Prevention of nosocomial malnutrition | Venous thromboembolism in CKD | Immediate postpartum levonorgestrel IUD insertion & breastfeeding outcomes: A noninferiority randomized controlled trial
December 7, 2017
AJM: From the publisher of The American Journal of Medicine
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Prevention of nosocomial malnutrition
Although nosocomial malnutrition is a potentially preventable cause of poor outcomes, increased costs, and readmissions, it has received scant attention. Malnutrition during hospitalization is associated with increased mortality for years after discharge; but it can be addressed through screening, diagnosis, and appropriate nutritional supplementation. Efforts to reduce hospital-acquired malnutrition promise to improve outcomes and reduce costs. Nosocomial malnutrition should be considered a National Patient Safety Issue.
The American Journal of Medicine (12/2017) 
Cystic Fibrosis Roundtable Discussion
This roundtable is between three international expert faculty in cystic fibrosis (CF) who discuss the role of aerosolized agents for improving airway clearance, including caveats from their own clinical experience in managing patients with CF. Register for this course.
Clinical Updates
Venous thromboembolism in CKD
A diagnosis of low estimated glomerular filtration rate (eGFR) or albuminuria is associated with an increased risk of venous thromboembolism (VTE). In this issue of the American Journal of Kidney Diseases, Manish M. Sood and colleagues investigate how this risk is affected when both low eGFR and albuminuria are present. The study suggests that albuminuria increases the risk of VTE markedly (1.6-fold) in patients with normal eGFR compared to those with lower levels of eGFR.
American Journal of Kidney Diseases (12/2017) 
Immediate postpartum levonorgestrel IUD insertion & breastfeeding outcomes: A noninferiority randomized controlled trial
Immediate postpartum levonorgestrel IUD users have noninferior breastfeeding outcomes, including lactogenesis and eight-week breastfeeding continuation, compared with those having delayed IUD insertion
American Journal of Obstetrics & Gynecology (12/2017) 
Smokers with psychological distress may be softening
Smokers who are unwilling or unable to quit are considered to be hardening, yet recent research indicates the smoking population overall is softening and not hardening. This study examined softening among smokers with psychological distress over a 19-year period and found people with psychological distress had higher prevalence and consumed more cigarettes per day than people without distress. However, the increase in quit attempts over time was similar among smokers in each of the distress levels, indicating that smokers with psychological distress are also softening over time.
American Journal of Preventive Medicine (12/2017) 
Stability of asthma symptom control in mild-moderate asthmatics
A total of 429 individuals with mild-moderate asthma (67% female, mean age 51.6) reported symptom control using the GINA criteria at five assessments during a one-year follow-up period. Individuals varied from completely stable in symptom control (18% remained in the same control level in all five visits) to completely unstable (12% changed control level between all subsequent visits). Only 4% of between-individual variation in the stability of symptom control was explained by the included exposures, and a secondary analysis indicated that history of symptom control stability was the best predictor of current stability. In the absence of predictors, previous history of symptom control stability is the best indicator of future stability and should be considered when monitoring symptom control.
The Journal of Allergy and Clinical Immunology: In Practice (12/2017) 
Examining the value of video visits to patients in an outpatient urology clinic
Increasing pressure on doctors to see more patients and generate more revenue certainly places a stress on the overall health care system. More patients lead to overcrowding and long wait times at physicians' offices. Some patients travel long distances only to spend a few minutes face-to-face with their physicians. The concept of telemedicine and video visits is coming into vogue. The authors in this study performed a survey of patients asking about video visits. About 94% of the patients possessed a device that would enable them to do a video visit and the median amount patients would pay for each visit was $20. In the future, doctors will have to incorporate technology to perform office visits since not all patients can be seen in person.
Urology (12/2017) 
Lipidome as a predictive tool in progression to type 2 diabetes in Finnish men
There is a need for early markers to track and predict the development of type 2 diabetes mellitus (T2DM) from the state of normal glucose tolerance through prediabetes and diabetes (T2DM). The authors tested whether the plasma molecular lipidome has biomarker potential to predicting the onset of T2DM. In conclusion, this study indicates that a lipid signature characteristic of T2DM is present years before the diagnosis and improves prediction of progression to T2DM. Molecular lipid biomarkers were shown to have predictive power also in a high-risk group, where standard risk factors are not helpful at distinguishing progressors from nonprogressors.
Metabolism -- Clinical and Experimental (12/2017) 
Medical News
Researchers compare diabetes prevalence between men, women
The overall crude diabetes prevalence across ethnic groups was 6.9% among men and 3.7% in women, with the difference persisting after standardizing for age, body mass index, lifestyle factors and socioeconomic status, according to a study in Diabetic Medicine. Researchers analyzed data from the UK Biobank involving 489,079 adults ages 40 to 69 and found that in a subgroup analysis of South Asian participants, Bangladeshi men had the highest prevalence of diabetes, followed by Pakistani and Indian men, compared with women.
Healio (free registration)/Endocrine Today (12/4) 
Study: Cardioprotective effects of exercise are immediate, enduring
One or a handful of exercise sessions train the heart and coronary arteries to endure brief periods of ischemia, minimizing infarct size and ventricular arrhythmia, researchers reported in JAMA Cardiology. The findings suggest that having able patients undergo a few sessions of exercise before a planned cardiac intervention might reduce in-hospital mortality and morbidity.
MedPage Today (free registration) (11/30) 
Business Practice News
Physicians lack staff to implement value-based care
Ninety percent of family physicians responding to a survey sponsored by Humana cited a lack of staff time as the primary top barrier to navigating and adopting value-based payment models, while 78% cited a lack of transparency, the same percentage said a lack of standardized performance measures are barriers and 75% said uniform insurer reports on performance would help. Half of the survey respondents said value-based payment models will encourage more collaboration between primary care physicians and specialists.
HealthLeaders Media (11/29) 
Hospitals adapt facilities for bariatric patients
Hospital rooms are being adapted or built to accommodate larger patients as bariatric admissions increase. Some accommodations include up to 600-pound weight limits on operating tables and special hoists in intensive care units, as well as beds that can support up to 1,000 pounds.
Gazette Review (Minneapolis) (12/3) 
Opioid abuse-related deaths up fourfold in US hospitals
An analysis of federal hospital data showed that inpatient mortality from opioid-related hospitalizations rose more than fourfold from 0.43% in 2000 to 2.02% in 2014, while admissions for opioid and heroin poisoning rose and admissions for opioid abuse fell. The findings, published in Health Affairs, might indicate more cases of dependence are being handled in community settings with only serious cases handled at hospitals, said researcher Zirui Song.
Modern Healthcare (tiered subscription model) (12/4) 
Patient's Perspective
Study IDs factors predicting patient sharing of medical records with providers
Researchers surveyed more than 1,600 patients and found that privacy concerns, issue involvement, patient-physician relationship and patient activation were the factors that most influence whether patients want to share their online medical records with providers. The findings, published in the Journal of Medical Internet Research, highlighted the importance of educating patients about an organization's security measures, researchers said.
Becker's Health IT & CIO Review (11/29) 
Self-correction begins with self-knowledge.
Baltasar Gracian,
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