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Measles in Our Not-So-Magical Kingdom

ABSTRACT & COMMENTARY: Routine vaccination would have prevented most of these recent cases in California.

Experts: Market case management to younger HC professionals

Case management is facing a major brain drain in the next decade as the bulk of its membership heads toward retirement.

Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis

The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.

Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina

Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?

Surgical Management of Infective Endocarditis

SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123.

HAI report: Hard-won gains fall short of ‘ambitious’ targets

Nobody said this was going to be easy. While much progress has been made, the unvarnished truth is that not one of the national health care associated infection (HAI) five-year reduction goals from 2009 to 2013 were met, the Centers for Disease Control and Prevention reports.¹

Physician Divorce Rates Lower Than Most Other Healthcare Professionals

A recent analysis on divorce rates among healthcare professionals in the U.S. paints a fairly rosy picture of home life for physicians.

A New Oral Treatment for Hyperkalemia: Patiromer

Patiromer (PAT) is an oral non-absorbable polymer that works by binding potassium (K+) in exchange for calcium in the distal colon. Currently available oral treatments for hyperkalemia are burdened by GI adverse effects as well as limited efficacy. Hyperkalemia is particularly problematic in chronic kidney disease (CKD), which may be compounded by the need to administer ACE inhibitors or angiotensin II receptor blockers (ARB).

Ambulatory BP Monitoring

The benefits of hypertension treatment (HTN), often cited as a 25% reduction in myocardial infarction, 40% reduction in stroke, and 50% reduction in heart failure, have generally been demonstrated in clinical trials based on an office blood pressure measurement. Since a substantial minority of patients enrolled in HTN trials — approximately one-third according to numerous estimates — ultimately turn out to have white coat HTN (wc-HTN), we may be underestimating the actual benefits of HTN treatment. Patients with wc-HTN do not suffer the same increased risk of cardiovascular events as HTN patients; hence, their inclusion in HTN trials “dilutes” treatment effects.

Pulmonary Embolism

For emergency physicians, acute pulmonary embolism (PE) provides a particularly complex diagnostic challenge. It has been estimated that 650,000 to 900,000 individuals annually suffer a fatal or nonfatal acute pulmonary embolism.¹ While the classic textbook clinical presentation is well known, it is insufficiently accurate and precise in the timely diagnosis of an acute PE. In addition, many patients presenting with seemingly typical exacerbations of their underlying cardiopulmonary disease or other chronic illness may be masking symptoms of an undiagnosed acute pulmonary embolism.² The high acuity coupled with the unreliable clinical presentation led to the development of several clinical tools, laboratory diagnostics, and radiographical studies to increase the clinician’s diagnostic power. This article we will review the Geneva Score and Wells Criteria, as well as the Kline and PERC rules. In addition, it will discuss special patient populations and diagnostic modalities for treating pulmonary emboli.