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Conference Highlights: Anesthesiology 2015

Conference Highlights: Anesthesiology 2015

New research was presented at Anesthesiology 2015, the American Society of Anesthesiologists’ annual meeting, from October 24 to 28 in San Diego. The features below highlight some of the studies emerging from the conference. Calming Anxious Surgical Patients The Particulars: The use of conversational hypnosis in medicine consists of talking quietly and positively to patients and focusing their attention on something other than the reason why they require medical care. Little is known regarding the use of conversational hypnosis to calm anxious patients prior to surgery. Data Breakdown: For a study, patients undergoing hand surgery were randomized to conversational hypnosis plus regional anesthesia or 25 mg of oral hydroxyzine 30 to 60 minutes before anesthesia. Relaxation levels were measured using a 0-10 scale, with 0 being no comfort and 10 being maximal comfort. The Analgesia/Nociception Index (ANI), which is a 0-100 scale, was also used to measure anxiety, with 0 being very anxious and 100 being relaxed. Analgesia/Nociception Index (ANI). Patients had higher average ANI scores after hypnosis when compared with patients in the medication treatment group. Average comfort scores also improved, from 6.7 prior to hypnosis to 9.3 after the intervention. This increase was favorable to increases seen in the medication treatment group. Take Home Pearl: Conversational hypnosis appears to increase patient self-reported comfort and reduce anxiety during regional anesthesia when compared with medication.   Anesthesia Requirements Vary Widely The Particulars: Current guidelines recommend that propofol use as general anesthesia during surgery be administered based on a patient’s age and weight. Few studies have assessed whether dosing can be better individualized. Data Breakdown: Researchers administered propofol in a...
You Can Grow New Brain Cells. Here’s How – VIDEO

You Can Grow New Brain Cells. Here’s How – VIDEO

Can we, as adults, grow new neurons? Neuroscientist Sandrine Thuret says that we can, and she offers research and practical advice on how we can help our brains better perform neurogenesis—improving mood, increasing memory formation and preventing the decline associated with aging along the...

Insights on Oral Glucose-Lowering Drug Choices

Guidelines advocate using metformin as initial pharmacologic therapy for lowering A1C in type 2 diabetes. “Despite these guidelines, relatively few studies have provided evidence for this recommendation, particularly with regard to outcomes other than A1C and glycemic control,” explains Niteesh K. Choudhry, MD, PhD. “Given that more agents are now available and the increasing use of newer drug classes, it’s important to clarify differences among the available therapies.” There has also been a shift toward focusing on the need to intensify treatment with a second oral agent or insulin to achieve A1C goals as part of patient-centric care. Various therapies come with different risks for short-term adverse events, but these differences have not been well assessed in clinical research. Examining Effects In a retrospective study published in JAMA Internal Medicine, Dr. Choudhry and colleagues sought to determine the effect of the initial oral glucose-lowering agent class on subsequent treatment intensification and several short-term adverse clinical events. Participants included more than 15,500 patients who were newly prescribed an oral glucose-lowering agent and then filled a second prescription for a drug in the same class with a dosage at or above the World Health Organization’s defined daily dose within 3 months of the end-of-day’s supply of the first prescription. “We found that only about 40% of patients in our study started therapy with metformin,” says Dr. Choudhry. “Patients who were initially prescribed metformin were less likely to require treatment intensification than those who started taking other drugs like sulfonylureas, thiazolidinediones, or dipeptidyl peptidase 4 inhibitors. We also observed no real advantages for other agents with regard to short-term clinical outcomes.” In...
Avoiding Heart Disease-Related Malpractice Risks

