Physicians acknowledge ordering unnecessary tests often due to fear of unlikely diagnosis, malpractice

Family Medicine_General PracticeA survey of emergency physicians provides insight into reasons behind the estimated $210 billion spent annually on medically unnecessary tests and procedures.”Physicians said they feel tremendous pressure not to be wrong, while acknowledging that some of the tests they order are for non-medical reasons,” said lead author Hemal Kanzaria, MD, an emergency physician at the University of California, Los Angeles, and a Robert Wood Johnson Foundation Clinical Scholar with support from the U.S. Department of Veterans Affairs.Over 85% of the 435 emergency physicians surveyed said they believe that too many diagnostic tests are ordered in their own departments. Even more striking, almost all respondents (97%) acknowledged personally ordering some “medically unnecessary” radiology tests, defined as imaging studies the physician would not order if there were no external pressures and s/he was only concerned with providing optimal medical care.

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Studies show young people ‘wish they were better informed about sex’

Pediatrics_Internal Medicine_General Practice_OBGYN_Family MedicineResearchers investigating how young men and women learn about sex found that a gap exists between the type of sex education young people want and what they receive.The researchers also identified differences between how men and women learn about sex and relationships. The two studies, published in BMJ Open, utilized data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) – the largest scientific study of its kind in the UK.”The terrain young people have to navigate as they are growing up has changed considerably over the past 20 years and it will inevitably continue to do so,” says study author Dr. Clare Tanton. “This means that while we need a more structured approach towards sex and relationships education, we must also be able to adapt to these changing needs.”In one of the two studies, data from Natsal-3 for 3,869 participants, conducted between 2010 and 2012, was compared with data from surveys conducted in 1990-1991 and 1999-2001, in order to assess how sources of information about sex may have changed over time.
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One in 4 patients who visited emergency department for chest pain did not receive follow-up care

Cardiology_IM_FM_GP_Emergency MedicinePatients with multiple health issues and who are at higher risk of adverse events are less likely to receive follow-up care from a physician after visiting an emergency department for chest pain, reports a study published in CMAJ(Canadian Medical Association Journal).Chest pain is one of the most common reasons people visit emergency departments, with about 500 000 visits every year in Canada alone.The study looked at 56 767 patients with chest pain who visited an emergency department in Ontario between April 2004 and March 2010. Of these, 42 535 (75%) were seen by a primary care physician or cardiologist within 30 days after discharge, and 14 232 (25%) did not receive follow-up care. Patients with multiple illnesses such as heart disease, kidney disease and dementia, and rural residency were less likely than others to receive follow-up care in the following month. Patients who had visited a primary care physician or cardiologist in the preceding year were more likely to see a physician after discharge.”We initially thought that emergency department physicians would risk stratify patients such that those with more medical and cardiac comorbidities would receive more physician follow-up care,” writes Dr. Dennis Ko, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and an interventional cardiologist at the Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, with coauthors. “However, patients with more medical comorbidities in our cohort were less likely to receive physician follow-up postdischarge.”

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Novel peptide shows promise in penetrating heart attack scar tissue to regenerate cardiac nerves and avert dangerous arrhythmias

Cardiology_IM_GP_FMCase Western Reserve’s chemical compound aimed at restoring spinal cord function may have an additional purpose: stopping potentially fatal arrhythmias after heart attack.Case Western Reserve neurosciences professor Jerry Silver, PhD, long has believed that lessons learned over decades from spinal cord research could someday apply to other areas of the body. He got the chance to test his theory when a colleague from another campus realized that his new compound – intracellular sigma peptide (ISP) – could address a critical cardiac issue.The results of the project, led by Oregon Health & Sciences University (OHSU) researcher Beth A. Habecker, PhD, exceeded even Silver’s greatest hopes: 100 percent success in animal models. Details can be found in Nature Communication.”Essentially, the OHSU group cured arrhythmia in the mouse using ISP,” Silver said. “They observed true regeneration right back into the scar within the infarct area. This is pretty exciting.”

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Early detection of heart attacks aided by gold nanoparticles


NYU Polytechnic School of Engineering professors have been collaborating with researchers from Peking University on a new test strip that is demonstrating great potential for the early detection of certain heart attacks.

