Jan Dyer

A “smart” water bottle—or money—or a coach? What’s the best way to encourage people at risk for kidney stones to drink more water? The prevalence of urinary stones has nearly doubled in the past 15 years, affecting 1 in 11 people, according to the National Institute of Health (NIH). The NIH says little high-quality research exists related to how to prevent stones, and most therapies treat people with the condition only after they are in excruciating pain.

To test new solutions, researchers from the Urinary Stone Disease Research Network and Duke Clinical Research are recruiting 1,642 participants for Prevention of Urinary Stones with Hydration (PUSH), a 2-year multisite clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

People with kidney stones, when counseled to drink more water, usually only increase intake by small amounts. So participants in the intervention group will receive water bottles (Hidrate Spark) that connect to an app and monitor how much they drink, with a goal of 2.5 liters of water per day. They will also receive financial incentives if they achieve their fluid targets, and meet with a health coach who will help them identify barriers to drinking more liquids and help devise solutions.

“Urinary stones are painful and debilitating, and their treatment is expensive,” said Ziya Kirkali, MD, program director of urology clinical research and epidemiology in NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases. “If successful, the study could change management of kidney stones.”

A “smart” water bottle—or money—or a coach? What’s the best way to encourage people at risk for kidney stones to drink more water? The prevalence of urinary stones has nearly doubled in the past 15 years, affecting 1 in 11 people, according to the National Institute of Health (NIH). The NIH says little high-quality research exists related to how to prevent stones, and most therapies treat people with the condition only after they are in excruciating pain.

To test new solutions, researchers from the Urinary Stone Disease Research Network and Duke Clinical Research are recruiting 1,642 participants for Prevention of Urinary Stones with Hydration (PUSH), a 2-year multisite clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

People with kidney stones, when counseled to drink more water, usually only increase intake by small amounts. So participants in the intervention group will receive water bottles (Hidrate Spark) that connect to an app and monitor how much they drink, with a goal of 2.5 liters of water per day. They will also receive financial incentives if they achieve their fluid targets, and meet with a health coach who will help them identify barriers to drinking more liquids and help devise solutions.

“Urinary stones are painful and debilitating, and their treatment is expensive,” said Ziya Kirkali, MD, program director of urology clinical research and epidemiology in NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases. “If successful, the study could change management of kidney stones.”

A “smart” water bottle—or money—or a coach? What’s the best way to encourage people at risk for kidney stones to drink more water? The prevalence of urinary stones has nearly doubled in the past 15 years, affecting 1 in 11 people, according to the National Institute of Health (NIH). The NIH says little high-quality research exists related to how to prevent stones, and most therapies treat people with the condition only after they are in excruciating pain.

To test new solutions, researchers from the Urinary Stone Disease Research Network and Duke Clinical Research are recruiting 1,642 participants for Prevention of Urinary Stones with Hydration (PUSH), a 2-year multisite clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

People with kidney stones, when counseled to drink more water, usually only increase intake by small amounts. So participants in the intervention group will receive water bottles (Hidrate Spark) that connect to an app and monitor how much they drink, with a goal of 2.5 liters of water per day. They will also receive financial incentives if they achieve their fluid targets, and meet with a health coach who will help them identify barriers to drinking more liquids and help devise solutions.

“Urinary stones are painful and debilitating, and their treatment is expensive,” said Ziya Kirkali, MD, program director of urology clinical research and epidemiology in NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases. “If successful, the study could change management of kidney stones.”

The National Occupational Research Agenda (NORA), a partnership program created by the National Institute for Occupational Safety and Health (NIOSH), is celebrating its second anniversary with a report addressing the question: how can research be better moved into practice in the workplace?

NORA has focused on 10 industry sectors representing major areas of the U.S. economy, and developed sector councils—comprising of stakeholders from universities, business, professional societies, government agencies, and worker organizations—that set priority research goals for the nation.

In the past 20 years, NIOSH has had an average of 740 active projects per year. It invested an average of $243.8 million per year in research between 2007 - 2015. Between 2007 - 2014, nearly 11,000 publications were developed through NIOSH-funded research.

Outcome measures include whether those NORA outputs have been used by others, in citations and research. NIOSH says its outputs are widely disseminated; the VA and other veterans’ organizations, for instance, disseminated NIOSH information on return-to-work issues for veterans with PTSD. As another example, academicians and researchers are using NIOSH findings to improve tuberculosis risk and prevention education in workplaces. And approximately 50% of the NIOSH products cited by another federal agency in a Federal Register document were aged ≥ 11 years —suggesting that NIOSH documents have a “sustained relevance and impact well beyond their publication date,” the report says.

NIOSH highlights NORA’s progress with “impact stories” about the influence of NORA on health, safety, and wellbeing of the U.S. workforce. Case in point: “Preventing Occupational Transmission of Blood-borne Pathogens Among Healthcare Workers” helped improve worker safety by instructing > 20,000 trainers and leading to new regulations, NIOSH says.

For its third decade, NIOSH says, NORA will build on the “many successes and lessons learned from the first 2 decades of this unique partnership approach.”

The National Occupational Research Agenda (NORA), a partnership program created by the National Institute for Occupational Safety and Health (NIOSH), is celebrating its second anniversary with a report addressing the question: how can research be better moved into practice in the workplace?

