Performance-Based Medicine
Novartis Approval for Gene Therapy Signals New Cancer Treatment Era
The U.S. Food and Drug Administration gave a green light to Novartis AG's leukemia treatment, marking the first time that a highly anticipated new type of potent gene-modifying immunotherapy has gained approval in the United States.
Medicine Still a Lucrative Profession
- Medical specialists continue to be relatively highly paid.
- Male specialists earn significantly more than do women specialists.
- U.S. Physicians earn considerably more than physicians elsewhere in the developed world.
- Medicine is not the most highly paid profession per year of required education.
- Other professionals can earn more, sooner in a career, and with less training.
Surgery for Torn Meniscus in the Knee is Often Unnecessary, Ineffective, Misdirected
- Surgical meniscus repair was not superior to sham surgery in a randomized, controlled trial.
- Non-surgical care of meniscus-injury related pain, such as exercise, was equally or more effective than surgical interventions.
- Approximately 700,000 arthroscopic partial meniscectomies are performed annually in the U.S.
- Annual direct medical costs are estimated at $4 billion.
- Physicians and patients should consider all non-surgical options before undertaking surgical intervention for knee pain related to meniscus injury.
Ablation in Patients with Atrial Fibrillation
According to the American College of Cardiology, ablation is the first-line treatment for atrial fibrillation. Dr. Oussama Wazni weighs the pros and cons of this treatment option.
American College of Cardiology Issues New Atrial Fibrillation Treatment Guidelines
- Use the CHA2DS2-VASc score for determining which patients are at greatest risk of stroke.
- Clinicians should take an individualized approach to antithrombotic therapy.
- Strict rate control is preferred over lenient.
- Catheter ablation is a first-line option.
This Procedure Is Now First-Line A-Fib Therapy: New ACC Guidelines
- Recent guidelines from the American college of Cardiology offer important revisions regarding the management of atrial fibrillation.
- Ablation is now a first-line therapy.
- Cardiologists should now use the more precise risk stratification scoring system.
- Tight heart rate control is preferred over lenient control.
- Antithrombotic therapy is to be individualized based on shared decision-making between patient and physician.
Predicting Risk in AF: Which Stratification Scheme Performs Best?
- The CHA2DS2-VASc is better at discriminating truly low-risk patients and finding those at high risk as well.
- In the first validation study from the EuroHeart survey, CHA2DS2-VASc had a similar C statistic to CHADS2 but improved prediction in truly low-risk patients and classified only a small proportion into the intermediate-risk category.
- the more precise the risk tool is to assess future risk of stroke, the better the chance that low-risk patients can avoid anticoagulation and that those who will benefit from anticoagulation will be identified accurately.
- The major weakness of CHADS2 is that a substantial proportion of patients (approximately 60%) are assigned a score of 1, indicating an intermediate risk of stroke, and the benefit of application of anticoagulation to this subset is uncertain.
Studies Link Backpacks, Back Pain in Kids, Adults
- Studies link heavy backpacks with low back pain in children.
- Chronic low back pain in children is strongly linked to chronic low back pain in adulthood.
- Low back pain is one of the most frequent causes of missed work days and long-term disability.
- Backpack weight should not exceed 15% to 20% of child’s body weight.
- Societies and associations have published backpack guidelines to reduce incidence of low back pain.
- This cost-free healthcare could prevent extensive future medical interventions.
More than 15 Million Americans at Risk of Significant Kidney Damage
- Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide.
- H2 blockers are equally effective for acid control and pose significantly less risk.
- Long-term PPI exposure is linked to significantly increased risk of chronic kidney disease (CKD), CKD progression, and end-stage renal disease.
- The risk of developing these diseases correlated directly with the duration of therapy.
- PPI use was associated with CKD in all analyses, including a time-varying new-user design.
- Twice-daily PPI dosing was associated with a higher risk than once-daily dosing.
New Guidelines Endorse Daily Aspirin, Without a Doubt
- Daily low-dose aspirin appears to be one of the most cost-effective disease, morbidity, and mortality preventatives available.
- Updated guidelines from U.S. Preventive Services Task Force (USPSTF) call for the use of aspirin to prevent both cardiovascular disease and gastrointestinal cancers.
- Major medical societies endorse daily aspirin.
- Long-term use appears necessary; greatest benefit after 7.5 years of use.
- Cancer and cardiovascular disease are two of the leading killers of Americans.
- Vast literature now supports the use of daily aspirin to prevent disease.
Mobile Apps Found to Improve Management of Chronic Conditions
- Systematic review of randomized, controlled trials finds that mobile apps can benefit patients with chronic diseases.
- Review included 9 RCTs.
- Disease states included diabetes mellitus, cardiovascular diseases, and chronic lung diseases.
- Interventions ranged from automatic text messages to enhanced clinician contact.
Laparoendoscopic Single-Site Varicocelectomy Significantly Superior to Conventional Lap Approach
- Laparoendoscopic single-site varicocelectomy found to be superior surgical approach for resolution of varicocele.
- Cochrane meta-analysis included 6 trials
- Laparoendoscopic single-site varicocelectomy was superior to conventional laparoscopic surgery with respect to postoperative pain scores, time to convalescence, cosmetic satisfaction, and other clinical variables.
- Operative time was shorter with CTL-V versus LESS-V.
- There were no differences between LESS-V and CTL-V in hospital stay and postoperative complications.
Cancer Outcomes Influenced by Health Insurance Status
- Two studies published in Cancer reveal that uninsured and Medicaid-insured patients have worse outcomes than patients with private insurance.
- In these 2 studies, patients with private insurance had a clear survival advantage
- Based on SEER data on glioblastoma multiforme outcomes, researchers found that an uninsured patient was 14% more likely to have a shorter survival time than a patient who carried private insurance.
- A patient insured through Medicaid was 10% more likely to have a shorter survival time.
- In a study of the outcomes of men diagnosed with testicular cancer, compared with men with private insurance, uninsured men were 88% more likely to die.
- Men insured through Medicaid were 51% more likely to die of the disease.
Sitting Is the New Smoking: Urge Patients to Stand, Walk, Turn Off TV
- Prediabetes increasingly detected in middle-aged Americans with normal BMI.
- All patients should be tested for diabetes and prediabetes.
- Researchers attribute rise in pre-diabetes to sedentary lifestyle.
- Studies have shown sitting and a sedentary lifestyle to be a significant health risk.
- Sitting for more than 3 hours per day cuts life expectancy by at least 3 years.
- Extended TV watching also tied to decreased lifespan.
Middle-Age Hearing Loss Results in 33% Higher Healthcare Costs
- Individuals diagnosed with hearing loss had 33% higher healthcare payments.
- Middle-aged individuals with hearing loss expended $14,165 per year in healthcare expenditures versus $10,629 for those with normal hearing over a 1.5-year period.
- The onset of hearing loss has been found to be gradual, with prevalence tripling from the age of 50 years to 60 years.
- Age-related hearing loss affects more than 60% of U.S. adults aged ≥70; has been linked to increased risk of hospitalization, decreased quality of life, and increased risk of functional and cognitive decline.
- This cohort study included 561,764 individuals.