Kurt H. Becker, a professor in the Department of Applied Physics and the Department of Mechanical and Aerospace Engineering, and WeiDong Zhu, a research associate professor in the Department of Mechanical and Aerospace Engineering, are helping develop a new colloidal gold test strip for cardiac troponin I (cTn-I) detection. The new strip uses microplasma-generated gold nanoparticles (AuNPs) and shows much higher detection sensitivity than conventional test strips. The new cTn-I test is based on the specific immune-chemical reactions between antigen and antibody on immunochromatographic test strips using AuNPs.

Compared to AuNPs produced by traditional chemical methods, the surfaces of the gold nanoparticles generated by the microplasma-induced liquid chemical process attract more antibodies, which results in significantly higher detection sensitivity.

cTn-I is a specific marker for myocardial infarction. The cTn-I level in patients experiencing myocardial infarction is several thousand times higher than in healthy people. The early detection of cTn-I is therefore a key factor of heart attack diagnosis and therapy.

The use of microplasmas to generate AuNP is yet another application of the microplasma technology developed by Becker and Zhu. Microplasmas have been used successfully in dental applications (improved bonding, tooth whitening, root canal disinfection), biological decontamination (inactivation of microorganisms and biofilms), and disinfection and preservation of fresh fruits and vegetables.

The microplasma-assisted synthesis of AuNPs has great potential for other biomedical and therapeutic applications such as tumor detection, cancer imaging, drug delivery, and treatment of degenerative diseases such as Alzheimer’s.

The routine use of gold nanoparticles in therapy and disease detection in patients is still years away: longer for therapeutic applications and shorter for biosensors. The biggest hurdle to overcome is the fact that the synthesis of monodisperse, size-controlled gold nanoparticles, even using microplasmas, is still a costly, time-consuming, and labor-intensive process, which limits their use currently to small-scale clinical studies, Becker explained.

Adapted by MNT from original media release


Researchers develop a new distance rehabilitation system for patients with heart pathologies

Cardiology_Internal Medicine_General Practice_Family Medicine

A team of Spanish researchers of the Universitat Politècnica de València, the Universidad Politécnica de Madrid and the company Medtronic have participated in the development of a new distance heart rehabilitation system based on physical exercise routines for people affected by heart pathologies.

The system is designed for both chronic patients and the recovery of people who have suffered a heart event (for instance, a heart attack) or if they have had heart surgery. In any of these cases, it helps patients to exercise and adopt a healthy lifestyle.

HeartCycle GEx has been developed within the European project HeartCycle. This system creates an online connection between the cardiologist in the hospital and the patients in their homes. The latter, equipped with sensorized t-shirts, do the rehabilitation exercises while their mobile telephones receive all the information about their heart and respiration rate, and messages to make more or less effort according to the doctor’s instructions, etc.

Its main advantage is its ability to motivate patients; GEx helps patients follow the rehabilitation program in an easier and more entertaining way. To that end, GEx incorporates multimedia content, an avatar, as well as graphic information about the indicators related to the patient’s performance (heart rate, effort level, etc).

“The Achilles’ heel of heart rehabilitation is that patients abandon it in a few weeks, so its effect is watered down. If the user is motivated, the level of compliance will increase and their health will improve. The most important aspect is to improve adherence to the rehabilitation plan and maintain it over time, and this system does just that”, explains Alvaro Martínez, researcher at the ITACA Institute of the Universitat Politècnica de València.

In addition, GEx will be connected to the hospital information systems in order to guarantee optimum, personalised health care for the patient. The system enables each user’s condition to be monitored and the response to the instructed therapy assessed, so personalised plans can be created and any deterioration in health status that requires immediate intervention can be detected.

The doctor has a web application in which to program the personalised rehabilitation plan that is sent to the patient – the prescribed plan is adapted to the patient’s physical condition, who performs an effort test – to design the most suitable prescription possible.

“Every time the patient does one of the exercises, the system sends new data, so the doctor can immediately determine whether the patient’s effort meets the standard set and make adjustments to the prescription if necessary”, adds Alvaro Martínez.

This doctor’s web application was entirely developed at the ITACA Institute of the Universitat Politècnica de València.

