American Heart Association — Hyperlipidemia

The AHA site for hyperlipidemia begins by explaining what the condition is, followed by a breakdown of the five major families of blood lipoproteins. An explanation of the monitoring cholesterol and how high cholesterol can often be tied to difference between hyperlipoproteinemia, hypercholesterolemia, and hypertriglyceridemia is provided, followed by a list of related AHA publications on these topics. In addition to those AHA publications, the hyperlipidemia page also provides links to educational websites on other topics that are geared toward patients, such as cholesterol, metabolic syndrome, and triglycerides.

Managing Cholesterol: An Interactive Health Tutorial

This module about cholesterol, developed by MedlinePlus, is available as a multimedia tutorial, with questions, as a self-running presentation, or as a downloadable PDF file. The module provides an overview of cholesterol and discusses the causes of high cholesterol and how the condition is diagnosed. The information about treatment options begins by providing general guidelines for other conditions, such as diabetes and thyroid problems. The treatment section also discusses how medication and dietary changes can be used to manage high cholesterol.

The three major recommendations discussed in this guideline, which was put together by the National Guideline Clearninghouse (NGC), focus on primary prevention, secondary prevention, and cost effectiveness. Topics covered within both prevention sections include screening, risk, and treatment. Cost effectiveness focuses on the medications that are both effective for treating hyperlipidemia and inexpensive, relative to other treatment options. The NGC includes numerical and alphabetical grading systems that judge the strength of the various recommendations, which physicians can use as an additional tool for judging the value of the guidelines.

The NLA prominently features four resources on their homepage, grouped together toward the bottom of the site, that physicians will find particularly helpful. The ReachMD program Lipid Luminations is a series of podcasts that review recent conferences, news updates, and treatment guidelines, and the link to theheart.org gives physicians a preview of what they can find there, with links to recent news stories and study findings. This central spot for resources also showcases papers from the 

, the journal of the NLA, and recent chatter from the NLA forum, with links to particular conversations that the NLA has chosen to highlight. The NLA website also features CME activities, patient education resources, and details about upcoming meetings and conferences.

A Study of Nutraceutical Drinks for Cholesterol

To determine if a drink supplemented with red yeast rice, niacin, phytosterol esters, L-Carnitine, vitamin C, and Co-Q-10 helps to reduce cholesterol levels.

Effects of Amino Acids on Regional Lipid Metabolism

To determine the effect that amino acids have on treating elevated fat levels in the blood, and to understand how the treatment works.

Hyperlipidemia and Primary Prevention of Stroke: Does Risk Factor Identification and Reduction Really Work?

To determine if the guidelines and treatment options for hyperlipidemia, a major risk factor for stroke, have helped to reduce the incidence of stroke.

Despite lipid screening guidelines from the United States Preventive Service Task Force, statin medications, and lifestyle modifications — all geared toward treating hyperlipidemia &mdash; “there are numerous barriers to maintaining adequate control of lipids.”

This activity reviews hyperlipidemia as defined by the American Heart Association: “an elevation of lipids in the bloodstream.” The program should enable participants to “recognize common lipid disorder syndromes in general internal medicine and family practice clinics” and “describe the principles of managing common lipid disorders.”

This course reviews current guidelines for patients with a variety of lipid disorders, as “abnormalities in lipid metabolism contribute to increased risk for developing coronary heart disease and other forms of vascular disease.” Topics in this CME program include primary and secondary prevention, the importance of vascular inflammation in coronary heart disease, and dyslipidemia. Clinical learning objectives state that the program should allow participants to review the management of hypercholesterolemia, mixed dislipidemia, low HDL, and metabolic syndrome.

Gastric Bypass Surgery for Patients with Hyperlipidemia

In a University of Iowa study, extremely obese patients who had this surgery experienced a significant reduction in their cholesterol levels within 6 months of surgery, and overall lipid profiles continue to improve for as long as 6 years after the procedure.

Low-carbohydrate Diet Increase Levels of Low-density Lipoproteins

Low-carbohydrate diets significantly increase levels of low-density lipoproteins (LDL), and individuals on low-carbohydrate diets do not lose more weight than people eating diets that are high in carbohydrates, a study from the University of Colorado at Denver reveals.

Atherosclerosis Induced by Chronic Inhibition of the Synthesis of Nitric Oxide in Moderately Hypercholesterolaemic Rabbits Is Suppressed by Pitavastatin

To determine if pitavastatin effectively reduces atherosclerotic regions in moderately hypercholesterolemic rabbits.

When atherosclerosis was induced by chronic inhibition of itric oxide synthase (NOS), pitavastatin effectively suppressed atherosclerosis “via inhibition of macrophage accumulation and macrophage foam cell formation.”

Long-term Treatment with Pitavastatin Is Effective and Well-tolerated By Patients with Primary Hypercholesterolemia or Combined Dyslipidemia

To determine the safety and tolerability of pitavastatin (4 mg once daily) during 52 weeks of treatment, and to assess the the effect on lipid and lipoprotein fractions and ratios, and LDL-C target attainment.

Pitavastatin was effective and well tolerated by patients with primary hypercholesterolemia or combined dyslipidemia. Additionally, about three-quarters of patients “achieved NCEP and EAS LDL-C targets at week 52, and HDL-C levels rose continually during follow up, while changes in other efficacy parameters were sustained over the year-long study.”

