Prolonged glucosamine usage in overweight and obese middle-aged women | Incidence of fever in labor and risk of neonatal sepsis | How has use of BRCA mutation testing changed over the years?
June 22, 2017
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Prolonged glucosamine usage in overweight and obese middle-aged women
There are concerns that glucosamine, a commonly used treatment for osteoarthritis, might adversely affect glucose metabolism and cause insulin resistance. This study of overweight middle-aged women over a 6.5-year period found that prolonged glucosamine use appears to be safe, at least in participants with a normal baseline HbA1c level; it does not seem to have an effect over new-onset diabetes. Future studies should focus on subjects with an increased risk of developing diabetes mellitus.
The American Journal of Medicine (6/2017) 
Free CME Activity on Neuromuscular Blocking Agents
The Real-world Experience with Neuromuscular Blockade Reversal webcast presents real-world cases in a variety of surgeries and clinical settings in which the use of NMB reversal agents played a significant role in the patients' clinical outcome. Upon completion of this activity, you may receive up to 1.0 AMA PRA Category 1 Credit. Click here to begin this activity!
Clinical Updates
Incidence of fever in labor and risk of neonatal sepsis
Intrapartum fever at ≥36 weeks' gestation is common at 6.8%, but the risk for early-onset neonatal sepsis in this population is low at 0.24%.
American Journal of Obstetrics & Gynecology (6/2017) 
How has use of BRCA mutation testing changed over the years?
This cohort study examined trends in the use of BRCA mutation testing in women with previously diagnosed breast or ovarian cancer and those without (unaffected women) between 2004 and 2014. The results show a gradual shift from the use of BRCA testing primarily in cancer patients to its use in unaffected women. The proportion of BRCA tests performed in unaffected women increased from 24.3% in 2004 to 61.5% in 2014.
American Journal of Preventive Medicine (6/2017) 
Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents (NSAIDs)
NSAID use can be limited by adverse drug reactions, including hypersensitivity reactions. This adult cohort study used electronic records to determine incidence and predictors of reactions to prescription NSAIDs. Of 62,719 patients prescribed NSAIDs, 1,035 (1.7%) had an adverse drug reaction, of which 189 (18.3%) were hypersensitivity reactions. Patients with prior drug hypersensitivity reactions (OR 1.8 [95% CI 1.3, 2.5]), female sex (OR 1.8 [95% CI 1.3, 2.4]), autoimmune disease (OR 1.7 [95% CI 1.1, 2.7]), and those prescribed the maximum standing NSAID dose (OR 1.5 [95% CI 1.1, 2.0]) have increased odds of NSAID hypersensitivity reaction. Awareness of NSAID hypersensitivity in patients with risk factors can guide counseling and safe prescribing practices.
The Journal of Allergy and Clinical Immunology: In Practice (6/2017) 
Cardiometabolic risk in COPD: Normal weight, but abdominal obesity
What influences the cardiometabolic risk in chronic obstructive pulmonary disorder (COPD)? Researchers from the Netherlands followed 81 clinically stable older persons with COPD (mean age 62.5 years) who had normal weight but low muscle mass and who were abdominally obese for 4 months after 4 months of exercise training. This group was compared with controls without abdominal obesity. Surprisingly, cardiometabolic risk profiles were not altered after the 4 months of exercise training. The underlying pathophysiology needs further study.
Journal of the American Medical Directors Association (6/2017) 
Overweight anorexia patients less likely to receive care
A history of overweight/obesity in adolescent patients with anorexia nervosa or atypical anorexia nervosa is associated with lower odds of receiving inpatient medical care despite greater percentage weight lost and no difference in illness duration.
Journal of Adolescent Health (6/2017) 
ADHD medication adherence during the transition to college
Adolescents and young adults with attention-deficit/hyperactivity disorder are under-represented in the literature regarding transition to college. This qualitative analysis will help guide future quantitative research and the development of intervention programs to facilitate transition and medication adherence during this critical developmental period.
Journal of Adolescent Health (6/2017) 
Medical News
USPSTF calls for obesity screenings for youths 6 and up
USPSTF calls for obesity screenings for youths 6 and up
(John Moore/Getty Images)
The US Preventive Services Task Force published updated guidelines in the Journal of the American Medical Association recommending health providers screen body mass index in children ages 6 and older and refer obese youths and their families to comprehensive and intensive behavioral-based weight loss interventions. The group also found insufficient evidence to make recommendations on the weight-loss benefits of metformin and orlistat for obese children.
Reuters (6/20),  MedPage Today (free registration) (6/20),  Medscape (free registration) (6/20) 
Heart group emphasizes need to reduce saturated fat intake
An American Heart Association advisory published in the journal Circulation said a review of study data strongly indicates that lowering saturated fat consumption and replacing it with unsaturated fats will reduce cardiovascular disease. The advisory noted that some studies have disagreed about the adverse cardiovascular effects of saturated fat, and the issue has been hotly debated, so lead author Dr. Frank Sacks said the AHA wanted to clarify that research "overwhelmingly supports limiting saturated fat in the diet to prevent diseases of the heart and blood vessels."
MedPage Today (free registration) (6/15) 
Study compares risk of CV events between patients with, without diabetes
Patients with and without diabetes and without coronary artery disease had the same adjusted risk of myocardial infarction, cardiac death and mortality 4.1 years after undergoing coronary angiography, according to a study in Diabetes Care. Danish researchers used a cohort of 93,866 patients and found that 75.3% and 65.7% of patients with diabetes without CAD were treated with statins and aspirin, respectively, compared with 46% and 52.7% of patients without diabetes and CAD.
Physician's Briefing/HealthDay News (6/20) 
Business Practice News
MedPAC report suggests MIPS may not help patients, clinicians
A Medicare Payment Advisory Commission report said commissioners are looking at revising the Quality Payment Program because its Merit-based Incentive Payment System may not help people choose a clinician or help practitioners change their practices to improve value. MedPAC also made recommendations on ways to improve the Medicare Part B drug program.
MedPage Today (free registration) (6/16) 
Hospital Value-Based Purchasing review shows mixed results
The Hospital Value-Based Purchasing program has not led to better clinical-process or patient-experience measures, researchers reported in The New England Journal of Medicine. The study found the initiative did not significantly reduce mortality among patients admitted to the hospital for acute myocardial infarction or heart failure, but it did reduce mortality for patients admitted for pneumonia.
Physician's Briefing/HealthDay News (6/14) 
Patient's Perspective
Study: Counseling helps families improve eating habits
Counseling families on healthy eating habits was effective at getting them to reduce food portion sizes and sugar-sweetened beverages served at the table, researchers reported in the Journal of the Academy of Nutrition and Dietetics. The study found other messages, such as eating more fruits and vegetables, did not resonate as much with families, but children in the counseling group still were less likely to gain unhealthy weight.
Star Tribune (Minneapolis-St. Paul, Minn.) (tiered subscription model) (6/19) 
Only someone who is well-prepared has the opportunity to improvise.
Ingmar Bergman,
director and screenwriter
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