Fetal ultrasound findings support early gestational diabetes screening | Study looks at missed breast cancers to improve diagnoses | Thyroid lesion reclassification could spare patients aggressive treatment
April 21, 2016
Providing Ultrasound Information to Enhance Patient Care and Safety
New research in Diabetes Care suggests fetal overgrowth begins prior to gestational diabetes screenings, and the authors suggest screening women closer to 24 weeks than 28 weeks. The study found women who developed gestational diabetes were almost five times more likely to have greater fetal abdominal circumference and nearly three times as likely to have a lower fetal head circumference to abdominal circumference ratio at 28 weeks, but at 20 weeks, there was no association between the measurements and gestational diabetes risk.
In a study published in Current Problems in Diagnostic Radiology, Medical College of Wisconsin researchers report strategies to help radiologists improve their breast cancer detection rate. The group studied missed breast cancer cases, and they urge clinicians to pay particular attention to subtle features of malignancy in ultrasound and mammography. They advise against using a screening mammogram to make a diagnosis without appropriate follow-up such as ultrasound.
A type of small thyroid lesion with a totally encased center that resembles cancer has been reclassified as noncancerous by a panel of physicians who reported the change in JAMA Oncology. Patients diagnosed with the downgraded lesion no longer need complete thyroidectomy and radioactive iodine treatment, and they will be spared a lifetime of follow-up monitoring. Industry experts have long called for reclassification of certain breast, prostate and lung lesions to prevent unnecessary treatments, and the thyroid classification may spark changes for management in other areas of oncology.
Researchers found that CT scan use for possible pediatric appendicitis dropped from 38.8% before the implementation of a multicomponent electronic clinical decision support tool to 17.7% by the end of the three-year study. The findings in Pediatrics, based on 2011 to 2013 data involving 2,803 children with acute abdominal pain, ages 3 to 18, also showed that ultrasound use rose from 45.7% before implementation to 59.7% during implementation.
Population health starts outside of hospitals. Social, environmental, and behavioral factors determine about 60% of a person's health status. To address these social factors, healthcare programs must integrate a community's non-medical data with clinical insights to yield positive results.
Guidelines to determine whether carotid screening is necessary in asymptomatic patients are inconsistent, raising questions about the appropriateness of most carotid screening and subsequent carotid revascularization procedures, according to a paper published in JAMA Internal Medicine. The study found that only 5.4% of carotid imaging studies included in the research were clearly appropriate, while the appropriateness of 83.4% of screenings was not clear. National guidelines don't address one-third of the reasons for carotid imaging listed by clinicians, the study found.
A shared decision-making tool for patients who visit the emergency department with chest pain was associated with fewer stress tests in follow-up and a better patient understanding of risks and management options, compared with standard care, new research finds. The intervention was vetted in a randomized trial discussed at a meeting of the American College of Cardiology. Experts characterized the benefit as modest but said the intervention was simple to implement, and there was no change in rates of major adverse events.
UK doctors are amassing the largest ever imaging dataset, which will include MRI, ultrasound and dual-energy X-ray imaging studies from 100,000 patients over the next six to eight years. They hope to identify early signs of health problems such as dementia, cancer and cardiovascular disease that can be applied clinically to better diagnose and treat patients.
The CMS' Next Generation ACO model addresses shortcomings in the Medicare Shared Savings Program cited by leaders of health systems, write Chris Dawe, Nico Lewine and Mike Miesen. The next-gen model allows participants to keep 80% to 100% of savings, assigns patients at the beginning of the plan year, offers incentives for beneficiaries to stay within the ACO network for care, and adjusts targets based on patient population characteristics.
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