NORA has focused on 10 industry sectors representing major areas of the U.S. economy, and developed sector councils—comprising of stakeholders from universities, business, professional societies, government agencies, and worker organizations—that set priority research goals for the nation.

In the past 20 years, NIOSH has had an average of 740 active projects per year. It invested an average of $243.8 million per year in research between 2007 - 2015. Between 2007 - 2014, nearly 11,000 publications were developed through NIOSH-funded research.

Outcome measures include whether those NORA outputs have been used by others, in citations and research. NIOSH says its outputs are widely disseminated; the VA and other veterans’ organizations, for instance, disseminated NIOSH information on return-to-work issues for veterans with PTSD. As another example, academicians and researchers are using NIOSH findings to improve tuberculosis risk and prevention education in workplaces. And approximately 50% of the NIOSH products cited by another federal agency in a Federal Register document were aged ≥ 11 years —suggesting that NIOSH documents have a “sustained relevance and impact well beyond their publication date,” the report says.

NIOSH highlights NORA’s progress with “impact stories” about the influence of NORA on health, safety, and wellbeing of the U.S. workforce. Case in point: “Preventing Occupational Transmission of Blood-borne Pathogens Among Healthcare Workers” helped improve worker safety by instructing > 20,000 trainers and leading to new regulations, NIOSH says.

For its third decade, NIOSH says, NORA will build on the “many successes and lessons learned from the first 2 decades of this unique partnership approach.”

The National Occupational Research Agenda (NORA), a partnership program created by the National Institute for Occupational Safety and Health (NIOSH), is celebrating its second anniversary with a report addressing the question: how can research be better moved into practice in the workplace?

NORA has focused on 10 industry sectors representing major areas of the U.S. economy, and developed sector councils—comprising of stakeholders from universities, business, professional societies, government agencies, and worker organizations—that set priority research goals for the nation.

In the past 20 years, NIOSH has had an average of 740 active projects per year. It invested an average of $243.8 million per year in research between 2007 - 2015. Between 2007 - 2014, nearly 11,000 publications were developed through NIOSH-funded research.

Outcome measures include whether those NORA outputs have been used by others, in citations and research. NIOSH says its outputs are widely disseminated; the VA and other veterans’ organizations, for instance, disseminated NIOSH information on return-to-work issues for veterans with PTSD. As another example, academicians and researchers are using NIOSH findings to improve tuberculosis risk and prevention education in workplaces. And approximately 50% of the NIOSH products cited by another federal agency in a Federal Register document were aged ≥ 11 years —suggesting that NIOSH documents have a “sustained relevance and impact well beyond their publication date,” the report says.

NIOSH highlights NORA’s progress with “impact stories” about the influence of NORA on health, safety, and wellbeing of the U.S. workforce. Case in point: “Preventing Occupational Transmission of Blood-borne Pathogens Among Healthcare Workers” helped improve worker safety by instructing > 20,000 trainers and leading to new regulations, NIOSH says.

For its third decade, NIOSH says, NORA will build on the “many successes and lessons learned from the first 2 decades of this unique partnership approach.”

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

The stereotype of someone with multiple comorbid conditions (MCCs) is an older, often overweight person. But according to an analysis of data from > 200,000 respondents in the 2015 Behavioral Risk Factor Surveillance System (BRFSS), people aged < 65 years are more likely to report MCCs, such as asthma, cognitive impairment, depression, smoking, obesity, disability, and lower quality of life (QOL). In fact, research indicates that most people with MCCs are of working age.

The study compared 2 groups of adults with MCCs: those aged > 65 years with those aged < 65 years. The researchers found significant differences by age group in 18 measures, suggesting that adults aged < 65 years were “worse off” compared with those aged > 65 years. Results were similar regardless of whether diabetes, depression, hypertension, and high cholesterol were included.

Other results from BRFSS data have shown that people with ≥ 3 chronic conditions are more likely to report poor QOL than those with fewer conditions. But that analysis did not compare age groups, the researchers say. In this study, most uninsured adults were aged < 65 years, and the younger adults with MCCs were more likely to report a cost barrier to health care. They also were less likely to report a recent routine check-up. According to the study. these are important findings because managing and treating existing chronic conditions and diagnosing incident ones are key to preventing worse health in the future. The younger cohort had lower levels of well-recognized risk factors—diabetes, hypertension, high cholesterol—than the older, but their levels were still high enough to be concerning.

A “somewhat unexpected” finding was that the younger group had a high rate of cognitive impairment. That could be the result of lack of sleep, side effects of medication, or use of illicit drugs, the researcher notes, and may not be associated with future risk of dementia. Whatever the cause, though, the researcher adds that being cognitively impaired can affect someone’s ability to manage other chronic conditions.

A patient with Merkel cell carcinoma (MCC) came to Sir Charles Gairdner Hospital in Perth, Australia, after 2 weeks of dyspnea. He was diagnosed with cardiac tamponade and received urgent pericardiocentesis. An echocardiogram and computer tomography scan showed a large infiltrating mass in the heart. Immunohistochemistry of the pericardial fluid revealed MCC. The MCC had metastasized to his heart—the tenth such reported case, and the second case reported of MCC causing cardiac tamponade.

