Annals of Internal Medicine tip sheet for May 28, 2013
2013-05-28
(Press-News.org) 1. Evidence Suggests Screening for Gestational Diabetes Can Improve Maternal and Fetal Outcomes
Evidence review will inform recommendations on screening for gestational diabetes
The oral glucose challenge test (OGCT) and testing for fasting plasma glucose levels may be the best way to rule out gestational diabetes mellitus (GDM) in women who are at about 24 weeks' gestation. The OGCT may be better for diagnosing women who have GDM. GDM puts babies at risk for having a high birth weight, low blood sugar, and jaundice. GDM is also associated with seizures or still birth. Women who are diagnosed with GDM can control their glucose levels and decrease risks for complications, making screening an important consideration. In 2008, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to assess the benefits and harms of screening women for GDM. To update its previous screening recommendations, researchers reviewed 51 cohort studies that assess the test characteristics of various screening methods for GDM. There is no gold standard glucose level threshold for diagnosing GDM, which makes comparing tests difficult. However, the researchers found that using the OGCT with a glucose threshold of 7.2 mmol/L had a sensitivity of 99 percent and a specificity of 77 percent, which would accurately identify patients who do not have GDM. Measuring fasting plasma glucose level was shown to be a good alternative for OGCT, especially for women who cannot tolerate a glucose drink. At a threshold of 4.7 mmol/L, it has a sensitivity similar to OGCT, but is not as good at predicting an abnormal oral glucose tolerance test (OGTT) result. For women found to have GDM, published evidence suggests that treatment reduces preeclampsia, shoulder dystocia, and high birth weight, and is associated with few harms. The researchers found limited evidence to support GDM screening at less than 24 weeks, but early screening may be justified in women at high risk for overt diabetes. There was not enough compelling evidence to recommend for or against risk factor-based screening. A draft recommendation statement will be posted for public comment at http://www.uspreventiveservicestaskforce.org on May 27 at 5:00 p.m. Final recommendations will be published in Annals of Internal Medicine.
Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To interview the lead author, please contact Bruce Conway at or bruce.donovan@albertahealthservices.ca 403-943-1212. For a copy of the draft recommendations, please contact Ana Fullmer at ana.fullmer@edelman.com or 202-351-6668.
2. Kocher and Emanuel: Transparency is the Key to Higher Quality and Cost Control Post Obamacare
Now that the Affordable Care Act (ACA) is the law, renowned health care reform advocates, Bob Kocher, MD, and Ezekiel Emanuel, MD, PhD, propose a "transparency imperative" to achieve higher quality and cost control under the new health care system. According to Drs. Kocher and Emanuel, the lack of price and quality transparency in U.S. health care promotes high costs, but not necessarily high quality care. They propose that all data on price, utilization, and quality be made publicly available unless there is a compelling reason to keep it confidential. To achieve transparency, the Federal Government will need to relax restrictions on public access to Medicare data. The authors write that all payers should make claims data publically available, with privacy protections, to enable quality measurement. Patients should know how many procedures a physician has performed (utilization), and have access to outcomes data for hospitals (quality). Personalized pricing information also should be made available so that patients can make comparisons. Currently, it is almost impossible for patients to obtain pricing information for health care services. Within local markets, different hospitals may have price disparities of more than 200%, with little or no correlation between cost and quality. The authors conclude that "transparency is essential for patients to consume care from providers who deliver greater value." They assert that the transparency approach will promote competition and is the best way to overcome local monopoly pricing power by providers.
Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To interview Dr. Kocher, please contact Adam Williams at adwilliams@apcoworldwide.com or 202-297-5121. To interview Dr. Emanuel, please contact Katie Delach at katie.delach@uphs.upenn.edu or 215-349-5964.
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2013-05-28
Irvine, CA & Seattle, WA — Scientists at UC Irvine reported this week that a synthetic compound ShK-186, originally derived from a sea anemone toxin, has been found to enhance metabolic activity and shows potential as a treatment for obesity and insulin resistance.
The findings published the week of May 27 in the Proceedings of the National Academy of Sciences reveal that ShK-186 selectively blocks the activity of a protein that promotes inflammation through the Kv1.3 potassium channel. The study presents the first evidence that the drug candidate – which in March showed ...
