Matthew Hoegh, MD

Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.

Study design: Survey review.

Setting: Large, continuously operative health survey.

Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).

Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.

Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.

Study design: Survey review.

Setting: Large, continuously operative health survey.

Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).

Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.

Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: The transgender population historically has not been identified in population research. Little is known about their health care needs.

Study design: Survey review.

Setting: Large, continuously operative health survey.

Synopsis: The Centers for Disease Control and Prevention added an optional Sexual Orientation and Gender Identity module to the Behavioral Risk Factor Surveillance System in 2014. Compared with non–transgender responders, transgender adults (0.55% of responders) were more likely to report “fair” or “poor” health status (24.5% vs. 18.2%), were more likely to have experienced severe mental distress in the last 30 days (20.3% vs. 11.6), and were more likely to be physically inactive (35% vs. 25.6%), smoke cigarettes (19.2% vs. 16.3%), and lack health care coverage (20.1% vs. 14.6%).

Bottom line: Transgender adults report worse physical and mental health status. Physicians should consider these disparities during screening and treatment.

Citation: Baker K. Findings from the Behavioral Risk Factor Surveillance System on health-related quality of life among U.S. transgender adults, 2014-2017. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2018.7931.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.

Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.

Setting: 695 sites in 34 countries, 4,401 patients.

Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.

Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.

Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.

Setting: 695 sites in 34 countries, 4,401 patients.

Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.

Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: Type 2 diabetes is the leading cause of kidney failure worldwide. Few treatment options exist to help improve on this outcome in patients with chronic kidney disease.

Study design: CREDENCE (industry-sponsored) double-blind, randomized placebo-controlled trial.

Setting: 695 sites in 34 countries, 4,401 patients.

Synopsis: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. Canagliflozin reduced serious adverse renal events or death from renal or cardiovascular causes at 2.62 years (11.1% vs. 15.5% with placebo; number needed to treat, 23).Bottom line: Canagliflozin lowered serious adverse renal events people with type 2 diabetics who also had chronic kidney disease.

Citation: Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Apr 14. doi: 10-1056/NEJMoa1811744.

Dr. Hoegh is a hospitalist at the University of Colorado at Denver, Aurora.

Background: Although neck and low back pain are leading causes of pain and disability, there is no consensus first-line pharmacologic therapy for treatment. Recent research has pointed to acetaminophen as being ineffective, which – in combination with increased awareness of opioid dependency and adverse risks – could lead to greater use of NSAIDs.

Study design: Systematic review and meta-analysis.

Setting: Randomized controlled trials.

Synopsis: Researchers used MEDLINE, EMBASE, CINAHL, CENTRAL, and LILACS to select 35 randomized, placebo-controlled trials evaluating the impact of NSAIDs on reducing spinal pain and disability from a total of 302 full-text articles. Trial data were pooled based on follow-up time and outcomes. Pain and disability outcomes were converted to a 100-point scale with a 10-point difference between groups defined as “clinically important.” NSAIDs were found to offer greater pain reduction than placebo in the immediate (number needed to treat, 5; 95% confidence interval, 4-6) and short (NNT, 6; 95% CI, 4-10) range. However, this effect did not meet the specified 10-point difference to support “clinical importance,” despite having favorable numbers needed to treat. Limited corresponding safety analysis did not find significant adverse event rate differences other than increased reporting of gastrointestinal symptoms.

Bottom line: NSAIDs reduce spinal pain, compared with placebo, with low numbers needed to treat, but nevertheless were not determined to have a “clinically important” effect.

Citation: Machado GC et al. Nonsteroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Ann Rheum Dis. 2017 Jul;76(7):1269-78.

Background: Although neck and low back pain are leading causes of pain and disability, there is no consensus first-line pharmacologic therapy for treatment. Recent research has pointed to acetaminophen as being ineffective, which – in combination with increased awareness of opioid dependency and adverse risks – could lead to greater use of NSAIDs.

