Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force

Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force (ePub) – Available for download at this site.
Source: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (via USGPO)

The Guide to Clinical Preventive Services presents abridged U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medications for use in primary care practice. The 2014 Guide continues the precedent set by earlier editions in providing the Task Force recommendations in a form that provides on-the-job clinical decision support for clinicians. The Guide is organized and cross referenced so that clinicians can search for recommendations alphabetically by topic and by patient category (adult or child/adolescent).

Related Resource

Choosing Wisely is an initiative of the ABIM Foundation that promotes patient-physician conversations about unnecessary medical tests and procedures.

Glancing at a grassy green roof significantly boosts concentration [news item]

Glancing at a grassy green roof significantly boosts concentration.

A green grassy roof in Toronto, a city renowned for its efforts to balance nature and urban space.

The study, published in the Journal of Environmental Psychology, gave 150 students a boring, attention-sapping task. The students were asked to press a key as a series of numbers repeatedly flashed on a computer screen, unless that number was three.

They were given a 40-second break midway through the task to view a city rooftop scene. Half the group viewed a flowering meadow green roof, the other half looked out onto a bare concrete roof.

After the break, students who glanced at the greener vista made significantly less errors and demonstrated superior concentration on the second half of the task, compared to those who viewed the concrete roof.

The green roof provided a restorative experience that boosted those mental resources that control attention, researchers concluded.

Read the entire news item here

Can social isolation fuel epidemics? [news release]

Can social isolation fuel epidemics?
From the 21 July 2015 MedicalExpress news release

Conventional wisdom has it that the more people stay within their own social groups and avoid others, the less likely it is small disease outbreaks turn into full-blown epidemics. But the conventional wisdom is wrong, according to two SFI researchers, and the consequences could reach far beyond epidemiology.

In a paper published in the July 20 early edition of the Proceedings of the National Academy of Sciences, Laurent Hébert-Dufresne and Benjamin Althouse show that when two separate diseases interact with each other, a population clustered into relatively isolated groups can lead to epidemics that spread like wildfire.

“We thought we understood how clustering works,” Hébert-Dufresne says,”but it behaves exactly opposite to what we thought once interactions are added in. Our intuition was totally wrong.”

At the heart of the new study are two effects that have had a lot of attention in recent years—social clustering and coinfection, in which one disease can change the infection dynamics of another—but haven’t been studied together. That, Hébert-Dufresne and Althouse say, turns out to be a major omission

Ordinarily, the pair say, clustering limits outbreaks. Maybe kids in one preschool get sick, for example, but since those kids don’t see kids from other preschools as often, they’re not likely to spread the disease very far. Coinfection often works the other way. Once someone is sick with, say, pneumococcal pneumonia, they’re more likely than others to come down with the flu, lowering the bar for an epidemic of both diseases.

But put the effects together, Hébert-Dufresne and Althouse discovered, and you get something that is more—and different—than the sum of its parts. While clustering works to prevent single-disease epidemics, interactions between diseases like pneumonia and the flu help keep each other going within a social group long enough that one of them can break out into other clusters, becoming a foothold for the other—or perhaps a spark in a dry forest. Both diseases, Althouse says, “can catch fire.” The end result is a larger, more rapidly developing, epidemic than would otherwise be possible.

That conclusion has immediate consequences for public health officials, whose worst-case scenarios might be different or even tame compared with the outbreaks Hébert-Dufresne and Althouse hypothesize. But there are equally important consequences for network scientists and complex systems researchers, who often think in epidemiological terms. Two ideas, for example, might interact with each other so that both spread more rapidly than they would on their own, just as diseases do.

Now that they’ve realized the importance of such interactions, “we hope to take this work in new and different directions in epidemiology, social science, and the study of dynamic networks,” Althouse says. “There’s great potential.”

More information: “Complex dynamics of synergistic coinfections on realistically clustered networks.”PNAS 2015 ; published ahead of print July 20, 2015, DOI: 10.1073/pnas.1507820112

Common chemicals may act together to increase cancer risk, study finds [news release]

Another reason not to use anti bacterial soaps

Common chemicals may act together to increase cancer risk, study finds
From the 20 July 2015 Oregon State University news release

In a nearly three-year investigation of the state of knowledge about environmentally influenced cancers, the scientists studied low-dose effects of 85 common chemicals not considered to be carcinogenic to humans.

The researchers reviewed the actions of these chemicals against a long list of mechanisms that are important for cancer development. Drawing on hundreds of laboratory studies, large databases of cancer information, and models that predict cancer development, they compared the chemicals’ biological activity patterns to 11 known cancer “hallmarks” – distinctive patterns of cellular and genetic disruption associated with early development of tumors.

n a nearly three-year investigation of the state of knowledge about environmentally influenced cancers, the scientists studied low-dose effects of 85 common chemicals not considered to be carcinogenic to humans.