Avoiding Heart Disease-Related Malpractice Risks

The Doctors Company recently completed an analysis of nearly 430 closed medical malpractice claims against cardiologists from 2007 to 2013. This data is relevant to cardiologists as well as general internists because both face similar liability threats. In a separate study of claims based on cardiac conditions, research showed that 22% of claims were against cardiologists, followed closely by internists at 19%. It’s important for both cardiologists and internists to gain a more sophisticated understanding of the malpractice landscape upon which they tread. Common Pitfalls According to The Doctor’s Company report, the most common allegation was diagnostic error, which includes failure to establish a differential diagnosis or failure to order appropriate tests. This is clearly an issue that extends to both cardiologists and internists but in different ways. For internists, failure to diagnose a myocardial infarction is an important liability pitfall to consider. These problems are understandable given the diagnostic difficulties and potential harms associated with errors of this kind as well as the overall prevalence of heart disease. For cardiologists, the closed claim data shows different potential risks. Failure to diagnose an acute coronary syndrome is less concerning than failure to diagnose “mimics,” such as aortic dissections presenting as chest pain, pulmonary embolisms presenting as shortness of breath, or cancer presenting as vague, non-specific symptoms. In the case of missed cancer diagnoses, failing to follow up on incidental masses found on imaging studies is a recurrent pitfall. Specialists sometimes develop tunnel vision, ignoring data and diagnoses outside their area of expertise. Drugs & Procedural Injuries Certain medications can be a source of liability danger because of their potential for side effects and/or their narrow...
Assessing the Value of Prescription Drug Monitoring Programs

Assessing the Value of Prescription Drug Monitoring Programs

Many local, state, and federal agencies have implemented different policies to address prescription drug abuse, including prescription drug monitoring programs (PDMP). “PDMPs are becoming increasingly popular because they provide clinicians with scheduled medication histories,” explains Christopher A. Griggs, MD, MPH. “When used appropriately, they can help identify patients who may be diverting medications or abusing them.” Throughout the country, some states have passed laws mandating that providers use PDMPs in certain circumstances to combat the prescription drug epidemic, but their potential limitations may be overlooked. “While these programs are a valuable tool in concept, their effectiveness must still be proven,” Dr. Griggs says. “PDMPs should be used in addition to more comprehensive and evidence-based strategies in order to combat prescription drug abuse.” Details Matter PDMP databases generate data from pharmacies that are directly reported to the state when prescriptions are filled, but Dr. Griggs says each state has varying delays in how long it takes for the data to appear in the database. “There are also concerns about identifying patients who ‘doctor shop’ because there is no clear definition of what constitutes questionable patient behavior,” he says. “This can make it challenging for physicians to balance their duty to treat pain, meet patient expectations, and prevent misuse and diversion.” In order for PDMPs to be effective, it is critical to recognize the amount of misuse and diversion that results from clinician prescribing. However, Dr. Griggs notes that PDMPs may be unable or ill-equipped to identify many important sources of diversion, such as chronic pain patients with one prescriber who divert their prescriptions. Looking Ahead Emergency physicians are essential to...

Will Medicare’s Published Physician Quality Data Push Your Patients Away?

By: Theresa Hush, CEO & Co-Founder, ICLOPS Centers for Medicare and Medicaid Services (CMS) won’t be the only group scrutinizing your quality and cost data anymore. As the next step toward value-based healthcare, Medicare has begun publishing provider performance data for PQRS under Physician Compare. Now patients and their families can make their own data-driven choices about healthcare providers with an online search. The website is a game-changer. Performance variation between providers is startling. There are 50 provider groups with performance at or lower than 65% for at least one published measure. By contrast, a handful of groups show all four measures over 95 percent. The 2013 data are limited and do not include all providers. Yet the information provides a powerful first impression. Based on the data, would an internet-savvy family member try to convince a parent to leave you? Take notice, physicians and health systems: Data will drive business. At a Glance: Physician Compare Data for PQRS Physician Compare is still evolving in scope of data publication while Medicare continues tweaking its calculations to instill more fairness and accuracy. Nevertheless, publication has begun and benchmarks are under discussion for the future. For PQRS measurement year 2013, this is what was on the site in July: ♦  623 Provider Groups who Reported PQRS or eRx in 2013 are listed ♦  Of the 623 Groups, Medicare published data for 138 ♦  Data is only for groups which reported through the Group Reporting Option (GPRO) Web Interface ♦  Aggregate data for four (of 22) GPRO PQRS measures are published for each group: ° Prescribing aspirin to patients with diabetes and heart disease °...
More than 35 Leading U.S. Health Organizations Launch Campaign to Improve Obesity Care

More than 35 Leading U.S. Health Organizations Launch Campaign to Improve Obesity Care

