February 2014 Focus

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In this Issue:

News Update
DNA Used to Predict Amputee’s Pain Levels
Focus on Cardiology
VA, Army Clinicians Rapidly Increase Prescribing of Novel Anticoagulants

Female Veterans Develop CVD Risk Factors at Younger Ages

Pharmacy Update
Greater Pharmacist Intervention Tested to Increase Anticoagulant Adherence Rates
Diabetes Clinical Consult
Military Sleep Disorders Raise Diabetes Risk
Pain Clinical Consult
How Prescribers Discuss Opioid Use/Abuse with Patients

U.S. MEDICINE NEWS UPDATE


DNA Used to Predict Amputees’ Pain Levels

SAN FRANCISCO – Researchers now are able to predict which wounded servicemembers are likely to develop persistent, chronic pain after amputation based on variants in their individual DNA sequences. A conference presentation noted that, from 2000 to 2011, 6,144 amputations occurred among 5,694 injured servicemembers, with more than one-third having major amputations, defined as the loss of a hand, foot or more. As many as 80% of all amputees experience pain in their residual limb, or a “phantom pain,” according to the report from Duke University.
More

http://www.usmedicine.com/clinical-topics/pain-management/dna-used-to-predict-amputees-pain-levels/

FOCUS ON CARDIOLOGY

VA, Army Clinicians Rapidly Increase Prescribing of Novel Anticoagulants

WASHINGTON – Use of novel anticoagulants has risen sharply both at the VA and in the Army in the last three years, freeing more atrial fibrillation patients from food restrictions and regular checks for coagulation time, as required when using warfarin. By fiscal year 2013, 12,000 veterans already were on dabigatran and the other two approved novel anticoagulants, rivaroxaban and apixaban, which also were prescribed to 19.3% of anticoagulant patients treated by the Army.
More

http://www.usmedicine.com/agencies/department-of-defense-dod/va-army-clinicians-rapidly-increase-prescribing-of-novel-anticoagulants/


Female Veterans Develop CVD Risk Factors at Younger Ages

Staff at Carl Vinson VA Mecial Center observe Women’s Heart Health Month

BOSTON – During the past 15 years, female veterans have developed risk factors for cardiovascular disease (CVD) at ever-younger ages, challenging many providers’ concept of the population at risk for heart disease. Women aged 35-44 had two or more CVD risk factors at about half the rate of their male counterparts, 11% vs. 20%. Among those 20 years older, however, the gap had significantly narrowed. In 2010, 38% of women aged 55-64 had two or more risk factors in 2010 compared with 52% of veteran men, for a relative risk of 0.73.
More

http://www.usmedicine.com/agencies/department-of-veterans-affairs/female-veterans-develop-cvd-risk-factors-at-younger-ages/

PHARMACY UPDATE

Greater Pharmacist Intervention Tested to Increase Anticoagulant Adherence Rates

Pei-Yu Lee, PharmD

PALO ALTO, CA – Medication is only effective if taken, yet how to make sure patients maintain adherence with anticoagulants and many other long-term medications for chronic diseases poses one of the greatest dilemmas for healthcare providers. In an effort to meet the challenge, the VA is turning to pharmacists to do more than just dispense drugs. It has found that a combination of scheduled pharmacist follow-up and safety monitoring can boost patient adherence for the novel anticoagulant dabigatran above 80%, a notable increase from the 50% or less seen for statins, antihypertensives and other long-term treatments of asymptomatic conditions such as atrial fibrillation.
More

http://www.usmedicine.com/agencies/department-of-veterans-affairs/greater-pharmacist-intervention-tested-to-increase-anticoagulant-adherence-rates/

DIABETES CLINICAL CONSULT

Military Sleep Disorders Raise Diabetes Risk
SEATTLE – Insomnia and other sleep disorders plaguing military servicemembers and veterans could be an independent risk factor for developing diabetes, not just a symptom of depression or post-traumatic stress disorder (PTSD), according to a new study. Past research has indicated a higher risk of type 2 diabetes associated with sleep characteristics, but study authors pointed out that the studies “have not thoroughly assessed the potential confounding effects of mental health conditions associated with alterations in sleep.”
More

http://www.usmedicine.com/agencies/department-of-defense-dod/military-sleep-disorders-raise-diabetes-risk/

PAIN CLINICAL CONSULT

How Prescribers Discuss Opioid Use/Abuse with Patients

INDIANAPOLIS – From press reports, it might seem that everyone is talking about opioid analgesics. The question that VA researchers set out to answer, however, is how prescribers were discussing use of the pain relievers with their patients. A pilot study by researchers from the Richard L. Roudebush VA Medical Center and the Regenstrief Institute, both in Indianapolis, sought to analyze the nature of those conversations in regular primary-care appointments. Study authors suggest that a better understanding of how patients and doctors discuss the potentially addictive pain medications could ultimately lead to more effective strategies for communicating about chronic pain treatment.
More

http://www.usmedicine.com/clinical-topics/pain-management/how-prescribers-discuss-opioid-useabuse-with-patients/

Brenda L. Mooney

Editorial Director, U.S. Medicine

mooney@usmedicine.com

39 York Street

Lambertville, NJ  08530

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