Jan Dyer

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.  

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.  

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.  

Black children aged 5 to 12 years are roughly twice as likely as white children to commit suicide, according to a study funded by the National Institute of Mental Health. But that trend reverses in adolescence: From ages 13 to 17 years, the suicide rates for white children are double those of black children.

The researchers used the CDC’s web-based Injury Statistics Query and Reporting System, analyzing data from 2001-2015 separately for each age group. The data were limited, the researchers say, and did not include information on contributing factors. They add that their findings highlight the need for a greater understanding of age-related racial disparities in youth suicide.

The disturbing findings are part of an overall rise in suicide nationwide. Suicide is the tenth leading cause of death in the US, according to the latest figures from the CDC. In 2016, nearly 45,000 Americans aged ≥ 10 years died by suicide.

In 2017, the CDC released Preventing Suicide: A Technical Package of Policy, Programs, and Practices, with evidence-based strategies (https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html). The strategies include creating protective environments by reducing access to lethal means among at-risk individuals and intervening at “suicide hotspots” by, for example, putting barriers on tall structures. “Like most public health problems,” the guide says, “suicide is preventable.”

Black children aged 5 to 12 years are roughly twice as likely as white children to commit suicide, according to a study funded by the National Institute of Mental Health. But that trend reverses in adolescence: From ages 13 to 17 years, the suicide rates for white children are double those of black children.

The researchers used the CDC’s web-based Injury Statistics Query and Reporting System, analyzing data from 2001-2015 separately for each age group. The data were limited, the researchers say, and did not include information on contributing factors. They add that their findings highlight the need for a greater understanding of age-related racial disparities in youth suicide.

The disturbing findings are part of an overall rise in suicide nationwide. Suicide is the tenth leading cause of death in the US, according to the latest figures from the CDC. In 2016, nearly 45,000 Americans aged ≥ 10 years died by suicide.

In 2017, the CDC released Preventing Suicide: A Technical Package of Policy, Programs, and Practices, with evidence-based strategies (https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html). The strategies include creating protective environments by reducing access to lethal means among at-risk individuals and intervening at “suicide hotspots” by, for example, putting barriers on tall structures. “Like most public health problems,” the guide says, “suicide is preventable.”

Black children aged 5 to 12 years are roughly twice as likely as white children to commit suicide, according to a study funded by the National Institute of Mental Health. But that trend reverses in adolescence: From ages 13 to 17 years, the suicide rates for white children are double those of black children.

The researchers used the CDC’s web-based Injury Statistics Query and Reporting System, analyzing data from 2001-2015 separately for each age group. The data were limited, the researchers say, and did not include information on contributing factors. They add that their findings highlight the need for a greater understanding of age-related racial disparities in youth suicide.

The disturbing findings are part of an overall rise in suicide nationwide. Suicide is the tenth leading cause of death in the US, according to the latest figures from the CDC. In 2016, nearly 45,000 Americans aged ≥ 10 years died by suicide.

In 2017, the CDC released Preventing Suicide: A Technical Package of Policy, Programs, and Practices, with evidence-based strategies (https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html). The strategies include creating protective environments by reducing access to lethal means among at-risk individuals and intervening at “suicide hotspots” by, for example, putting barriers on tall structures. “Like most public health problems,” the guide says, “suicide is preventable.”

As more hospitalized patients develop infections that are immune to antibiotics, researchers are looking into new preventive therapies. National Institute of Allergy and Infectious-supported researchers are studying monoclonal antibodies and their effects on Pseudomonas aeruginosa (P aeruginosa) and Staphylococcus aureus (S aureus), which are among the antibiotic-resistant bacteria that the World Health Organization says pose the greatest risk to human health.

The monoclonal antibodies can be administered along with standard antibiotic therapy. Monoclonal antibodies have been used in cancer, Ebola, and respiratory syncytial virus but rarely have been used to target bacterial pathogens, National Institute of Health says.

One trial, EVADE, will evaluate the safety of the investigational medicine MEDI3902 and whether it can prevent pneumonia caused by P aeruginosa. The other study, SAATELLITE, will test the safety and efficacy of another investigational medicine, suvratoxumab, against S aureus. The researchers hope to enroll 30 patients from 15 intensive care units.

As more hospitalized patients develop infections that are immune to antibiotics, researchers are looking into new preventive therapies. National Institute of Allergy and Infectious-supported researchers are studying monoclonal antibodies and their effects on Pseudomonas aeruginosa (P aeruginosa) and Staphylococcus aureus (S aureus), which are among the antibiotic-resistant bacteria that the World Health Organization says pose the greatest risk to human health.

The monoclonal antibodies can be administered along with standard antibiotic therapy. Monoclonal antibodies have been used in cancer, Ebola, and respiratory syncytial virus but rarely have been used to target bacterial pathogens, National Institute of Health says.

One trial, EVADE, will evaluate the safety of the investigational medicine MEDI3902 and whether it can prevent pneumonia caused by P aeruginosa. The other study, SAATELLITE, will test the safety and efficacy of another investigational medicine, suvratoxumab, against S aureus. The researchers hope to enroll 30 patients from 15 intensive care units.

