User login
Ups and Downs of Local Health Departments
Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.
The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.
Related: Meta-Analysis Examines Quality of VA Health Care
At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.
Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.
Related: Pharmacists in the Emergency Department: Feasibility and Cost
For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.
However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”
Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments
Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.
The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.
Related: Meta-Analysis Examines Quality of VA Health Care
At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.
Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.
Related: Pharmacists in the Emergency Department: Feasibility and Cost
For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.
However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”
Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments
Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.
The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.
Related: Meta-Analysis Examines Quality of VA Health Care
At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.
Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.
Related: Pharmacists in the Emergency Department: Feasibility and Cost
For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.
However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”
Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments
Colorectal Screening: Available but Underused
The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.
Related: Are Periodic Endoscopies Useful for Patients Under 40?
To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024, the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.
Related: Do Age and Gender Matter in Colorectal Cancer?
The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.
“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.”
The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.
Related: Are Periodic Endoscopies Useful for Patients Under 40?
To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024, the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.
Related: Do Age and Gender Matter in Colorectal Cancer?
The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.
“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.”
The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.
Related: Are Periodic Endoscopies Useful for Patients Under 40?
To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024, the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.
Related: Do Age and Gender Matter in Colorectal Cancer?
The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.
“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.”
Education and Anxiety Disorders
Adults with lower than a high school education are more than twice as likely to have experienced an anxiety disorder in the past year than those with higher levels of education, according to a study by the Substance Abuse and Mental Health Services Administration.
The National Survey on Drug Use and Health’s 2008 to 2012 Mental Health Surveillance Study (MHSS) found an estimated 12.9 million adults aged ≥ 18 years had 1 or more anxiety disorders in the past year. That included 3.9 million with lower than a high school education, 3.3 million high school graduates, 2.8 million with some college, and 3 million with college education or higher.
In the past year, 12.9% of adults with lower than a high school education had anxiety disorders compared with 5% of high school graduates and 4.3% of adults with college degrees or higher levels of education.
Although the MHSS results cannot be used to determine whether anxiety stopped people from finishing high school, the research showed that having an anxiety disorder can lower the odds of finishing high school and attending college and reach past the school years into the health and well-being of later adulthood.
Adults with lower than a high school education are more than twice as likely to have experienced an anxiety disorder in the past year than those with higher levels of education, according to a study by the Substance Abuse and Mental Health Services Administration.
The National Survey on Drug Use and Health’s 2008 to 2012 Mental Health Surveillance Study (MHSS) found an estimated 12.9 million adults aged ≥ 18 years had 1 or more anxiety disorders in the past year. That included 3.9 million with lower than a high school education, 3.3 million high school graduates, 2.8 million with some college, and 3 million with college education or higher.
In the past year, 12.9% of adults with lower than a high school education had anxiety disorders compared with 5% of high school graduates and 4.3% of adults with college degrees or higher levels of education.
Although the MHSS results cannot be used to determine whether anxiety stopped people from finishing high school, the research showed that having an anxiety disorder can lower the odds of finishing high school and attending college and reach past the school years into the health and well-being of later adulthood.
Adults with lower than a high school education are more than twice as likely to have experienced an anxiety disorder in the past year than those with higher levels of education, according to a study by the Substance Abuse and Mental Health Services Administration.
The National Survey on Drug Use and Health’s 2008 to 2012 Mental Health Surveillance Study (MHSS) found an estimated 12.9 million adults aged ≥ 18 years had 1 or more anxiety disorders in the past year. That included 3.9 million with lower than a high school education, 3.3 million high school graduates, 2.8 million with some college, and 3 million with college education or higher.
In the past year, 12.9% of adults with lower than a high school education had anxiety disorders compared with 5% of high school graduates and 4.3% of adults with college degrees or higher levels of education.
Although the MHSS results cannot be used to determine whether anxiety stopped people from finishing high school, the research showed that having an anxiety disorder can lower the odds of finishing high school and attending college and reach past the school years into the health and well-being of later adulthood.
FDA Approves Genetic Test for NSCLC
The FDA has approved the first blood-based genetic test to detect epidermal growth factor receptor (EGFR) gene mutations present in 10% to 20% of non-small cell lung cancers (NSCLC).