Pitavastatin (Livalo) for Hyperlipidemia and Mixed Dyslipidemia: A Novel Therapeutic Agent, or a ‘Me-Too’ Drug?

To review the use of pitavastatin for the treatment of hyperlipidemia by examining “the available data from clinical trials as well as other information relevant to clinical practice.”

In studies against other drugs in its class, pitavastatin has demonstrated high potency and has been shown to significantly reduce atherosclerotic plaque volumes. However, the researchers caution that, “because the 20-mg dose of atorvastatin was a poor comparator, pitavastatin should not replace standard therapy after ACS.”

Articles

Feature Articles

Access a collection of resources on hyperlipidemia for you and your patients.

The Net Guide: Hyperlipidemia

Read personal stories from migraine sufferers, articles on the latest research, and tips from Health Central’s migraine section. Visitors can use the Ask the Clinician tool, featured in the community section, where questions can be submitted and each week health experts respond. Past questions answered have included “Are severe headaches worsened by coughing, sneezing, bending?” and “How does a migraine cause stuttering or slurring of words?” Additionally, there is a community forum, where visitors can connect to others, a migraine glossary, where they can research commonly used and associated terms, and a number of videos that outline symptoms, treatments, and more. Videos include “Find out the Key Cause of Migraine Pain” and “Nerve Stimulation Leads to Migraine Relief.”

This extensive 10-page section on Migraine will leave visitors pretty knowledgeable on all the basics including causes and triggers, preventative steps, and treatment options. Under the “What are some variants of migraine headaches?” header, patients can read about vertebrobasilar migraines, hemiplegic migraines, or retinal and ocular migraines in detail. In the “What should migraine sufferers do portion?” the writers advise patients to create regular sleeping and waking schedules, exercise regularly, limit caffeine, and other lifestyle changes for optimal health. A slideshow on headaches and migraine triggers is also available for viewing and lists a number of possibilities including the boss as a possible culprit, warm weather, and strong scents.

Featuring podcasts, blogs, articles on headache information, patient stories, and more, the National Headache Foundation’s website offers a number of resources for patients with migraine and headache. In the “Programs” section, visitors can read about local events taking place, read poetry, and view artwork submitted by migraine sufferers. In the “Education” section, visitors can access quizzes, multimedia tools, checklists, and instructional health modules. The site also features information for health professionals in the form of CME activities, links to clinical trials, tools, and information about fellowships, research grants, and more.

This program “reviews migraine epidemiology and comorbidities,” provides an understanding of migraine, pathophysiology, and diagnostic criteria, and discusses “new treatment options.”

This activity is designed to help physicians “recognize the various classes of migraine and its impact on quality of life,” “explain the different phases of a migraine headache,” and “describe available treatment strategies for the management of migraine.”

Comorbid Migraine Does Not Affect Efficacy of Milnacipran in Management of Patients with Fibromyalgia (APS 2010)

This activity helps physicians to “demonstrate management strategies to provide adequate pain relief for a spectrum of patients with chronic pain,” “compare existing and novel pharmacologic agents and technologies under investigation for pain management,” and “select appropriate therapies for patients that will provide effective analgesia while minimizing risk.”

Migraine Is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders

Franco A, Goncalves D, Castanharo S, et al.

The study is designed to “assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD.”

The study included “158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls.” The results demonstrated that “among individuals with TMD, migraine was the most prevalent HA (55.3%), followed by tension-type headache (30.2%),” and 14.5% had no headache. The researchers concluded that “TMD was associated with increased primary HA prevalence rates” and migraine was the most common primary HA diagnosis” for those with TMD.

Association between Body Mass Index and Migraine

Téllez-Zenteno J, Pahwa D, Hernandez-Ronquillo L, et al.

To “explore the prevalence of overweight and obesity in patients with migraine.”

The researchers studied “1,371 patients with migraine and 612 controls.” Age and gender were matched for both groups. The results demonstrated that “overweight and obesity in migraine patients versus controls” was “statistically significant;” however, no “association was found between the disability and severity of migraine and BMI.”

Plasma and Saliva Levels of Nerve Growth Factor and Neuropeptides in Chronic Migraine Patients

The study was designed to “investigate the level and interrelationship of nerve growth factor (NGF) and sensory neuropeptides [substance P (SP), calcitonin gene-related peptide (CGRP)]” in the “plasma and saliva of chronic migraine patients.” Researchers also sought to “analyze the association between pain intensity and their concentration.”

The “plasma and resting whole saliva were collected from 33 chronic migraine patients and 36 control subjects.” The results demonstrated that “chronic migraine patients showed higher NGF and neuropeptide levels in both plasma and saliva.” Also of note, “plasma NGF, and plasma and saliva levels of SP and CGRP were highly associated with pain intensity.” The researchers concluded that the “increased production of NGF and sensory neuropeptides may play an important role in the maintenance of pain in chronic migraine and analysis.”

Pilot Study to Compare Frovatriptan vs. Topiramate for Prevention of Migraine

This study will “compare the effectiveness of daily treatment vs. treatment during the pre-headache phase for prevention of migraine.”

