In the News
Fasting Blood Biomarker Alpha-Hydroxybutyrate Predicts Risk for Diabetes in New Study from HDL, Inc. and University of Utah
APIC Teaches the ABC’s of Antibiotic Resistance
Antibiotic resistance, responsible for more than 23,000 deaths per year in the US, is the theme of International Infection Prevention Week (IIPW), October 19-25. It is hosted annually by the Association for Professionals in Infection Control and Epidemiology (APIC). IIPW puts the spotlight on timely infection prevention issues facing patients and healthcare professionals.
"Antibiotic resistance is an urgent health concern that demands the full attention of healthcare professionals and consumers alike,” said APIC 2014 president Jennie Mayfield, BSN, MPH, CIC. “Patients and families have an important role to play in preventing overuse and helping to ensure appropriate use of antibiotics. With the rise of deadly antibiotic-resistant infections, everyone needs to be asking 'is this antibiotic really necessary?'”
APIC’s new informational poster for consumers on the ABC’s of antibiotics illustrates when antibiotics work and when they don't, what happens if antibiotics are used improperly, and the role that patients play in preventing the proliferation of antibiotic-resistant bacteria. The poster also includes the top five questions consumers should ask their healthcare professionals about antibiotics:
1. “Do I really need an antibiotic?”
2. “Can I get better without an antibiotic?”
3. “What side effects or drug interactions can I expect?”
4. “What side effects should I report to you?”
5. “How do you know what kind of infection I have? I understand that antibiotics won’t work for viral infections.”
Estimates from the Centers for Disease Control and Prevention (CDC) find that one of the most common bacteria responsible for healthcare-associated infections, C. difficile, could be reduced by 26 percent if the use of high-risk, broad-spectrum antibiotics was reduced by 30 percent. The White House recently announced a new Executive Order and National Strategy for Combatting Antibiotic-resistant Bacteria, which emphasized the need for antibiotic stewardship programs to help clinicians improve prescribing practices.
"International Infection Prevention Week is the perfect time to raise awareness about antibiotic resistance and the need for stewardship programs within healthcare institutions,” said Katrina Crist, CEO of APIC. “We are grateful to the numerous corporate champions and association partners who have joined with APIC to spread these important patient safety messages."
On October 21, APIC will host a complimentary webinar on antimicrobial resistance and stewardship programs to educate clinicians on the need to improve prescribing practices. The webinar will be presented by experts Ramanan Laxminarayan, PhD, director of the Center for Disease Dynamics, Economics & Policy, and Arjun Srinivasan, MD, associate director for Healthcare Associated Infection Prevention Programs for the CDC.
Additionally, APIC will be hosting a Twitter chat on October 22 at 2 p.m. ET. The conversation will focus on antibiotic resistance and the importance of preserving antibiotics. The hashtag for the chat is #IIPWChat.
In 2013 APIC launched a new campaign entitled “Infection Prevention and You” to help raise awareness of infection prevention issues and share resources with consumers. These resources and activities are a continuation of that campaign.
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at apic.org.
American Journal of Medicine to Publish Article Linking Psoriasis With Cardiometabolic Diseases
Mounting evidence that patients with psoriasis are at an increased risk of developing cardiovascular diseases and metabolic diseases ("cardiometabolic diseases") is the subject of an article to be published in the December 2014 issue of the American Journal of Medicine.
The article, titled "Accumulating Evidence for the Association and Shared Pathogenic Mechanisms between Psoriasis and Cardiometabolic Diseases," was written by seven councilors of the International Psoriasis Council (IPC), a global nonprofit focused on psoriasis research, education, and patient care. The article is a summary of the November 2013 meeting of the IPC Think Tank, an annual gathering of global psoriasis experts to discuss the most pressing issues facing the understanding and treatment of that disease.
At the meeting, a global panel of dermatology, immunology, and cardiovascular specialists discussed the status of research investigating the potential association of psoriasis with various cardiometabolic-related comorbidities.
Summarizing these discussions, the American Journal of Medicine article explores the potential shared pathogenic mechanisms, genetic connectivity, and inflammatory links between psoriasis and various cardiometabolic diseases such as heart disease, obesity, and diabetes.
"It is highly unique to have expert perspectives from a multitude of disciplines at once. These types of interactions accelerate our understanding of the association between various cardiometabolic conditions and psoriasis," said Dr. Nehal N. Mehta, an expert in cardiometabolic diseases and co-author of the article. "Based on the evidence presented and outlined at this symposium, the link between psoriasis and cardiometabolic diseases demonstrates strong mechanistic ties; however, definitive evidence still is elusive. More studies are needed to better understand this association."