The test—cobas EGFR Mutation Test v2—is a “companion diagnostic” for patients who may benefit from erlotinib, a treatment for patients with locally advanced or metastatic NSCLC. Insofar as the test provides positive results, the FDA says, it may also benefit patients who are too ill or otherwise unable to provide a tumor specimen for EGFR testing.
The cobas EGFR Mutation Test v2 was evaluated for efficacy in a clinical trial of patients whose tumor biopsies were previously confirmed positive for the EGFR exon 19 deletion or L858R mutations, as determined by the cobas EGFR Mutation Test v1.
Erlotinib is approved for patients with locally advanced or metastatic NSCLC after at least 1 chemotherapy regimen has proved ineffective. It is also approved for first-line treatment of patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or L858 substitution mutations as detected by an FDA-approved test. It has not been evaluated as first-line treatment in patients with metastatic NSCLC whose tumors have other EGFR mutations.
The FDA has approved the first blood-based genetic test to detect epidermal growth factor receptor (EGFR) gene mutations present in 10% to 20% of non-small cell lung cancers (NSCLC).
The test—cobas EGFR Mutation Test v2—is a “companion diagnostic” for patients who may benefit from erlotinib, a treatment for patients with locally advanced or metastatic NSCLC. Insofar as the test provides positive results, the FDA says, it may also benefit patients who are too ill or otherwise unable to provide a tumor specimen for EGFR testing.
The cobas EGFR Mutation Test v2 was evaluated for efficacy in a clinical trial of patients whose tumor biopsies were previously confirmed positive for the EGFR exon 19 deletion or L858R mutations, as determined by the cobas EGFR Mutation Test v1.
Erlotinib is approved for patients with locally advanced or metastatic NSCLC after at least 1 chemotherapy regimen has proved ineffective. It is also approved for first-line treatment of patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or L858 substitution mutations as detected by an FDA-approved test. It has not been evaluated as first-line treatment in patients with metastatic NSCLC whose tumors have other EGFR mutations.
The FDA has approved the first blood-based genetic test to detect epidermal growth factor receptor (EGFR) gene mutations present in 10% to 20% of non-small cell lung cancers (NSCLC).
The test—cobas EGFR Mutation Test v2—is a “companion diagnostic” for patients who may benefit from erlotinib, a treatment for patients with locally advanced or metastatic NSCLC. Insofar as the test provides positive results, the FDA says, it may also benefit patients who are too ill or otherwise unable to provide a tumor specimen for EGFR testing.
The cobas EGFR Mutation Test v2 was evaluated for efficacy in a clinical trial of patients whose tumor biopsies were previously confirmed positive for the EGFR exon 19 deletion or L858R mutations, as determined by the cobas EGFR Mutation Test v1.
Erlotinib is approved for patients with locally advanced or metastatic NSCLC after at least 1 chemotherapy regimen has proved ineffective. It is also approved for first-line treatment of patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or L858 substitution mutations as detected by an FDA-approved test. It has not been evaluated as first-line treatment in patients with metastatic NSCLC whose tumors have other EGFR mutations.
Legionnaires Disease: An Ever-Growing Risk
In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.
Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.
Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.
The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.
The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.
The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.
The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.
Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.
In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.
Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.
Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.
The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.
The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.
The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.
The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.
Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.
In 1976, several thousand members of the American Legion were celebrating the bicentennial in Philadelphia, and many were staying at the Bellevue-Stratford Hotel. Within a week of the convention, more than 182 attendees, mostly men, had been hospitalized with tiredness, chest pains, congestion, and fever, and 29 had died.
Finally, a year later the deadly bacterium infecting them was identified. Although also responsible for earlier outbreaks, Legionella pneumophila had been breeding in the hotel’s cooling towers. An important overlooked clue was that even people simply walking by the hotel got sick.
Although that outbreak led to changes in how water management and climate control systems are monitored, the bacterium still takes about 5,000 lives a year. According to the CDC, between 2000 and 2014, reported cases of legionellosis, which comprises both Legionnaire disease and a milder form, Pontiac fever, jumped 286%.
The data come from 27 field investigations of outbreaks, involving 415 cases. Of those, health care-associated outbreaks accounted for 57%. Although 44% of the cases were travel related, the health care-related outbreaks resulted in more deaths.
