Anne Dixon, MD, joins Lungcast to discuss obesity's effect on asthma, and the newest recommendations for managed care.

New Asthma Management Guidelines: A Podcast Primer

Expert David W. Goodman, MD, explains why adults with ADHD may face unknown challenges during the pandemic.

Adult ADHD Challenges During COVID-19

What you need to know about vaccinator and patient education, counseling, billing, and reimbursement.

ACP Policy Statement on COVID-19 Vaccine Distribution and Administration

New ADA guidelines list more than 40 recommendations related to blood pressure targets, screening and diagnosis, and overall management strategies.

Cardiovascular Disease in Diabetes: How to Manage Risks

An American Red Cross discusses the importance of National Blood Donor Month and the challenges faced during the COVID-19 pandemic.

The National Blood Shortage: An Unprecedented Challenge

Students share their experience in the virtual classroom, navigating new requirements, and the lessons learned from their position in a global pandemic.

How COVID-19 Transformed Medical Education

Research has shown that opioids are overprescribed after surgery, which may lead to diversion or other adverse outcomes, including 

After the 2016 Centers for Disease Control and Prevention (CDC) guideline for opioid prescription for chronic pain was published, experts have noted the potential for the guide to affect postoperative opioid prescribing.

Investigators, led by Tori N. Sutherland, MD, MPH, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, found the guidelines had associations with clinically relevant changes in opioid prescription patterns after surgery including decreases in prescription rates.

The team performed a cross-sectional study to assess the association of the 2016 CDC opioid prescribing guideline with postoperative opioid dispensing 2 years before and after publication.

They followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline checklist for observational studies.

Data was collected from the Clinformatics Data Mart Database. The study sample included patients ≥18 years with a claim for any of 8 general and orthopedic surgical procedures from March 2014 – March 2018.

Exclusions included patients who did not fill an opioid prescription within the first 7 days of surgery, patients with claims for more than 1 eligible procedure on the same day, and those who did not have 90 days of continuous enrollment prior to procedure and 30 days after.

The sample was restricted to include patients with no fulfilled opioid prescriptions 90 days prior to surgery to capture new opioid prescriptions, rather than refills for established chronic pain.

Primary outcomes included the total amount of opioid dispensed in first prescription filled within 7 days of surgery or hospital discharge, measured in morphine milligram equivalents (MMEs).

Further, secondary outcomes included total opioids dispensed across all filled prescriptions in MME within 30 days after surgery or discharge, and percentage of patients receiving an opioid refill within 30 days after surgery.

The study included 361,556 opioid-naïve patients who underwent 8 general and orthopedic surgical procedures between March 2014 – March 2018.

Of the total, 45.4% (164,009) were male and median age was 58 years.

Prior to CDC guideline release, the mean amount of opioid for first-filled prescriptions dispensed increased from 301 MME (95% CI, 295 – 307 MME) to 325 MME (95% CI, 319 – 331 MME).

Following guideline release, the mean amount of opioid received in the first filled prescription decreased from 316 MME (95% CI, 311 – 322 MME) to 266 MME (95% CI, 260 – 271 MME).

Investigators noted the total amount of opioid dispensed in the first prescription after surgery in 2 years following CDC guideline release, in comparison to an increasing trend in the prior 2 years.

They found the prerelease trend was 1.43 MME/month (95% CI, 0.62 – 2.24 MME/month, 

= .001), while the post release trend was -2.18 MME/month (95% CI, -3.01 to -1.35 MME/month, 

The overall trend change noted was -3.61 MME/month (95% CI, -4.87 to -2.35 MME/month, 

In addition, the changes in initial dispensing trends were found to be greatest for patients undergoing hip or knee replacement at -8.64 MME/month (95% CI, -11.68 to -5.60 MME/month, 

The team observed minimal changes in rates of refill at 0.14% per month (95% CI, 0.06% - 0.23% per month, 

Then, the team found absolute amounts prescribed remained high, with 47.7% (95% CI, 47.4% - 47.9%) of patients treated in post-guideline period receiving 2 times the initial opioid dose based on available recommendations.

The investigators concluded that opioid dispensing after surgery had a substantial decrease after the release of the 2016 CDC guidelines, in comparison to an observed trend during the 2 years prior.