The clinicians report on several “important illustrative aspects” that appeared while they were unraveling the clues to the patient’s condition. One aspect was the challenge of the histopathologic diagnosis itself. The majority of patients with MCC present with localized disease, they note. Only 4% of patients have distant metastases, usually to lymph nodes, lung, central nervous system, and bone. MCC metastases to the heart are extremely rare. Most commonly, a cancer that spreads to the heart has started in the lungs, esophagus, or breast, or has begun as lymphoma, melanoma, or leukemia.  

However, it’s “exponentially more likely,” the clinicians say, for a cardiac tumor to be a metastasis than a primary cardiac tumor, and it is uncommon for the heart to be the only site of metastatic disease from a noncardiac malignancy. Thus, the patient represented a unique case: apart from an internal mammary lymph node, the heart was the only site of distant metastatic spread.  

This patient’s case highlights the importance of early and accurate diagnosis of MCC with aggressive surgical treatment for localized disease, the clinicians say. New cardiac symptoms in the setting of malignancy should raise suspicion of cardiac metastasis.

Source:
Di Loreto M, Francis R. BMJ Case Rep. 2017. pii: bcr-2017-221311.
doi: 10.1136/bcr-2017-221311.

A patient with Merkel cell carcinoma (MCC) came to Sir Charles Gairdner Hospital in Perth, Australia, after 2 weeks of dyspnea. He was diagnosed with cardiac tamponade and received urgent pericardiocentesis. An echocardiogram and computer tomography scan showed a large infiltrating mass in the heart. Immunohistochemistry of the pericardial fluid revealed MCC. The MCC had metastasized to his heart—the tenth such reported case, and the second case reported of MCC causing cardiac tamponade.

The clinicians report on several “important illustrative aspects” that appeared while they were unraveling the clues to the patient’s condition. One aspect was the challenge of the histopathologic diagnosis itself. The majority of patients with MCC present with localized disease, they note. Only 4% of patients have distant metastases, usually to lymph nodes, lung, central nervous system, and bone. MCC metastases to the heart are extremely rare. Most commonly, a cancer that spreads to the heart has started in the lungs, esophagus, or breast, or has begun as lymphoma, melanoma, or leukemia.  

However, it’s “exponentially more likely,” the clinicians say, for a cardiac tumor to be a metastasis than a primary cardiac tumor, and it is uncommon for the heart to be the only site of metastatic disease from a noncardiac malignancy. Thus, the patient represented a unique case: apart from an internal mammary lymph node, the heart was the only site of distant metastatic spread.  

This patient’s case highlights the importance of early and accurate diagnosis of MCC with aggressive surgical treatment for localized disease, the clinicians say. New cardiac symptoms in the setting of malignancy should raise suspicion of cardiac metastasis.

Source:
Di Loreto M, Francis R. BMJ Case Rep. 2017. pii: bcr-2017-221311.
doi: 10.1136/bcr-2017-221311.

A patient with Merkel cell carcinoma (MCC) came to Sir Charles Gairdner Hospital in Perth, Australia, after 2 weeks of dyspnea. He was diagnosed with cardiac tamponade and received urgent pericardiocentesis. An echocardiogram and computer tomography scan showed a large infiltrating mass in the heart. Immunohistochemistry of the pericardial fluid revealed MCC. The MCC had metastasized to his heart—the tenth such reported case, and the second case reported of MCC causing cardiac tamponade.

The clinicians report on several “important illustrative aspects” that appeared while they were unraveling the clues to the patient’s condition. One aspect was the challenge of the histopathologic diagnosis itself. The majority of patients with MCC present with localized disease, they note. Only 4% of patients have distant metastases, usually to lymph nodes, lung, central nervous system, and bone. MCC metastases to the heart are extremely rare. Most commonly, a cancer that spreads to the heart has started in the lungs, esophagus, or breast, or has begun as lymphoma, melanoma, or leukemia.  

However, it’s “exponentially more likely,” the clinicians say, for a cardiac tumor to be a metastasis than a primary cardiac tumor, and it is uncommon for the heart to be the only site of metastatic disease from a noncardiac malignancy. Thus, the patient represented a unique case: apart from an internal mammary lymph node, the heart was the only site of distant metastatic spread.  

This patient’s case highlights the importance of early and accurate diagnosis of MCC with aggressive surgical treatment for localized disease, the clinicians say. New cardiac symptoms in the setting of malignancy should raise suspicion of cardiac metastasis.

Source:
Di Loreto M, Francis R. BMJ Case Rep. 2017. pii: bcr-2017-221311.
doi: 10.1136/bcr-2017-221311.

Although studies have examined the relationship between thyroid disorder (TD) and type 1 diabetes mellitus (T1DM), the information on TD and type 2 diabetes mellitus (T2DM) is limited, say researchers from Shahid Beheshti University of Medical Sciences and Aja University of Medical Science in Tehran, Iran, who report on an 11-year follow-up from the Tehran Thyroid Study. However, undetected TDs may compromise metabolic control of patients with diabetes mellitus (DM), impaired glucose tolerance, or impaired fasting glucose, the researchers point out. Undetected TDs also may increase the risk of cardiovascular diseases. And DM and prediabetes can affect thyroid tests.