Treximet in Acute Migraine Headache: Assessing Cognitive Function

The study is designed to “determine the type and intensity of cognitive dysfunction associated with migraine headache” and to evaluate the extent that “Treximet may relieve the cognitive dysfunction in a safe and effective manner.”

Trial of Comprehensive Migraine Intervention

The goal of the study is to “determine whether a migraine protocol designed for use in an emergency room can be used to deliver the headache care that many migraine patients never receive.”

A Study to Evaluate the Efficacy and Tolerability of Rizatriptan for Treatment of Acute Migraine in Children and Adolescents

The study is designed to “provide efficacy data for Rizatriptan in children and adolescents.”

Formulation and Evaluation of Rizatriptan Benzoate Mouth Disintegrating Tablets

Indian Journal of Pharmaceutical Sciences 

The investigation was designed to develop and evaluate mouth disintegrating tablets of rizatriptan benzoate.

The team developed the disintegrating tablets using “superdisintegrants crospovidone, carboxymethylcellulose calcium, Indion 414 and Indion 234” through the “direct compression method.” The tablets were evaluated for “thickness, uniformity of weight, content uniformity, hardness, friability, wetting time, in vitro and in vivo disintegration time, mouth feel, in vitro drug release and assay by high performance liquid chromatography.” The researchers found that the “formulation containing combination of crospovidone and Indion 234” produced the best results. Also, “apart from fulfilling all official and other specifications, the tablets exhibited higher rate of release.”

Mind Your Heart: Migraines Linked to Heart Disease

The Net Guide: Migraine and Headache

This site serves as an excellent starting point for patients with food allergies; visitors can access information specific to a certain type of food allergy, such as milk, egg, peanut, tree nuts, fish, shellfish, soy, and wheat, or obtain more general information. Also featured are tips on grocery shopping; an animation depicting how an allergic reaction occurs; articles on food allergies; a back-to-school toolkit featuring lunch suggestions, field trip tips, and a Food Allergy Action Plan; pointers on how to read a food label; allergy-friendly recipes; daily tips; and a support network for teens with food allergies.

A growing number of children are developing allergies to nuts; with that in mind, KidsHealth.org created this page to educate young patients on how nut allergies can be managed. The site provides easy-to-read content focusing on topics such as why the body goes “nuts over nuts,” how nut or peanut allergies are diagnosed and treated, creating an emergency plan, how to handle a nut or peanut allergy, and the effects of allergic reactions. Visitors can also download audio of the article, and print a list of foods to avoid.

American Academy of Allergy, Asthma & Immunology

At this site, healthcare professionals who treat patients with allergies can find an abundance of useful resources. Here, physicians can learn about a program designed to “advance allergy and asthma care for underserved populations by placing participating volunteer allergist/immunologists at community clinics in underserved areas;” read the “Ask the Expert” column, which has recently focused on topics such as cashew allergy and anaphylaxis possibly due to wheatgrass; access tools to help keep children with allergic diseases safe in school and access resources on converting to electronic records.

New England Journal of Medicine: Allergy/Immunology

This page features a collection of hundreds of articles covering topics such as allergy, monoclonal antibodies, immunodeficiency, and autoimmune diseases—some of which offer CME credit. Also included are case reports, reviews, and editorial commentary. Among the titles currently available are: “Allogeneic Hematopoietic Stem-Cell Transplantation for Sickle Cell Disease,” “Case 21-2008: An 11-Month-Old Boy with Fever and Pulmonary Infiltrates,” and “Food Allergy.” (Note: to access full content, a subscription to the journal is required.)

Allergic Rhinitis and the Costs of Undertreatment: A Clinical and Economic

Featuring four patient case studies, this program will focus on the clinical and economic burden of allergic rhinitis (AR) and disease sequelae; guidelines and methods designed to promote adherence to evidence-based treatment; the benefits, limitations, and pharmacoeconomics of all available treatment modalities, including pharmacotherapy and allergen immunotherapy; and methods used to support best practices in the management of AR and disease sequelae.

Critical Challenges in Allergic Diseases: Optimizing Outcomes in Patients with Allergic Rhinitis and Urticaria

This educational webcast aims to “improve the diagnosis and treatment of allergic rhinitis (AR) and chronic idiopathic urticaria and to provide a rational foundation for the development of effective allergen avoidance and treatment strategies.” Content covers the pathophysiology and immunologic underpinnings of AR and urticaria, risk factors for AR and urticaria and triggers of symptoms, comorbid conditions associated with poorly controlled AR, and the latest management strategies for AR and urticaria.

Emergency Medicine: Allergic Reaction and Emergency Care

In this podcast, part of a collection offered by the Medical University of South Carolina, Sam Kini, MD, talks about emergency care for allergic reactions triggered by events such as insect stings and bites, food allergies, and drug allergies. Kini also identifies common symptoms of allergic reactions and explains how they are treated in the emergency department.

Allergy and Asthma Network Mothers of Asthmatics

Direct your patients and their families to this podcast channel from the Allergy and Asthma Network Mothers of Asthmatics, where they can listen as James Sublett, MD, discusses ways to reduce allergens and irritants in the home. Viewers can also learn about asthma-centered awareness efforts taking place in Washington, DC.

Allergic and Non-allergic Rhinitis in Swimmers: Clinical and Cytological Aspects

To describe the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms.

