Type 2 diabetes patients with established atherosclerotic cardiovascular disease who don't meet glycemic targets with metformin and lifestyle modification should be given a glucose-lowering drug with proven cardiovascular benefit and/or mortality reduction, such as liraglutide or empagliflozin, according to the American Diabetes Association's 2018 guidelines published in Diabetes Care. Children and adolescents who are overweight or obese and have one or more additional risk factors should also be screened for prediabetes and type 2 diabetes, the ADA recommends.
The US Preventive Services Task Force recommends against the use of hormone replacement therapy for prevention of chronic diseases in postmenopausal women, as the risks outweigh any benefits. The statement, published in the Journal of the American Medical Association, was based on findings from 18 studies involving more than 40,000 women that showed combined estrogen and progesterone increases the risk of breast cancer and heart disease, while estrogen alone is tied to a higher risk of blood clots, stroke and gallbladder disease.
The American College of Cardiology published an expert consensus document on managing bleeding in patients taking oral anticoagulants in its Journal of the American College of Cardiology, adding to its recent consensus report on managing anticoagulation in patients with nonvalvular atrial fibrillation. Writing committee chairman Dr. Gordon Tomaselli said the pathway provides a "conceptual framework to support clinician decision-making" for patients with bleeding complications who are taking oral anticoagulant therapy.
A study in the journal Diabetes/Metabolism Research and Reviews showed that 20% of type 2 diabetes patients ages 45 and younger had early signs of kidney damage, while 7% had eye problems. Danish researchers evaluated more than 5,000 diabetes patients and found that having diabetes at a young age increases a person's risk of developing life-threatening cardiovascular diseases, blindness or kidney failure.
A study supported by the National Heart, Lung, and Blood Institute found that the delivery of powerful clot-busting drugs via catheter for the prevention of post-thrombotic syndrome in patients with deep vein thrombosis was associated with minimal benefit, based on data for almost 700 participants with DVT. The study in The New England Journal of Medicine found similar rates of post-thrombotic syndrome with and without the procedure, but rates of dangerous bleeding were higher with the procedure.
A 2017 Medscape survey found the majority of 10,523 nurses were satisfied with their careers, although up to 41% of satisfied nurses wished they had chosen a different practice setting. For more than 40% of APRNs, the most rewarding aspect of their job was helping people; meanwhile, among nurse practitioners, 27% said dealing with paperwork was a downside of nursing, while up to 28% of those who were dissatisfied with their careers planned to find a new path within their field.
A primary goal for clinicians is to try to get patients on optimal doses of guideline-directed medical therapy. However, there are often multiple barriers that interfere with this process. Completing prior authorization forms and navigating the various medication-assistance programs are two frequent challenges that clinicians and their office staff face when working to ensure patients can access and afford prescribed medications. We share some resources and tips for negotiating prior authorization and patient-assistance programs in a recent article. PCNA News and Resources.