CME: Anxiety and Depressive Symptoms in Cancer Survivors

CME: Anxiety and Depressive Symptoms in Cancer Survivors

Studies have shown that distress is common among people with cancer, but the types and causes vary. “Research shows that 20% to 25% of newly diagnosed cancer patients and/or survivors are at risk for mood or anxiety disorders, but these problems can go undetected unless they’re considered to be a possibility and then evaluated,” says Barbara L. Andersen, PhD. The days surrounding the diagnosis and initiation of cancer treatment tend to be the most stressful for patients. Failing to address psychological needs, regardless of when they arise, can increase risks for stress and anxiety as well as depressive symptoms. It can also reduce quality of life, increase risks for adverse effects, and lead to more physical symptoms. Treatment for anxiety or depression is often successful and has the potential to reduce the risk of cancer recurrence or disease-related death. “Clinicians may not be able to prevent some of the chronic or late medical effects of cancer, but we can play a vital role in preventing or reducing the emotional fall-out at diagnosis and thereafter,” Dr. Andersen says. If symptoms of anxiety or depression can be recognized and treated effectively, there is a chance that clinicians can reduce the human cost of cancer. New Recommendations Recently, the American Society of Clinical Oncology (ASCO) released new guidelines to help manage anxiety and depressive symptoms in adults with cancer. The document is a clinical practice guideline adaptation that incorporates recommendations that have been set forth from other organizations. The guidelines detail optimal strategies for screening and assessing patients and offer options for psychological and supportive care interventions for those experiencing symptoms of...
Free CME Here, Get Your Free CME!

Free CME Here, Get Your Free CME!

For physicians practicing in most states (what gives, Indiana?), obtaining continuing medical education credits is a necessity, like it or not. For license registration, 54 boards require anywhere from 12 hours (Alabama) to 50 hours (a few states) of CME per year. We know you’re all busier than ever, and burnt out more than ever, so obtaining these credits by attending society annual meetings is increasingly difficult and inconvenient. And getting those credits, be it online, through medical journals, or in person, can be really expensive. Lucky for you, your good friends at Physician’s Weekly have partnered with AKH, Inc. Advancing Knowledge in Healthcare to provide you with free, 0.50-credit CME activities. The types of feature articles you’ve been reading all along on physiciansweekly.com and/or on the posters hanging in your facility now have CME attached to them. All you have to do is read the articles (and their accompanying figures or tables), link over to the AKH website, complete a quick, one-time registration with AKH, and complete a three-question post-test. That’s it! Activities span multiple specialties and are continually being added to a growing list of offerings, so be sure to bookmark our CME Corner web page and refer back often. Recently added activities include: Social Support After Acute Myocardial Infarction An Update for Preventing MRSA Patient Preferences for Non-Insulin Diabetes Drugs Preventing SSIs: An Evidence-Based Update Guidelines for Metastatic Castration-Resistant Prostate Cancer Recognizing & Treating Caregiver Burden Guidelines for Managing Fatigue in Cancer Survivors   Check out our CME Corner for more...

Weight Loss Benefits Asthma Patients

Findings from a small investigation indicate that weight loss among obese adults with asthma appears to improve symptom severity, airway hyper-responsiveness, and disease control. It also appears to improve lung function and quality of life. Patients involved in the study who followed a behavioral weight reduction program for 3 months fared better than a group of matched control patients. Source: Chest, June 2015. An abstract of the study is available at...

The Effects of Oral Nutritional Supplementation

A study suggests that oral nutritional supplementation (ONS) among hospitalized older adults with COPD appears to reduce length of stay (LOS), hospitalization costs, and readmission risks when compared with no ONS: ONS Hospitalization Non-ONS Hospitalization LOS 6.9 days 8.8 days Hospitalization costs $10,953 $12,523 Probability of 30-day readmission 0.29 0.34   Source: Chest, June 2015. An abstract of the study is available at...

Hydration & Mucociliary Clearance in Chronic Bronchitis

Abnormal regulation of airway surface hydration appears to slow mucociliary clearance in chronic bronchitis and contributes to the disease pathogenesis, according to researchers in North Carolina. Investigators found that increased mucus concentration was associated with decreased mucociliary clearance. Source: American Journal of Respiratory and Critical Care Medicine, April 24, 2015 (online). An abstract of the study is available at...