WASHINGTON, Oct. 20, 2015 /PRNewswire/ — More than 35 leading U.S. healthcare organizations have joined together to form National Obesity Care Week (NOCW), an annual campaign to advance a comprehensive, compassionate and personalized approach to treating obesity as a disease. Scheduled for November 1-7, 2015, the inaugural event calls upon healthcare professionals, patients and policymakers to “Change the Way We Care” for obesity for the benefit of those individuals living with obesity. “No one organization is capable of reaching all the individuals affected by obesity and single-handedly transforming care in America,” said Francesca Dea, CAE, Executive Director of The Obesity Society (TOS). “It takes a collective effort to achieve significant change and we are thrilled with the overwhelming level of support for our inaugural initiative. By working together, our collective voice is stronger and we can achieve great things.” While obesity has been in the national spotlight in recent years, research shows that conversations about how to address the disease are not happening where it matters most – with healthcare professionals.i Nearly half of people affected by obesity say they have not been advised by a physician about maintaining a healthy weight, according to the Associated Press-NORC Center for Public Affairs Research.i National Obesity Care Week seeks to remedy this problem with a multi-tiered approach, including broad public awareness, healthcare professional education and influencer engagement. Specifically, the campaign will focus on improving healthcare professionals’ understanding of obesity as a disease and knowledge of the full spectrum of evidence-based medical strategies. “In recent years, medical research and clinical studies have advanced our understanding of the physiological and psychological complexities of obesity and...
ED Fast Tracking & Patient Satisfaction

ED Fast Tracking & Patient Satisfaction

CMS announced a new hospital-payment system called value-based purchasing (VBP) in October 2012. The patient experience of care domain in VBP is based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and encompasses eight aspects of consumer experiences in the healthcare system: 1) communication with nurses, 2) communication with doctors, 3) responsiveness of hospital staff, 4) pain management, 5) cleanliness and quietness of the hospital environment, 6) communication about medicines, 7) discharge information, and 8) the overall rating of hospital. Press-Ganey surveys of patient satisfaction are currently used by almost half of all hospitals in the United States, with many questions being directed at specific components of the HCAHPS survey. There is increasing hospital awareness of customer satisfaction with implementation of VBP, and some states have linked physician salaries to patient satisfaction. There also appears to be a trend amongst emergency physician groups that links compensation and incentive payments to patient satisfaction scores, but few data exploring the effect of this trend are available. Fast Tracking Programs ED fast track is a designated area where lower acuity patients are rapidly seen in the ED. “ED fast track programs have become more prevalent in recent years,” says Calvin Hwang, MD. Some studies indicate that nearly 80% of EDs in the U.S. currently incorporate some type of fast track area. In a study published in the Western Journal of Emergency Medicine, Dr. Hwang and colleagues examined if implementing an ED fast track had an effect on Press-Ganey scores of patient satisfaction. Improvements Observed For the study, Dr. Hwang and colleagues analyzed data from respondents to a Press-Ganey...

Predicting Infections After RSA

The rate of reverse shoulder arthroplasties (RSA) is increasing as its indications are expanding, but various reports suggest that these procedures are associated with a high complication rate. “Research has shown that several comorbidities can increase the risk of infection in orthopedic surgeries, including diabetes, smoking, morbid obesity, and rheumatoid arthritis,” explains Brent J. Morris, MD. Although several small studies have been conducted, few analyses have examined a large series of patients and controlled for confounding factors to confirm which variables are risk factors for infection after RSA. To address this research gap, Dr. Morris and colleagues had a study published in the Journal of Should & Elbow Surgery to explore risk factors for periprosthetic infection after RSA. Identifying Risk Factors For the study, the investigators reviewed 301 primary RSAs with a minimum of 1-year follow-up in a prospectively collected shoulder arthroplasty registry. Overall, about 5% of the study group experienced periprosthetic infections after RSA, a finding that was similar to what has been seen in previous studies. “A failed prior arthroplasty was identified as an independent risk factor for infection after RSA,” says Dr. Morris. “We also found that age appeared to be an important consideration. Patients younger than 65 were at greater risk for infection after RSA. It’s possible that prior shoulder surgery increases risks for infection because of unrecognized indolent infections.” Prior surgery can also create a large amount of dead space that may predispose these patients to infections. The analysis also examined the effect of patient comorbidities on risk of infection after RSA. According to the findings, a history of smoking, diabetes, rheumatoid arthritis, or...

