July 15, 2016
We're all aware that there is an obesity epidemic and its linked to dozens of health problems. But nothing we've done so far — public awareness campaigns, changes in school lunch programs, and approving new drugs for weight loss — has halted this epidemic. The prevalence of obesity continues to climb in young adults and most of us keep packing on the pounds as we get older! Thus preventing weight gain in young adults is critically important to long-term outcomes. The recent results of the Study of Novel Approaches to Weight Gain Prevention (SNAP) provides evidence to guide recommendations for behavioral change.
March 25, 2016
For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS2 score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS2 score is 5 or higher and not bridging if the CHADS2 score is 2 or lower. But what about patients with a CHADS2 score of 3 or 4?
March 11, 2016
Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25,
50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for
patients with diabetes requiring insulin continues to expand. Current
guidelines for glycemic management of patients with type 2 diabetes provide
specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based
February 26, 2016
With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes. Several healthcare-related applications and mobile phone text messaging systems have already been designed; yet, very few have undergone rigorous testing to confirm clinical benefit. The investigators of the Tobacco, Exercise, and Diet Messages (TEXT ME) trial designed a text message-based intervention to encourage lifestyle modifications and evaluated its impact on cardiovascular risk in patients with established CHD. The TEXT ME study provides robust findings to support a simple, inexpensive intervention to modify cardiovascular risk … at least over the short term.
February 10, 2016
The debate over the intensity of blood pressure
(BP) lowering for patients with hypertension has been going on for decades. Additional fuel to the fire was recently added
with the early halt and publication of the Systolic Blood Pressure Intervention
Trial (SPRINT). So “how low should
you go” for patients with high BP? Do lower BP goals reduce CV outcomes and
death, particularly in patients at high risk?
Do they cause greater adverse effects? Or perhaps even worsen CV outcomes?
These questions were examined in SPRINT.
October 16, 2015
The recommended treatment
duration for a first episode of unprovoked venous thromboembolism (VTE) is, at
a minimum, 3 months with extended anticoagulation favored for those who are not
at high risk for bleeding. However, the
optimal duration of anticoagulation therapy remains unknown.
The Prolonged Anticoagulation
Treatment for a First Episode of Idiopathic Pulmonary Embolism (PADIS-PE) study
examines this question but, most importantly, provides insights about patient outcomes after anticoagulation
treatment is discontinued
September 18, 2015
Many clinicians are questioning the role pharmacists play in anticoagulation therapy management as direct oral anticoagulants (DOACs) increasingly replace warfarin for a variety of indications. A recent study examined medication adherence and therapy management practices at Veterans Health Administration (VHA) patient care sites. Although this study does not have all the answers, it does reveal the importance of patient selection and ongoing patient monitoring – potentially key roles for pharmacists.
August 24, 2015
To treat acute asthma exacerbations in children,
how about a single dose of dexamethasone and your done! Sounds simple, easy, and convenient. But is it too good to be true?
July 18, 2015
health professional takes an oath to service patients. To fulfill this
covenant, patient trust must be earned. Without trust, patients are unlikely to
share sensitive, personal information, hindering the provision of optimal
care. Gaining trust is influenced by many factors. What influence does attire
have on patients’ perceptions of their healthcare providers?