Where do Medicare beneficiaries seek non-urgent care? | Helmet laws, helmet use, and bicycle ridership | Early prediction of fetal cytomegalovirus infection
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September 22, 2016
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Where do Medicare beneficiaries seek non-urgent care?
There is limited information on where and how often Medicare beneficiaries seek care for non-urgent conditions when a physician office visit is not available. Emergency departments are often an alternative site of care, and urgent care centers have now also emerged to fill this need. The purpose of the study was to characterize the site of care for Medicare beneficiaries with non-urgent conditions; the relationship between physician office, urgent care center, and emergency department utilization; and specifically the role of urgent care centers.
The American Journal of Medicine (9/2016) 
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Clinical Updates
Helmet laws, helmet use, and bicycle ridership
Using multiple approaches to identify causal effects, this study provides evidence that bicycle helmet laws produce sustained increases in helmet use among urban high-school students. The study finds limited evidence that helmet laws may slightly reduce cycling.
Journal of Adolescent Health (9/2016) 
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Early prediction of fetal cytomegalovirus infection
Prediction of neonatal outcome in congenital cytomegalovirus infection can be achieved at the time of prenatal diagnosis as early as in the second trimester of pregnancy.
American Journal of Obstetrics & Gynecology (9/2016) 
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Long-term effects of childhood residential moves
Links between childhood residential mobility and adverse outcomes are incompletely understood. A national cohort of people born in Denmark in 1971–1997 was followed and residential moves during each age year between birth and age 14 years examined. Incidence rate ratios for attempted suicide, violent criminality, psychiatric illness, substance misuse, and natural and unnatural deaths were estimated. Elevated risks were observed for all examined outcomes, with excess risk seen among those exposed to multiple relocations in a year. Risks grew incrementally with increasing age of exposure to mobility.
American Journal of Preventive Medicine (9/2016) 
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Limited advantages to combination therapy for Alzheimer's disease
Combining therapies to treat Alzheimer’s disease (AD) has been proposed to be effective for treatment, but the benefits remain controversial. In a meta-analysis performed in Hong Kong, 5,019 patients with AD were assigned to receive either monotherapy with AChE1 or memantine, or combination therapy, or both. Only combination therapy displayed a benefit on neuropsychiatric and behavioral symptoms, but it showed no superiority for cognitive function, activities of daily living, and global changes. Combination therapy's additional cost may not be necessary.
Journal of the American Medical Directors Association (9/2016) 
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Transitioning from pediatric to adult health care with chronic conditions
Young people exhibit a variety of distinct views on transition and may consequently have strong preferences for how their transition is managed. These findings help clinicians to understand these preferences better when helping a young person through transition.
Journal of Adolescent Health (9/2016) 
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Monitoring for pulmonary hypertension following pulmonary embolism
Pulmonary hypertension and chronic thromboembolic pulmonary hypertension may develop after a pulmonary embolism event. A ventilation-perfusion scan is recommended as a first-line modality for suspected chronic thromboembolic pulmonary hypertension. In this study, the authors determined the prevalence of pulmonary hypertension following incident pulmonary embolism and the disease-monitoring patterns in this population.
The American Journal of Medicine (9/2016) 
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Medical News
Report warns against codeine in prescriptions for children
Children should not be prescribed codeine for pain or cough due to potential harms, including breathing problems and even death, according to an American Academy of Pediatrics statement published in Pediatrics. The AAP said physicians should weigh the risks of the drug and consider whether evidence shows it is effective.
Reuters (9/19),  ABC News/The Associated Press (9/19) 
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Antibiotic overprescription remains steady, CDC study shows
Amid growing concerns about drug resistance, overprescription of antibiotics remained steady from 2006 to 2012, CDC researchers found, with 55% of inpatient care involving at least one antibiotic dose and more doctors turning to newer drugs. The authors of the study, published in JAMA Internal Medicine, say many doctors believe patients want the drugs, and clinicians may reason that taking the medications won't hurt.
HealthDay News (9/19) 
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Study links sudden cardiac death risk to thyroid hormone levels
A Dutch study of 10,318 adults ages 45 and older with normal thyroid function found those with higher free thyroxine levels had more than double the risk of sudden cardiac death. The link between high FT4 levels and sudden cardiac death was independent of high blood pressure, high cholesterol and other cardiovascular risk factors, researchers reported in Circulation.
CardiovascularBusiness.com (9/20) 
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Business Practice News
CMS: Hospital readmission rates drop average of 8%
The CMS reported an average 8% decrease in hospital readmission rates from 2010 to 2015. Agency officials credited much of the improvement to the Hospital Readmissions Reduction Program that cuts Medicare reimbursements for hospitals with 30-day readmission rates that are higher than expected for acute myocardial infarction, heart failure and pneumonia.
Medscape (free registration) (9/15) 
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How to incorporate extensivists into coordinated care
Incorporating extensivists -- specially trained physicians and advanced practice registered nurses -- into primary care to coordinate care of patients with multiple complex medical conditions could reduce spending while improving outcomes, experts say. Five keys for a successful extensivist model include focusing on the post-discharge period, prioritizing quality over productivity, planning for financial challenges, possibly using a hospitalist-extensivist model and being realistic about patient volume.
HealthLeaders Media (9/15) 
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Patient's Perspective
Study questions benefits of wearable activity trackers
Study questions benefits of wearable activity trackers.
(Dave Kotinsky/Getty Images)
Young, overweight to moderately obese adults who used wearable trackers lost an average of 7.72 pounds over a span of two years, while those who used web-based tracking lost an average of 13 pounds, according to a study published in the Journal of the American Medical Association. Experts note that wearable activity trackers work well for some people, and their utility comes down to how they are used to support a more active lifestyle.
Reuters (9/21) 
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The first step toward success is taken when you refuse to be a captive of the environment in which you first find yourself.
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