User login
Here are the stories our MDedge editors across specialties think you need to know about today:
A ‘Fraternity of People Who Are Struggling’
Kathleen Ronan spent a week in a New Jersey hospital, including 5 days in the ICU, battling the novel coronavirus.
Her years of working as a home health nurse told her that the return home wouldn’t be easy, but nothing prepared her for just how much she would struggle. The once-active Ronan, 51, now needed a walker to traverse the few steps from her bed to the toilet, an effort that left her gasping for air. Her brain couldn’t even focus on an audiobook, let alone a short magazine article. “It just completely knocked the stuffing out of me,” Ronan said.
Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of patients leaving the ICU, researchers have documented what they call post–intensive care syndrome (PICS) — a constellation of physical, cognitive, and psychiatric symptoms that result from an ICU stay. Although underlying illness plays a role in these symptoms, the amount of time spent in critical care is a major factor.
The good news is that over the past decade, researchers have made important strides in understanding what makes PICS symptoms worse and how critical care physicians can tweak ICU protocols to reduce PICS severity. Practitioners will need to draw on this knowledge to help Ronan and the thousands of COVID-19 ICU patients like her. Read more.
The evolution of ‘COVIDists’
At the start of the pandemic earlier this year hospitalists at Baystate Health in Western Massachusetts realized the necessity of a new model of care for COVID-19 patients. Challenges included a massive surge of COVID-19 patients, a limited supply of PPE, an inadequate number of intensivists for managing the anticipated ventilated patients, and the potential of losing some of our workforce if they became infected. Hospitalists there came up with an elaborate plan to manage the disease burden and the strain on resources effectively.
A focused group of 10 hospitalists who volunteered to take care of COVID-19 patients with a particular interest in the pandemic and experience in critical care were selected, and the term “COVIDists” was coined to refer to them. The group underwent rapid training in various treatment protocols and ongoing clinical trials.
All the hospitalized COVID-19 patients were grouped together to COVID units, and the COVIDists were deployed to those units geographically. COVIDists were given lighter than usual patient loads to deal with the extra time needed for donning and doffing of PPE and for coordination with specialists. COVIDists were almost the only clinicians physically visiting the patients in most cases, and they became the “eyes and ears” of specialists since the specialists were advised to minimize exposure and pursue telemedicine consults. Read more.
How low should you go?
Cardiovascular risk continues to reduce as systolic blood pressure decreases right down to levels as low as 90 mm Hg, according to a new study.
Researchers analyzed data from a cohort of 1,457 participants (mean age, 58 years) who did not have any traditional cardiovascular risk factors and had a systolic blood pressure level between 90 and 129 mm Hg at baseline. Results showed that, during a mean follow-up of 14.5 years, there was an increase in traditional cardiovascular risk factors, coronary artery calcium, and incident cardiovascular events with increasing systolic blood pressure levels.
“We modeled systolic blood pressure on a continuous scale and saw the risk increasing in a linear fashion as blood pressure increased and this occurred right down to 90 mm Hg. We didn’t see any nadir or J-point where there may be an increased risk at lower pressures,” said lead author Seamus Whelton, MD, assistant professor of medicine at the division of cardiology at Johns Hopkins Medicine, Baltimore.
“From an individual level we can now say that in healthy individuals, a systolic pressure in the 90s is not too low. It is a positive thing. And it is recommended to try and keep systolic pressure at these levels if possible by maintaining a healthy lifestyle,” Dr. Whelton said in an interview. Read more.
Asthma tops spending on avoidable pediatric inpatient stays
Asthma costs nearly equaled potentially avoidable hospital bills for diabetes, gastroenteritis, and UTIs combined in a study of in-patient stays among children aged 3 months to 17 years.
Indeed, hospital charges for the treatment of children with asthma made up nearly half of all potentially avoidable pediatric inpatient costs in 2017, according to the Agency for Healthcare Research and Quality.
The cost of potentially avoidable visits for asthma that year was $278 million, versus $284 million combined for the other three conditions, Kimberly W. McDermott, PhD, and H. Joanna Jiang, PhD, reported in an AHRQ statistical brief.