Postoperative Cardiac Issues After Arthroplasty

Cardiac events are major postoperative complications that can occur in patients undergoing total knee arthroplasty and total hip arthroplasty. Some studies have shown that serious cardiac complications, including myocardial infarction and cardiac arrest, account for 7% to 20% of all major systemic complications following these procedures. “Hospitals are increasingly implementing performance-based outcome metrics and penalizing those with high readmission rates after elective procedures like these,” explains Andrew J. Schoenfeld, MD, MSc. “As such, it’s important to look at risk factors that may play a role in the development of cardiac complications after total knee arthroplasty and total hip arthroplasty.” Little is known about how patient-based risk factors affect risks for postoperative cardiac complications among total knee and hip arthroplasty recipients. Understanding these risk factors can help clinicians counsel their patients before their surgery. By identifying high-risk patients, targeted interventions can be developed to improve patient outcomes and reduce the incidence of unplanned hospital readmissions and morbidity after total knee and hip arthroplasty. A Detailed Investigation Previous studies on adverse postoperative cardiac outcomes after arthroplasty may be limited because their samples usually come from individual centers and the surgeons performing these procedures may have extensive experience. In the Journal of Bone & Joint Surgery, Dr. Schoenfeld and colleagues had a study published that examined the rates, risk factors, and time of occurrence for cardiac complications at 30 days following total knee and hip arthroplasty. “Our study sample included more than 46,000 patients undergoing either primary unilateral total knee arthroplasty or total hip arthroplasty at numerous medical centers in the United States participating in the American College of Surgeons’ National Surgical...
Discharging Patients With Diabetes

Discharging Patients With Diabetes

Research indicates that the care of inpatients with hyperglycemia and diabetes has improved significantly in the past decade. However, few studies have assessed the optimal management of these patients after hospital discharge. Currently, most patients admitted with uncontrolled diabetes are discharged home on their preadmission medications or no therapy. Testing an Algorithm Recently, the Endocrine Society released inpatient guidelines for the management of patients with diabetes. These guidelines include an algorithm with which to base post-discharge care, but recommendations are based solely on expert consensus. Accordingly, Guillermo Umpierrez, MD, and colleagues conducted an exploratory study to test the safety and efficacy of this algorithm, based on admission A1C levels. Participants included general medicine and surgical patients aged 18 to 80 with type 2 diabetes who were treated with insulin therapy in the hospital. “For the study, patients with an A1C at admission of 7% or less were discharged home with the same medications they were on prior to admission,” explains Dr. Umpierrez. “Unfortunately, most people admitted to the hospital have an A1C between 8% and 9%. Patients with an A1C of 7% to 9% restarted their preadmission oral agents and received basal insulin at 50% of their in-hospital daily dose. Those with an A1C higher than 9% were discharged on oral agents plus 80% of the basal insulin dose they received in the hospital.” The primary outcome of the study was A1C change at 12 weeks after discharge. Key Findings The average A1C among participants decreased from 8.7% at baseline to 7.3% at 12 weeks after discharge, according to the results. Patients discharged on basal insulin were able to...
Understanding and Implementing Pneumococcal Vaccination Recommendations for Adults

Understanding and Implementing Pneumococcal Vaccination Recommendations for Adults