Study design: Systematic review and meta-analysis.

Setting: Randomized controlled trials.

Synopsis: Researchers used MEDLINE, EMBASE, CINAHL, CENTRAL, and LILACS to select 35 randomized, placebo-controlled trials evaluating the impact of NSAIDs on reducing spinal pain and disability from a total of 302 full-text articles. Trial data were pooled based on follow-up time and outcomes. Pain and disability outcomes were converted to a 100-point scale with a 10-point difference between groups defined as “clinically important.” NSAIDs were found to offer greater pain reduction than placebo in the immediate (number needed to treat, 5; 95% confidence interval, 4-6) and short (NNT, 6; 95% CI, 4-10) range. However, this effect did not meet the specified 10-point difference to support “clinical importance,” despite having favorable numbers needed to treat. Limited corresponding safety analysis did not find significant adverse event rate differences other than increased reporting of gastrointestinal symptoms.

Bottom line: NSAIDs reduce spinal pain, compared with placebo, with low numbers needed to treat, but nevertheless were not determined to have a “clinically important” effect.

Citation: Machado GC et al. Nonsteroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Ann Rheum Dis. 2017 Jul;76(7):1269-78.

Background: Although neck and low back pain are leading causes of pain and disability, there is no consensus first-line pharmacologic therapy for treatment. Recent research has pointed to acetaminophen as being ineffective, which – in combination with increased awareness of opioid dependency and adverse risks – could lead to greater use of NSAIDs.

Study design: Systematic review and meta-analysis.

Setting: Randomized controlled trials.

Synopsis: Researchers used MEDLINE, EMBASE, CINAHL, CENTRAL, and LILACS to select 35 randomized, placebo-controlled trials evaluating the impact of NSAIDs on reducing spinal pain and disability from a total of 302 full-text articles. Trial data were pooled based on follow-up time and outcomes. Pain and disability outcomes were converted to a 100-point scale with a 10-point difference between groups defined as “clinically important.” NSAIDs were found to offer greater pain reduction than placebo in the immediate (number needed to treat, 5; 95% confidence interval, 4-6) and short (NNT, 6; 95% CI, 4-10) range. However, this effect did not meet the specified 10-point difference to support “clinical importance,” despite having favorable numbers needed to treat. Limited corresponding safety analysis did not find significant adverse event rate differences other than increased reporting of gastrointestinal symptoms.

Bottom line: NSAIDs reduce spinal pain, compared with placebo, with low numbers needed to treat, but nevertheless were not determined to have a “clinically important” effect.

Citation: Machado GC et al. Nonsteroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Ann Rheum Dis. 2017 Jul;76(7):1269-78.

 

Background: Severe hypoglycemia caused by glucose-lowering medications is a known public health and patient safety issue. Identifying patients with T2D at risk of severe hypoglycemia might facilitate interventions to offset that risk.

Study design: Prospective cohort.

Setting: Kaiser Permanente Northern California (derivation and internal validation cohort); Veterans Affairs Diabetes Epidemiology Cohort and Group Health Cooperative (external validation cohorts).

Synopsis: Through EHR data, 206,435 eligible patients with T2D were randomly split into derivation (80%) and internal validation (20%) samples. EHR data were reviewed for preselected clinical risk factors for hypoglycemia with a primary outcome of ED visit or hospital admission with a primary diagnosis of hypoglycemia over the ensuing year. A predictive tool was built based on six variables: prior hypoglycemia episodes, number of ED encounters for any reason in the prior year, insulin use, sulfonylurea use, presence of severe or end-stage kidney disease, and age. Predicted 12-month risk was categorized as high (greater than 5%), intermediate (1%-5%) or low (less than 1%). In the internal validation sample, 2.0%, 10.7%, and 87.3% of patients were categorized as high, intermediate, and low risk, respectively. Observed 12-month hypoglycemia-related health care utilization rates were 6.7%, 1.4%, and 0.2%, respectively. The external validation cohorts performed similarly.

