of life (QOL). A Welcome Guideline Recently, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) released a joint clinical practice guideline for treating men with metastatic CRPC. Published in the Journal of Clinical Oncology, the guideline builds upon previous ASCO/CCO recommendations based on a systematic review of 28 randomized clinical trials published between 1979 and 2004. Since the previous guideline was released, an additional 28 trials on systemic therapies have been identified for treating metastatic CRPC, including analyses involving targeted therapies and immunotherapies. These additional randomized trials helped inform the current recommendations. The updated guideline includes recommendations on systemic therapies indicated for use along with androgen deprivation. They address survival and QOL benefits, side effects, and cost considerations for each of these therapies (Table). The expert panel also recommends that palliative care be offered to all patients, particularly for those exhibiting symptoms or QOL decrements. Recently, there has been significant progress in the care of advanced prostate cancer, with several new treatments gaining FDA approval over the last few years, says Ethan Basch, MD, MSc, who co-chaired the ASCO/CCO expert writing...
Decision Aids & Difficult Choices

Decision Aids & Difficult Choices

With advance care planning, clinicians can help honor patient preferences and goals in cases of incapacitating illness or when injuries prevent adequate communication. These tools are designed to help prioritize treatment goals, but each person’s personal care goals will vary with regard to life-sustaining interventions. Some will prioritize living longer, whereas others may not wish to be kept alive when it is unlikely that they will have a meaningful recovery or better quality of life. Studies show that religious and spiritual values and beliefs may also affect goals of care. Research suggests that less than half of severely or terminally ill patients have advance directives in their medical record. Compounding the problem is that physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids for advance care planning support three key components of the process: 1) learning about anticipated conditions and options for care; 2) considering these options; and 3) communicating preferences for future care. “The type of decision aid that will be most useful for decision makers depends on the patient’s current health status and the predictability of illness trajectories,” says Mary Butler, PhD, MBA (Figure). For example, healthy people may benefit most from general decision aids that focus on choice-of-healthcare proxies and goals of care for hypothetical situations. For patients with life-threatening illnesses, decision aids may focus on decisions to accept, withhold, or terminate specific treatments. Analyzing Current Decision Aids In a review published in Annals of Internal Medicine that was commissioned as a technical brief by the AHRQ Effective Health Care Program, Dr. Butler and colleagues provided an...
CME – CIPN: A Guide for Prevention & Management

CME – CIPN: A Guide for Prevention & Management

Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related adverse effect that can significantly affect long-term quality of life and interfere with cancer treatments. The pain can lead to reductions in chemotherapy doses and early discontinuation of the therapy. Studies estimate that about 38% of patients who are treated with multiple agents will develop CIPN, but this rate varies depending on the types of chemotherapy regimens used, duration of exposure to these agents, and how patients are assessed. “CIPN is an important issue, especially within the context of the most commonly used chemotherapy regimens,” says Dawn L. Hershman, MD, MS. “Many of the drugs that have been evaluated for treating and preventing CIPN are agents that have documented efficacy for other common neuropathies. CIPN, however, is more difficult to manage than other neuropathies because there is greater variability in its pathophysiology and associated symptoms.” A New Guideline In 2014, the American Society of Clinical Oncology (ASCO) released a systematic review and evidence-based guideline on the management of CIPN in adult cancer survivors. The ASCO writing panel that developed the guideline systematically reviewed randomized controlled trials (RCTs) from the literature on managing CIPN, compared outcomes among trials, and provided guidance on the effectiveness of prevention and treatment options for CIPN in adults with a history of cancer. Primary outcomes included incidence and severity of neuropathy as measured by neurophysiologic changes, patient-reported outcomes, and quality of life. For the analysis, 48 RCTs met the eligibility criteria and comprised the evidentiary basis for the recommendations. “We studied many agents that have been used for CIPN, but few actually worked,” explains Dr. Hershman, who...