“Today, the heart rehabilitation programs in Spain take place in hospitals or specialized centres. HeartCycle GEx is a different and convenient alternative to access to those programs since the patients can follow them anywhere, even at home, maintaining the level of health care that they receive”, says Cecilia Vera, researcher at the Life Supporting Technologies Group of the Universidad Politécnica de Madrid.

Validation in hospitals

GEx has been validated with 132 patients at three hospitals in Spain, Germany and the United Kingdom and, according to the tests performed, it provides better results than traditional rehabilitation programs, “This improvement is seen in the patient’s functional capacity, as well as in weight loss and a reduction in cholesterol levels”, says Alvaro Martínez.

“HeartCycle GEx is an initial step to the new heart rehabilitation systems of the future, providing personalised solutions, adapted to each patient and accessible from any location”, adds Cecilia Vera.

The results have been released in the European Journal of Preventive Cardiology.

Adapted by MNT from original media release

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High fitness levels reduce hypertension risk


While being physically fit is beneficial in and of itself, researchers now report that people with high levels of fitness are less likely to develop high blood pressure – also referred to as hypertension – a risk factor for cardiovascular disease.

The study, published in the Journal of the American Heart Association, examined the association of fitness with hypertension among participants undergoing treadmill stress tests to rule out ischemia as a cause of chest pain or shortness of breath.

“If you’re exercising and you’re fit, your chances of developing hypertension are much less than someone else who has the same characteristics but isn’t fit,” says Dr. Mouaz H. Al-Mallah, senior author of the study.

Normal blood pressure is below 120/80 mm Hg – the first number (systolic measurement) represents peak pressure in the arteries and the second number (diastolic measurement) represents minimum pressure in the arteries. Blood pressure is considered to be high when it is greater than 140/90 mm Hg.

There are two types of hypertension. While secondary hypertension appears suddenly and is caused by underlying conditions such as kidney or thyroid problems, primary hypertension has no identifiable cause and develops gradually over the course of many years.

In the US, hypertension affects 1 in 3 adults. According to the American Heart Association (AHA), 78 million people in the country have been diagnosed with the condition.

“Hypertension is associated with a lot of other illnesses and adds significantly to health care costs,” explains Dr. Al-Mallah, “so we need to know how we can reduce it.”

Measuring physical fitness and high blood pressure

The researchers assessed 57,284 participants from the Henry Ford Exercise Testing (FIT) Project, from 1991-2009, taking treadmill stress tests. Of these, 35,175 participants had a history of hypertension.

The team measured the physical fitness of the participants by estimating how much oxygen their bodies used per kg ofbody weight per minute, and thus how much energy they burned in metabolic equivalents (METs).

With 1 MET representing the amount of energy expended by the body at rest, a large number of METs reflects a high-intensity workout.

The researchers observed that participants whose most intense exercise was less than 6 METs had more than a 70% likelihood of having hypertension at the start of the study. Conversely, participants whose maximal exercise output was 12 METs were less than 50% likely to have hypertension.

During the stress test, participants who managed to reach 12 METs or more were 20% less likely to develop hypertension compared with participants who reached less than 6 METs.

A total of 8,053 new cases of hypertension were reported in participants’ medical records and administrative claims during the study’s follow-up period. Of these new cases, 49% were among participants with the lowest fitness (less than 6 METs), and only 21% were among participants with the highest fitness (more than 12 METs).

Fitness: a ‘strong predictor’ of hypertension

Although the study uses a large and diverse population sample, the participants were all originally referred for a stress test, indicating that their initial cardiovascular disease risk would be greater than that of the general population, potentially hindering the generalizability of the findings. The study was also limited by a lack of measuring incidental hypertension in a clinical setting.

Dr. Al-Mallah states that further study is required in order to determine how increasing and decreasing fitness levels affect the risk of hypertension over time. Physical activity was not formally assessed in the study, and this could be addressed in future research as well.

Hypertension is a major risk factor for cardiovascular disease, the number one cause of premature mortality in the developed world. High levels of exercise have been associated with protecting the body from certain health conditions, and now this study suggests adding hypertension to the list.

“Fitness is a strong predictor of who develops hypertension and who does not,” says Dr. Al-Mallah. “This is a clear message to everyone: patients, physicians and lawmakers. It’s very important to be fit.”

Medical News Today also recently reported on a study suggesting that sugars may contribute more to hypertension risk than salt.

Written by James McIntosh