Renin-angiotensin system inhibition effect on readmission in heart failure patients | Asthma-related hospitalizations can be prevented with better pharmacotherapy | A better diet in adolescence can mean less weight gain from adolescence to adulthood
October 20, 2016
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Renin-angiotensin system inhibition effect on readmission in heart failure patients
Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, the authors examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.
The American Journal of Medicine (10/2016) 
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Clinical Updates
Asthma-related hospitalizations can be prevented with better pharmacotherapy
Choice of asthma controller therapy and adherence to treatment can affect the risk of future severe exacerbations leading t years to 40 years from a random sample of the national French database, 275 patients (1.5%) with an asthma-related hospitalization were identified. Three distinct treatment profile clusters were identified using Ward's minimum-variance hierarchical clustering method: 1) patients with less than 1 unit dispensation of any controller medication (61.2%); 2) patients with frequent dispensations of long-acting beta agonists (LABAs)/inhaled corticosteroids (ICS) in fixed-dose combinations (34.7%); 3) patients receiving combinations of individual ICS and LABAs, with more dispensations of LABAs than ICS. The results indicate that a large fraction of asthma-related hospitalizations can potentially be prevented with better pharmacotherapy.
The Journal of Allergy and Clinical Immunology: In Practice (10/2016) 
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A better diet in adolescence can mean less weight gain from adolescence to adulthood
The A Priori Diet Quality Score (APDQS) reflects overall diet quality and is related to weight change in young adulthood and middle age; however, little is known about the APDQS in relation to weight gain from adolescence to young adulthood. This longitudinal study followed adolescents from mean age 15 years to follow-ups at mean ages 20 and 25 years, using surveys to assign APDQS. Both higher diet quality in adolescence and improvement in diet quality over subsequent years were associated with less weight gain during the transition from adolescence to young adulthood, independent of energy intake, eating behavior, physical activity, and cigarette smoking. Establishment of high-quality dietary patterns in adolescence may help mitigate excess weight gain by young adulthood.
The Journal of Pediatrics (10/2016) 
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Gamma-aminobutyric (GABA) acid as biomarker for migraine
Migraine is prevalent and disabling yet is poorly understood. One way to understand migraine better is to examine clinical characteristics and potential biomarkers, such as gamma-aminobutyric acid (GABA). This work explored whether relevant disease characteristics of migraine are associated with brain GABA levels. Higher pain and central sensitization scores were associated with increased brain GABA levels in individuals with migraine. These findings offer preliminary evidence for the usefulness of measuring pain and central sensitization in migraine and provide some support for the possible role of GABA in migraine pathophysiology and its potential as a diagnostic marker.
The Journal of Pain (10/2016) 
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Weak hand grip predicts diabetes?
US researchers studied a subsample from the Mexican Health and Aging study age 50+ (n=1,841). Weakness measured by Normalized Grip Strength was found to be associated with increased risk of diabetes and other cardiometabolic problems. In the past, the older Mexican population had high mortality from complications of diabetes. Although this has declined due to better health care accessibility, it could be even better if the risk of diabetes is identified and interventions began sooner.
Journal of the American Medical Directors Association (10/2016) 
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Assessing acidemia in neonates with a 5-minute Apgar score of 7 or greater
This study examines whether rates of acidemia and associated factors in neonates with 5-minute Apgar scores of 7 or greater can be assessed through the collection of fetal cord blood gases.
American Journal of Obstetrics & Gynecology (10/2016) 
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Is the prevalence of coronary heart disease decreasing in the US?
This study evaluated recent trends in the prevalence of coronary heart disease in the US population aged 40 years and older. Between 2001 and 2012, the overall prevalence of coronary heart disease significantly decreased from 10.3% to 8.0%; angina prevalence significantly decreased from 7.8% to 5.5%; and myocardial infarction prevalence decreased from 5.5% to 4.7%. While the overall prevalence of coronary heart disease decreased significantly over the 12-year survey period, this reduction was seen mainly among persons without established coronary heart disease risk factors.
American Journal of Preventive Medicine (10/2016) 
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Continuing Medical Education
Live CME Breakfast Symposium Registration now open
Live CME Breakfast Symposium Registration Now Open
Register today for "Comprehensive and Individualized Patient Care in Idiopathic Pulmonary Fibrosis: Refining Approaches to Diagnosis, Prognosis, and Treatment" held on Oct. 24 in Los Angeles at the JW Marriott Los Angeles LA LIVE. This live activity has been designed to meet the educational needs of health care professionals involved in the diagnosis, treatment, or management of patients with IPF. Register for this live activity.
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Medical News
Group issues recommendations on minimizing statin-CVD drug interaction risks
A scientific statement from the American Heart Association published in Circulation advises health care professionals to understand the adverse effects, dosage limits and monitoring parameters related to interactions between statins and other drugs for cardiovascular disease to minimize risks of toxicity. The group warns about a risk of muscle injury from using lovastatin, simvastatin or pravastatin with fibrate cholesterol drug gemfibrozil, and gives recommendations on other drug combinations.
MedPage Today (free registration) (10/17),  HealthDay News (10/17) 
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Prediagnosis obesity may raise risk of secondary primary cancers
A Korean study in the Journal of Clinical Oncology found prediagnosis obesity in cancer survivors was associated with an increased risk of developing secondary primary cancers. The findings, based on data for about 240,000 male cancer survivors, also showed a slightly stronger link between body mass index and secondary primary cancers in male cancer survivors, compared with the association between BMI and the risk of first cancers in the general population.
MedPage Today (free registration) (10/18) 
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Researchers link BMI in adolescence to diabetes mortality in midlife
A study in Diabetes Care showed that overweight and obese adolescents who belonged to the 85th to 94th percentiles and 95th percentile or higher, respectively, had a hazard ratio of 8.0 and 17.2 for diabetes mortality in midlife, respectively, compared with those in the fifth to 24th percentiles. Israeli researchers evaluated 2,294,139 adolescents between 1967 and 2010 and found a graded increase in diabetes mortality from a body mass index of 20.0 to 22.4 kg/m2 onward and from the 25th to the 49th BMI percentile group.
DoctorsLounge.com/HealthDay News (10/17) 
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Business Practice News
CMS aims to reduce administrative burdens in new payment models
The CMS has begun an 18-month physician-led pilot project to work with clinicians to boost satisfaction and decrease administrative burdens in Medicare's advanced alternative payment models. The project will include Next Generation Accountable Care Organizations, Pioneer ACOs, Medicare Shared Savings Program Track 2 and 3 ACOs, and Oncology Care Model 2-sided Track participants.
BeckersHospitalReview.com (10/13) 
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Medical groups raise concerns about new bundled payment plan
The American Hospital Association is asking CMS to hold off from expanding mandatory bundled payment models to allow time to assess existing ones. Plans call for launching cardiac bundles in 98 areas, but Dr. Linda Gillam, chairwoman of the American College of Cardiology's Partners in Quality Committee, said that proposal puts small hospitals at risk if they transfer patients but are still responsible for the patients' episode of care.
MedCityNews.com (10/17) 
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Patient's Perspective
Many mental health patients wait days in ED for a hospital bed
An American College of Emergency Physicians survey found that one-fifth of emergency department physicians have seen psychiatric patients who waited two to five days before they were admitted to the hospital. Many mental health patients spend extended periods in hospital EDs because there are few psychiatric inpatient beds and inadequate access to outpatient psychiatric stabilization services, among other issues.
HealthDay News (10/17) 
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