Comparing Incentive-Based Smoking Cessation Programs

Smoking cessation programs that offer rewards appear to be more commonly accepted than those including refundable deposits, according to a study. Among patients assigned to reward-based programs, 90% accepted the assignment, compared with less than 15% of those assigned to deposit-based programs. Reward-based programs also had higher abstinence rates (16% vs 10%). Source: New England Journal of Medicine, May 28, 2015. An abstract of the study is available at...

Injection Drug Use, Hepatitis C, & HIV

A substantial percentage of the excess mortality in HIV-infected injection drug users (IDUs) appears to be explained by hepatitis C coinfection, according to international research. Mortality was higher in IDUs than in non-IDUs, but the effect of injection drug use on mortality was substantially attenuated after adjusting for hepatitis C infection. Attenuation of the effect of hepatitis C was less substantial after adjustment for injection drug use. Source: Journal of Acquired Immune Deficiency Syndromes, July 1, 2015. An abstract of the study is available at...

Is CD4 Count Monitoring Effective?

Study investigators suggest that annual CD4 cell count monitoring in virally suppressed HIV patients with a CD4 count of 250 cells/μl or greater at baseline appears to be sufficient for clinical management. No significant differences were observed in time to a confirmed CD4 cell count of less than 200 cells/μl between annual and biannual monitoring. Source: Journal of Acquired Immune Deficiency Syndromes, July 1, 2015. An abstract of the study is available at...

Contraception Among HIV-Positive Women

Results of a meta-analysis indicate that HIV treatment and contraceptive methods can interact in various clinically meaningful ways. Concomitant use was found to possibly alter contraceptive efficacy and cause drug–drug interactions. Although hormonal contraceptives were not shown to affect HIV progression, their impact on HIV transmission and acquisition remains unclear. Source: HIV Medicine, July 2015. An abstract of the study is available at...

Trends in Hepatitis A Virus Infection

The incidence of hepatitis A virus (HAV) infection appears to have declined from 6.0 to 0.4 cases per 100,000 between 1999 and 2011, according to a study. However, researchers found that HAV-related hospitalizations increased from 7.3% to 24.5% during this period. The average age among hospitalized patients increased from 36 to 45 years. Source: Journal of Infectious Diseases, July 15, 2015. An abstract of the study is available at...

Hyperlipidemia & CHD Risks

Cumulative exposure to hyperlipidemia in young adulthood appears to raise the subsequent risk of coronary heart disease (CHD) in a dose-dependent fashion, according to findings of a study. Adults with prolonged exposure to even moderate elevations in non–HDL cholesterol had higher risks for future CHD. The research team noted that this patient group may benefit from more aggressive primary prevention. Source: Circulation, February 3, 2015. An abstract of the study is available at...

Obstructive Sleep Apnea, Atrial Fibrillation, and Stroke

Researchers in Connecticut have found that obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) appears to be an independent predictor of stroke. The authors also found that ischemic stroke was more common in AF patients with OSA when compared with those who did not have OSA (25.4% vs 8.2%). They concluded that this association may have important clinical implications in ischemic stroke risk stratification. Source: American Journal of Cardiology, February 15, 2015. An abstract of the study is available at...

Physical Activity, PAD, & Mortality

Regular vigorous activity appears to help decrease risks for peripheral artery disease (PAD) as well as all-cause mortality in at-risk patients, according to a study. In addition, the research showed that participants undergoing non-emergency coronary angiography who reported performing regular vigorous activity were less likely to have PAD, had higher ankle-brachial index scores, and had better cardiovascular outcomes. Source: Mayo Clinic Proceedings, March 2015. An abstract of the study is available at best corded circular saw...

Statins Cost-Effective in Older Adults

Statins appear to be cost-effective for primary prevention of cardiovascular disease in adults aged 75 and older, according to a study. Investigators estimated that statin treatment of all adults aged 75 to 84 would prevent 4.3% of incident myocardial infarctions and 2.3% of coronary heart disease deaths at an incremental cost per disability-adjusted life-year of $25,200. Source: Annals of Internal Medicine, April 21, 2015. An abstract of the study is available at...
CME: Social Support After Acute Myocardial Infarction

CME: Social Support After Acute Myocardial Infarction

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...

