Efficacy of a transition clinic on hospital readmissions | Prenatal chromosomal microarray analysis in fetuses with congenital heart disease: a prospective cohort study | Validity of the asthma control test questionnaire among smoking asthmatics
Effective care models are needed to guide patients to the post-discharge care and social services they require to prevent unnecessary readmissions and improve post-discharge health. A primary care-staffed post-discharge transition clinic is a promising strategy for improving short-term access to follow-up care for vulnerable populations -- patients who completed an appointment in the transition clinic had similar risk of readmission as patients seen by their primary care physician.
New On-demand COPD CME Activity In this free Conference Reporter, An Update on Scientific Advances and Clinical Strategies in COPD, 2 experts summarize the key learnings, focusing on COPD, from this year's CHEST Annual Meeting 2017. Upon completing this activity, you may receive up to 1.0 AMA PRA Category 1 Credit™. Click here to begin this activity!
We evaluated the Asthma Control Test (ACT) for assessing asthma control among smokers. 151 participants were classified at enrollment as well controlled (24%), not well-controlled (42%), or very poorly controlled (34%). ACT scores were associated with Physician Global Assessment of asthma as the "gold standard" (P<0.001), and area under the receiver operator curve (95% confidence interval [CI]) for an ACT cut-off score of ≤19 (not well-controlled) was 0.76 (0.67, 0.84). Cronbach's alpha for ACT at enrollment was 0.81. The intra-class correlation coefficients for agreement of scores at enrollment and 6 weeks was 0.68 in participant with stable asthma (n=93). The ACT questionnaire was reliable and discriminated between levels of asthma control in smoking asthmatics with similar sensitivity and specificity as nonsmoking asthmatics.
This study used National Health and Nutrition Examination Survey data to determine the effect of dog and cat allergen exposure and sensitization on asthma morbidity in the US population. More than 50% of households had a dog, cat or both, and the prevalence of allergic sensitization was similar for dog and cat (approximately 12%). Among those who were sensitized, elevated exposure to pet allergens was associated with an increased prevalence of asthma and asthma attacks. Indeed, 44.2% of the asthma attacks were attributable to exposure to high levels of dog allergen in the bedroom among asthmatics sensitive to dog and 30.3% attributable to cat allergen exposure among the comparable cat sensitive-exposed group. Reducing pet allergen exposures has the potential for a significant decrease in asthma morbidity.
Cervical cancer screening declined in young women aged 18-20 years since introduction of 2009 screening guidelines. From 2006 to 2014, Pap smears and colposcopies declined 73% and 88%, respectively, in young women enrolled in Tennessee's Medicaid program. Results estimated a minimum cost savings of $45 per enrolled woman age 18-20 years.
Authors of this study explored the impact of sugar-sweetened beverage point of purchase warning label policies in Baltimore, Philadelphia, and San Francisco. Agent-based models simulated, over a seven-year period, the mean change in BMI and obesity prevalence and found implementing sugar-sweetened beverage warning labels at all sugar-sweetened beverage retailers would lower adolescent obesity prevalence in all three cities.
Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their impacts on prescribing and health outcomes remain unclear, with conflicting reports. The authors sought to determine if prescriber use of Oregon's prescription drug monitoring program led to fewer high-risk opioid prescriptions or overdose events. Results show that although opioid prescribing declined statewide after implementing the PDMP, registrants did not demonstrate greater declines than nonregistrants.
New CME/CE Activity: Multiple Sclerosis Clinical Updates
Four expert faculty will review recent prognosis and diagnostic strategies of multiple sclerosis from content presented at the MS Paris 2017 Joint ECTRIMS-ACTRIMS Meeting. An analysis of clinical trial data of current and emerging disease modifying therapies will be discussed. The faculty will also review how to implement recent scientific data to safely manage patients with MS for optimal outcomes. Upon completion of this activity, learners will gain a better understanding of recent clinical trial data for the treatment of MS, ultimately improving patient outcomes. Begin this activity!
The US Preventive Services Task Force released new guidelines in the Journal of the American Medical Association advising against ovarian cancer screening for women with no signs or symptoms of the disease, as the harms of screening outweigh the benefits, but the recommendation does not apply to women who are at high risk of ovarian cancer, including those who carry a BRCA gene mutation. "Evidence shows that current screening methods do not prevent women from dying of ovarian cancer and that screening can lead to unnecessary surgery in women without cancer," task force member Michael Barry said.
A CDC report showed more than 8% of adults over age 20 have depression, and the rate for women was almost double that for men. The research, published in the NCHS Data Brief, found about 80% of adults with depression also reported problems with performing daily tasks.
Medical practices should clearly communicate billing policies and payment options to patients, who are shouldering a growing proportion of their health care costs and might become angry when faced with unexpected charges, writes CareCredit CEO Dave Fasoli. Clear communication builds trust and is best done through a variety of channels, including the practice's website, email and prominently displayed brochures and posters, Fasoli writes.
Hospital CEOs say location and a growing interest in shift work are among the reasons it is more difficult for rural hospitals to recruit physicians. Frank May of UCHealth Yampa Valley Medical Center in Colorado said rural hospitals should seek out physicians who are committed to the community and consider greater use of telehealth, while Vince Oliver of Island Hospital in Washington state suggested having a full hospitalist program and working with osteopathic medicine schools.
The CMS is committed to moving from fee-for-service to a value-based US health care delivery system that focuses on quality over volume, Administrator Seema Verma told the CMS Quality Conference. Verma said while the agency supports quality there have been "unintended negative consequences of too many quality measures" and cited the Meaningful Measures initiative as a key part of efforts to focus on quality linked to outcomes without over-emphasizing process.
Poverty is an issue for about 17 million residents of suburbs in the US, and nearly one-fifth of them lack health insurance, according to a study in Health Affairs. Those with coverage have difficulty accessing medical providers, experts say.