Bottom line: A simple tool using readily available data can be used to estimate the 12-month risk of severe hypoglycemia in patients with T2D.

Citation: Karter AJ et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med. 2017 Oct 1;177(10):1461-70.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine. 

 

Background: Severe hypoglycemia caused by glucose-lowering medications is a known public health and patient safety issue. Identifying patients with T2D at risk of severe hypoglycemia might facilitate interventions to offset that risk.

Study design: Prospective cohort.

Setting: Kaiser Permanente Northern California (derivation and internal validation cohort); Veterans Affairs Diabetes Epidemiology Cohort and Group Health Cooperative (external validation cohorts).

Synopsis: Through EHR data, 206,435 eligible patients with T2D were randomly split into derivation (80%) and internal validation (20%) samples. EHR data were reviewed for preselected clinical risk factors for hypoglycemia with a primary outcome of ED visit or hospital admission with a primary diagnosis of hypoglycemia over the ensuing year. A predictive tool was built based on six variables: prior hypoglycemia episodes, number of ED encounters for any reason in the prior year, insulin use, sulfonylurea use, presence of severe or end-stage kidney disease, and age. Predicted 12-month risk was categorized as high (greater than 5%), intermediate (1%-5%) or low (less than 1%). In the internal validation sample, 2.0%, 10.7%, and 87.3% of patients were categorized as high, intermediate, and low risk, respectively. Observed 12-month hypoglycemia-related health care utilization rates were 6.7%, 1.4%, and 0.2%, respectively. The external validation cohorts performed similarly.

Bottom line: A simple tool using readily available data can be used to estimate the 12-month risk of severe hypoglycemia in patients with T2D.

Citation: Karter AJ et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med. 2017 Oct 1;177(10):1461-70.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine. 

 

Background: Severe hypoglycemia caused by glucose-lowering medications is a known public health and patient safety issue. Identifying patients with T2D at risk of severe hypoglycemia might facilitate interventions to offset that risk.

Study design: Prospective cohort.

Setting: Kaiser Permanente Northern California (derivation and internal validation cohort); Veterans Affairs Diabetes Epidemiology Cohort and Group Health Cooperative (external validation cohorts).

Synopsis: Through EHR data, 206,435 eligible patients with T2D were randomly split into derivation (80%) and internal validation (20%) samples. EHR data were reviewed for preselected clinical risk factors for hypoglycemia with a primary outcome of ED visit or hospital admission with a primary diagnosis of hypoglycemia over the ensuing year. A predictive tool was built based on six variables: prior hypoglycemia episodes, number of ED encounters for any reason in the prior year, insulin use, sulfonylurea use, presence of severe or end-stage kidney disease, and age. Predicted 12-month risk was categorized as high (greater than 5%), intermediate (1%-5%) or low (less than 1%). In the internal validation sample, 2.0%, 10.7%, and 87.3% of patients were categorized as high, intermediate, and low risk, respectively. Observed 12-month hypoglycemia-related health care utilization rates were 6.7%, 1.4%, and 0.2%, respectively. The external validation cohorts performed similarly.

Bottom line: A simple tool using readily available data can be used to estimate the 12-month risk of severe hypoglycemia in patients with T2D.

Citation: Karter AJ et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med. 2017 Oct 1;177(10):1461-70.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine. 

 

Background: Elective operations have become increasingly more common in the elderly. This population is at a higher risk for postsurgical complications. Previous research into preoperative risk assessment relied on geriatricians, of whom there is a national shortage.

Study design: Prospective cohort study.

Setting: Preoperative surgery clinics at the University of Michigan Health System.