The CDC-investigated outbreak sources all had at least 1 deficiency, and half had deficiencies in more than 2 categories. Most cases were linked to process failures, such as contaminated potable water and human error.
The infection is fatal for about 1 in 10 people. Those at highest risk are people aged ≥ 50 years, smokers, and those with chronic lung disease, weakened immune systems, or other underlying medical conditions.
The CDC says the federal government is improving health care for veterans by requiring plans for prevention of Legionnaires disease at VHA hospitals and long-term care facilities. Health care providers can test (using a urinary antigen test and a culture from a lower respiratory specimen) for Legionnaires disease in people with serious pneumonia, especially those in intensive care or who recently stayed in a health care facility or hotel, or on a cruise ship.
Widespread use of effective water management programs, the CDC advises, in addition to early diagnosis, might reduce the number and size of Legionnaires disease outbreaks.
IHS and CMS Partner for Patient Safety Improvements
The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.
The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.
This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”
The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.
The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.
This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”
The IHS and Centers for Medicare & Medicaid Services (CMS) are partnering to “strengthen the quality of care delivered in IHS-operated hospitals.” IHS hospitals will receive assistance from a CMS-supported Hospital Engagement Network (HEN) whose purpose is to help health care facilities deliver better care and spend more efficiently. The effort includes IHS hospitals in the Great Plains Area.
The HENs focus on reducing preventable patient harm, such as hospital-acquired infections and avoidable readmissions. They help identify proven solutions and then share them among hospitals. The HENs also track and monitor hospital progress in meeting quality improvement goals. The IHS will be able to access technical assistance and support, for example, from quality improvement experts.
This is not the first time the 2 organizations have joined forces. The new partnership actually dates from 2013, when some parts of IHS participated in a “first-round” HEN. “Quality improvement is a continuous effort at IHS hospitals—as it is at all health care facilities,” says Mary Smith, IHS principal deputy director. “Working with a Hospital Engagement Network brings more resources and underscores our commitment to focus on delivering efficient and high-quality care for our patients.”
Standard vs Intensive Emergency Stroke Treatment
Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.
“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”
In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.
Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.
Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”
Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.
“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”
In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.
Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.
Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”
Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.
“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”
In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.
Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.
Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”
Follow-up Findings From ACCORD
Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.
The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.
The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.
Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.
The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.
The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.
Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.
The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.
The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.
Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.
The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.
The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.
Intensive control of blood sugar levels can cut the risk of diabetic retinopathy in half, according to a follow-up study of the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.
The finding from the ACCORD Follow-on eye study (ACCORDION) “sends a powerful message to people with type 2 diabetes mellitus (T2DM) who worry about losing vision,” said Emily Chew, MD, deputy director of the National Eye Institute Division of Epidemiology and Clinical Applications and lead author of the study report.
The ACCORDION trial is an assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD. That study tested 3 treatment strategies to reduce the risk of cardiovascular disease in people with longstanding T2DM: maintaining near-normal blood sugar levels (intensive control), improving blood lipid levels, and lowering blood pressure.
Because of an increase in death among participants in the intensive glycemic control group, ACCORD was aborted at 3.5 years. (The increased mortality, which was due to a range of causes, was seen in both intensive and standard groups.) From the data they had, the researchers found tight control reduced glycemia to an average HbA1C of 6.4% compared with 7.7% among those in the standard control group. It did not cut the risk of cardiovascular disease, but it had cut retinopathy progression by about one- third when the study was abruptly ended.
The follow-up study reassessed diabetic retinopathy 4 years after the intensive control portion of ACCORD had ended, 8 years after enrollment. Average HbA1C was nearly the same. Diabetic retinopathy, however, had advanced in only 5.8% of participants in the intensive group, compared with 12.7% of the standard treatment group.
The continuing beneficial effects—an approximately 50% reduction in risk of further retinopathy progression—are attributed to “metabolic memory,” a phenomenon also known as the “legacy effect.” Similar effects have been seen in 2 other large, long studies: the 10-year-long Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Project.
TRICARE Covering TMS for Major Depressive Disorder
TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.
Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.
The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.
TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.
Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.
The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.
TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.
Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.
The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.
Pairing and Sharing for Kidney Transplants
It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.
“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.
Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.
Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University, which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.
It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.
“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.
Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.
Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University, which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.
It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.
“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.
Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.
Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University, which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.