Surgeons Who Can’t Perform Open Surgery

Now I’m really worried about surgical education. Here’s why: A friend told me that a new attending on his staff was having some problems. Although the young surgeon was a graduate of 5 years of general surgery plus 2 years of fellowship, he was unable to do an inguinal hernia or a laparoscopic cholecystectomy by himself. This is just an anecdote, but the issue has been identified by others. Remember the paper from Annals of Surgery in September of 2013 that described a survey of fellowship directors? It stated that 66% of graduates of 5-year general surgery training programs could not conduct a major case unsupervised for 30 minutes, and 30% could not independently perform a laparoscopic cholecystectomy. A study published online in JAMA Surgery in February looked at 20 years of ACGME surgical resident case logs and found that although minimally invasive surgery is being done much more frequently, it is currently performed in more than 50% of cases for only five procedures—cholecystectomy, appendectomy, adult anti-reflex surgery, partial gastric resection, and thoracic wedge resection. In 2007, the Residency Review Committee for Surgery increased the required number of basic laparoscopic surgery cases from a minimum of 34 to 60 and from 0 to 25 for advanced. The authors expressed concern that there might not be enough minimally invasive cases for all of the residents to do. They also pointed out that since all but five operation procedures are still predominantly performed the open way, there was still a need for residents to learn it. However, as laparoscopic cases increase, the number of open cases will decrease because the total...

Just Culture? Just Kidding.

The big health system that owns the hospital where I do much of my elective scheduled surgery has recently embraced the “Just Culture” model of peer review. A part of this change is the elimination of department based peer review in favor of a system wide approach to peer review based on “Just Culture principals”. I have struggled with this for several reasons. First, I’m not sure what they mean when they talk about Just Culture. I am often obtuse when it comes to these sorts of new age concepts. I have read the materials the system provided. I have watched the educational videos. I have done Medline and Google Scholar searches of Just Culture Peer Review. I have read a book by a noted Just Culture proponent from Industry on the subject. And still, I don’t see how this is any sort of improvement over the department based Peer Review and Morbidity and Mortality discussions we have traditionally used. The Administrator pushing this concept tells me that it is more comprehensive and system oriented; that it de-emphasizes “blame’ in favor of behavioral change and systems based solutions; that the old culture of “Blame, Shame, Train” didn’t work and was needlessly punitive. Instead we are offered an algorithm consisting of almost fifty boxes and arrows and pathways to analyze an adverse event as a “failure to meet the duty to produce a desired outcome.” Or a “failure to meet the duty to follow a rule or procedure.” In all of the diffused babble of boxes and pathways and action plans there is no mention of personal responsibility. That is...
When HF Worsens in the Hospital

When HF Worsens in the Hospital

Acute heart failure (HF) leads to more than 1 million hospitalizations in the United States each year, and the 1-year mortality rate after these events ranges between 20% and 30%. “Some of these patients will experience worsening HF during their hospitalization, showing signs or symptoms that require therapy to be escalated,” says Adam D. DeVore, MD. Although worsening HF has been used as an endpoint in many clinical trials, few data are available that look at the prevalence of worsening in-hospital HF and its associated outcomes. In a study published in the Journal of the American Heart Association, Dr. DeVore and colleagues used inpatient data from the Acute Decompensated Heart Failure National Registry to examine the prevalence and outcomes of patients with worsening HF, which was defined as requiring escalation of therapy at least 12 hours after patients present to the hospital. “Our study was unique in that it provided ‘real world’ data on these patients,” says Dr. DeVore. Patients with worsening HF were compared with those who had an uncomplicated hospital course and those who had a complicated presentation. Assessing Outcomes “Our study showed that 11% of patients with acute HF developed in-hospital worsening HF,” says Dr. DeVore. Those with worsening HF in the hospital had the highest rates of mortality, all-cause readmission, and Medicare payments at 30 days and 1 year after being hospitalized. These patients also had worse post-discharge outcomes and higher costs when compared with patients who had uncomplicated hospital courses and with those who had complicated presentations. When compared with an uncomplicated hospital course, worsening in-hospital HF was associated with more than a two-fold...
Hypertension: Examining Cost Effectiveness of Treatment