The pneumococcal disease immunization schedule for adults in the United States is relatively complex. Two types of pneumococcal vaccines are to be administered in a variety of combinations and at different intervals based on a patient’s age (younger than 65 years vs aged 65 years and older), underlying risk conditions, and pneumococcal vaccination history. Vaccine recommendations such as those for influenza require only one dose of vaccine to be administered to every U.S. adult every year. Little effort is required by clinicians beyond checking for serious adverse reactions to past doses, which are extremely rare. For pneumococcal disease, the vaccine recommendations are less straightforward. The adult pneumococcal recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) may seem complex to busy healthcare professionals and their patients. For example, whereas ACIP carefully differentiates recommendations for those with “chronic conditions” versus “immunocompromising conditions,” clinicians may not distinguish between these categories with their patients. The National Foundation for Infectious Diseases (NFID) is dedicated to educating healthcare professionals and the public about the burden of vaccine-preventable diseases and the importance of vaccinating according to ACIP recommendations. To promote widespread education about vaccines, NFID created a dedicated webpage with pneumococcal vaccination resources for healthcare professionals. Online Tools The NFID Pneumococcal Vaccination Resources page (www.adultvaccination.org/professional-resources/pneumo) includes a variety of fact sheets, templates, and assessment tools. Of key importance is the guidance provided on vaccinating higher-risk adults who are younger than 65 years (Table). Whereas most patients who need the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) also require a second PPSV23 dose at least 5 years after the first...
Conference Highlights: TCT 2015

Conference Highlights: TCT 2015

New research was presented at TCT 2015, the Cardiovascular Research Foundation’s Transcatheter Cardiovascular Therapeutics annual meeting, from October 11 to 15 in San Francisco. The features below highlight some of the studies that emerged from the conference.   Estimating Fractional Flow Reserve With CT The Particulars: Comparisons of diagnostic angiography with fractional flow reserve derived from CT (FFR-CT) in patients with chest pain are lacking. Data Breakdown: For a study, researchers looked at patients who were either undergoing planned invasive testing with diagnostic angiography or planned noninvasive testing. Participants were assigned to usual care or a strategy guided by FFR-CT. Average costs were 32% lower for patients in the FFR-CT arm than for the invasive testing group. The difference in costs was driven mostly by the lower costs of invasive procedures. In addition, 61% of angiograms were canceled after FFR-CT data were obtained by physicians. Only 12% of patients who underwent angiography following FFR-CT did not have obstructive coronary disease, compared with 73% of those assigned directly to diagnostic angiography. Take Home Pearl: A diagnostic strategy with FFR-CT among chest pain patients suspected to have coronary artery disease appears to reduce the number of patients requiring invasive diagnostic angiography, resource utilization, and associated costs.   —————————————————————- Improving Care With Mitral Valve Teams The Particulars: Patients with mitral valve disease require complex care from cardiologists and surgeons. A team approach to this care could increase coordination and collaboration. Data Breakdown: David L. Brown, MD, FACC, FACP, FSCAI, founder of the Heart Hospital Baylor Plano and president and chairman of the medical staff, suggests that cardiologists and surgeons must work together...

A New Resource for HIV Care Providers

The HIV Medicine Association has launched a new website, HIVClinician.org, to provide information and tools to help HIV medical providers and clinics adapt to healthcare financing and system reforms. A key difference between the HIV clinicians and others who are adapting to healthcare reform is that many HIV patients who have been uninsured have relied on the Ryan White program, which has been critical in supporting HIV care and has allowed HIV clinics to develop comprehensive HIV care programs. However, with grant funding, some HIV clinics have been operating in a parallel healthcare system. The resources available at HIVClinician.org are intended to help HIV and Ryan White-funded clinics adapt and leverage healthcare reform for their patients. “The site is unlike others that cover the most recent literature on HIV or the most recent treatments for HIV,” explains HIVMA Board member Alan Taege, MD. “HIVClinician.org is geared more toward the actual problems of navigating through patients’ coverage issues, billing and coding, and adapting to healthcare reform.” The facts sheets, issue briefs, webinars, wall posters, pocket guides, and other materials on HIVClinician.org encompass three main goals: Improve access to quality HIV care and treatment. Assist Ryan White programs, which provide HIV/AIDS services to uninsured and under-insured patients, with developing business strategies and systems to ensure sustainability. Offer resources to support the integration of Ryan White medical providers into payment and system delivery reforms. The Resources In the Healthcare Reform section, website visitors will find information on what HIV providers need to know about Affordable Care Act (ACA) enrollment, accountable care organization considerations for HIV providers, and key ACA-related terms.  Users of...