Among the conclusions made and identified in the manuscript:
>>There is a need to elucidate the link between psoriasis and cardiometabolic pathophysiologic mechanisms in order to better manage the psoriasis patient.
>>Identification of shared pathways through transcriptome studies (studying RNA) and genome-wide association studies (GWAS) is shifting the psoriasis model to one that is analogous to other systemic pro-inflammatory states, such as atherosclerosis and metabolic syndrome.
>>Novel imaging techniques may be pivotal in identifying and quantifying inflammation in psoriasis and cardiometabolic disease.
>>Models of inflammation in healthy human subjects have illustrated a pro-inflammatory state characterized by large increases of cytokines that also are prominent in psoriasis, including TNF-a. These subjects showed temporary biochemical changes consistent with those found in cardiometabolic diseases, suggesting that inflammation does precede disease.
>>Prospective studies in patients starting at 30 years of age to monitor the development of metabolic diseases in psoriasis may be the only definitive way to better understand the temporal relationships between these two diseases.
"The Think Tank, resulting in the article, exemplifies IPC's mission to bring together leaders in psoriasis thereby advancing our understanding of this disease," said Prof. Christopher Griffiths, University of Manchester, UK, and IPC President.
Source: International Psoriasis Council, psoriasiscouncil.org
Fasting Blood Biomarker Alpha-Hydroxybutyrate Predicts Risk for Diabetes in New Study from HDL, Inc. and University of Utah
Could a single serum biomarker predict risk for diabetes as accurately as a more complex, hours-long diagnostic procedure?
According to researchers at Health Diagnostic Laboratory, Inc. (HDL, Inc.) and the University of Utah, the answer is "yes." In a newly published study, the scientists found that fasting levels of the serum marker alpha-hydroxybutyrate (a-HB), measured as part of a routine blood draw, could be a valuable clinical surrogate for the oral glucose tolerance test (OGTT).
The decades-old OGTT measures the body's ability to respond to a "glucose challenge," and can uncover impaired glucose metabolism and subsequent risk for diabetes. However, while the OGTT has been considered a standard in the prediction of diabetes risk, it is not often used in clinical practice due to the logistical difficulty of the procedure, which can take as long as three hours to administer.
The cross-sectional study from HDL, Inc., in which 217 patients were evaluated for diabetes risk with an OGTT and a blood panel of fasting biomarkers, found that elevated levels of a-HB were strongly predictive of abnormalities in glucose regulation, even after controlling for known risk factors such as age, gender, body-mass index, fasting glucose, and hemoglobin A1c. Remarkably, the research showed that a-HB was able to predict an impaired early insulin response during the OGTT, even in patients who would be considered low risk by conventional measures – thus offering a window for early lifestyle interventions that may delay or even halt disease progression.
"Our findings suggest that a-HB may have broad application as a rapid, sensitive, and inexpensive tool for detecting states of subclinical hyperglycemia, insulin resistance, and pancreatic beta-cell dysfunction indicative of increased risk for diabetes and cardiovascular disease," said Maciek Sasinowski, MD, PhD, Vice President of Clinical Affairs at HDL, Inc. and co-author of the study.
The research paper, "Serum alpha-hydroxybutyrate (a-HB) predicts elevated 1-hour glucose levels and early-phase beta-cell dysfunction during OGTT," was recently published in BMJ Open Diabetes Research & Care, the new joint venture between the British Medical Journal and the American Diabetes Association, and can be found highlighted as the current "Editor's Choice" at the journal's website: bit.ly/ahbstudyhdl.
The results are the latest to emerge from the comprehensive research effort at HDL, Inc. aimed at reducing the significant morbidity and mortality due to cardiovascular and cardiometabolic disease. Notably, a-HB is a key component of a broad, multimarker panel developed by HDL, Inc. that was recently shown to identify many patients with hidden risk for diabetes who were classified as normoglycemic by traditional tests.
For more information, visit myHDL.com, and make HDL, Inc. part of your digital lifestyle at Facebook.com/myhdl and on Twitter @hdltweets.
SOURCE Health Diagnostic Laboratory
Nurses and Physician Assistants Play a Key Role in Patient Support
Decision Resources Group finds that, as pharmas increasingly seek to differentiate their products and promote adherence through patient education and support resources, they should not neglect nurses and physician assistants (PAs). The “Taking the Pulse Nurses 2014” study has found that 79 percent of nurse practitioners (NPs) and 69 percent of PAs provide or recommend patient support resources to patients. NPs and PAs, in particular, are an important audience for pharmas, since they write prescriptions and enjoy broad autonomy in their practices. There is substantial demand for patient resources from pharma among these professionals—nearly 2 in 5 physician assistants agree that they would feel motivated to engage pharma digital assets more often if pharmas provided them more resources that they could share with their patients.