The researchers evaluated 435 patients with DM, 286 with prediabetes, and 989 healthy controls. They conducted follow-up assessments every 3 years. About 19% of both the diabetic and prediabetic groups had TD, as did about 14% of the healthy controls. However, after adjusting for age, sex, smoking, blood pressure, body mass index, thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides, and cholesterol, no significant difference was found among the 3 groups. The mean incidence of TD was 14, 18, and 21 per 1000 patients per year in patients with DM, prediabetes, and healthy controls, respectively.

As in other studies, subclinical hypothyroidism and clinical hyperthyroidism were the most and the least common TD in patients with DM. Baseline TSH > 1.94 mU/L was predictive of TD with 70% sensitivity and specificity and had better predictive value than TPOAb . The researchers say conducting screening tests in all patients is not recommended except in those with TPOAb ≥ 401 U/mL or TSH > 1.94 mU/L.

Source:

Gholampour Dehaki M, Amouzegar A, Delshad H, Mehrabi Y, Tohidi M, Azizi F. PLoS One. 2017;12(10): e0184808.
doi: 10.1371/journal.pone.0184808.

Although studies have examined the relationship between thyroid disorder (TD) and type 1 diabetes mellitus (T1DM), the information on TD and type 2 diabetes mellitus (T2DM) is limited, say researchers from Shahid Beheshti University of Medical Sciences and Aja University of Medical Science in Tehran, Iran, who report on an 11-year follow-up from the Tehran Thyroid Study. However, undetected TDs may compromise metabolic control of patients with diabetes mellitus (DM), impaired glucose tolerance, or impaired fasting glucose, the researchers point out. Undetected TDs also may increase the risk of cardiovascular diseases. And DM and prediabetes can affect thyroid tests.

The researchers evaluated 435 patients with DM, 286 with prediabetes, and 989 healthy controls. They conducted follow-up assessments every 3 years. About 19% of both the diabetic and prediabetic groups had TD, as did about 14% of the healthy controls. However, after adjusting for age, sex, smoking, blood pressure, body mass index, thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides, and cholesterol, no significant difference was found among the 3 groups. The mean incidence of TD was 14, 18, and 21 per 1000 patients per year in patients with DM, prediabetes, and healthy controls, respectively.

As in other studies, subclinical hypothyroidism and clinical hyperthyroidism were the most and the least common TD in patients with DM. Baseline TSH > 1.94 mU/L was predictive of TD with 70% sensitivity and specificity and had better predictive value than TPOAb . The researchers say conducting screening tests in all patients is not recommended except in those with TPOAb ≥ 401 U/mL or TSH > 1.94 mU/L.

Source:

Gholampour Dehaki M, Amouzegar A, Delshad H, Mehrabi Y, Tohidi M, Azizi F. PLoS One. 2017;12(10): e0184808.
doi: 10.1371/journal.pone.0184808.

Although studies have examined the relationship between thyroid disorder (TD) and type 1 diabetes mellitus (T1DM), the information on TD and type 2 diabetes mellitus (T2DM) is limited, say researchers from Shahid Beheshti University of Medical Sciences and Aja University of Medical Science in Tehran, Iran, who report on an 11-year follow-up from the Tehran Thyroid Study. However, undetected TDs may compromise metabolic control of patients with diabetes mellitus (DM), impaired glucose tolerance, or impaired fasting glucose, the researchers point out. Undetected TDs also may increase the risk of cardiovascular diseases. And DM and prediabetes can affect thyroid tests.

The researchers evaluated 435 patients with DM, 286 with prediabetes, and 989 healthy controls. They conducted follow-up assessments every 3 years. About 19% of both the diabetic and prediabetic groups had TD, as did about 14% of the healthy controls. However, after adjusting for age, sex, smoking, blood pressure, body mass index, thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides, and cholesterol, no significant difference was found among the 3 groups. The mean incidence of TD was 14, 18, and 21 per 1000 patients per year in patients with DM, prediabetes, and healthy controls, respectively.

As in other studies, subclinical hypothyroidism and clinical hyperthyroidism were the most and the least common TD in patients with DM. Baseline TSH > 1.94 mU/L was predictive of TD with 70% sensitivity and specificity and had better predictive value than TPOAb . The researchers say conducting screening tests in all patients is not recommended except in those with TPOAb ≥ 401 U/mL or TSH > 1.94 mU/L.

Source:

Gholampour Dehaki M, Amouzegar A, Delshad H, Mehrabi Y, Tohidi M, Azizi F. PLoS One. 2017;12(10): e0184808.
doi: 10.1371/journal.pone.0184808.

Lung cancer has an 80% cure rate when caught early, and screening programs are key to providing this chance. The VA and the Bristol-Myers Squibb Foundation have established the VA-Partnership to increase Access to Lung Screening (VA-PALS) Implementation Network.

The initiative builds upon experience gained from other screening programs, the VA says, including those of the VA’s Office of Rural Health, which is supporting the project’s goal to reach veterans living in rural areas. It also adds to a portfolio of other major VA lung cancer initiatives, including the VALOR Trial (Veterans Affairs Lung Cancer Or Stereotactic Radiotherapy) and the APOLLO Network (Applied Proteogenomics OrganizationaL Learning and Outcomes).

“Research shows that with comprehensive lung screening programs, early identification of lung cancer leads to more effective treatments and, ultimately, saves lives,” said John Damonti, president of Bristol-Myers Squibb Foundation, the project’s sponsor.

