News from the Annals of Internal Medicine: Oct. 15, 2013

Date: Oct-15-2013Lifestyle changes can prevent diabetes in high-risk patients

A review of published evidence found that comprehensive lifestyle changes can reduce the incidence of type 2 diabetes in high-risk patients. Evidence was not strong enough to determine if patients already diagnosed with type 2 diabetes could benefit from such interventions. Researchers reviewed available research to assess the effects of comprehensive lifestyle interventions in the prevention of diabetes in adults who have been identified as high-risk (having metabolic syndrome or prediabetes) and the prevention of diabetic complications in adults diagnosed with type 2 diabetes. All lifestyle interventions studied for both groups included a diet and exercise component and were supported by individual, group, and/or telephone counseling. Other lifestyle interventions included a smoking cessation course, regular blood glucose and blood pressure monitoring, and stress management. The research suggests that lifestyle changes can decrease the incidence of type 2 diabetes in high-risk patients. There was no evidence that lifestyle interventions could reduce all-cause mortality in patients already diagnosed with diabetes and insufficient evidence to suggest a reduction in disease-related complications in these patients.

Unruptured brain aneurysms are common, but few cause harm

Undetected, unruptured cerebral aneurysms (UCA) are prevalent, but may not be clinically significant. A brain aneurysm is a weak spot on a blood vessel in the brain that fills with blood and bulges. Only a small percentage of aneurysms cause complications or rupture. Since ruptures can be catastrophic and have high mortality and morbidity rates, doctors have an interest in finding ways to detect aneurysms and figure out which ones present a potential risk to the patient. Researchers used three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) to screen 4,813 Chinese adults aged 35 to 70 for brain aneurysm. Three radiologists who were blinded to patient information identified the location and size of UCAs and estimated the overall and age-and sex-specific prevalence. UCAs were present in approximately 7 percent of the adults studied, but only about 8.7 percent of the aneurysms were thought to be at risk for rupture based on their size, shape, and location. UCAs were more common in women, and prevalence in both sexes increased with age.

Administrative data too subjective to provide a reliable basis for hospital comparisons

Administrative-reported rates of hospital-acquired pressure ulcers (HAPUs) may not be a reliable measure of hospital performance. The Centers for Medicare & Medicaid Services require hospitals to make rates of hospital-acquired conditions (HACs) publicly available. A hospital's total HAC score includes a HAPU measure generated from administrative data. Accurate measurement is important because under the Patient Protection and Affordable Care Act, hospitals with the highest HAC rates will be financially penalized. To assess the validity of the measurement, researchers compared HAPU rates generated by administrative data to those generated from direct surveillance. Direct surveillance revealed that administrative data frequently misclassified hospitals as having high or low HAPU rates relative to others. The authors of an accompanying editorial write that the problem with the care and documentation of pressure ulcers is that physicians have limited knowledge of this particular clinical issue. The authors suggest that all providers learn pressure ulcer assessment and terminology. Until then, administrative data alone may not be an appropriate method for comparing hospitals by HAPU rates for public reporting or financial penalty.

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.