Hypertension: Examining Cost Effectiveness of Treatment

According to current estimates, 44% of the 64 million adults in the United States with hypertension did not have their condition controlled in 2014. In 2014, the Eighth Joint National Committee released its first updated guidelines on hypertension since 2003. Several important changes were made from the earlier guideline, including recommendations to focus on diastolic rather than systolic blood pressure (BP) for adults younger than 60 and setting more conservative BP goals for adults aged 60 and older (150/90 mm Hg) as well as for patients with diabetes or chronic kidney disease (140/90 mm Hg). Estimating Cost Effectiveness “Few analyses have examined the health benefits and cost-effectiveness of treating hypertension in the U.S.,” says Andrew E. Moran, MD, MPH. To address this research gap, Dr. Moran and colleagues published a study in the New England Journal of Medicine that sought to estimate the incremental health gains and cost-effectiveness of implementing the strongest recommendations for hypertension therapy in the 2014 guidelines among adults. Using the Cardiovascular Disease Policy Model, the study team simulated drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease (CVD), and quality-adjusted life-years gained by treating previously untreated adults between the ages of 35 and 74 from 2014 through 2024. “Our model pulled together data from many studies to quantify the value of treating hypertension,” adds Dr. Moran. “This information is important for policy-makers and physicians to determine if controlling hypertension is a worthwhile investment.” Big Rewards for Achieving Goals The study found that, on average, about 860,000 people with existing CVD and hypertension who are not being treated with antihypertensive medications would be...
Hospital Medicine 2015

Hospital Medicine 2015

New research was presented at Hospital Medicine 2015, the annual meeting of the Society of Hospital Medicine, from March 29 to April 1 in National Harbor, MD. The features below highlight some of the studies emerging from the conference that are relevant to emergency medicine. ED Waiting Times for Telemetry Patients The Particulars: Few studies have assessed differences in the time for a bed assignment between telemetry and non-telemetry patients after an ED admission order has been entered. Data Breakdown: Researchers conducted a study that compared the time between a request for a telemetry bed and when that bed was secured between telemetry and non-telemetry patients at a hospital with 84% telemetry capability. Telemetry patients waited an average of 42 minutes, whereas non-telemetry patients had an average wait time of 50 minutes, representing a statistically significant difference. Take Home Pearl: Patients assigned to telemetry do not appear to spend much more time in the ED waiting for a bed when compared with patients assigned to non-telemetry. Syncope in EDs The Particulars: Studies have shown that evidence-based medicine is not always utilized during syncope evaluation, causing unnecessary testing and increased costs. A multi-faceted intervention may help improve the quality and safety of syncope care. Data Breakdown: For a study, a multidisciplinary group developed a syncope evaluation algorithm based on an evidence review that included a risk stratification tool. The algorithm was posted in the ED and on an intranet and accompanied by an ED syncope order set and note template, ED nursing education on orthostatic vital signs, and education of physicians. When comparing pre- and post-intervention data, significant improvements were...
Managing Migraine in the ED