The state inpatient databases of the AHRQ’s Healthcare Cost and Utilization Project included 1.4 million inpatient stays among children aged 3 months to 17 years in 2017, of which 8% (108,300) were deemed potentially preventable.
Rates of potentially avoidable stays for asthma (159 per 100,000 population), gastroenteritis (90 per 100,000), and UTIs (41 per 100,000) were highest for children aged 0-4 years and generally decreased with age, but diabetes stays increased with age, rising from 12 per 100,000 in children aged 5-9 years to 38 per 100,000 for those 15-17 years old, the researchers said. Read more.
Adding monoclonal antibodies to Botox for migraine prevention
Adjunctive preventive therapy with a calcitonin gene–related peptide monoclonal antibody (CGRP-mAb) medication is safe and effective in patients with chronic migraine who have only achieved a partial response to onabotulinumtoxinA (Botox) treatment.
Investigators found the CGRP-mAbs significantly reduced the number of headache days and pain severity with adverse event rates similar to those reported in previous trials of these medications.
Although Botox is associated with significant clinical improvement in chronic migraine, it often fails to adequately control headache frequency and additional medications are needed. Three CGRP-mAbs have recently been approved for migraine prevention, with results from clinical trials demonstrating they are effective for both chronic and episodic migraine. Patients treated with Botox had been excluded from these earlier trials, however. Read more.
For more on COVID-19, visit our Resource Center. All of our latest news is available on MDedge.com.
Here are the stories our MDedge editors across specialties think you need to know about today:
A ‘Fraternity of People Who Are Struggling’
Kathleen Ronan spent a week in a New Jersey hospital, including 5 days in the ICU, battling the novel coronavirus.
Her years of working as a home health nurse told her that the return home wouldn’t be easy, but nothing prepared her for just how much she would struggle. The once-active Ronan, 51, now needed a walker to traverse the few steps from her bed to the toilet, an effort that left her gasping for air. Her brain couldn’t even focus on an audiobook, let alone a short magazine article. “It just completely knocked the stuffing out of me,” Ronan said.
Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of patients leaving the ICU, researchers have documented what they call post–intensive care syndrome (PICS) — a constellation of physical, cognitive, and psychiatric symptoms that result from an ICU stay. Although underlying illness plays a role in these symptoms, the amount of time spent in critical care is a major factor.
The good news is that over the past decade, researchers have made important strides in understanding what makes PICS symptoms worse and how critical care physicians can tweak ICU protocols to reduce PICS severity. Practitioners will need to draw on this knowledge to help Ronan and the thousands of COVID-19 ICU patients like her. Read more.
The evolution of ‘COVIDists’
At the start of the pandemic earlier this year hospitalists at Baystate Health in Western Massachusetts realized the necessity of a new model of care for COVID-19 patients. Challenges included a massive surge of COVID-19 patients, a limited supply of PPE, an inadequate number of intensivists for managing the anticipated ventilated patients, and the potential of losing some of our workforce if they became infected. Hospitalists there came up with an elaborate plan to manage the disease burden and the strain on resources effectively.
A focused group of 10 hospitalists who volunteered to take care of COVID-19 patients with a particular interest in the pandemic and experience in critical care were selected, and the term “COVIDists” was coined to refer to them. The group underwent rapid training in various treatment protocols and ongoing clinical trials.
All the hospitalized COVID-19 patients were grouped together to COVID units, and the COVIDists were deployed to those units geographically. COVIDists were given lighter than usual patient loads to deal with the extra time needed for donning and doffing of PPE and for coordination with specialists. COVIDists were almost the only clinicians physically visiting the patients in most cases, and they became the “eyes and ears” of specialists since the specialists were advised to minimize exposure and pursue telemedicine consults. Read more.
How low should you go?
Cardiovascular risk continues to reduce as systolic blood pressure decreases right down to levels as low as 90 mm Hg, according to a new study.
Researchers analyzed data from a cohort of 1,457 participants (mean age, 58 years) who did not have any traditional cardiovascular risk factors and had a systolic blood pressure level between 90 and 129 mm Hg at baseline. Results showed that, during a mean follow-up of 14.5 years, there was an increase in traditional cardiovascular risk factors, coronary artery calcium, and incident cardiovascular events with increasing systolic blood pressure levels.