The project will launch with lung-screening services at the Phoenix VA Health Care System in Arizona by December 2017, and then extend these services to 9 additional VA medical facilities starting in 2018.

Lung cancer has an 80% cure rate when caught early, and screening programs are key to providing this chance. The VA and the Bristol-Myers Squibb Foundation have established the VA-Partnership to increase Access to Lung Screening (VA-PALS) Implementation Network.

The initiative builds upon experience gained from other screening programs, the VA says, including those of the VA’s Office of Rural Health, which is supporting the project’s goal to reach veterans living in rural areas. It also adds to a portfolio of other major VA lung cancer initiatives, including the VALOR Trial (Veterans Affairs Lung Cancer Or Stereotactic Radiotherapy) and the APOLLO Network (Applied Proteogenomics OrganizationaL Learning and Outcomes).

“Research shows that with comprehensive lung screening programs, early identification of lung cancer leads to more effective treatments and, ultimately, saves lives,” said John Damonti, president of Bristol-Myers Squibb Foundation, the project’s sponsor.

The project will launch with lung-screening services at the Phoenix VA Health Care System in Arizona by December 2017, and then extend these services to 9 additional VA medical facilities starting in 2018.

Lung cancer has an 80% cure rate when caught early, and screening programs are key to providing this chance. The VA and the Bristol-Myers Squibb Foundation have established the VA-Partnership to increase Access to Lung Screening (VA-PALS) Implementation Network.

The initiative builds upon experience gained from other screening programs, the VA says, including those of the VA’s Office of Rural Health, which is supporting the project’s goal to reach veterans living in rural areas. It also adds to a portfolio of other major VA lung cancer initiatives, including the VALOR Trial (Veterans Affairs Lung Cancer Or Stereotactic Radiotherapy) and the APOLLO Network (Applied Proteogenomics OrganizationaL Learning and Outcomes).

“Research shows that with comprehensive lung screening programs, early identification of lung cancer leads to more effective treatments and, ultimately, saves lives,” said John Damonti, president of Bristol-Myers Squibb Foundation, the project’s sponsor.

The project will launch with lung-screening services at the Phoenix VA Health Care System in Arizona by December 2017, and then extend these services to 9 additional VA medical facilities starting in 2018.

Women of all ages and sizes will be glad to know that they now have some say in the amount of pressure applied to the breast during a mammography. The FDA has cleared Senographe Pristina with Self-Compression, the first patient-assisted 2D digital mammography system.

Digital mammograms use a computer along with x-rays. During an exam with the new system, the technologist positions the patient and initiates compression, then guides the patient in using the handheld wireless remote control to adjust the compression to a comfortable level. The technologist makes the final decision on whether the compression is adequate.

A clinical validation demonstrated that the addition of a remote to allow self-compression did not negatively affect image quality. Nor did allowing the patient to help with adjustments make the exam take significantly longer.

Women of all ages and sizes will be glad to know that they now have some say in the amount of pressure applied to the breast during a mammography. The FDA has cleared Senographe Pristina with Self-Compression, the first patient-assisted 2D digital mammography system.

Digital mammograms use a computer along with x-rays. During an exam with the new system, the technologist positions the patient and initiates compression, then guides the patient in using the handheld wireless remote control to adjust the compression to a comfortable level. The technologist makes the final decision on whether the compression is adequate.

A clinical validation demonstrated that the addition of a remote to allow self-compression did not negatively affect image quality. Nor did allowing the patient to help with adjustments make the exam take significantly longer.

Women of all ages and sizes will be glad to know that they now have some say in the amount of pressure applied to the breast during a mammography. The FDA has cleared Senographe Pristina with Self-Compression, the first patient-assisted 2D digital mammography system.

Digital mammograms use a computer along with x-rays. During an exam with the new system, the technologist positions the patient and initiates compression, then guides the patient in using the handheld wireless remote control to adjust the compression to a comfortable level. The technologist makes the final decision on whether the compression is adequate.

A clinical validation demonstrated that the addition of a remote to allow self-compression did not negatively affect image quality. Nor did allowing the patient to help with adjustments make the exam take significantly longer.

The VA has boiled down its experience in dealing with the opioid epidemic to 8 best practices, which it is now sharing with others in government and the health care industry who work to balance pain management and opioid prescribing. 

The best practices are summed up by the acronym STOP PAIN, which stands for:

• S—Stepped Care Model, which encourages a continuum of care from onset through treatment. It also incorporates self-management through participation in groups such as Narcotics or Alcoholics Anonymous, counseling, treatment programs, primary care, and other medical specialists;
• T—Treatment alternatives/complementary care, expanding provider options beyond standard care in treating chronic pain. “Complementary health” includes evidence-based treatments, such as acupuncture, yoga, and progressive relaxation;

Related:  Implementation and Evaluation of an APRN-Led Opioid Monitoring Clinic

• O—Ongoing monitoring of usage;
• P—Practice guidelines, which provide evidence-based recommendations for minimizing harm and increasing patient safety. (https://www.healthquality.va.gov/guidelines/MH/sud/ and https://www.healthquality.va.gov/guidelines/Pain/cot/);
• P—Prescription monitoring. The VA has a number of data sources to allow it to monitor opioid use to target specific education in real time. The practice patterns of providers differ, along with the case mixes: a provider with relatively high opioid prescribing may have an appropriate practice, or be someone who could benefit from education. These tools allow the VA to drill down to the patient level to evaluate use. Other tools can evaluate the treatment of patient panels and the veterans’ risk of potential abuse. Together, these allow identification of potential problems, educational targeting, and tracking of progress;