As more hospitalized patients develop infections that are immune to antibiotics, researchers are looking into new preventive therapies. National Institute of Allergy and Infectious-supported researchers are studying monoclonal antibodies and their effects on Pseudomonas aeruginosa (P aeruginosa) and Staphylococcus aureus (S aureus), which are among the antibiotic-resistant bacteria that the World Health Organization says pose the greatest risk to human health.

The monoclonal antibodies can be administered along with standard antibiotic therapy. Monoclonal antibodies have been used in cancer, Ebola, and respiratory syncytial virus but rarely have been used to target bacterial pathogens, National Institute of Health says.

One trial, EVADE, will evaluate the safety of the investigational medicine MEDI3902 and whether it can prevent pneumonia caused by P aeruginosa. The other study, SAATELLITE, will test the safety and efficacy of another investigational medicine, suvratoxumab, against S aureus. The researchers hope to enroll 30 patients from 15 intensive care units.

American Indians and Alaska Natives (AI/ANs) have a high risk of diabetes-related vision loss, in part because only half get the annual eye exam needed for timely diagnosis and treatment. But using an innovative telemedicine program, IHS increased the number of AI/ANs who receive an annual retina exam by 20% from 2007 to 2015.

The IHS teleophthalmology program, established in 2000, provides high-quality retinal exams in primary care clinics. More than 70,000 retinal exams have been done for AI/AN patients, IHS says. The exam can be done during a regular office visit without dilation. The retinal photographs are sent electronically to a central reading center where they’re interpreted by trained and certified IHS eye doctors.

The program, available at about 100 sites in 25 states, has not only increased access, IHS says, but also reduced the overall cost of care by preventing complications resulting from delayed or missed care. Screening and treating eye disease in patients with diabetes mellitus costs $3,190 per quality-adjusted life-year saved, IHS says; $840,000 would be saved annually in detecting high-risk diabetic retinopathy (DR). Another $1,090,000 would be saved by reducing the need for additional surgery for complications resulting from delayed identification of patients with high-risk DR.

The program has been validated to American Telemedicine Association Category 3, meaning its clinical outcome is equal to or better than a conventional eye examination for DR. As one of the few and largest programs validated and operating at this level, IHS says the teleophthalmology program has brought high-quality point-of-care specialty service to more than 150,000 AI/AN patients.

American Indians and Alaska Natives (AI/ANs) have a high risk of diabetes-related vision loss, in part because only half get the annual eye exam needed for timely diagnosis and treatment. But using an innovative telemedicine program, IHS increased the number of AI/ANs who receive an annual retina exam by 20% from 2007 to 2015.

The IHS teleophthalmology program, established in 2000, provides high-quality retinal exams in primary care clinics. More than 70,000 retinal exams have been done for AI/AN patients, IHS says. The exam can be done during a regular office visit without dilation. The retinal photographs are sent electronically to a central reading center where they’re interpreted by trained and certified IHS eye doctors.

The program, available at about 100 sites in 25 states, has not only increased access, IHS says, but also reduced the overall cost of care by preventing complications resulting from delayed or missed care. Screening and treating eye disease in patients with diabetes mellitus costs $3,190 per quality-adjusted life-year saved, IHS says; $840,000 would be saved annually in detecting high-risk diabetic retinopathy (DR). Another $1,090,000 would be saved by reducing the need for additional surgery for complications resulting from delayed identification of patients with high-risk DR.

The program has been validated to American Telemedicine Association Category 3, meaning its clinical outcome is equal to or better than a conventional eye examination for DR. As one of the few and largest programs validated and operating at this level, IHS says the teleophthalmology program has brought high-quality point-of-care specialty service to more than 150,000 AI/AN patients.

American Indians and Alaska Natives (AI/ANs) have a high risk of diabetes-related vision loss, in part because only half get the annual eye exam needed for timely diagnosis and treatment. But using an innovative telemedicine program, IHS increased the number of AI/ANs who receive an annual retina exam by 20% from 2007 to 2015.

The IHS teleophthalmology program, established in 2000, provides high-quality retinal exams in primary care clinics. More than 70,000 retinal exams have been done for AI/AN patients, IHS says. The exam can be done during a regular office visit without dilation. The retinal photographs are sent electronically to a central reading center where they’re interpreted by trained and certified IHS eye doctors.

The program, available at about 100 sites in 25 states, has not only increased access, IHS says, but also reduced the overall cost of care by preventing complications resulting from delayed or missed care. Screening and treating eye disease in patients with diabetes mellitus costs $3,190 per quality-adjusted life-year saved, IHS says; $840,000 would be saved annually in detecting high-risk diabetic retinopathy (DR). Another $1,090,000 would be saved by reducing the need for additional surgery for complications resulting from delayed identification of patients with high-risk DR.

The program has been validated to American Telemedicine Association Category 3, meaning its clinical outcome is equal to or better than a conventional eye examination for DR. As one of the few and largest programs validated and operating at this level, IHS says the teleophthalmology program has brought high-quality point-of-care specialty service to more than 150,000 AI/AN patients.

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.

The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.

At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.

The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.

Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.

The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.

Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.

Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.

A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.

Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.

Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.