Addressing Factors Contributing to Heart Disease

Studies show that coronary artery disease (CAD) causes roughly 1.2 million heart attacks each year and more than 40% of those who suffer these events will die. Fortunately, physicians are more informed than ever before and are able to keep a close eye on their patients’ heart attack risk. They can prescribe proper medications and offer lifestyle changes that are tailored to each person’s needs. At the same time, new advancements—including next-generation diagnostic reports—are available to help physicians empower patients to better understand and improve their heart health. Published research has identified several key risk factors for heart disease that fall outside the realm of what patients can control, but the good news is many risk factors for heart disease are controllable. The key is to use the resources we have to identify modifiable risk factors early. Such actionable items include efforts to quit smoking, control blood pressure and cholesterol levels, and manage diabetes, among others. Emerging Tools Recent advancements in cholesterol testing are enabling physicians to look beyond standard lipid levels and helping provide patients with a more detailed picture of their heart health. Testing that measures the small particle of lipoproteins—for example, Apo B, LP(a) and mapping of HDL to assure the quality of HDL particles—have revolutionized risk factor modification. Additionally, it is now known that inflammatory markers, such as lipoprotein-associated phospholipase A2 and myeloperoxidase, are directly correlated to arterial intima inflammation and an increased risk of CAD. Furthermore, measuring insulin resistance and insulin levels could identify prediabetes early and possibly prevent the development of CAD. Additional diagnostic advancements include genotype testing for sensitivity to statins. This...

Baffling Deficiency of New ICD-10 Codes

Many years in the creation and tens of thousands more codes than ICD-9, yet the new ICD-10 list may be inadequate. An actor was hospitalized after his foot became caught an elevator raising the stage during a performance of the Broadway show “Spider-Man: Turn Off The Dark.” As a connoisseur of ICD-10 codes, I decided to see if I could classify this injury correctly. To my surprise, I could not. The only codes having to do with elevators are the W303XXs Contact with grain storage elevator. Since I had once read that the codes were originally developed in Europe, I even searched for “lift.” But all I got were Y93F2 Activity, caregiving, lifting and W240XXs Contact with lifting devices, not elsewhere classified. Contact with lifting devices, not elsewhere classified hardly seems appropriate for elevators, which are so common. People are frequently hurt on them or by falling down their shafts. All you get when you search “shaft” are hundreds of codes dealing with bones. We know that ICD-10 has given us such gems as V982XXA Accident to, on or involving ice yacht, V9542XA Forced landing of spacecraft injuring occupant, V9027XA Drowning and submersion due to falling or jumping from burning water-skis, W5609XA Other contact with dolphin, and V9733XD Sucked into jet engine subsequent encounter. [Click on the links to read my comments about those codes.] So how is it that there’s no code for contact with an elevator? For that matter, what about injury during a Broadway show? Surely both elevator and Broadway show injuries are much more common than say V8022XA Occupant of animal-drawn vehicle injured in collision...
Conference Highlights: IDWeek 2015

Conference Highlights: IDWeek 2015

New research was presented at IDWeek 2015, the combined annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, HIV Medicine Association, and Pediatric Infectious Diseases Society, from October 7-11 in San Diego. The features below highlight some of the studies that emerged from the conference. This is the first part of a two-part series of coverage from IDWeek 2015.   TB Biomarker Identified The Particulars: Few studies have explored the possibility of biomarkers being helpful for diagnosing tuberculosis (TB) and making a prognosis for patients with the disease. Data Breakdown: For a study, researchers collected and analyzed clean catch urine samples from untreated patients with TB. Data were also reviewed on a subset of patients who received the first 3 months of therapy for TB. Urine samples from patients with TB were compared with samples from matched healthy participants. One compound—the 490 urinary biomarker—was different across all data sets, with nearly 55,000 counts of the biomarker being seen in patients with active pulmonary TB compared with counts of just 7,500 in healthy participants. The average abundance of the 490 urinary biomarker decreased from nearly 76,000 counts to 18,000 counts after 2 months of treatment. Take Home Pearl: The 490 urinary biomarker may potentially serve as a duel diagnostic and prognostic marker of active pulmonary TB.   Many Children & Adolescents Susceptible to Measles The Particulars: Data are lacking on the estimated number of children and adolescents who are currently susceptible to measles infection. Data Breakdown: Answers to a poll of healthcare provider-verified responses regarding children and adolescent immunization coverage were assessed for a...
CME: Counseling Young Adults With Hypertension