A group of elite swimmers aged 9-21 with rhinitis symptoms underwent a complete diagnostic workup both before and after one month of using a nasal clip while swimming. Of the swimmers, 44% had allergic rhinitis (AR), and 35% had a predominant neutrophilic inflammation. “The use of a nose clip reduced cellular infiltration and nasal resistances only in the subjects with neutrophilic rhinitis, whereas a clinical improvement was seen also in AR.”

Diet and Nutritional Status of Children with Food Allergies

To assess the food intake and nutritional status of children with food allergies following an elimination diet.

Results of a cross-sectional study demonstrated that children with food allergies had weight-for-age and height-for-age scores lower than controls, even when they received similar nutrient intakes. Therefore, “nutritional evaluation is essential for the follow up of children with food allergies.”

Allergy Immunotherapy for the Reduction of Asthma (AIR)

Albert Einstein College of Medicine of Yeshiva University

To determine the effect of allergy immunotherapy in decreasing asthma- and allergy-related disease in children who have multiple episodes of wheezing and who are at high risk for developing persisting asthma. Although allergy immunotherapy has been practiced for many years to treat asthma and environmental allergies in older children and adults, it has not yet been systematically studied in young children.

Peanut and Tree Nut Allergies on the Rise

More and more, peanut allergies and tree nut allergies are being reported in adults and children across the country. According to the results of a study published in 

The Journal of Allergy and Clinical Immunology

, 3 million Americans reported having a peanut allergy, a TN allergy, or both.

In this “Pediatric Points” blog post, Jill Taylor discusses findings from a National Institute of Allergy and Infectious Diseases study indicating that due to a lack of uniformity in diagnostic criteria, there are many people who think that they have a food allergy when they actually don’t.

Among the content examined in this report is a study presented at the American Academy of Allergy, Asthma & Immunology 2010 Annual Meeting examining the safety and efficacy of oral immunotherapy (OIT) for egg allergy in children. Results showed that children in the OIT group were more likely to pass an oral food challenge, and showed significant decreases in both egg IgE levels and egg percutaneous skin tests compared with the placebo group.

Omalizumab in the Treatment of Peanut Allergy

This open-label, non-randomized trial aims to assess whether treatment with omalizumab can eliminate or reduce symptoms of peanut allergy. The primary outcome measure will be the “proportion of patients who have a four-fold increase in the dose of peanut protein needed to induce positive challenge (with final threshold dose >1000 mg) at the 6-month oral food challenge.”

The Costs and Consequences of Omalizumab in Uncontrolled Asthma from a USA

To estimate the costs and consequences of treatment with omalizumab—an anti-immunoglobulin E antibody that improves symptoms in uncontrolled allergic asthma&mdash;compared to usual  care from a US payer perspective.

Researchers estimated payer costs, quality-adjusted survival (QALY), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses, and found that “adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment.”

The Net Guide: Allergies

AllergyCast is a free iPhone/iPod Touch application developed by the McNeil Consumer Healthcare Division, the makers of Zyrtec (Cetirizine). This application provides allergy and weather forecasts for locations specified by city/state or ZIP code. AllergyCast is visually appealing, and does the task it was designed to (deliver an allergy and weather forecast) without difficulty. Additionally, AllergyCast provides specific information on what pollen types are currently predominant. The app may be helpful for physicians who manage patients with allergies, is certainly useful for those who have allergies, and is an excellent example of how an app can be used to market another product, in this case an antihistamine.

Mediquations is a physician-developed medical calculator that features more than 220 medical calculations, support for US and SI units, and is available for the iPhone, iPad, and Android smartphones. Data entry is easy and intuitive. Mediquations has an excellent search function, the ability to designate favorite calculations for rapid reference, and a log of recent calculations that allows the user to quickly find a calculation from the list of over 220 in the current version. Calculation results can be shared by e-mail. Although medical calculations that require the results of another calculation are not linked, as in MedCalc, the app does provide detailed information about each calculation, including links to primary source literature. Mediquations is an excellent app for any healthcare professional who uses scoring systems or frequently uses medical calculations. It is an excellent value.

StatCoder is a comprehensive E&M coding resource for the iPhone and iPad. All E&M encounter types are included, and feedback on the appropriate level of coding is provided when different elements of the history, exam, or medical decision-making sections are tapped to indicate that the item was documented. This highly detailed feedback can help physicians improve the quality of their medical documentation. Additionally, undercoding becomes quite apparent and if accompanied with a change in billing habits, will result in increased charges for medical care provided. STAT E&M Coder is a resource valuable for practicing physicians (at any point in their career) who wish to improve the quality of their medical documentation and ensure that they get paid for the work they perform. Though more expensive than most iPhone medical apps, it will pay for itself in less than a day by reducing undercoding for E&M services. The only detractor to the app are the small buttons that are tapped to indicate if an item was documented.

How the Documents To Go App Can Be Used in Medicine [iPhone] 

Business users have long enjoyed the company of their Microsoft Office documents at all times in the form of the preloaded Documents To Go software on their Blackberries. Now, this venerable application looks to be acquainted with medical students.

