Dosing of direct-acting oral anticoagulants | Examining soda sponsorship of health organizations | Hereditary angioedema management in emergency departments
January 19, 2017
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Dosing of direct-acting oral anticoagulants
Compared with vitamin K antagonists, direct-acting oral anticoagulants (DOACs) have fixed dosing and limited drug interactions and do not require therapeutic drug level monitoring. Dose adjustments are recommended for moderate renal dysfunction, low body weight, and select drug interactions.
The American Journal of Medicine (1/2017) 
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Clinical Updates
Examining soda sponsorship of health organizations
Reducing soda consumption is important for stemming the obesity epidemic. This study investigated the nature, extent, and implications of soda company sponsorship of US health and medical organizations between 2011 and 2015. Researchers also looked at corporate lobbying expenditures on soda- or nutrition-related public health legislation during this time period. Results show that the Coca-Cola Co. and PepsiCo sponsored a total of 96 national health organizations, including many devoted to fighting the obesity epidemic, while simultaneously lobbying against 29 public health bills intended to reduce soda consumption or improve nutrition.
American Journal of Preventive Medicine (1/2017) 
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Hereditary angioedema management in emergency departments
There is a lack of standardized acute treatment for hereditary angioedema (HAE) between emergency departments, which may affect patient outcomes. Four new, on-demand HAE therapies are now FDA-approved for treatment. Their proper use has been highlighted by a recent published guideline. The present study examined potential areas for improvement in emergency department (ED) care of HAE by enlisting 105 HAE patients to complete an anonymous 30-question survey about their ED experiences. Patient surveys reported that (1) 99% felt that the ED personnel needed to improve their understanding of HAE, (2) 45% claimed that the seriousness of their illness was not appreciated, and (3) 59% stated that medical management needed to be improved. Six of 39 (15.1%) patients who needed ED care for an acute HAE episode did not receive specific anti-HAE therapy. It would be expected that ED care of HAE would improve if ED physicians adhered to guideline care.
The Journal of Allergy and Clinical Immunology: In Practice (1/2017) 
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Incomplete and contradictory MOLST forms
Incomplete Medical Orders for Life-Sustaining Treatment (MOLST) forms or ones containing contradictory information were often found in a sample of 100 patients transferred to the emergency department (ED). The MOLST form is the New York version of POLST (Physicians' Orders for Life Sustaining Treatment). New York researchers found 69% of the 100 forms had at least one blank section. Fourteen percent had contradictory information, e.g. stating comfort measure only, then also wanting to be sent to hospital and receive IV fluids and/or antibiotics.
Journal of the American Medical Directors Association (1/2017) 
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Capsaicin patch for diabetic peripheral neuropathy
Painful diabetic peripheral neuropathy (PDPN) is a debilitating condition and has been shown to affect approximately one-quarter of patients with type 2 diabetes mellitus. This 12-week study evaluated the efficacy and safety of capsaicin 8% patch versus placebo patch in patients with PDPN. Patients with PDPN were randomized to one 30-minute treatment (capsaicin 8% patch or placebo patch) to painful areas of their feet. Overall, 369 patients were randomized. The results show that one capsaicin treatment provides modest improvements in pain and sleep quality. Results confirm the clinical utility of the capsaicin 8% patch in the diabetic population.
The Journal of Pain (1/2017) 
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Childhood sexual abuse and early timing of puberty
This longitudinal study using gold-standard objective methods for pubertal staging confirmed earlier pubertal onset of both breast and pubic hair development in sexually abused females. Competing alternative models of obesity and biological father absence did not eradicate findings. Early puberty may affect risks of maladjustment and reproductive cancers.