Other key findings from the “Taking the Pulse Nurses 2014” study include:
>>Increasing patient education: NPs and PAs are spending more time on patient education—47 percent of PAs and 43 percent of NPs say the time they spend on patient education has increased over the past two years.
>>Health professionals' use of EHRs: NPs and PAs spend much more time using electronic health records (EHRs) than physicians do—where physicians spend an average 2.8 hours per day using EHRs, PAs spend 4.4 hours in EHRs and NPs 4.7 hours. EHR use by these professionals increased significantly from 2013 to 2014, without a corresponding decrease in time spent on other digital resources.
>>Interest in pharma digital resources: There is strong interest among NPs and PAs in pharma digital resources tailored to their clinical and professional needs—for example, 42 percent of NPs indicated that they would be inclined to engage pharma digital resources more often if they were tailored to patient populations of interest.
Comments from Principal Analyst Matthew Arnold:
"Nurses and PAs are really healthcare reform's front line, and they play an important role in patient engagement. Those pharma companies that are making substantial investments in patient resources should factor the needs of these professionals into their outreach plans."
"The top priorities communicated to nurses and PAs by hospitals and practices were patient satisfaction, quality of care, and patient outcomes, so you can see the impact of healthcare reform-driven incentives on the provision of care, and those measures are fueling investment in patient-centric pill-plus add-ons by pharmas."
Arnold has also written a blog on the subject, which can be found here.
Source: Decision Resources Group, decisionresourcesgroup.com
Coffee Consumption May Increase Survival and Reduce Healthcare Costs
Xcenda, the strategic consulting arm of AmerisourceBergen, one of the largest global pharmaceutical sourcing and distribution service companies, recently conducted the first-ever health economic analysis on coffee consumption. This research was analyzed in an economic model and found that moderate coffee consumption was associated with an increase in life years and a reduction in healthcare costs. The study looked at population-level coffee consumption across the United States by reviewing meta-analyses on the association of coffee and chronic diseases and cancers.
"This is the first time that coffee consumption has been analyzed through the lens of health economics," said Amy Grogg, PharmD, President, AmerisourceBergen Consulting Services. "With our new healthcare system being hyper-focused on reducing costs and improving outcomes, health economic research critically examines the effectiveness and value of health-affecting behaviors, resources, and systems on a population. When we applied a health economic analysis to coffee, we were excited to see that this morning necessity may be a cost-effective means to improve health outcomes."
One of the study's key findings showed that coffee consumption was associated with increased life years at a population level. Moderate coffee drinkers gained a half-year over their lifetime compared with a 6.1 to 8.5 life year gain for those who quit smoking at the age of 35 and a 1.8 to 4.5 life year gain for physical activity person vs. an inactive person. The research also showed that coffee consumption may be a cost-effective way to prevent chronic disease such as Alzheimer's, depression, diabetes, heart failure, Parkinson's, and stroke, as well as cancer.
Furthermore, Xcenda quantified the potential health economic impact of coffee consumption in the United States for healthcare payers over one year by estimating the healthcare cost savings of coffee consumption associated with prevention of chronic disease. Of the diseases included in the analyses, the effect on diabetes prevention was the most impactful and was responsible for $175 annual healthcare savings per coffee drinker.
"Our health economic model estimated that coffee consumption prevents over 50,000 deaths per year due to chronic disease and cancer and results in an estimated healthcare savings of $33.4 billion per year," said Ken O'Day, PhD, MPA, and Director at Xcenda. "This shows us that coffee may be more than just a morning pick-me-up"
Xcenda's coffee study was conducted and tested by fellows and seasoned researchers throughout 2013. The company presented the findings at the 2014 ISPOR (International Society for Pharmacoeconomics and Outcomes Research) conference. For more information on Xcenda's Health Economics and Outcomes Research, visit xcenda.com.
Antibiotic Use by Age 2 Associated with Obesity Risk
Repeated exposure to broad-spectrum antibiotics in the first two years of life is associated with early childhood obesity, say researchers from The Children's Hospital of Philadelphia in a retrospective study based on data from electronic health records from the extensive CHOP Care Network.