Related: Prescribing Patterns Shift After Detailing-Policy Change

• A—Academic detailing. The Academic Detailing program, a one-on-one peer education program for frontline providers, gives specific information on practice alternatives and resources, opioid safety, and can compare the practice of the provider to that of peers; (https://www.pbm.va.gov/PBM/academicdetailingservicehome.asp and

https://www.pbm.va.gov/PBM/academicdetailingservice/Pain_and_Opioid_Safety.asp)

• I—Informed consent for patients prior to long-term opioid therapy. This process includes education on the risks of opioid therapy, opioid interactions, and safe prescribing practices such as urine drug screens; and
• N—Naloxone distribution. The Opioid Overdose Education & Naloxone Distribution program focuses on educating providers (https://www.pbm.va.gov/PBM/academicdetailingservice/Opioid_Overdose_Education_and_Naloxone_Distribution.asp).

For more information, visit https://www.va.gov/painmanagement.

The VA has boiled down its experience in dealing with the opioid epidemic to 8 best practices, which it is now sharing with others in government and the health care industry who work to balance pain management and opioid prescribing. 

The best practices are summed up by the acronym STOP PAIN, which stands for:

• S—Stepped Care Model, which encourages a continuum of care from onset through treatment. It also incorporates self-management through participation in groups such as Narcotics or Alcoholics Anonymous, counseling, treatment programs, primary care, and other medical specialists;
• T—Treatment alternatives/complementary care, expanding provider options beyond standard care in treating chronic pain. “Complementary health” includes evidence-based treatments, such as acupuncture, yoga, and progressive relaxation;

Related:  Implementation and Evaluation of an APRN-Led Opioid Monitoring Clinic

• O—Ongoing monitoring of usage;
• P—Practice guidelines, which provide evidence-based recommendations for minimizing harm and increasing patient safety. (https://www.healthquality.va.gov/guidelines/MH/sud/ and https://www.healthquality.va.gov/guidelines/Pain/cot/);
• P—Prescription monitoring. The VA has a number of data sources to allow it to monitor opioid use to target specific education in real time. The practice patterns of providers differ, along with the case mixes: a provider with relatively high opioid prescribing may have an appropriate practice, or be someone who could benefit from education. These tools allow the VA to drill down to the patient level to evaluate use. Other tools can evaluate the treatment of patient panels and the veterans’ risk of potential abuse. Together, these allow identification of potential problems, educational targeting, and tracking of progress;

Related: Prescribing Patterns Shift After Detailing-Policy Change

• A—Academic detailing. The Academic Detailing program, a one-on-one peer education program for frontline providers, gives specific information on practice alternatives and resources, opioid safety, and can compare the practice of the provider to that of peers; (https://www.pbm.va.gov/PBM/academicdetailingservicehome.asp and

https://www.pbm.va.gov/PBM/academicdetailingservice/Pain_and_Opioid_Safety.asp)

• I—Informed consent for patients prior to long-term opioid therapy. This process includes education on the risks of opioid therapy, opioid interactions, and safe prescribing practices such as urine drug screens; and
• N—Naloxone distribution. The Opioid Overdose Education & Naloxone Distribution program focuses on educating providers (https://www.pbm.va.gov/PBM/academicdetailingservice/Opioid_Overdose_Education_and_Naloxone_Distribution.asp).

For more information, visit https://www.va.gov/painmanagement.

The VA has boiled down its experience in dealing with the opioid epidemic to 8 best practices, which it is now sharing with others in government and the health care industry who work to balance pain management and opioid prescribing. 

The best practices are summed up by the acronym STOP PAIN, which stands for:

• S—Stepped Care Model, which encourages a continuum of care from onset through treatment. It also incorporates self-management through participation in groups such as Narcotics or Alcoholics Anonymous, counseling, treatment programs, primary care, and other medical specialists;
• T—Treatment alternatives/complementary care, expanding provider options beyond standard care in treating chronic pain. “Complementary health” includes evidence-based treatments, such as acupuncture, yoga, and progressive relaxation;

Related:  Implementation and Evaluation of an APRN-Led Opioid Monitoring Clinic

• O—Ongoing monitoring of usage;
• P—Practice guidelines, which provide evidence-based recommendations for minimizing harm and increasing patient safety. (https://www.healthquality.va.gov/guidelines/MH/sud/ and https://www.healthquality.va.gov/guidelines/Pain/cot/);
• P—Prescription monitoring. The VA has a number of data sources to allow it to monitor opioid use to target specific education in real time. The practice patterns of providers differ, along with the case mixes: a provider with relatively high opioid prescribing may have an appropriate practice, or be someone who could benefit from education. These tools allow the VA to drill down to the patient level to evaluate use. Other tools can evaluate the treatment of patient panels and the veterans’ risk of potential abuse. Together, these allow identification of potential problems, educational targeting, and tracking of progress;