The Future of Mobile Health—A Free Must Read Report Made for UNICEF 

PSFK, a trends research and innovation company based out of New York, made a fabulous presentation for the United Nations Children’s Fund. The presentation has 207 slides, which provide a great comprehensive review of where we currently stand in the medical/healthcare app ecosystem.

Google Shows how Mobile Healthcare Apps can Sync with their Personal Health Record

At the recent O’Reilly Open Source Convention, Google took time to show mobile apps they have created that can collect what most would consider benign, everyday data, such as how much you run every day. This type of data collecting, “Observations of Daily Living”, can be entered into your Google Health personal health record.

Cardiothoracic Surgeon Develops App to Predict Risk of Heart Surgery

Dr. Edward Bender of Missouri has released five iPhone apps, all designed to assist patients and surgeons contemplating cardiac and thoracic procedures. His newest iPhone app, CTSNetWiki, gathers data from all the major cardiothoracic societies to allow patients and doctors to compute the risk of various heart surgeries.

This month, physician reviewer Robert Robinson, MD, shares his thoughts on three apps for the iPhone.

App Wrap

Atul Gawande, MD, MPH, centers this tragic and uplifting 

piece around the story of Sara Thomas Monopoli, who finds out in her 39th week of pregnancy that she has non-small cell lung cancer that has “metastasized to multiple lymph nodes in her chest and its lining.” She and her family struggle to balance the competing desires for survival and quality of life, a dynamic that spirals out of control as Thomas Monopoli’s condition worsens and all involved find themselves unprepared to make end-of-life decisions on the fly. Gawande, who is the Associate Director of Brigham and Women’s Hospital’s Center for Surgery and Public Health, was one of the unprepared, having seen Thomas Monopoli for an unrelated thyroid cancer. “Given the extent of the surgery that would have been required, and the potential complications, the best course was to do nothing. But explaining my reasoning to Sara meant confronting the mortality of her lung cancer, something that I felt ill-prepared to do.” The moral of the story? Have these discussions before you get sick, and if you get sick and haven’t, start talking early. No one wants family members to have to decide by committee in an ICU whether you’d be better off dying.

Some of the greatest technological marvels ever created were born out of the conversations that follow this question, which unfortunately is typically asked in the wake of a major disaster. Bridges collapse and we get safer bridges; food becomes contaminated and we get better manufacturing processes; prisoners escape and we get more secure prisons. So if there’s any silver lining to the oil spill in the Gulf of Mexico, it’s that in the future, offshore oil exploration will come with more stringent safeguards. Your patients can benefit too. A bad experience with one informs the changes that allow you to deliver better care with every one after.

It Don’t Matter if You’re Black or White

What’s in the water over there in crazy old England? Am I right? Am I right? *elbow nudge* Quite a few stories have cropped up in recent years about both black and white children being born to the same mixed race parents (

), including two sets of twins born of the same mother (http://hcp.lv/9BxQ7I), and the strange case of a blond-haired white-skinned child born to two Nigerian parents with no mixedrace ancestry. Experts chalk it up to the mysterious ways of genetics, but remain baffled by the blond hair. “The hair is extremely unusual. Even many blond children don’t have blond hair like this at birth,” said Professor Bryan Sykes, head of Human Genetics at Oxford University.

In a confluence of ineptitude, CT brain perfusion scanners nationwide are delivering far more radiation (as much as 13 times the typical amount) than is indicated or necessary because of a desire for clearer images, a “counterintuitive” scanner feature intended to lower radiation that actually increases levels, and a lack of standards on both state and federal levels. Case in point: Alabama (where more than 10% of cases occurred) “does not define an acceptable dosing level. ‘No such thing as an overdose,’ said James L. McNees, director of the Alabama Office of Radiation Control.” Meanwhile, patients are left with thick bands of missing hair on their heads, other associated conditions, and no apologies.

“Independent of age, smoking, alcohol intake, physical activity, diabetes mellitus, hypertension, and depression,” getting more or less than seven hours of sleep was associated with cardiovascular disease in a West Virginia University School of Medicine study published in 

. The association “persisted in subgroup analyses by gender, race-ethnicity, and body mass index categories. Also, similar associations were observed when we examined myocardial infarction and stroke separately.”

These Pretzels Are Making Me Thirsty…and Nauseous…and Incontinent

So what’s in Kellogg’s cereal that’s making everyone sick? Why, 2-methylnaphthalene, that’s what! Or, at least that’s what health officials suspect, because neither the FDA nor the EPA has any “basic health and safety data for 2-methylnaphthalene.” This stems from a clause in the Toxic Substance Control Act which “exempted from regulation about 62,000 chemicals that were in commercial use.” Tragicomically, “In 1994, the EPA invited the chemical industry to submit health and safety data for 2-methylnaphthalene because it was being produced in large quantities,” said Mary F. Dominiak of the EPA. “Chemical manufacturers have yet to disclose that information.”

If your job requires you to sit for most of the day, you might want to get up and take a jaunt around the office a couple of times an hour. A recent study (

) found that sitting for 6 hours per day increases a woman’s risk of death by 37% (17% for men). Researchers found that the risk factor remained high even for those that exercise, though the probability skyrockets for those that don’t: “94 percent for women and 48 percent for men.”