What Happens if You Break Non-Competes?

Non-compete agreements, while frowned on by the AMA, continue to be used frequently in many states. A variety of state courts regularly enforce non-compete agreements, with certain exceptions. Why Do Non-Compete Agreements Exist? ♦   To ensure that employees don’t become an unfair competitive threat in the geographic area they previously serviced after their employment has been terminated; ♦   To make it more difficult for competitors to unfairly obtain knowledge of one’s business practices by hiring away employees; ♦   When a business is sold, to ensure that the seller does not form a rival company that would unfairly undermine the buyer’s business plans for the acquired business; ♦   To ensure that franchise buyers adhere to territorial guidelines so as not to impinge on sales of other franchise operators. Implications in the Healthcare Field Non-compete agreements are often required when physicians are hired in as employees, or even when partnerships are formed. In many jurisdictions, courts will not enforce non-compete agreements that are unreasonable or where the threat of damage to business interests is not adequately defined. To be “reasonable”, the non-compete agreements cannot exceed what is necessary to protect the legitimate business interests of the business or employer. Non-competes may only protect against unfair competition, not all competition. Courts take into account many factors in determining what is “reasonable.” These include: ♦   The degree to which the restrictions in the non-compete would interfere with the ability of the employee to use his talents and earn a living ♦   The geographic scope of the restrictions ♦   The duration of the restrictions (usually 3 years or less, but for physicians, generally one...

Gender & AMI Recovery

Women appear to have worse health than men after experiencing an acute myocardial infarction (AMI), according to a study. Researchers found that women had significantly lower generic and disease-specific health status scores than men when assessed at baseline and at 1 and 12 months after an AMI. Source: Circulation, June 2,...

Predicting Risk in ACS Patients

Fasting triglyceride levels appear to help predict long- and short-term cardiovascular risk among patients with acute coronary syndrome (ACS) who are treated with statins, according to a study. When compared with ACS patients with the lowest triglyceride levels, those with the highest levels had a hazard ratio of 1.61 for experiencing long-term cardiovascular risks. Source: Journal of the American College of Cardiology, June 2,...
Managing Autism in the ED

Managing Autism in the ED

There has been increasing attention on the impact of the rising prevalence of autism spectrum disorder (ASD) on the healthcare system. People with ASD can present with behaviors and agitation that can be dangerous and create stress and difficulty for families and caregivers as well as healthcare providers. “The prevalence of ASD is rising, and many of these patients will present to EDs for care,” says Arvind Venkat, MD. “Unfortunately, ED personnel receive minimal formal training and have limited experience with treating children, adolescents, and adults with ASD. This has led to limited treatment success and often results in unwanted outcomes.” Addressing Unique Needs In a study published in the journal Child and Adolescent Psychiatric Clinics of North America, Dr. Venkat and colleagues described important aspects of managing agitation in patients with ASD who present to the ED. The article notes that ASD is characterized by impairment in social interactions and communication skills. ASD is also characterized by other non-specific atypical behaviors, such as anxiety, depression, attention issues, temper tantrums, and aggression or self-injury. “Those with ASD often have impairments in cognitive and adaptive functioning, learning styles, attention skills, and sensory processing abilities,” Dr. Venkat says. “ED personnel and crisis responders need to understand the unique needs of individuals with ASD so that they can rapidly assess and optimally treat patients in a manner that is least restrictive.” Patient Assessment According to Dr. Venkat, the challenge for ED personnel is to gather the key information that is needed to address issues that may be underlying or contributing causes of the ED visit. “Signs of acute agitation may be the...

Assessing Laparoscopic Repair of PEH

Laparoscopic repair of paraesophageal hernia (PEH) using a biological mesh appears to result in excellent long-term quality of life (QOL), according to Johns Hopkins researchers. Overall QOL scores improved from baseline out to 36 months among patients undergoing laparoscopic surgery for PEH. Source: JAMA Surgery, May...
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