Synopsis: A total of 736 elderly patients had a preoperative Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) administered by a surgical physician assistant in clinic. VESPA assessed activities of daily living, history of falling or gait impairment, and depressive symptoms. Patients underwent a Mini-Cog examination and a Timed Up and Go assessment. Patients were asked whether they expected they could manage themselves alone after discharge. One in seven patients reported difficulty with one or more of the activities of daily living and one in three stated they would be unable to manage postoperative self-care alone. Overall, 25.3% of patients had geriatric or surgical complications. The VESPA score predicted postoperative complications (area under the curve, 0.76). More specifically, preexisting difficulties with activities of daily living, anticipated self-care difficulty, a Charlson Comorbidity score of 2 or greater, male sex, or higher surgical relative value units were all independently associated with postoperative complications.

Bottom line: Elderly patients at an increased risk of postoperative complications can be identified by nonphysician staff using the VESPA preoperative assessment.

Citation: Min L et al. Estimating risk of postsurgical general and geriatric complications using the VESPA preoperative tool. JAMA Surg. 2017 Aug 2. doi: 10.1001/jamasurg.2017.2635.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine. 

 

Background: Elective operations have become increasingly more common in the elderly. This population is at a higher risk for postsurgical complications. Previous research into preoperative risk assessment relied on geriatricians, of whom there is a national shortage.

Study design: Prospective cohort study.

Setting: Preoperative surgery clinics at the University of Michigan Health System.

Synopsis: A total of 736 elderly patients had a preoperative Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) administered by a surgical physician assistant in clinic. VESPA assessed activities of daily living, history of falling or gait impairment, and depressive symptoms. Patients underwent a Mini-Cog examination and a Timed Up and Go assessment. Patients were asked whether they expected they could manage themselves alone after discharge. One in seven patients reported difficulty with one or more of the activities of daily living and one in three stated they would be unable to manage postoperative self-care alone. Overall, 25.3% of patients had geriatric or surgical complications. The VESPA score predicted postoperative complications (area under the curve, 0.76). More specifically, preexisting difficulties with activities of daily living, anticipated self-care difficulty, a Charlson Comorbidity score of 2 or greater, male sex, or higher surgical relative value units were all independently associated with postoperative complications.

Bottom line: Elderly patients at an increased risk of postoperative complications can be identified by nonphysician staff using the VESPA preoperative assessment.

Citation: Min L et al. Estimating risk of postsurgical general and geriatric complications using the VESPA preoperative tool. JAMA Surg. 2017 Aug 2. doi: 10.1001/jamasurg.2017.2635.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine. 

 

Background: Elective operations have become increasingly more common in the elderly. This population is at a higher risk for postsurgical complications. Previous research into preoperative risk assessment relied on geriatricians, of whom there is a national shortage.

Study design: Prospective cohort study.

Setting: Preoperative surgery clinics at the University of Michigan Health System.

Synopsis: A total of 736 elderly patients had a preoperative Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) administered by a surgical physician assistant in clinic. VESPA assessed activities of daily living, history of falling or gait impairment, and depressive symptoms. Patients underwent a Mini-Cog examination and a Timed Up and Go assessment. Patients were asked whether they expected they could manage themselves alone after discharge. One in seven patients reported difficulty with one or more of the activities of daily living and one in three stated they would be unable to manage postoperative self-care alone. Overall, 25.3% of patients had geriatric or surgical complications. The VESPA score predicted postoperative complications (area under the curve, 0.76). More specifically, preexisting difficulties with activities of daily living, anticipated self-care difficulty, a Charlson Comorbidity score of 2 or greater, male sex, or higher surgical relative value units were all independently associated with postoperative complications.

Bottom line: Elderly patients at an increased risk of postoperative complications can be identified by nonphysician staff using the VESPA preoperative assessment.

Citation: Min L et al. Estimating risk of postsurgical general and geriatric complications using the VESPA preoperative tool. JAMA Surg. 2017 Aug 2. doi: 10.1001/jamasurg.2017.2635.

Dr. Hoegh is a hospitalist at the University of Colorado School of Medicine.