Reduction in unnecessary folate testing | Predictors of symptom recurrence in omalizumab-treated chronic urticaria | Overall muscle strength not necessarily indicated by handgrip strength
August 16, 2018
AJM: From the publisher of The American Journal of Medicine
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Top News
Reduction in unnecessary folate testing
The red blood cell folate laboratory test has limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate levels, have resulted in only modest success. In the current study, restricting RBC folate ordering resulted in a large and sustained reduction in folate testing. Significant cost savings were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency.
The American Journal of Medicine (8/2018) 
New Free CME: Clinical Issues in Atopic Dermatitis
In this CME activity, expert faculty will review the pathophysiologic underpinnings of atopic dermatitis, best practices for comprehensive patient evaluations and the clinical profiles of systemic treatment options, including biology therapy, for patients with moderate-to-severe disease. Upon completing this activity, you may receive up to 1.0 AMA PRA Category 1 Credit. Click here to begin this activity!
Clinical Updates
Predictors of symptom recurrence in omalizumab-treated chronic urticaria
Omalizumab is used for controlling chronic spontaneous urticaria (CSU), but symptoms can recur rapidly or slowly with drug discontinuation. This study analyzed data from three clinical trials of omalizumab (total 978 patients) to identify potential predictors of the speed of symptom return after stopping omalizumab therapy. Of 746 variables assessed, two were identified through statistical modeling as predictors of symptom return: baseline UAS7 (urticaria activity score over 7 days) and early area above the curve (AAC -- determined by plotting the UAS7 scores across time points). The results suggested that high baseline UAS7 and low UAS7 AAC (slow decrease of symptoms) indicate higher probability of rapid symptom return than low baseline UAS7 and high UAS7 AAC.
The Journal of Allergy and Clinical Immunology: In Practice (8/2018) 
Overall muscle strength not necessarily indicated by handgrip strength
Measurement of muscle strength is an important part of the geriatric assessment because of its predictive validity for decline in cognition, mobility, and functional status. This study assessed the agreement between handgrip strength (HGS) and knee extension strength (KES) in five cohorts of older adults. A low to moderate agreement between HGS and KES was found as a function of age and health status at a population level and an agreement between HGS and KES varied on individual level. The use of one muscle group strength measure seems unjustified as an indicator of overall limb muscle strength.
Journal of the American Medical Directors Association (8/2018) 
Phenotypes differ between child- and adult-onset atopic dermatitis
The associations and clinical characteristics of adult- compared to child-onset atopic dermatitis (AD) were studied by Silverberg, et al., in a prospective observational study in 356 adults. Adult- vs. childhood-onset AD was significantly associated with birthplace outside the US and a decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy. Latent class analysis revealed that adult-onset AD was significantly associated with two of the three classes identified: (a) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck and hand dermatitis; and (b) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; but not (c) lower probability of flexural dermatitis, but highest probabilities of virtually all other signs and symptoms. Distinct phenotypes with lesional predilection for the hands and/or head/neck were noted in adults with adult versus child-onset atopic dermatitis.
The Journal of Allergy and Clinical Immunology: In Practice (8/2018) 
Continuing Medical Education
New On-Demand CME: Clinical Issues in Severe Asthma
New On-Demand CME: Clinical Issues in Severe Asthma
During this web-based Clinical Issues™ program, a panel of expert faculty will discuss and debate a series of topics related to comprehensively evaluating and longitudinally managing patients with severe asthma, including how the evolving evidence base should shape clinical decision-making and implications of new study data presented at the 2018 American Thoracic Society International Conference. Upon completion of this activity, you may receive up to 1.5 AMA PRA Category 1 Credits™. Begin this activity!
Medical News
Vigorous exercise lowers risk of chronic diseases, disability
Researchers interviewed 1,584 Australians over the age of 50 and found that those who were involved in vigorous physical activity were able to stave off chronic disease, disability and mental impairment for 10 years, compared with those who only engaged in moderate physical activity or were inactive. The findings in the journal Scientific Reports also showed that those with the highest levels of physical activity were twice as likely to prevent stroke, heart disease, angina, cancer and diabetes, and to be in optimal physical and mental shape.
Specialty Pharmacy Times (8/9) 
Survey: Only 3.4% know sedentary lifestyle raises cancer risks
A survey of 351 people found 63.5% knew a sedentary lifestyle increased heart disease risks and 65.8% knew it raised the likelihood of metabolic conditions. However, researchers wrote in the Journal of Health Communication that only 3.4% of respondents knew a sedentary lifestyle increased cancer risks, 3.4% were aware it increased respiratory disease risks and 0.9% knew it increased the likelihood of gastrointestinal conditions.
HealthDay News (8/13) 
HF patients sent DASH diet meals have lower readmission risks
Heart failure patients who received prepackaged meals that followed Dietary Approaches to Stop Hypertension diet recommendations had a lower risk of hospital readmission within 30 days of discharge, according to a 66-patient study in the journal Circulation: Heart Failure. Both groups in the study were given information about following a sodium-restricted diet, but those who also received meals were limited to 1,500 milligrams of sodium a day.
HealthDay News (8/14) 
Business Practice News
CMS proposes major changes to Medicare's ACO program
The CMS has proposed overhauling Medicare's Accountable Care Organization program, with proposed changes that include limiting from six years to two years the amount of time an ACO can remain in an upside-risk arrangement, authorizing termination of ACOs with multiple years of weak financial performance and allowing certain ACOs under performance-based risk to offer incentives to patients for taking steps to improve their health. The CMS expects the proposal, estimated to save Medicare $2.2 billion over 10 years, to result in the dropping out of about 107 ACOs.
Healthcare Finance (8/9) 
Mayo Clinic leads US hospitals ranking
Mayo Clinic has topped the U.S. News & World Report's 2018-2019 Best Hospitals Honor Roll rankings for the third straight year. Cleveland Clinic, Johns Hopkins Hospital, Massachusetts General Hospital and University of Michigan Hospitals-Michigan Medicine rounded out the top five.
HealthLeaders Media (8/14) 
Patient's Perspective
Survey finds patients underestimate future long-term care expenses
A recent survey conducted by the Moll Law Group among 2,000 patients and family caregivers found that patients underestimate whether and when they might need long-term care as well as the costs, making them vulnerable to high out-of-pocket expenses at long-term care facilities. Data from the survey revealed the average respondent's projection for long-term care costs was about $25,350, compared to actual average expenses averaging $47,000 or more depending on the chosen facility.
Patient Engagement HIT (8/14) 
Ordinary life does not interest me. I seek only the high moments.
Anais Nin,
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