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Bad Cholesterol

Bad Cholesterol

“Your good cholesterol is fine, but your bad cholesterol is plotting to hack into your computer, empty your bank account, and steal your wife.”      ...
AKH CME: Allergy Management in the Primary Care Setting: A New Look at Improving Outcomes in Patients with Common Allergies

AKH CME: Allergy Management in the Primary Care Setting: A New Look at Improving Outcomes in Patients with Common Allergies

CME Credit: 1.0 hour activities The goal of this activity is to provide learners with a practical appreciation of the role of the primary care physician in safe, effective environmental allergy diagnosis and treatment. Participants will become familiar with techniques for patient safety and efficient strategies to administer allergy testing and treatment in the primary care practice....

AKH CME: Opportunistic Mold Infections: Progress & Challenges

CME Credit: 0.5 hour activities These programs review the epidemiology, current and emerging diagnostic techniques, why therapy fails, current therapeutic options, and the development of novel treatment choices for improving care in patients with invasive mold infections and...

AKH CME: Allergy and Asthma in Children

CME Credit: 0.5 hour activity This module will focus on the links between atopy, specifically allergic rhinitis and childhood asthma. The goal is to enhance the ability of primary care providers (PCPs) to identify patients with allergic conditions that are associated with...
AKH CME: Hemophilia Clinician Education Series

AKH CME: Hemophilia Clinician Education Series

CME Credit: 0.25 hour activities The Clinician Education Series is a collection of free educational presentations supported by an educational grant from Baxalta Incorporated and jointly provided by SolutionSight, Inc and AKH Inc. These presentations provide clinical information and therapy management approaches for hemophilia...
AKH CME: Bridging the Gap: Clinical Trial Design and Implication for Translating Research into Clinical Practice in Epilepsy

AKH CME: Bridging the Gap: Clinical Trial Design and Implication for Translating Research into Clinical Practice in Epilepsy

CME Credit: 0.25 hour activities Epilepsy affects some 2.3 million adults and 467,711 children in the United States. Selecting the best drug for a particular patient and for a specific seizure type can be challenging for clinicians. Evidence based recommendations on the efficacy, tolerability, and safety of several AEDs were developed in 2004. Since this publication, new agents and data have emerged. Concurrently, optimal treatment designs for trials have been brought into question and new study designs developed. The regulatory requirements for the EU and the US vary substantially and their trial outcomes do not directly correlate to clinical application. There is an urgent need for education on the safe and appropriate interpretation and application of trial data to clinical...
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...
Anxiety and Depressive Symptoms in Cancer Survivors

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...
Patient Preferences for Non-Insulin Diabetes Drugs

Patient Preferences for Non-Insulin Diabetes Drugs

As type 2 diabetes has become a more manageable chronic condition, there has been a recent push to implement patient-centered care approaches for those with the disease. “Studies have shown that type 2 diabetes is often poorly controlled, and adherence to insulin and non-insulin medications is frequently suboptimal,” explains Tanjala S. Purnell, PhD, MPH. “This can increase patients’ risk for developing cardiovascular disease, chronic kidney disease, and other health problems. Understanding why patients prefer certain treatments for their diabetes is an important and necessary part of achieving patient-centered care.” The issue of treatment preference in type 2 diabetes is complex because there is a wide range of medication options. With these options comes consideration of drug-related benefits, harms, and burden as well as the likelihood or uncertainty of treatment-related outcomes. When measuring patient preferences, Dr. Purnell says it is important to determine how patients value specific outcomes, such as the importance of weight maintenance or glycemic control. It is also important to measure how patients choose between treatment options and how their choices are influenced by particular attributes of treatment. A Systematic Review Although patient preferences are deemed important by major diabetes professional societies, little is known about how these preferences influence treatment for type 2 diabetes. To address this research gap, Dr. Purnell and colleagues conducted a systematic review that identified and analyzed studies of patient preferences in patients with type 2 diabetes not on insulin. The study, published in Diabetes Care, reviewed several databases for articles in which patient preferences for diabetes medication treatment were assessed. For the analysis, many important attributes were examined in clinical studies...

AKH CME: Lipids and Cardiovascular Disease

CME Credit: 1.0 hour activity The content of this activity was initially presented live at the 2014 ISSFAL Congress held in Stockholm, Sweden.  Topics Include Mediterranean Diet, Milk Fat Globule Membrane (MFGM), DHA Fatty Acid, and Omega-3 Index in Heart Failure...
Recommendations on Cardiac Imaging Radiation

Recommendations on Cardiac Imaging Radiation

The development of cardiac imaging technologies has revolutionized cardiovascular medicine by allowing for routine, non-invasive assessments of myocardial perfusion and anatomy. “Despite these advances, little evidence exists regarding the impact of radiation exposure on cardiac patients,” says Andrew J. Einstein, MD, PhD. In November 2012, a symposium sponsored by the NIH/National Heart, Lung, and Blood Institute and the National Cancer Institute was conducted to address these knowledge gaps. Dr. Einstein and other symposium participants identified key components of a framework to target critical radiation safety issues for patients, laboratories, and patients with known or suspected cardiovascular disease. Key Recommendations Several important recommendations resulted from the symposium and were published in the Journal of the American College of Cardiology. The overriding theme is to use shared decision making between providers and patients when disclosing the use of ionizing radiation. According to the recommendations, use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering and reinforced by the performing provider team. The recommendations also provide measures to ensure the safety and effectiveness of these imaging procedures. “A cardiac imaging procedure with an effective radiation dose of 3 mSv or less is associated with a low risk of adverse events from radiation exposure,” says Dr. Einstein. “This doesn’t require a detailed discussion from ordering physicians or written consent from patients. However, if the effective radiation dose exceeds 20 mSv, ordering physicians should have a discussion with patients about their specific radiation exposure risks and any projected cancer risks or get written informed consent from patients.” Justification for using cardiac...
Severe Chronic  Bronchitis  in Advanced  Emphysema