Managing Migraine in the ED

Migraine is one of the most common disorders for which patients seek medical treatment in the ED. Studies show that migraine causes most of the 5 million headache visits to EDs in the United States each year. “The average annual costs for migraine-related ED visits are at least $700 million,” says Mia T. Minen, MD, MPH. “Considering the high costs of ED care of migraines and the fact that the ED environment is typically not conducive to treating these headaches, it’s important for healthcare systems to make efforts to prevent or divert ED migraine visits and take steps to ensure fewer return visits.” Research suggests that the current state of migraine management in EDs is suboptimal. In the journal Headache, Dr. Minen and colleagues reviewed how patients with migraine are managed in the ED. The analysis identified characteristics of patients seeking ED care for migraine and examined guidelines and current practices regarding ED imaging use for migraine. It also explored how current ED care for migraine deviates from recommended treatment practices and investigated potential methods for improving outcomes following ED treatment. Characterizing Patients Few studies have looked at the makeup of patients that utilize the ED for migraine and why these individuals seek care in the ED. Some research has suggested that migraineurs who use EDs are more likely to be female, older, and non-white. Narcotic use, lower socioeconomic status, and overuse of emergency services have also been linked to ED visits for migraine. In addition, mood disorders may contribute to ED visits for migraine. Assessing Diagnostics Imaging practices for migraine in the ED vary widely despite clinical recommendations...
Post-Op Pain in Pediatric Urology

Post-Op Pain in Pediatric Urology

Management of pain is a critical aspect of postoperative care in pediatric urology. Currently, clinicians who aim to control postoperative pain in children use a combination of both opioids and anti-inflammatory drugs. Regional anesthesia with a caudal block is another effective pain management technique that is used in pediatric urology, but these blocks only last 6 to 8 hours unless an indwelling caudal catheter is used. Having an indwelling caudal catheter in place often limits patients’ mobility and requires a hospital admission after surgery. An Evolution in Care Continuous infusion of site-specific analgesia is a more evolved way to provide prolonged pain management. Continuous infusion has been found to result in fewer side effects and better postoperative recovery. This treatment approach has been shown to lead to earlier mobilization and earlier discharge than standard therapy. One FDA-approved device that currently is used to provide continuous infusion of analgesia is the ON-Q® pump (I-Flow/Kimberly-Clark). The device is an elastomeric pump that delivers 0.25% bupivacaine at the incision site via a flexible silver-coated catheter. The catheter, which is tunneled subcutaneously at the completion of a patient’s surgery, is attached to the elastomeric pump, which has a flow-limiting valve. The local anesthetic is delivered at a constant flow rate (0.4mg/kg) for the entire duration of use. The pump functions automatically and doesn’t require any manipulation by patients or their families. The pump is carried in a small pouch, which allows patients to maintain mobility and be discharged home. Supporting Data In a recent prospective randomized controlled trial conducted at Children’s Hospital of Orange County, my colleagues and I confirmed the efficacy of...
Improving Mucus Clearance in COPD

Improving Mucus Clearance in COPD

The mucus hyper-secretion that characterizes COPD has been shown to contribute to disease-related morbidity and mortality. Currently available medications for COPD do not specifically address mucus clearance, making this phenomenon an area of unmet need for patients, says Sanjay Sethi, MD. In 2010, the FDA approved the Lung Flute (Medical Acoustics, LCC) to treat COPD and other lung diseases characterized by retained secretions and congestion following positive findings from an 8-week study involving 40 patients. The hand-held respiratory device produces a low frequency acoustic wave with moderately vigorous exhalation to increase mucus clearance. An Extended Look For a study published in Clinical and Translational Medicine, Dr. Sethi and colleagues sought long-term data to confirm observations from previous research showing that the Lung Flute benefits patients with COPD and chronic bronchitis. “Participants were randomized to the device as add-on therapy or to continue their standard COPD care,” says Dr. Sethi. “We assessed change in respiratory symptoms as measured with the Chronic COPD Questionnaire (CCQ) from baseline to 26 weeks in 69 patients.” Secondary endpoints included health status, BODE (BMI, Airflow Obstruction, Dyspnea, and Exercise Capacity) index score, and exacerbation frequency. Patients using the Lung Flute reported significant improvements from baseline on the CCQ as well as on the St. George’s Respiratory Questionnaire, which measures quality of life. Those using the device breathed better, coughed less, and experienced reductions in sputum production when compared with the control group, whose COPD symptoms remained stable in the study. The researchers also observed differences between groups on the BODE index. “Patients using the Lung Flute seemed to stabilize on the BODE index, whereas these...
AAN 2015

