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.