2013-05-28
Dartmouth College researchers have identified a new regulator for plant hormone signaling -- the KISS ME DEADLY family of proteins (KMDs) – that may help to improve production of fruits, vegetables and grains.
The study's results will be published the week of May 27 in the journal Proceedings of the National Academy of Sciences. Journalists can access the paper, titled "SCFKMD controls cytokinin signaling by regulating the degradation of type-B response regulators," through EurekAlert!.
Professor G. Eric Schaller, the paper's senior author, studies the molecular mechanisms ...
2013-05-28
Human foetal stem cell grafts improve both motor and sensory functions in rats suffering from a spinal cord injury, according to research published this week in BioMed Central's open access journal Stem Cell Research and Therapy. This cell replacement therapy also improves the structural integrity of the spine, providing a functional relay through the injury site. The research gives hope for the treatment of spinal cord injuries in humans.
Grafting human neural stem cells into the spine is a promising approach to promote the recovery of function after spinal injury. ...
2013-05-28
BOSTON – In any given year, 400,000 Americans suffering from end-stage kidney disease will undergo dialysis, and as many as 20 to 25 percent of those dialysis patients will die, a statistic comparable to many types of cancer. But while cancer doctors may be more accustomed to talking with patients about the likely course of their disease, a new study from Beth Israel Deaconess Medical Center finds that doctors who treat patients with kidney failure are reluctant to discuss a difficult prognosis, and their patients are likely to have distorted expectations about their own ...
2013-05-28
Boston, MA – Developing new vaccines to protect against diseases that plague humans is fraught with numerous challenges—one being that microbes tend to vary how they look on the surface to avoid being identified and destroyed by the immune system. However, researchers from Brigham and Women's Hospital (BWH) have discovered a sugar polymer that is common on the cell surface of several pathogens. This common sugar molecule makes it a promising target for the development of a broad-spectrum vaccine that can protect against numerous deadly microbes expressing this sugar on ...
2013-05-28
Since the 1980s, doctors and patients have been encouraged to share decision making. Proponents argue that this approach promotes doctor-patient communication, enhances patient satisfaction, improves health outcomes, and even may lower cost.
Yet, a hospital-based study found that patients who want to participate in their medical decisions end up spending more time in the hospital and raising costs of their hospital stay by an average of $865.
The findings, published in JAMA Internal Medicine, came from the first hospital-based study to examine how patients' desire ...
2013-05-28
MINNEAPOLIS – A large analysis of more than 100 studies from around the world shows that exposure to pesticides, or bug and weed killers, and solvents is likely associated with a higher risk of developing Parkinson's disease. The research appears in the May 28, 2013, print issue of Neurology®, the medical journal of the American Academy of Neurology.
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2013-05-28
MINNEAPOLIS – A new guideline from the American Academy of Neurology will help people who take blood thinners decide whether or not to take them during surgery or other medical procedures. The guideline is published in the May 28, 2013, print issue of Neurology®, the medical journal of the American Academy of Neurology.
People who have had a stroke often take blood thinners such as aspirin or warfarin to prevent another stroke. Blood thinners, or anticlotting drugs, are also used to prevent a first stroke in people with atrial fibrillation, an irregular or fast heartbeat. ...
2013-05-28
An international team led by researchers at the University of California, San Diego School of Medicine reports that a single injection of human neural stem cells produced neuronal regeneration and improvement of function and mobility in rats impaired by an acute spinal cord injury (SCI).
The findings are published in the May 28, 2013 online issue of Stem Cell Research & Therapy.
Martin Marsala, MD, professor in the Department of Anesthesiology, with colleagues at UC San Diego and in Slovakia, the Czech Republic and The Netherlands, said grafting neural stem cells derived ...
2013-05-28
Madison, Wis. – Down syndrome, the most common genetic form of intellectual disability, results from an extra copy of one chromosome. Although people with Down syndrome experience intellectual difficulties and other problems, scientists have had trouble identifying why that extra chromosome causes such widespread effects.
In new research published this week, Anita Bhattacharyya, a neuroscientist at the Waisman Center at the University of Wisconsin-Madison, reports on brain cells that were grown from skin cells of individuals with Down syndrome.
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[Press-News.org] Annals of Internal Medicine tip sheet for May 28, 2013