“We modeled systolic blood pressure on a continuous scale and saw the risk increasing in a linear fashion as blood pressure increased and this occurred right down to 90 mm Hg. We didn’t see any nadir or J-point where there may be an increased risk at lower pressures,” said lead author Seamus Whelton, MD, assistant professor of medicine at the division of cardiology at Johns Hopkins Medicine, Baltimore.
“From an individual level we can now say that in healthy individuals, a systolic pressure in the 90s is not too low. It is a positive thing. And it is recommended to try and keep systolic pressure at these levels if possible by maintaining a healthy lifestyle,” Dr. Whelton said in an interview. Read more.
Asthma tops spending on avoidable pediatric inpatient stays
Asthma costs nearly equaled potentially avoidable hospital bills for diabetes, gastroenteritis, and UTIs combined in a study of in-patient stays among children aged 3 months to 17 years.
Indeed, hospital charges for the treatment of children with asthma made up nearly half of all potentially avoidable pediatric inpatient costs in 2017, according to the Agency for Healthcare Research and Quality.
The cost of potentially avoidable visits for asthma that year was $278 million, versus $284 million combined for the other three conditions, Kimberly W. McDermott, PhD, and H. Joanna Jiang, PhD, reported in an AHRQ statistical brief.
The state inpatient databases of the AHRQ’s Healthcare Cost and Utilization Project included 1.4 million inpatient stays among children aged 3 months to 17 years in 2017, of which 8% (108,300) were deemed potentially preventable.
Rates of potentially avoidable stays for asthma (159 per 100,000 population), gastroenteritis (90 per 100,000), and UTIs (41 per 100,000) were highest for children aged 0-4 years and generally decreased with age, but diabetes stays increased with age, rising from 12 per 100,000 in children aged 5-9 years to 38 per 100,000 for those 15-17 years old, the researchers said. Read more.
Adding monoclonal antibodies to Botox for migraine prevention
Adjunctive preventive therapy with a calcitonin gene–related peptide monoclonal antibody (CGRP-mAb) medication is safe and effective in patients with chronic migraine who have only achieved a partial response to onabotulinumtoxinA (Botox) treatment.
Investigators found the CGRP-mAbs significantly reduced the number of headache days and pain severity with adverse event rates similar to those reported in previous trials of these medications.
Although Botox is associated with significant clinical improvement in chronic migraine, it often fails to adequately control headache frequency and additional medications are needed. Three CGRP-mAbs have recently been approved for migraine prevention, with results from clinical trials demonstrating they are effective for both chronic and episodic migraine. Patients treated with Botox had been excluded from these earlier trials, however. Read more.
For more on COVID-19, visit our Resource Center. All of our latest news is available on MDedge.com.
Here are the stories our MDedge editors across specialties think you need to know about today:
A ‘Fraternity of People Who Are Struggling’
Kathleen Ronan spent a week in a New Jersey hospital, including 5 days in the ICU, battling the novel coronavirus.
Her years of working as a home health nurse told her that the return home wouldn’t be easy, but nothing prepared her for just how much she would struggle. The once-active Ronan, 51, now needed a walker to traverse the few steps from her bed to the toilet, an effort that left her gasping for air. Her brain couldn’t even focus on an audiobook, let alone a short magazine article. “It just completely knocked the stuffing out of me,” Ronan said.
Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of patients leaving the ICU, researchers have documented what they call post–intensive care syndrome (PICS) — a constellation of physical, cognitive, and psychiatric symptoms that result from an ICU stay. Although underlying illness plays a role in these symptoms, the amount of time spent in critical care is a major factor.
The good news is that over the past decade, researchers have made important strides in understanding what makes PICS symptoms worse and how critical care physicians can tweak ICU protocols to reduce PICS severity. Practitioners will need to draw on this knowledge to help Ronan and the thousands of COVID-19 ICU patients like her. Read more.