The researchers reviewed the actions of these chemicals against a long list of mechanisms that are important for cancer development. Drawing on hundreds of laboratory studies, large databases of cancer information, and models that predict cancer development, they compared the chemicals’ biological activity patterns to 11 known cancer “hallmarks” – distinctive patterns of cellular and genetic disruption associated with early development of tumors.

The chemicals included bisphenol A (BPA), used in plastic food and beverage containers; rotenone, a broad-spectrum insecticide; paraquat, an agricultural herbicide; and triclosan, an antibacterial agent used in soaps and cosmetics.

Read the entire article here

 

The top five unnecessary tests, treatments in newborn medicine

The top five unnecessary tests, treatments in newborn medicine

The top five unnecessary tests and treatments have been identified in newborn medicine, according to an article published online July 20 in Pediatrics.

…

These included:
(1) avoiding routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or apnea and desaturation treatment in preterm infants;
(2) for treatment of initially asymptomatic infants without evidence of bacterial infection, routine continuation of antibiotics beyond 48 hours should be avoided;
(3) routine pneumograms for predischarge assessment of ongoing/prolonged apnea of prematurity should be avoided;
(4) in the absence of indication, daily chest radiographs should be avoided for intubated infants; and (5) in preterm infants, routine screening term-equivalent or discharge brain magnetic resonance imaging should be avoided.

“The Choosing Wisely **Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost,” the authors write. “This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.”

Read the entire article here

 

**Choosing Wisely is an initiative of the ABIM Foundation that promotes patient-physician conversations about unnecessary medical tests and procedures.

coding answers

From the 7 January 2015 Medical Economics article

The new year brings changes to many evaluation and management codes physicians use, including chronic care management and advanced planning

Read the entire article here

It takes a village… to ward off dangerous infections? New microbiome research suggests so [news release]

It takes a village… to ward off dangerous infections? New microbiome research suggests so
FROM the 23 July 2015 UM HealthSystem news release

Your gut’s “village” of bacteria may protect you against C. difficile infection – or not.

 

Like a collection of ragtag villagers fighting off an invading army, the mix of bacteria that live in our guts may band together to keep dangerous infections from taking hold, new research suggests.

…

But some “villages” may succeed better than others at holding off the invasion, because of key differences in the kinds of bacteria that make up their feisty population, the team from theUniversity of Michigan Medical School reports.

The researchers even show it may be possible to predict which collections of gut bacteria will resist invasion the best — opening the door to new ways of aiding them in their fight.

…these models could serve as a diagnostic tool, to predict which patients will need the most protection against C-diff before they go to the hospital, or even to custom-design a protective dose of bacteria before or after a C-diff exposure.

In other words, to see which villages need the most reinforcements to prevail in battle.

Community matters

Schloss, who is a key member of the Medical School’s Host Microbiome Initiative, notes that no one species of bacteria by itself protected against colonization. It was the mix that did it. And no one particular mix of specific bacteria was spectacularly better than others – several of the diverse “villages” resisted invasion.

Resistance was associated with members of the Porphyromonadaceae, Lachnospiraceae, Lactobacillus, Alistipes, and Turicibacter families of bacteria. Susceptibility to C. difficile, on the other hand, was associated with loss of these protective species and a rise in Escherichia or Streptococcus bacteria.

“It’s the community that matters, and antibiotics screw it up,” Schloss explains. Being able to use advance genetic tools to detect the DNA of dozens of different bacteria species, and tell how common or rare each one is in a particular gut, made this research possible.

Clostridium difficile bacteria kill
thousands of Americans each year.

Then, this massive amount of information about the villages of bacteria present in each of the mice in the experiment, and the relative success of each village in fighting off C-diff, was fed into the computer model created by the team.

Read the entire article here

How to save against jaw-dropping prescription drug prices

How to save against jaw-dropping prescription drug prices July 17, 2015 by Danielle Braff, Chicago Tribune

From the article

Pharmaceutical experts clued us in on how to get the biggest discounts at the pharmacy counter.

Shop around: A 2013 study by Consumer Reports found that doing a little comparison shopping can have a big payoff, especially if you’re paying out of pocket for your medications. The study found a $749 difference between the highest- and lowest-priced stores when shopping for a month’s supply of five drugs. Costco was the least expensive (and you don’t have to be a member to use its pharmacy), while CVS, Target and Rite Aid were the most expensive.

Be proactive about getting the generic version: Ask if there are generic or less-expensive brand-name drugs that would work just as well as the prescription and over-the-counter medications you’re taking now,” Engle said. “If a generic is not available, check to see if you can use a therapeutic alternative, which is a similar drug that gives the same result that is available as a generic.”

Split pills: Check with your pharmacist to see if your medication is safe to split and — if it is available in a variety of strengths that cost about the same amount.

Read the entire article here

Related Resource

Prescription drug cost assistance (from Health Resources for All Edited by Janice Flahiff)
Including

• Partnership for Prescription Assistance is a directory which helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free.
• Extra Help (program thru the US Social Security Administration for limited income people)
• NeedyMeds – Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care. Includes coverage gap programs.