Positive airway pressure therapies and COPD | The value of urodynamics in an academic specialty referral practice | Disparities in the management of ectopic pregnancy
July 13, 2017
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Positive airway pressure therapies and COPD
Positive airway pressure therapy may be used in patients with chronic obstructive pulmonary disease, but its impact on hospitalization risk remains controversial. In this study of COPD patients, initiation of positive airway pressure therapy was associated with a reduction in hospitalization, especially in those with comorbidities such as sleep-disordered breathing, chronic respiratory failure, and congestive heart failure.
The American Journal of Medicine (7/2017) 
Updates in Improving Care of Patients with Rheumatoid Arthritis
This activity provides rheumatologists with critical updates in care of patients with rheumatoid arthritis reported at the 2016 ACR Annual Meeting. Upon completion of this activity, you may receive up to 1.75 AMA PRA Category 1 Credit(s). Click here to begin this activity!
Clinical Updates
The value of urodynamics in an academic specialty referral practice
Urinary incontinence in females can be due to stress, urge or mixed. Stress incontinence occurs due to weakness in pelvic floor or sphincter and patients often report leaking urine with cough or Valsalva maneuver. Urge incontinence is leaking urine due to episodes of urgency and bladder overactivity. The most common form of incontinence is mixed. The authors in this study used urodynamics to discern the type of incontinence. Urodynamics is a study done in the office to evaluate the relationship between pressure and volume in bladder during filling and voiding phase. It is important to distinguish the different types of incontinence because the management of stress incontinence is typically surgical (example -- slings) whereas a majority of urge incontinence can be managed with medical therapy (anticholinergics).
Urology (7/2017) 
Disparities in the management of ectopic pregnancy
There is substantial variation in the management of ectopic pregnancy. There are significant racial and insurance related disparities associated with treatment.
American Journal of Obstetrics & Gynecology (7/2017) 
Feedback may significantly improve adherence to treatment
This systematic review examined 24 studies to determine whether providing feedback improves adherence to treatment. Of 24 studies, 16 found a significant improvement in adherence in the intervention group whereas adherence worsened in the control group. The meta-analysis included six studies and revealed mean percentage adherence increased by 10.02% in the intervention groups compared with control groups. Use of feedback effectively improves treatment adherence and may reduce avoidable health care costs caused by non-adherence.
American Journal of Preventive Medicine (7/2017) 
Does low-impact flooring reduce fall injuries?
A study from New Zealand tested whether low-impact flooring (LIF) produced fewer injuries from falls than standard vinyl flooring in nursing home residents' bedrooms. Over 31 months there were nearly the same number of falls in both groups. However, injuries from falls did decrease in the LIF group (22%) versus the control group (34%). Fractures occurred less than 1% in the LIF group, but fractures occurred in 2.3% of controls.
Journal of the American Medical Directors Association (7/2017) 
Long-term pain and recovery after major pediatric surgery: A qualitative study
Research developing targeted treatment that is focused on coping with children's long-term pain after surgery is needed due to the high prevalence of chronic pain after surgery. This study aimed to understand the child's and family's experiences of pain, and to gather stakeholder input regarding barriers and facilitators of perioperative intervention delivery. Findings indicate that families experienced surgery as stressful, and felt under-prepared for pain and recovery. Families and health care providers expressed interest in a preoperative intervention that teaches coping skills.
The Journal of Pain (7/2017) 
Do physicians talk to adolescents about sex?
This review article establishes the infrequency and inconsistency with which physicians talk to adolescents about sex and highlights the need for improvements in future research designs. The study addresses a unique range of sexual topics and provides alternative approaches for physicians who regularly counsel adolescents about sexual health.
Journal of Adolescent Health (7/2017) 
Medical News
Blacks at higher risk of dying from first heart attack
Blacks at higher risk of dying from first heart attack
(Spencer Platt/Getty Images)
Black men and women ages 45 to 64 had a higher risk of death from a first heart attack than white men and women in the same age group, according to a review of study data published in Circulation. Researchers said the higher risk may be linked to heart risk factors and living conditions.
HealthDay News (7/10) 
USPSTF: Behavioral counseling helps reduce CVD risk
A US Preventive Services Task Force final C grade recommendation said behavioral counseling has modest positive benefits for preventing cardiovascular disease in adults who have no risk factors, according to a report in the Journal of the American Medical Association. "The Task Force encourages primary care clinicians to talk to their patients about eating healthy and physical activity, and if they are interested and motivated to make lifestyle changes, offer and refer them to counseling," said task force Vice Chair Susan Curry.
Medscape (free registration) (7/11) 
Business Practice News
Small medical practices can thrive under value-based care
Small medical practices may initially lack some of the infrastructure needed for the transition from fee-for-service to value-based care, but small practices can thrive after the transition if they have the right culture and leadership, says Phytel Vice President Karen Handmaker. By forming partnerships, small practices can gain access to some of the technology they lack while remaining independent, say Handmaker and Jeffrey Galles, whose Utica Park Clinic partnered with insurers and focused on wellness.
Healthcare Finance News (7/6) 
Experts: Residency slots, efficiency keys to physician shortage
An aging workforce is driving a US physician shortage and it could get worse before it gets better, said Dr. Janis Orlowski of the Association of American Medical Colleges. Experts said increasing the number of medical residency slots and using health care technology to increase physician efficiency may be two solutions.
Healthcare Finance News (7/6) 
Study: 100% hand hygiene does not eliminate MRSA transmission
Tests conducted in a simulated NICU found 100% hand hygiene compliance reduced colonization of methicillin-resistant Staphylococcus aureus bacteria by 86%, suggesting that even optimal hygiene cannot eradicate MRSA transmission to infants, researchers reported in Infection Control & Hospital Epidemiology. "The biggest implication is that hospitals should not just rely upon hand hygiene alone for protecting patients from becoming colonized and possibly infected with a difficult-to-treat organism," said lead author Neal Goldstein.
Becker's Hospital Review (6/30) 
Patient's Perspective
Report: Patient medication errors have doubled since 2000
The rate of serious medication errors made by patients increased from 1.09 per 100,000 Americans in 2000 to 2.28 per 100,000 in 2012. The findings, reported in Clinical Toxicology, showed one-third of cases led to a hospitalization and most mistakes involved the wrong drug, an incorrect dosage or taking a drug twice.
HealthDay News (7/10) 
Change doth unknit the tranquil strength of men.
Matthew Arnold,
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