The evolution of ‘COVIDists’
At the start of the pandemic earlier this year hospitalists at Baystate Health in Western Massachusetts realized the necessity of a new model of care for COVID-19 patients. Challenges included a massive surge of COVID-19 patients, a limited supply of PPE, an inadequate number of intensivists for managing the anticipated ventilated patients, and the potential of losing some of our workforce if they became infected. Hospitalists there came up with an elaborate plan to manage the disease burden and the strain on resources effectively.
A focused group of 10 hospitalists who volunteered to take care of COVID-19 patients with a particular interest in the pandemic and experience in critical care were selected, and the term “COVIDists” was coined to refer to them. The group underwent rapid training in various treatment protocols and ongoing clinical trials.
All the hospitalized COVID-19 patients were grouped together to COVID units, and the COVIDists were deployed to those units geographically. COVIDists were given lighter than usual patient loads to deal with the extra time needed for donning and doffing of PPE and for coordination with specialists. COVIDists were almost the only clinicians physically visiting the patients in most cases, and they became the “eyes and ears” of specialists since the specialists were advised to minimize exposure and pursue telemedicine consults. Read more.
How low should you go?
Cardiovascular risk continues to reduce as systolic blood pressure decreases right down to levels as low as 90 mm Hg, according to a new study.
Researchers analyzed data from a cohort of 1,457 participants (mean age, 58 years) who did not have any traditional cardiovascular risk factors and had a systolic blood pressure level between 90 and 129 mm Hg at baseline. Results showed that, during a mean follow-up of 14.5 years, there was an increase in traditional cardiovascular risk factors, coronary artery calcium, and incident cardiovascular events with increasing systolic blood pressure levels.
“We modeled systolic blood pressure on a continuous scale and saw the risk increasing in a linear fashion as blood pressure increased and this occurred right down to 90 mm Hg. We didn’t see any nadir or J-point where there may be an increased risk at lower pressures,” said lead author Seamus Whelton, MD, assistant professor of medicine at the division of cardiology at Johns Hopkins Medicine, Baltimore.
“From an individual level we can now say that in healthy individuals, a systolic pressure in the 90s is not too low. It is a positive thing. And it is recommended to try and keep systolic pressure at these levels if possible by maintaining a healthy lifestyle,” Dr. Whelton said in an interview. Read more.
Asthma tops spending on avoidable pediatric inpatient stays
Asthma costs nearly equaled potentially avoidable hospital bills for diabetes, gastroenteritis, and UTIs combined in a study of in-patient stays among children aged 3 months to 17 years.
Indeed, hospital charges for the treatment of children with asthma made up nearly half of all potentially avoidable pediatric inpatient costs in 2017, according to the Agency for Healthcare Research and Quality.
The cost of potentially avoidable visits for asthma that year was $278 million, versus $284 million combined for the other three conditions, Kimberly W. McDermott, PhD, and H. Joanna Jiang, PhD, reported in an AHRQ statistical brief.
The state inpatient databases of the AHRQ’s Healthcare Cost and Utilization Project included 1.4 million inpatient stays among children aged 3 months to 17 years in 2017, of which 8% (108,300) were deemed potentially preventable.
Rates of potentially avoidable stays for asthma (159 per 100,000 population), gastroenteritis (90 per 100,000), and UTIs (41 per 100,000) were highest for children aged 0-4 years and generally decreased with age, but diabetes stays increased with age, rising from 12 per 100,000 in children aged 5-9 years to 38 per 100,000 for those 15-17 years old, the researchers said. Read more.
Adding monoclonal antibodies to Botox for migraine prevention
Adjunctive preventive therapy with a calcitonin gene–related peptide monoclonal antibody (CGRP-mAb) medication is safe and effective in patients with chronic migraine who have only achieved a partial response to onabotulinumtoxinA (Botox) treatment.
Investigators found the CGRP-mAbs significantly reduced the number of headache days and pain severity with adverse event rates similar to those reported in previous trials of these medications.
Although Botox is associated with significant clinical improvement in chronic migraine, it often fails to adequately control headache frequency and additional medications are needed. Three CGRP-mAbs have recently been approved for migraine prevention, with results from clinical trials demonstrating they are effective for both chronic and episodic migraine. Patients treated with Botox had been excluded from these earlier trials, however. Read more.
For more on COVID-19, visit our Resource Center. All of our latest news is available on MDedge.com.