Related: Prescribing Patterns Shift After Detailing-Policy Change

• A—Academic detailing. The Academic Detailing program, a one-on-one peer education program for frontline providers, gives specific information on practice alternatives and resources, opioid safety, and can compare the practice of the provider to that of peers; (https://www.pbm.va.gov/PBM/academicdetailingservicehome.asp and

https://www.pbm.va.gov/PBM/academicdetailingservice/Pain_and_Opioid_Safety.asp)

• I—Informed consent for patients prior to long-term opioid therapy. This process includes education on the risks of opioid therapy, opioid interactions, and safe prescribing practices such as urine drug screens; and
• N—Naloxone distribution. The Opioid Overdose Education & Naloxone Distribution program focuses on educating providers (https://www.pbm.va.gov/PBM/academicdetailingservice/Opioid_Overdose_Education_and_Naloxone_Distribution.asp).

For more information, visit https://www.va.gov/painmanagement.

A 40-year-old man suddenly began to lose vision in his left eye. The retinal exam was normal for the right eye. But the left showed isolated subinternal limited membrane hemorrhage at the fovea along with a white-centered hemorrhage above the fovea.

The patient had no history of trauma or Valsalva retinopathy. His blood pressure was normal as was his blood glucose. However, when bloodwork showed a high total count, increased platelet count, and the peripheral smear indicated myeloid hyperplasia, clinicians at LV Prasad Eye Institute in Hyderabad, India, diagnosed the patient with underlying chronic myeloid leukemia (CML).  

A physical examination revealed a palpable spleenomegaly—underscoring the fact, the clinicians note, that when an ophthalmologic finding suggests a systemic disease, a general physical examination will reveal more clinical clues. The patient was referred to an oncologist and started on imatinib for CML.

White-centered or pale-centered hemorrhages are believed to represent an accumulation of leukemic cells or platelet fibrin aggregates, the clinicians say. Blood dyscrasias, such as anemias, leukemia, multiple myeloma, and other platelet disorders may present with similar features. Such hemorrhages are known to resolve spontaneously when the patient is treated for the underlying condition, and the hematologic status improves, the clinicians say. This patient’s hemorrhage gradually resolved over the next month, and his visual acuity improved to 20/20.

Ocular manifestations as a presenting sign of leukemia, especially chronic, are rare, the clinicians say. They note that retinal hemorrhages are one of the “most striking findings” in leukemia, and because they can be directly observed, they provide a “subtle but important clue toward an otherwise asymptomatic disease.” If diagnosed early and treated promptly, patients with CML have a good survival rate.

Source:

Tyagi M, Agarwal K, Paulose RM, Rani PK. BMJ Case Rep. 2017;2017: pii: bcr-2017-21974.

doi: 10.1136/bcr-2017-219741.

A 40-year-old man suddenly began to lose vision in his left eye. The retinal exam was normal for the right eye. But the left showed isolated subinternal limited membrane hemorrhage at the fovea along with a white-centered hemorrhage above the fovea.

The patient had no history of trauma or Valsalva retinopathy. His blood pressure was normal as was his blood glucose. However, when bloodwork showed a high total count, increased platelet count, and the peripheral smear indicated myeloid hyperplasia, clinicians at LV Prasad Eye Institute in Hyderabad, India, diagnosed the patient with underlying chronic myeloid leukemia (CML).  

A physical examination revealed a palpable spleenomegaly—underscoring the fact, the clinicians note, that when an ophthalmologic finding suggests a systemic disease, a general physical examination will reveal more clinical clues. The patient was referred to an oncologist and started on imatinib for CML.

White-centered or pale-centered hemorrhages are believed to represent an accumulation of leukemic cells or platelet fibrin aggregates, the clinicians say. Blood dyscrasias, such as anemias, leukemia, multiple myeloma, and other platelet disorders may present with similar features. Such hemorrhages are known to resolve spontaneously when the patient is treated for the underlying condition, and the hematologic status improves, the clinicians say. This patient’s hemorrhage gradually resolved over the next month, and his visual acuity improved to 20/20.

Ocular manifestations as a presenting sign of leukemia, especially chronic, are rare, the clinicians say. They note that retinal hemorrhages are one of the “most striking findings” in leukemia, and because they can be directly observed, they provide a “subtle but important clue toward an otherwise asymptomatic disease.” If diagnosed early and treated promptly, patients with CML have a good survival rate.

Source:

Tyagi M, Agarwal K, Paulose RM, Rani PK. BMJ Case Rep. 2017;2017: pii: bcr-2017-21974.

doi: 10.1136/bcr-2017-219741.

A 40-year-old man suddenly began to lose vision in his left eye. The retinal exam was normal for the right eye. But the left showed isolated subinternal limited membrane hemorrhage at the fovea along with a white-centered hemorrhage above the fovea.

The patient had no history of trauma or Valsalva retinopathy. His blood pressure was normal as was his blood glucose. However, when bloodwork showed a high total count, increased platelet count, and the peripheral smear indicated myeloid hyperplasia, clinicians at LV Prasad Eye Institute in Hyderabad, India, diagnosed the patient with underlying chronic myeloid leukemia (CML).  

A physical examination revealed a palpable spleenomegaly—underscoring the fact, the clinicians note, that when an ophthalmologic finding suggests a systemic disease, a general physical examination will reveal more clinical clues. The patient was referred to an oncologist and started on imatinib for CML.