CME: Counseling Young Adults With Hypertension

Published studies show that about 9% of men and 7% of women who fall in the young adult age range—defined as ages 18 to 39—have hypertension. “Although young adults have lower rates of hypertension when compared with those aged 40 and older, only about 38% of these individuals have their hypertension under control,” explains Heather M. Johnson, MD, MS. Recent guidelines have identified lifestyle modifications as a critical first-line step to controlling hypertension. Several strategies are recommended, including losing weight for overweight and obese individuals; adopting the Dietary Approaches to Stop Hypertension (DASH) plan; reducing dietary sodium; increasing physical activity; consuming alcohol in moderation; and quitting smoking. “Lifestyle modifications have been shown to be effective in improving hypertension control, reducing cardiovascular risk, and enhancing the efficacy of antihypertensive medications,” says Dr. Johnson. Despite these benefits, research suggests that adults with hypertension receive little physician education about lifestyle modifications. Few studies have assessed lifestyle education among patients who develop incident hypertension. Examining Current Patterns An understanding of lifestyle education patterns and the influence of such counseling are needed to develop targeted hypertension interventions. In a study published in the Journal of General Internal Medicine, Dr. Johnson and colleagues sought to determine the presence of any documented lifestyle education in an electronic health record system for young adults with incident hypertension. The study also aimed to identify patient, provider, and visit predictors of receiving documented education. “Our study results showed that only 55% of the 500 participants received documented lifestyle education from a clinician within 1 year of presenting with incident hypertension,” Dr. Johnson says. Just 23% of participants received an...
Men Get Breast Cancer Too

Men Get Breast Cancer Too

The pink ribbon symbolizing breast cancer appears everywhere. And that is because October is breast cancer awareness month. I applaud this campaign, and I truly believe that it has saved and is saving lives. However, we are over-looking a forgotten segment of the population in this disease: men. Men get breast cancer too. While breast cancer in men is just a tiny fraction of patients, we need to remind people that they are at risk as well. The male patients I treated with breast cancer did not believe that they could possibly be afflicted with this disease; they thought it was only a “women’s disease”. In fact, when I ordered mammograms on men in the past, some thought I was joking. Breast cancer awareness is a great thing to advocate for, but we need to not forget men here. Men with breast cancer tend to do much worse than women. They tend to die earlier and fail treatment at a higher rate. One of the reasons is because this disease has not been studied much in men as it has in women. Men receive the same treatment as women because that is all that is available at the present time. More clinical trials are needed to develop specific treatments for men with breast cancer. “Men receive the same treatment as women because that is all that is available at the present time. More clinical trials are needed to develop specific treatments for men with breast cancer.” Emotionally, men also have a much more difficult time. They are often stigmatized as having a “women’s disease”. Many are embarrassed to tell...
Two Ways to Deal with ED "Frequent Flyers"

Two Ways to Deal with ED "Frequent Flyers"

A hospital in Maryland has come up with a novel solution for patients who are “frequent flyers,” politically correctly termed “super utilizers,” in its emergency room. After identifying 318 people who visited the emergency department four or more times in 4 months, Sinai Hospital referred them to primary care doctors, social services, mental health and substance abuse programs, and insurance providers. One young man who made eight trips to the emergency department in 4 months, often by ambulance, was assigned to a care coordinator who worked with him to arrange his medical care and deal with his nutritional, social, and economic problems. The project, detailed in a recent Baltimore Sun article, cost the state $800,000 over 3 years. But it has resulted in 1000 fewer emergency department visits and paid for itself. In fact, the patient described above has not felt the need to visit the emergency department once since he enrolled in the program. A few other hospitals in Maryland have seen similar results, although each hospital has unique issues. Some have discovered that the patients have a more pressing need for social interventions than medical care. Because they save money in the long run and the patients are healthier, the hospitals are not losing revenue with fewer emergency visits. A doctor in Japan took a more direct approach. According to Asian media outlet Rocket News, a man with elbow pain was seen in the emergency department of Mutsu City General Hospital. He was treated and released, but showed up a few hours later with abdominal pain. He was again examined and discharged. He returned a third time...
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