Severe Chronic Bronchitis in Advanced Emphysema

Studies have shown that chronic bronchitis occurs in 18% to 45% of patients with COPD and is associated with a higher risk for exacerbations and hospitalizations as well as an accelerated decline in lung function. However, chronic bronchitis has not been well described in patients with advanced emphysema. “The data regarding mortality in this patient population are conflicting,” says Victor Kim, MD. “Few studies have assessed the effects of chronic bronchitis on hospitalization rates in those with advanced emphysema.” A Novel Concept Severe chronic bronchitis is a novel concept, according to Dr. Kim, MD, lead author of a study published in the journal COPD that investigated this relationship. “We defined severe chronic bronchitis as the presence of cough and sputum along with chest trouble based on patient responses to the St. George’s Respiratory Questionnaire (SGRQ), a measure of health-related quality of life (HRQOL),” he says. Patients who had been randomized to medical therapy in the National Emphysema Treatment Trial were grouped by Dr. Kim and colleagues into those with or without chronic bronchitis. “The classic definition of chronic bronchitis is based on affirmative answers to questions about the presence of cough and sputum for 3 months out of the year for at least 2 consecutive years,” Dr. Kim explains. Participants were then categorized into those with severe chronic bronchitis or no severe chronic bronchitis based on the presence of chest trouble. Associations between chronic bronchitis and severe chronic bronchitis with all-cause mortality and time to all-cause hospitalization were assessed. Lung function and SGRQ scores over time were also compared between groups. Key Findings “Emphysema and chronic bronchitis are generally...
Type 2 Diabetes Phase 3 Research Study

Type 2 Diabetes Phase 3 Research Study

  [device] Refer your high-risk cardiovascular patients for study participation today!   An innovative approach to delivering treatment that does not require needles or pills. ITCA 650 (exenatide in DUROS® device) is an investigational drug product that is being developed for the treatment of Type 2 Diabetes. ITCA 650 is a match stick sized titanium cylinder placed just under the skin in the abdomen where it slowly delivers a continuous and consistent subcutaneous infusion of exenatide for up to six months. Participants must:  – be at least 40 years of age – be diagnosed with Type 2 Diabetes for at least 3 months – have a history of coronary, cerebrovascular, or peripheral artery disease Participants will receive: – the investigational product   (active treatment or placebo) – all study-related care at no cost For additional details, contact Intarcia today! Via phone at: 1-855-936-2555 Or e-mail: FREEDOMCVOStudy@intarcia.com [/device] [notdevice]   Refer your high-risk cardiovascular patients for study participation today!   An innovative approach to delivering treatment that does not require needles or pills. ITCA 650 (exenatide in DUROS® device) is an investigational drug product that is being developed for the treatment of Type 2 Diabetes. ITCA 650 is a match stick sized titanium cylinder placed just under the skin in the abdomen where it slowly delivers a continuous and consistent subcutaneous infusion of exenatide for up to six months. Participants must:  – be at least 40 years of age – be diagnosed with Type 2 Diabetes for at least 3 months – have a history of coronary, cerebrovascular, or peripheral artery disease Participants will receive: – the investigational product   (active treatment or placebo)...

Dealing With Diabetes & Depression

Rates of depression are significantly higher for patients with diabetes, especially those who are elderly, when compared with people without diabetes. About 20% to 30% of patients with diabetes suffer from clinically relevant depressive disorders. “Depression can worsen glycemic control in those with diabetes,” says Jason C. Baker, MD. Research suggests depression is associated with a higher risk of developing diabetes complications and adverse outcomes. Conversely, improving depressive symptoms has been shown to lead to better glycemic control. “Depression can result in reduced physical activity and a greater need for medical care and prescriptions, which in turn can increase healthcare costs and worsen quality of life,” Dr. Baker says. “In order to improve the management of patients with these two conditions, it’s imperative that healthcare providers be aware of this link and its consequences.” He adds that effective pharmacologic and non-pharmacologic treatments are available and may be of benefit in some situations. Routine Screening The stress of managing diabetes on a daily basis and the effects of the disease on the brain may contribute to depression, according to Dr. Baker. “There are multiple factors that may be at play, but one of the most important things clinicians can do is screen patients with diabetes for depression,” he says. “Oftentimes, physicians focus solely on the chief complaint or on A1C, blood pressure, and cholesterol numbers. We need to take a more holistic approach and be vigilant about seeking out depression or other mental health problems. This should become a routine part of all diabetes care.” Dr. Baker says that it can be challenging to address depression when managing patients with...
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