The researchers found that children with four or more exposures to broad spectrum antibiotics during infancy were particularly more likely to be at risk for obesity. The study, published online September 29, 2014 in JAMA Pediatrics, did not directly examine cause and effect, said Charles Bailey, MD, PhD, lead author of the study, but he added, "as pediatricians, we're interested in whether events that happen early in life might reset the baseline and have a long-term effect on how the body regulates weight."
The researchers were intrigued by the emerging idea that the microbial population that begins to colonize shortly after birth in infants' intestines, known as the microbiome, plays an important role in establishing energy metabolism. Previous studies have shown that antibiotic exposure influences the microbiome's diversity and composition. "The thought is that the microbiome may be critically dependent on what is going on during infancy," Bailey added.
The study team analyzed electronic health records from 2001 to 2013 of 64,580 children with annual visits at ages 0 to 23 months, as well as one or more visits at ages 24 to 59 months within the CHOP Care Network. They assessed the relationships between antibiotic prescription and related diagnoses before age 24 months and the development of obesity in the following three years.
The investigators saw the association with broad-spectrum drugs, but they reported no significant association between obesity and narrow-spectrum drugs. For this study, they classified first-line therapy for common pediatric infections, such as penicillin and amoxicillin, as narrow-spectrum. They considered broad-spectrum antibiotics to include those recommended in current guidelines as second-line therapy.
"Treating obesity is going to be a matter of finding the collection of things that together have a major effect, even though each alone has only a small effect," said Patricia DeRusso, MD, director of the Healthy Weight Program, vice president of Medical Staff Affairs at Children's Hospital, and senior author of the study. "Part of what we are exploring in this study is one of those factors that we can possibly modify in the way we take care of kids and make it better."
Future investigations are needed involving multiple large pediatric health systems that will take a broader look at several populations and how adopting guidelines that accentuate the use of narrow-spectrum antibiotics might affect patients' risk of obesity, Dr. Bailey said. In addition to supporting this type of research locally, CHOP is also a key contributor to networks such as PEDSnet that link many children's hospitals to make more effective clinical research possible. Researchers also are looking at ways the microbial communities living in infants' intestines are swayed by dietary and environmental factors.
Childhood obesity has more than doubled in children over the past 30 years, according to the Centers for Disease Control and Prevention. Many will remain obese into adulthood and be susceptible to heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. Medical researchers at CHOP want to identify ways to intervene as early as possible, in order to avert the lifetime of medical, developmental, and social problems associated with obesity.
Source: The Children's Hospital of Philadelphia, chop.edu
New Imaging Tool May Allow Tailoring of Stroke Prevention to Each Patient
A study using a relatively new imaging tool, optical coherence tomography (OCT), offered a new look at the composition of carotid artery disease and has the potential to alter how physicians understand and treat the disease, a leading cause of stroke.
The study, conducted at Baptist Health Lexington between September 2010 and May 2012, was featured in the June 2014 issue of the Journal of the American College of Cardiology (JACC) Cardiovascular Interventions. Interventional cardiologist Dr. Michael R. Jones served as a principal investigator of the study, which also included neurosurgeons Dr. William H. Brooks and Dr. Christian N. Ramsey, neurointerventional radiologist Dr.Curtis A. Given II, and physicians from Case Western Reserve University in Cleveland, Ohio, and Pitangueiras Hospital in Jundiai, Brazil.
The study involved a retrospective review of 53 patients suspected of having carotid artery stenosis, a narrowing caused by the build-up of plaque. The patients—both symptomatic and asymptomatic for stroke—underwent diagnostic carotid angiography as well as OCT.
"Because OCT offers such high resolution images, we were able to identify some plaque as 'vulnerable' or 'unstable,'" explained Jones.
Physicians have suspected that unstable plaque is at risk for rupture. The body treats a rupture in a blood vessel as a wound and forms a blood clot to stop the bleeding. This clot can then dislodge from the plaque and travel to the brain causing a stroke. Less commonly, the plaque itself can break off and travel to the brain.
The study revealed that symptomatic patients had a larger percentage of unstable plaque but actually less blockage when compared to the plaque found in vessels of asymptomatic patients.
It has long been thought that opening carotid arteries severely narrowed by plaque—either with surgery or a stent—is one of the most effective ways to prevent stroke. The OCT study revealed that severity of the narrowing was not as much of a predictor of stroke as the composition of the plaque itself.
"This study, along with others sure to come, could change the way we test patients with carotid artery disease," Jones said. "It could be that they might be better served with looking at the type of plaque they have rather than by measuring the severity of their blockage."
Source: Baptist Health Lexington, BaptistHealthLexington.com