“Concurrently, our observation of high opioid amounts dispensed relative to recommendations indicates ongoing opportunities to improve pain treatment after surgery and the potential need for additional policy and clinical interventions to transform care,” investigators wrote.

Association of the 2016 US Centers for Disease Control and Prevention Opioid Prescribing Guideline with Changes in Opioid Dispensing After Surgery

Articles

Opioid prescription decreased substantially in 2 years following 2016 CDC guideline for prescribing opioids for chronic pain. 

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Opioid-Induced Constipation

Opioid-Induced Constipation condition center page, resources on the topics of medical news and expert insight into OIC can be found. Content includes articles, interviews, videos, podcasts, and breaking news on opioid effects-related research, treatment, and drug development.

Pain

Chronic Pain

Decrease in Postoperative Opioid Dispensing Associated With CDC Guidelines

While it warrants future studies, thus far there is no connection between treatment for 

A team, led by Melissa Claros-Erazo, Department of Psychiatry and Behavioral Sciences, Jackson Behavioral Health Hospital, Identified whether effective treatments for depression also results in an improvement in renal function.

Researchers often believe there is a bidirectional relationship between depression and renal dysfunction. However, there is still a lack of longitudinal data exploring this link in patients with major depressive disorder, as depression could contribute to the progression of chronic kidney disease.

In the retrospective analysis, the researchers examined 1600 outpatients who underwent double-blind, placebo-controlled, randomized antidepressant treatment (DBPCRAT) of MDD in 13 Eli Lilly and Company clinical trials.

The team measured magnitude of depression symptoms using the Hamilton Depression Rating scale (HAMD) and estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Following 7 weeks of treatment, HAMD scores decreased by 11.8 points, compared to just 9.3 points in the placebo group (

<0.0001). In the antidepressant treatment cohort, eGFR decreased by 0.28 ml/min/1.73 m

The researchers also identified various predictors of HAMD scores at week 7, including baseline HAMD scores (B = 0.237; 

 <0.001), and antidepressant treatment (B = −2.28, 

The best predictors forecasting eGFR were baseline eGFR (B = 0.651, 

 <0.0001), increasing age (B = −0.194, 

 <0.0001), and female gender (B = −0.984, 

“Short-term, MDD was not associated with clinically significant decrements in eGFR,” the authors wrote. “Future studies will determine whether depression treatment over a more prolonged period of time is associated with improvement in eGFR, especially in minorities and other high-risk populations.”

 (CKD) has stabilized in recent years in the US, it is unclear whether this trend is consistent throughout all major sociodemographic groups.

A team, led by Priya Vart, PhD, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, identified trends in the prevalence of chronic kidney disease for all major sociodemographic groups in recent years.

In the repeated cross-sectional study, the investigators analyzed data from the National Health and Nutrition Examination Surveys for 1988-1994 and every 2 years from 1999-2016 on 54,554 individuals at least 20 years old with information on race and ethnicity, socioeconomic status, and serum creatinine levels.

The age-, sex-, and race/ethnicity-adjusted overall prevalence of stage 3 and 4 chronic kidney disease increased from 3.9% in the 1988-1994 time period to 5.2% in the 2003-2004 (difference, 1.3%; 95% CI, 0.9%-1.7%).

This remained relatively stable after 2004 at 5.1% in 2015-2016 (difference, −0.1%; 95% CI, −0.7% to 0.4%). The trend in adjusted disease prevalence overall differed substantially based on race/ethnicity (

The investigators also discovered higher disease prevalence for those with lower educational levels, while income largely remained consistent throughout the entire study period. The results were similar in most subgroups when including albuminuria to define chronic kidney disease.

The study, “Randomized, Placebo-controlled, Antidepressant Treatment of Patients with Major Depressive Disorder: Changes in Glomerular Filtration Rate,” was published online in 

Baseline eGFR and increasing age were good predictors of eGFR.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

Inflammation

Nephrology

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Family Medicine

Family Medicine condition center page, resources on the topics of medical news and expert insight into family care can be found. Content includes articles, interviews, videos, podcasts, and breaking news on Family medicine research, treatment, and drug development.