Journal of Adolescent Health (1/2017) 
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Association between gout and type 2 diabetes
The authors investigated the association between gout and the risk of type 2 diabetes mellitus. Gout is a common and treatable form of inflammatory arthritis that affects 3.9% of adults in the US and 6.24% of the total population in Taiwan. Although type 2 diabetes is a comorbid condition of gout, pathologic activation of anti-interleukin (IL)-1β plays a role in both gout and type 2 diabetes. In addition, canakinumab (an IL-1β monoclonal antibody) provides significant pain and inflammation relief and reduces the risk of new pain flares in patients with acute gouty arthritis. Moreover, the genetic risk factors for and the rate of incidences of gout and type 2 diabetes are interdependent. Prospective data from two generations of the Framingham Heart Study reveal that individuals, including young adults, with higher serum uric acid are at a higher risk of type 2 diabetes. Although Mendelian randomization studies (using uric acid-associated loci as an instrumental variable) have revealed that serum urate concentrations are associated with gout, consistent evidence for a causal association between uric acid-associated loci and incident type 2 diabetes is lacking. However, hyperuricemia, the precursor of gout, plays a causal role in the development of insulin resistance, prediabetes, and diabetes.
The American Journal of Medicine (1/2017) 
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Continuing Medical Education
Elsevier Clinical Perspectives and Analysis -- ESMO 2016
Elsevier Clinical Perspectives and Analysis - ESMO 2016
Results from several key clinical trials evaluating therapeutic approaches for patients with metastatic breast cancer, metastatic castration resistant prostate cancer and non-small cell lung cancer were presented at the European Society for Medical Oncology 2016 Congress on Oct. 7 to 11, 2016, in Copenhagen, Denmark. Participate in any of the following activities and hear leading experts in their respective fields discuss the implications for current practice and future research. Begin these activities.
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Medical News
Study analyzes 3 CVD prevention interventions
A report in the Annals of Family Medicine found the health and economic impact of three interventions to prevent cardiovascular disease varied based on demographics and clinical objectives. Hypertension screening had the highest health impact, followed by cholesterol screening, while aspirin counseling was found to be cost-saving.
Physician's Briefing/HealthDay News (1/17) 
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Report: Opioid-dependent births surging in the US
The number of infants born to opioid-dependent mothers in the US annually has increased nearly fivefold in the last decade, and women ages 15 to 17 had the highest nonmedical opioid use during pregnancy, according to a report from the Substance Abuse and Mental Health Services Administration. The findings, based on 2012 data, also showed that substance abuse treatment programs for pregnant and postpartum women were only offered in 13% of outpatient facilities and 13% of residential facilities.
HealthDay News (1/17) 
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Exercise may help older adults improve memory, brain function
A study published in the journal Cortex found older adults who had high scores on cardiorespiratory fitness tests had increased brain activity and memory performance, compared with those who had low fitness levels. Researchers said cardiorespiratory fitness can be increased through regular moderate to vigorous activities such as walking, jogging or swimming.
Business Standard (India)/Indo-Asian News Service (1/15) 
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Business Practice News
Study sounds alarm on superbugs in US hospitals
Study sounds alarm on superbugs in US hospitals.
(Oli Scarff/AFP/Getty Images)
A study published in Proceedings of the National Academy of Sciences found a variety of carbapenem-resistant Enterobacteriaceae species in three Boston hospitals and one California hospital, findings that suggest the potentially deadly superbug is more prevalent in US hospitals than previously believed. CRE species cause 9,300 infections in the US each year and 600 deaths, with incidence rising, and researchers say greater surveillance is needed.
HealthDay News (1/16) 
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MedPAC considers overhaul of MIPS quality reporting
Quality reporting requirements under the Medicare Access and Chip Reauthorization Act's Merit Based Incentive Program may be too burdensome to be of value, according to the Medicare Payment Advisory Commission's technical staff, who asked MedPAC experts whether and how to adjust the program. Suggestions included reducing or eliminating clinician reporting and eliminating the "exceptional performance" fund.
MedPage Today (free registration) (1/13) 
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Patient's Perspective
Hospitals create support centers for caregivers
The risk of financial penalties for high readmission rates has prompted hospitals to create support centers for family caregivers so patients have a successful transition to home, said Jill Gottlieb of Northern Westchester Hospital. Susan Reinhard, director of AARP, said family caregivers can spend many hours at the hospital but may not get attention from staff.
USA Today/Kaiser Health News (1/11) 
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