Livescribe’s Echo Smartpen allows you to record page-specific audio as you take notes in a specially designed notebook. “Tap record, write down your key points, tap stop, tap your notes,” and everything spoken during the time spent taking down notes will be played back to you. Each pen can store content for up to eight notebooks simultaneously, the data of which can be uploaded to Livescribe Desktop, which stores both audio files and scanned copies of notebook pages. While useful, Echo ownership can be expensive over time, as a two-pack of 100-sheet notebooks costs $24.95.

Dictation Tool Doesn’t Eliminate Typing, but Comes Close

Nuance recently released version 11 of its highly successful Dragon NaturallySpeaking dictation software that boasts 99.6% accuracy, which, according to a 

review, means users no longer have to read training text in order to acclimate to the product and vice versa (

). Beyond simple dictation, the program allows users to control computer functions to the extent that you can tell it to Google something or search through your e-mail. NaturallySpeaking is a bit pricey (up to $799.99 for the Legal version), but with performance “three times faster than typing” and an automatic algorithm that learns from transcription errors to improve accuracy even further, you’ll more than make up for the outlay in increased productivity.

Mayo Clinic Unveils Healthcare-first Social Media Center

On July 27, the Mayo Clinic announced the debut of a healthcare-first Social Media Center (

), a tool the organization hopes will “accelerate effective application of social media tools throughout Mayo Clinic and spur broader and deeper engagement in social media by hospitals, medical professionals and patients to improve health globally.” For now, the site basically houses a (very informative) blog discussing topics such as keeping staff in the loop, dealing with the legal issues surrounding social media, and the importance of asking for forgiveness rather than permission. Mayo Clinic will reveal more about the Social Media Center when it hosts its second Social Media Summit, September 27-29 in Jacksonville, Florida.

How Using Social Media Benefits Physicians: A Mind Map

Jaquelyn Kittredge created this “mind map” as a way to explain all the “different possibilities” available to a “healthcare client” looking to get into the social media game. If you’re still hesitant or trying to convince colleagues to jump on the bandwagon, take a look at this; it might help make your case.

Free Tax Prep? But That Doesn’t Benefit Us!

If your state operates an easy-file tax program, watch out, because Intuit could be gunning to gut it. Despite “user satisfaction above 98%” for California’s free ReadyReturn and CalFile programs, and annual savings to taxpayers and the state of $4-$10 million and $500,000, respectively, the makers of TurboTax have spent $3.37 million since 2005 lobbying politicians to end the free program and replace it with their own, which costs more and provides less. Though their lobbying has been unsuccessful thus far, legislators aligned with Intuit “held back votes on 20 bills [in 2009]…kill[ing] funding for domestic violence shelters, police and fire departments, and prevention of swine flu outbreaks.”

don’t like to make fun of death (other than when it tries to take us from our beds at night while we’re hiding in the closet), but when egg-faced government officials are involved, we can’t help but snicker. Tokyo authorities, looking to congratulate the city’s oldest man, Sogen Kato, on his 111th birthday, went to his house and found a paja-maed mummy that had been lying in bed for 30 years. Whoops! The family, of course, had been collecting his pension all the while. Naturally, this revelation initiated a meeting with Tokyo’s oldest woman, 113-year-old Fusa Furuya, who, it turns out, hasn’t been seen since 1986 (

). Might want to tighten up the record-keeping system.

Younger brothers everywhere are going to have to change their dinosaur vocabulary a bit. Now when gutting their T. rex older brothers with three massive horns, they’ll have to go by the name Torosaurus, because, according to a new paleontological theory (

), “as many as a third of all known dinosaur species” are actually juvenile forms of other dinosaurs. Even worse, the horns may just have been for sex appeal (

). “I don’t imagine holding up a thin bony shield that can gush blood would be a very effective means of defense,” said researcher John Scannella.

Use these spreadsheets to figure out which airlines will rob you of the least amount of money on your next vacation. Smarter Travel has guides to overall fee schedules for American and European carriers, frequent flyer fees, carry-on bags, and a not-so-related-but-still-helpful guide to tipping.

Check Up

August 2010 MDNG: Primary Care/Cardiology Check Up

I am pleased to announce the launch of the next phase of HCPLive.com in early September 2010. The new version of our website will be a fully customizable portal designed to provide physicians with the latest news and information about developments that affect their specialty and the practice of medicine at large. We’ll cover breakthrough technologies, the latest social media tools for patients and physicians, the ongoing revolution in electronic medical records, results from key research studies, the happenings on Capitol Hill and in statehouses across the country that can have an impact on your practice, and more. HCPLive will be updated daily to deliver more unique online content and specialty coverage built with the healthcare professional in mind. I urge readers to register today to enjoy the full benefits of the new site when it launches -- it’s fast; it’s easy; and it’s free.

Registered HCPLive.com members will enjoy:

• MyHCPLive, which allows you to personalize your own page with your favorite HCPLive content, private e-mail access, weather, news, stock tips, and more

• The latest conference coverage, including interviews with KOLs, real-time coverage of the latest sessions, and podcasts covering breaking news in your specialty

• Webinars and white papers covering the topics that YOU care about, including healthcare reform, healthcare technology, practice management, and financial advice

 to sign up today. And watch your inbox for more news about HCPLive. com. I think you’ll agree that there’s nothing else like it online for today’s busy physician.