Researchers Explore Link Between Depression, Renal Dysfunction

Direct-acting antivirals (DAA) reduce the risk of all-cause mortality, as well as mortality from liver disease and drug use for patients with 

A team, led by Naveed Z. Janjua, MBBS, DrPH, BC Centre for Disease Control Clinical Professor, School of Population and Public Health, University of British Columbia, evaluated the effect of sustained virologic response (SVR) from direct acting antiviral therapy on all-cause, liver- and drug-related mortality.

In the population-based cohort, the researchers examined data of from the BC Hepatitis Testers Cohort of individuals tested for hepatitis C since 1990, linked with data on medical visits, hospitalizations, prescription drugs, and mortality.

The researchers followed individuals who received DAAs (n = 10,855; SVR, 10,426) and participants who did not receive HCV treatment to death or December 31, 2019 (n = 10,855). The median follow-up time was 2.2 years.

The team used inverse probability of treatment weighting to balance the baseline profile of treated and untreated individuals. They also performed multivariable proportional hazard modeling to assess the effects of direct acting antiviral treatment on mortality.

Overall, the all-cause mortality rate was 19.5 per 1000 person-years among the subgroup of patients with a sustained virologic response (deaths = 552). The all-cause mortality rate—86.5 per 1000 person-years—was significantly higher in the no-SVR group (deaths = 96), but even higher—99.2 per 1000 person-years—among the untreated group (deaths = 2133).

Using the multivariable model, SVR was linked to significant reductions in all-cause (aHR, 0.26; 95% CI, 0.17-0.21), liver (subdistribution [as]HR, 0.22; 95%CI, 0.18-0.27), and drug-related mortality(asHR, 0.26; 95%CI, 0.21-0.32) compared to no-treatment.

There was also a higher risk of liver-related mortality in older patients and individuals with cirrhosis. On the other hand, younger age, injection use, problematic alcohol use, and HIV/HBV co-infections were linked to a higher risk of drug-related mortality.

“DAA treatment is associated with a substantial reduction in all-cause, liver- and drug-related mortality,” the authors wrote. “The association of IDU and related syndemic factors with a higher risk of drug-related mortality calls for an integrated social support, addiction, and HCV care approach among people with IDU.”

Earlier this year, researchers found a regimen of direct-acting antiviral treatments is safe and efficacious against HCV infections following liver transplantation.

HCV infections represent 1 of the most frequent causes of liver transplantations globally. Patients with HCV viremia at the time of transplantation universally develop recurrent HCV in the allograph, which causes accelerated fibrosis and graft loss.

The safety profile was positive, with no severe adverse effects observed.

Ribavirin was used in 82% of the patients. While 23.9% of this patient subgroup suffered from adverse effects, the majority were deemed mild.

In addition, the median follow-up after the transplant surgery was 55 months (IQR, 43-51), with a global and graft survival at 1 and 3 years of 100%.

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study,

Sustained virologic response following direct acting antiviral treatment substantially reduced the all-cause mortality rate in patients with HCV.

Infectious Disease

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on viruses, infections, and bacteria. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for COVID-19, influenza, vaccine-preventable diseases, and more.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Hepatitis C

Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Hospital Medicine

Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

DAA Treatment Reduces Risk of Death for Hepatitis C Patients

A recent study aimed to investigate the uncertainty surrounding patients with 

 or mechanical heart valves who may benefit from bridging with low molecular weight heparin (LMWH) after the procedure.

Investigators noted that there have been previous diverse guidelines to solve this issue. However, the concern remains that the patients may be at a high risk of thrombotic complications cause by a procagulable state of vitamin K antagonists.

The team, led by Michael J. Kovacs, Department of Medicine, Western University, found in patients with AF or mechanical heart valve with warfarin interrupted for a procedure, there was no significant benefit in postoperative dalteparin bridging in prevention of major arterial thromboembolism.

Investigators conducted a randomized, double-blind, placebo-controlled trial to assess the need of postoperative bridging with LMWH dalteparin in patients with AF or prosthetic mechanical valves who required warfarin.

They hypothesized it would lead to fewer bleeding events, as well as a lower rate of thromboembolism, linking it to the thromboembolism with bleeding in their prior pilot study.