White-centered or pale-centered hemorrhages are believed to represent an accumulation of leukemic cells or platelet fibrin aggregates, the clinicians say. Blood dyscrasias, such as anemias, leukemia, multiple myeloma, and other platelet disorders may present with similar features. Such hemorrhages are known to resolve spontaneously when the patient is treated for the underlying condition, and the hematologic status improves, the clinicians say. This patient’s hemorrhage gradually resolved over the next month, and his visual acuity improved to 20/20.

Ocular manifestations as a presenting sign of leukemia, especially chronic, are rare, the clinicians say. They note that retinal hemorrhages are one of the “most striking findings” in leukemia, and because they can be directly observed, they provide a “subtle but important clue toward an otherwise asymptomatic disease.” If diagnosed early and treated promptly, patients with CML have a good survival rate.

Source:

Tyagi M, Agarwal K, Paulose RM, Rani PK. BMJ Case Rep. 2017;2017: pii: bcr-2017-21974.

doi: 10.1136/bcr-2017-219741.

After decades of decline, progress has slowed in preventing stroke deaths, according to a CDC Vital Signs report. The report is a “wake-up call,” CDC Director Brenda Fitzgerald says.

About 3 in every 4 states showed stalled rates of decline between 2000 and 2015. In some states, the trend of declining stroke deaths has actually reversed. It is a “disturbing” finding, the researchers say—particularly because 80% of strokes are preventable.

Every 40 seconds, someone in the U.S. has a stroke. Each year, > 140,000 die. Blacks continue to be hardest hit by stroke but stroke deaths are on the rise among Hispanics (by 6% each year between 2013 and 2015) and people living in the South.

Death rates continued to drop steadily between the years 2000 and 2015 among adults aged ≥ 35 years. However, people are dying of stroke at younger ages. Over the past 15 years, stroke hospitalizations have increased among adults aged 18 to 54 years. But the researchers note that risk factors, such as high blood pressure, high cholesterol, obesity, and diabetes are also appearing in younger people. Moreover, those risk factors may not be recognized and treated in middle-aged adults aged 35 to 64 years.

The study categorizes stroke deaths in the U.S. from 2000 to 2015, by age, sex, race/ethnicity, and geographic area. It does not, however, address causes for the slowdown, although it cites other studies that point to obesity and diabetes as contributors. High blood pressure is the single “most important preventable and treatable risk factor for stroke,” the CDC says.

After decades of decline, progress has slowed in preventing stroke deaths, according to a CDC Vital Signs report. The report is a “wake-up call,” CDC Director Brenda Fitzgerald says.

About 3 in every 4 states showed stalled rates of decline between 2000 and 2015. In some states, the trend of declining stroke deaths has actually reversed. It is a “disturbing” finding, the researchers say—particularly because 80% of strokes are preventable.

Every 40 seconds, someone in the U.S. has a stroke. Each year, > 140,000 die. Blacks continue to be hardest hit by stroke but stroke deaths are on the rise among Hispanics (by 6% each year between 2013 and 2015) and people living in the South.

Death rates continued to drop steadily between the years 2000 and 2015 among adults aged ≥ 35 years. However, people are dying of stroke at younger ages. Over the past 15 years, stroke hospitalizations have increased among adults aged 18 to 54 years. But the researchers note that risk factors, such as high blood pressure, high cholesterol, obesity, and diabetes are also appearing in younger people. Moreover, those risk factors may not be recognized and treated in middle-aged adults aged 35 to 64 years.

The study categorizes stroke deaths in the U.S. from 2000 to 2015, by age, sex, race/ethnicity, and geographic area. It does not, however, address causes for the slowdown, although it cites other studies that point to obesity and diabetes as contributors. High blood pressure is the single “most important preventable and treatable risk factor for stroke,” the CDC says.

After decades of decline, progress has slowed in preventing stroke deaths, according to a CDC Vital Signs report. The report is a “wake-up call,” CDC Director Brenda Fitzgerald says.

About 3 in every 4 states showed stalled rates of decline between 2000 and 2015. In some states, the trend of declining stroke deaths has actually reversed. It is a “disturbing” finding, the researchers say—particularly because 80% of strokes are preventable.

Every 40 seconds, someone in the U.S. has a stroke. Each year, > 140,000 die. Blacks continue to be hardest hit by stroke but stroke deaths are on the rise among Hispanics (by 6% each year between 2013 and 2015) and people living in the South.

Death rates continued to drop steadily between the years 2000 and 2015 among adults aged ≥ 35 years. However, people are dying of stroke at younger ages. Over the past 15 years, stroke hospitalizations have increased among adults aged 18 to 54 years. But the researchers note that risk factors, such as high blood pressure, high cholesterol, obesity, and diabetes are also appearing in younger people. Moreover, those risk factors may not be recognized and treated in middle-aged adults aged 35 to 64 years.

The study categorizes stroke deaths in the U.S. from 2000 to 2015, by age, sex, race/ethnicity, and geographic area. It does not, however, address causes for the slowdown, although it cites other studies that point to obesity and diabetes as contributors. High blood pressure is the single “most important preventable and treatable risk factor for stroke,” the CDC says.