Editor's Note

HCPLive will deliver more unique online content and specialty coverage built with the health care professional in mind.

It'll Be the Biggest Thing Since the Internet

Facebook is rapidly becoming more popular than e-mail, with millions of users of all ages signing up for accounts. Maybe it’s time you checked it out to see what all the fuss is about.

“Why do I need Facebook?” my mom asked me again. I answered as I always have: “You don’t need it, Mom. It’s just another way of interacting with people. It’s a communications tool that allows you to stay in touch with people. Everyone finds their own way to use it. It’s fun. Try it out.”

“Most people I know use e-mail,” she usually replies. “I’ll just use that.” Until recently, I would have agreed with her and not pushed her to join Facebook, but recent data has made me think that perhaps she should give Facebook a test drive. Perhaps we all should.

Last year marked the first time that Americans began using Facebook more frequently than e-mail, with users spending 15.8% of their time on social networking sites and 11.5% of their time on e-mail. This year, e-mail is truly being left in the dust, according to research from The Nielsen Company (http://hcp.lv/9B2cCl), we spend nearly 23% of our time on social networking sites and only 8% on e-mail. Quite a change in just one year’s time!

The picture changes a bit when you look at cell phone use. We actually spend quite a bit more time using e-mail on our cell phones (41%) than we do on social networking (28%). However, with the availability of newer smartphones and more third-party applications that make it easier to access websites without going through a true Internet portal, it will be interesting to see how these numbers change in 2011.

This gets even more intriguing when we consider who is actually using sites like Facebook, whether on their PC or mobile device. The Nielsen report, “

Social Networking’s New Global Footprint

”, revealed that social networking is becoming a multigenerational experience, with its popularity increasing among members of the 50-64 generation and the 64 generation. In 2007-2008, the number of 50 to 64-year-ol users was twice that of teenagers. So, we can no longer say that social networking is a venue of the young. This is a communications tool that is touching all of our populations, which means that patients of all ages will come into our offices having been shaped by the health information they receive from their Facebook experiences.

Does this mean that e-mail will go the way of the dinosaurs? I doubt it. As popular as Facebook has become, it still has well-known privacy issues, so it is not the ideal tool for communicating in a health or business setting. Facebook won’t replace e-mail any more than texting has replaced voice calling on cell phones. Just as there are times that we need to speak directly to somebody instead of texting them, we will likely always need the secure, one-on-one, private communication of an e-mail, especially in health care.

Still, if you are not on Facebook, I encourage you to give it a try. Many of your friends and family (and patients) of all ages are probably on Facebook. It is valauble to know firsthand how our patients are getting their information online, and from what venues. Knowing the names of those venues doesn’t replace having personal experiences with them. You don’t have to be an expert, just be familiar enough to know what a “wall” and a news feed are, as well as the meaning of “what’s on your mind?”

Or, join because you just want to be part of the “now” conversation, as my mom decided to. Yes, it’s true: my mom took the Facebook plunge. She still prefers e-mail, but she does find it useful to get on Facebook to drop a quick “hi” or “happy birthday,” especially to friends and relatives in faraway places. As I’ve explained to her many times, there’s no right or wrong way to use it. You’ll find your way, and then you’ll be able to join the conversation your patients are now part of, and in growing numbers!

Gwenn Schurgin O’Keeffe, MD, FAAP, (aka “Dr. Gwenn”) is a pediatrician, health journalist, parenting and social media expert, and is CEO and Editor-In-Chief of Pediatrics Now (

), an online health and communications company dedicated to providing reliable information for today’s busy families. She also writes the blog Dr. Gwenn Is In (

Columns

Social Media Notebook: Is Facebook Making E-mail a Dinosaur?

Poor communication and incomplete information increase the risk of adverse events during transitions of care. The use of an integrated EMR system ensures physicians all along the continuum of care have access to the right data at the right time, reducing medical errors and improving outcomes.

Institute of Medicine report “To Err is Human,”

 published in 1999, focused the nation’s attention on the risk of medical errors in healthcare delivery. At the time, it was estimated that medical errors were the eighth leading cause of death in the United States. Medical errors do not occur only in hospitals; they occur in ambulatory patient environments, particularly in the setting of patients transitioning from one care environment to another (for example, from home to the hospital, hospital to home).

In the ambulatory environment, there are millions of patient visits to specialists each year. The baby boomers are aging and there are a growing number of adults living with multiple medical conditions. As a result, both the number of referrals by primary care physicians (PCPs) to specialists and patient self-referrals to specialists are growing. In either case, such specialty visits may result in the patient’s care regimen being modified.

When the patient has the specialty consultation, if the specialist is unaware of vital patient information—such as the patient’s current medications, allergies, recent test results, and histories&mdash;and the patient inadvertently or purposely omits information, the specialist may prescribe care and medications that could result in an adverse event.

If, after the specialist reviews the new care plan with the patient, the patient returns home and is confused about his or her new treatment regimen (for example, whether it is okay to take the medication prescribed by the specialist as well as other medications prescribed by his or her PCP), the patient may take the wrong doses, take the wrong medications, or omit important medications—any of which could result in an adverse event. If the patient’s primary care doctor has not received information about the specialty consultation and is unaware of the changes to the patient’s treatment plan, then he or she may continue to prescribe what may now be obsolete or redundant medications and care processes, or start new medications that could interact with those prescribed by the specialist, resulting in adverse events.