The team noted the study included the same patient population as the pilot study, including patients aged ≥18 years with mechanical heart valves, atrial fibrillation, atrial flutter and a CHADS, and risk factor (including transient ischemic attack or stroke, diabetes, age ≥15 years)

Eligible patients were receiving long-term anticoagulation with warfarin as well as required elective non-cardiac surgery or invasive procedure.

Exclusions included active bleeding within 30 days before stopping warfarin, platelet count <100×109/L, and mechanical valve with history of stroke or ischemic attack.

The team discontinued warfarin 5 days before the procedure. Patients were given dalteparin 200 IU/kg subcutaneously 72 and 48 hours before the procedure, and 100 IU/kg 24 hours before the procedure.

Then, warfarin was resumed the evening of the procedure at 2 times the daily dose the first day and then following the INR result.

Outcomes were assessed from the time of randomization to 90 days, with the primary efficacy outcome including major thromboembolism, ischemic stroke, transient ischemic attack.

Secondary efficacy outcomes included individual major thromboembolism outcomes and a composite outcome, including major bleeding.

A total of 1677 patients gave informed consent between February 2007 – March 2016 at 10 sites in Canada and India.

Of this number, 1471 were randomized after the procedure with 821 patients to dalteparin and 650 to placebo.

The mean age of the patients was 69.7 years, with 64.3% men and 79.3% with atrial fibrillation and 20.7% with mechanical valves.

Investigators noted an imbalance in randomization due to a programming error led all patients in the AF and low bleeding risk group being assigned to dalteparin at 2 recruitment sites. However, the team correct the imbalance in the affected group with 80% of patients allocated to placebo and 20% to dalteparin.

Investigators noted the rate of major thromboembolism at 90 days was 1.2%, with 8 events in 650 patients for placebo, while the rate was 1.0%, with 8 events in 820 patients for dalteparin (

= .064, risk difference -0.3%; 95% CI, -1.3 – 0.8).

Further, the team found 13 events (2.0%) of major bleeding in 650 patients for placebo and 11 events (1.3%) in 820 patients for dalteparin (

.32, risk difference -0.7; 95% CI, -2.0 – 0.7).

Kovacs and colleagues found no significant difference in the outcomes of the subgroups of AF and mechanical heart valve.

They also performed analysis to exclude bias for the imbalance in randomization, finding no statistically significant meaning (

After the results, investigators concluded that postoperative bridging with dalteparin did not have a benefit in prevention of major thromboembolism in patients with AF or mechanical heart valves managed with warfarin.

“Although warfarin is being used less frequently in patients with atrial fibrillation, it is still the long-term anticoagulant of choice for patients with mechanical heart valves and in other populations, such as patients receiving dialysis, those with limited supply of direct oral anticoagulants, and in resource constrained settings,” investigators wrote.

They noted the need for further studies in determination of need for bridging before procedures in patients with mechanical heart valves.

Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): double blind randomised controlled trial

The rate of major thromboembolism within 90 days was 1.2% for placebo and 1.0% for dalteparin. 

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more.

Arterial Disease

Arterial Disease condition center page, resources on the topics of medical news and expert insight into PAD / CAD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on peripheral artery and coronary artery disease research, treatment, and drug development.

No Signficant Benefit to Dalteparin Bridging in Prevention of Arterial Thromboembolism 

A recent study out of Poland estimated that elderly patients with asthma have an increased risk of delirium episodes during hospitalizations. No known link in delirium and asthma had been made prior to the study.

The correlation between delirium and asthma were assessed by Prof. Andrzej Bozek and fellow colleagues from Dermatology and Allergology in Zabrze at the Medical University of Silesia Katowice in Poland.

“Analyzing patients with asthma draws attention to the problem of the high rate of morbidity caused by delirium in elderly patients with asthma,” the team wrote.

The team also noted the predisposing factors for delirium such as advanced age, hypertension, smoking, and other genetic factors in an attempt to find commonality between delirium and obstructive diseases.

The participants for the study consisted of 1417 patients with asthma, 1882 with chronic obstructive pulmonary disease (COPD), and 2187 without obstructive disease. The ages of the participants ranged from 65-95 years old, and all hospitalizations were recorded between 2006 and 2015.

The common cause for hospitalization among most patients were cardiac disease, sepsis, surgery, asthmatic condition, and trauma.