AAN 2015

New research was presented at AAN 2015, the American Academy of Neurology’s annual meeting, from April 18 to 25 in Washington, DC. The features below highlight some of the studies that emerged from the conference. LOS & Return ED Visits in Stroke Patients The Particulars: The initial hospitalization for patients with acute, mild ischemic stroke can impact long-term outcomes. However, few studies have assessed whether hospital length of stay (LOS) is related to clinical characteristics, in-hospital care processes, and long-term clinical outcomes in this patient population. Data Breakdown: For a study, adults diagnosed with acute ischemic stroke were grouped according to their LOS. Despite no significant differences between patients, researchers found that inpatient therapy evaluations took place later in those with a LOS longer than 1 day. Patients with an LOS longer than 1 day were more likely to return to the ED within 1 year. Take Home Pearls: Among ischemic stroke patients, time to therapy evaluation appears to be associated with LOS and risk for return ED visits. Coordination of inpatient care processes, along with assessment and treatment of comorbidities, may impact hospital LOS. Mental Illness, Substance Abuse, & Children The Particulars: Understanding outcomes among groups of patients at higher risk of primary and medication-induced psychiatric illness, such as those with neurological conditions, may help reduce the burden of mental illness. Data Breakdown: Study investigators compared mental health and substance abuse diagnosis patterns and length of stay (LOS) in children with epilepsy, cerebral palsy, and Tourette syndrome with those of the general pediatric population. Depression was the most common psychiatric diagnosis in the general population as well as...
An Update on Managing IBS & CIC

An Update on Managing IBS & CIC

IBS and chronic idiopathic constipation (CIC) are among the most common functional gastrointestinal (GI) disorders, with studies estimating that between 5% and 15% of the general population experiences IBS symptoms, whereas CIC symptoms occur in about 14% of people. Recently, the American College of Gastroenterology (ACG) released a monograph—published in the American Journal of Gastroenterology—that updated prior monographs on approaches to treating IBS and CIC. To develop the monograph, the ACG’s Institute for Clinical Research & Education conducted a systematic review and meta-analysis of randomized clinical trials that assessed several types of interventions for IBS and CIC. “We looked back at previous monographs from recent years,” explains Eamonn M.M. Quigley, MD, FACG, a co-author of the update. “The last monograph on constipation came out in 2005, whereas the last one on IBS was released in 2009. Since then, there have been significant developments that warranted an update.” Diet & Fiber An important addition to the ACG guidelines is new information on the relationship between diet and IBS (Table 1). “Research has shown that diet has emerged as a major issue, especially for patients with IBS,” says Dr. Quigley. “This isn’t new for patients because they’ve known for years about certain foods upsetting their GI tract. For clinicians, however, we now have good evidence that diet is a major factor in the precipitation of IBS attacks.” The guidelines note that specialized diets may improve IBS symptoms for some, but the recommendation was labeled as weak because of a low quality of evidence. Current data show that gluten-free diets and diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—also known as...
Examining Diets for Patients With Diabetes

Examining Diets for Patients With Diabetes

Studies of patients with type 2 diabetes have shown that a low-carbohydrate diet can achieve at least comparable reductions in body weight, blood pressure, and insulin concentrations when compared with a high-carbohydrate diet. A low-carbohydrate diet can also lead to greater improvements in glycemic control, according to some studies. To better understand the impact of dietary carbohydrates on diabetes control, William S. Yancy Jr., MD, and colleagues performed a comprehensive comparison that was published in Diabetes Care. The researchers examined the effects of a very low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) with those of a high-unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease risk factors in type 2 diabetes. For the study, overweight and obese adults with type 2 diabetes were randomized to LC—which consisted of 14% carbohydrates, 28% proteins, and 58% fats—or an energy-matched HC—which consisted of 53% carbohydrates, 17% proteins, and 30% fats. Both diets had less than 10% saturated fat. “All participants met regularly over the 6-month study, were taught about their respective diets, and were provided some of the foods,” says Dr. Yancy. “They were also enrolled in a physical activity program in which they were monitored for 60 minutes at an exercise facility at least three times per week.” Important Findings Based on various measures, the researchers found that LC led to greater glycemic control and achieved greater reductions in triglycerides, anti-glycemic medication scores, and glycemic variability. “A1C also improved more with LC than with HC in patients who had out-of-control A1C at the beginning of the study,” explains Dr. Yancy. “By reducing the number of medications needed to control blood sugar,...
AACR 2015