Given these examples, it is clear that there is a critical need to ensure access to the flow of vital information to all of these constituents across transitions of care. 

 demonstrated that, during more than one-fifth of all patient encounters (22%), physicians had access to incomplete patient information.

EMRs promote communication between providers, but only if everyone has access to the system

Despite the availability of improved communications technology, lack of access and interoperability can still pose challenges to care coordination. All too often, physicians who have an EMR need to communicate with another physician involved in the patient’s care who either uses another brand of EMR or who doesn’t have an EMR at all. In this situation, the EMR user frequently resorts to what I call the “dump truck method” of communication: they gather together and print every detail about the patient from their EMR and send it to the next treating clinician. The receiving clinician, already overloaded with work and information, must then sort through this excess and decide which data is important enough to manually enter into their own records. This is clearly disruptive to their clinical workflow and creates the risk that the clinician or staff might inadvertently omit important information or make an error while transcribing the information into their system.

Physicians working in a large integrated delivery network (IDN), who refer their patients within the IDN and share an EMR system, have all of the electronic records at hand when a patient arrives for a visit. The primary care provider and specialist can readily communicate through the EMR and maintain an updated patient record. The existence of this readily available data that the system can read, understand, report on, and re-use allows for a variety of measures that can improve quality and reduce errors, including:

		EMR clinical decision support, such as medication-allergy and medication interaction, alerts visible to the clinician at the point of care

		Appropriate medication management through real-time, point-of-care medication reconciliation

		Dramatically enhanced real-time clinician communication

		Graphically displayed results and trends

		Appropriate patient-centric disease management and health maintenance follow-up

Within an EMR-enabled IDN, these tools are available to the treating clinicians who share an EMR as part of their existing workflow. These doctors do not need to shuffle papers, log on to a separate electronic system, or enter data into their own records. All of the information they need is within their EMR exactly where they would expect to find it, regardless of whether the patient is referred by the patient’s PCP and being seen by the specialist, or is returning to the PCP after having seen the specialist.

There is a tremendous effort currently underway to increase EMR adoption and “meaningful use” by all clinicians in the United States, many of whom are already overburdened with their workloads. For this effort to be successful, we cannot expect clinicians to disrupt their workflow and toggle across multiple systems as well as juggle paper. In order to support patient safety across these transitions of care environments, it will be critical to enable the flow of discrete data (date-, time-, and source-stamped) across all EMR systems regardless of the manufacturer of the system, so that clinicians can access important patient information when and where they need to, with no disruption to their usual workflow.

As EMRs and personal health records are more broadly adopted in the United States, it is essential that vital patient information flow across these systems so that treating physicians are immediately aware of changes made to a patient’s care plan, and the patient always has the most up-to-date information regarding his or her care plan readily available to avoid any confusion and assist in patient compliance. Succinct information about the care plan made accessible to providers as part of their normal workflow, and to patients in their chosen format (eg, the Internet, or on paper), will dramatically help prevent adverse events and improve the quality of care.

Provides information about an intervention that “encourages patients to take a more active role in their health care” by providing them with “specific tools and skills that are reinforced by a ‘transition coach’ (a nurse, social worker, or trained volunteer) who follows patients across settings for the first four weeks after leaving the hospital.” The intervention includes several components, such as the use of a “patient-centered health record that helps guide patients through the care process.”

Project RED is a research group at Boston University Medical Center that “develops and tests strategies to improve the hospital discharge process in a way that promotes patient safety and reduces re-hospitalization rates.”

Among the goals of the Care Transitions Program is to improve skills among healthcare providers, enhance the ability of health information technology to promote health information exchange across care settings, implement system level interventions to improve quality and safety, and develop performance measures and public reporting mechanisms.

Care Transitions Quality Improvement Organization Support Center

Go here to learn about programs and initiatives dedicated to “improving coordination across the continuum of care… and promote seamless transitions from the hospital to home, skilled nursing care, or home health care.”

Transitions of Care Consensus Policy Statement

This document identifies five principles for effective care transitions, focusing on accountability, clear and direct communication of treatment plans and follow-up expectations, the provision of timely feedback, involving the patient and family where appropriate, unless inappropriate, in all steps, and “respect of the hub of coordination of care.”

Holly Miller, MD, MBA FHIMSS, is Chief Medical Officer of MedAllies. She is a longtime member of the 

How to Improve Patient Safety during Transitions of Care

There Are 7 Keys to Achieving Long-term Profit

From greater system efficiencies to improved reimbursement to better communication with patients and other providers, implementing a full-featured EMR system can produce many tangible benefits your practice, provided you have a clear understanding of total system costs.

The government continues to push physicians to adopt electronic medical records. But in spite of current stimulus funding, moving to an EMR still represents a large investment of time and money. Many physicians considering an EMR see nothing but new costs and new disruptions to practice flow. Yet, although implementing an EMR is expensive, physician practices of every size have succeeded in realizing a net financial gain from their EMR. What do these practices have in common? A steady commitment to getting the most out of electronic medicine. There are seven keys to achieving long-term profitability with an EMR.

August 2010