Diagnosis for both asthma and COPD were made according to the International Classification of Disease (ICD)-10 code and later verified by a clinical professional.

The team admitted difficulty in observing the exact cause of delirium in patients, especially considering the lack of literature on the subject. Limitations included a small sample group, a lack of study on the impact of drugs on patients with delirium, and the nonrecognition of delirium that occurs in hospitals.

However, the study did find that incidents of delirium were more common in patients with an obstructive pulmonary disease.

All episodes of delirium that occurred during the 9-year span were independently associated with asthma. Additionally, death from a delirium episode was also associated with asthma. However, no connection was made between delirium and COPD regarding patient deaths.

Despite a myriad of causes of hospitalization among patients, the study found that asthma played a significant role in the development of delirium. The team recommended a stronger focus on the implications of asthmatic conditions in older patients, noting an increased risk of death caused by a delirium episode.

The study did note that evidence of improvement in mental functions and the treatment of asthma were confirmed in previous studies, and urged for greater care for patients suffering from obstructive conditions.

“Such patients require adequate preparation and caution during surgical procedures and other hospitalizations.” the team wrote.

The study, “Asthma and delirium episodes during hospitalization,” was published online in Aging Medicine.

A new Polish study calls for greater focus on asthma and the link to delirium in older patients, who may face greater mortality risk.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Asthma

Neurology

Neurology condition center page is a comprehensive resource for clinical news and insights on nervous system disorders. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for Alzheimer's disease, brain injury, PTSD, and more.

Geriatrics

Geriatric medicine condition center page is a comprehensive resource for clinical news and insights on frequent geriatric-related diseases and conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for sleep disorder, dementia, Alzheimer's disease, and more.

Investigators Propose Link Between Asthma, Obstructive Disease and Delirium

Videos

Wally Smith, MD, discusses the mechanisms of actions of various therapies for SCD and the patient factors associated with the choice of therapy.  

Sickle Cell

Sickle Cell condition center page, resources on the topics of medical news and expert insight into sickle cell disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sickle cell research, treatment, and drug development.

Patient Factors Associated With the Choice of SCD Therapy 

Researchers urge parents and doctors to take a closer look at the common disease and its possible more severe subtypes.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Ophthalmology

Ophthalmology page, resources on the topics of medical news and expert insight into ophthalmic disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on eye disease research, treatment, and drug development.

Pediatrics

Pediatrics page, resources on the topics of medical news and expert insight into childhood health care can be found. Content includes articles, interviews, videos, podcasts, and breaking news on pediatric disease research, treatment, and drug development.

 Allergic Conjunctivitis Linked to Worsened Pediatric Quality of Life

Wally Smith, MD, reviews the goals of treatment and discusses current disease-modifying therapies for SCD. 

Evolution of Therapies in Sickle Cell Disease 

A patient advocate speaks about connecting with sickle cell disease communities to improve mental health and create disease awareness.  

Building Relationships in the SCD Community  

A patient with SCD and his mother discuss their mental health journey with sickle cell disease and resources that helped them. 

The Mental Health Journey With Sickle Cell Disease 

A discussion on the importance of mental health awareness and utilization of mental health resources in sickle cell disease, given the statistics of the disorder. 

Mental Health and Sickle Cell Disease 

Cassandra Trimnell, a patient advocate, narrates her experience in dealing with the physical and emotional pain of sickle cell disease and finding the beauty in living with the disorder.

Pain Management With Sickle Cell Disease  

Patient advocate, Cassandra Trimnell, talks about her experience of being a mother with sickle cell disease.  

A Young Mother’s Journey With Sickle Cell Disease 

A patient with sickle cell disease explains how growing up with the sickle cell disease has impacted his quality of life. 

Impact of Sickle Cell Disease on Everyday Life 

Cassandra Trimnell, a patient advocate, explains the lack of public knowledge regarding sickle cell disease and how she creates awareness.  

Latest News

Decrease in Postoperative Opioid Dispensing Associated With CDC Guidelines

Researchers Explore Link Between Depression, Renal Dysfunction

DAA Treatment Reduces Risk of Death for Hepatitis C Patients

No Signficant Benefit to Dalteparin Bridging in Prevention of Arterial Thromboembolism

Investigators Propose Link Between Asthma, Obstructive Disease and Delirium