AACR 2015

New research was presented at AACR 2015, the American Association for Cancer Research’s annual meeting, from April 18 to 22 in Philadelphia. The features below highlight some of the studies that emerged from the conference. Forecasting Breast Cancer Cases The Particulars: Predicting the number of breast cancer cases in the United States through 2030 could help with developing a proactive roadmap for optimizing prevention and treatment strategies. Data Breakdown: For a study, National Cancer Institute researchers used Surveillance, Epidemiology, and End Results program data, Census Bureau population projections, and mathematical models to forecast the number of breast cancer cases in the country from 2011 to 2030. Depending on the model used, the team forecasted that the number of new invasive and in situ breast cancer cases would increase from 25% to 55% by 2030. The proportion of new cases in women aged 50 to 69 was projected to decrease by 2030. However, the proportion of cases in women aged 70 to 84 was projected to increase, as was the proportion of early estrogen receptor (ER)-positive in situ cancers. Take Home Pearls: The number of breast cancer cases among American women is projected to increase by up to 55% by 2030. This increase will likely be driven by increases in ER-positive cases and cases in women older than 70. Antidepressants for Lung Cancer? The Particulars: Early evidence suggests that antidepressants may target important pathways in cancer cells. It has been suspected that these drugs could possibly be repurposed for cancer treatment, but large studies are needed to confirm this possibility. Data Breakdown: Antidepressant use was assessed among more than 1,000...
AATS 2015

AATS 2015

New research was presented at AATS 2015, the annual meeting of the American Association for Thoracic Surgery, from April 25 to 29 in Seattle. The features below highlight some of the studies emerging from the conference. Pneumonectomy for NSCLC After Chemo-Radiation Therapy The Particulars: Previous research has shown that locally advanced non-small-cell lung cancer (NSCLC) is associated with a poor prognosis, meaning that effective treatment strategies are needed for the disease. Pneumonectomy after neoadjuvant concurrent chemo-radiation therapy may be beneficial in NSCLC patients, but research is lacking on this treatment strategy. Data Breakdown: For a study, researchers performed retrospective analyses of 16 patients who underwent pneumonectomy after neoadjuvant concurrent chemo-radiation therapy to treat NSCLC. Nearly 40% of patients obtained a pathologically complete response. Following treatment, all abnormal blood tumor marker levels were normal. At an average follow-up of about 40 months, all patients were alive and only two had recurrent tumors. Toxicity was manageable, and no serious complications were observed. Take Home Pearl: Pneumonectomy after neoadjuvant concurrent chemo-radiation therapy appears to be a feasible and effective treatment strategy for NSCLC. Supraventricular Tachycardia Following Pulmonary Lobectomy The Particulars: Few studies have assessed the rate of supraventricular tachycardia (SVT) in patients undergoing pulmonary lobectomy. Research is needed to determine if SVT is associated with length of stay (LOS) and to establish the incidence of stroke, mor­tality, and readmission in these patients. Data Breakdown: Researchers reviewed the cases of more than 20,000 lobectomies performed in 2009 to 2011. They found that 11.8% of patients had postoperative SVT. Clinical predictors of SVT included being 75 or older, male, and having COPD, congestive heart...
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