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AHRQ Study: Joint Replacement to Become the Most Common Elective Surgical Procedure in the Next Decades

By 2030, about 11 million Americans will have either a hip or knee replacement, making it one of the nation's most common elective surgical procedures, according to an AHRQ-funded study. Using data from AHRQ's Healthcare Cost and Utilization Project State Inpatient Database, researchers analyzed general population trends by year, state, gender, and age group from 1990 to 2010. In 2010, researchers estimate that approximately 7 million Americans had had a total hip or knee replacement, including 620,000 individuals who had both procedures, according to the study. Researchers attributed the increase in joint replacement surgeries to several factors: the aging of the baby boomer population, high rates of diagnosis and treatment of arthritis, and demands for improved mobility and high quality of life. Also contributing to the trend are younger individuals undergoing these procedures, coupled with improvements in life expectancy. In some cases, researchers said, younger patients will outlive their implants and require expensive revision surgeries with substantial cost implications. The majority of the individuals (70%) who have undergone total hip and/or knee replacement surgery are alive today. The study and abstract were published in The Journal of Bone and Joint Surgery.

  
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June 13-19: Men's Health Week

The purpose of National Men's Health Week is to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. Passed by Congress and signed into law by President Bill Clinton on May 31, 1994, this week in Men's Health Month provides an opportunity for healthcare providers, public policymakers, the media, and individuals to encourage men and boys to seek regular medical advice and early treatment for disease and injury. For more information, contact: Men's Health Network | 202.543.6461, ext. 101 or | http://www.menshealthweek.org

 

EHR Drug Allergy Safety Warnings Need Urgent Improvement

An urgent need exists to improve the accuracy and relevance of drug allergy safety alerts issued through computerized provider order entry systems, according to an AHRQ study. The improvements are needed to reduce the rate of alert overrides by clinicians who may be subject to "alert fatigue," or becoming desensitized to safety alerts by either ignoring or failing to respond appropriately to them. Based on more than 611,000 drug allergy alert records from 2004 to 2013 at two large Boston academic hospitals, the study found that alerts for two serious reactions were overridden about three-quarters of the time. "Rising Drug Allergy Alert Overrides in Electronic Health Records: An Observational Retrospective Study of a Decade of Experience" and abstract were published in the Journal of the American Medical Informatics Association.

  
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Fully Electronic Health Record Associated With Lower Odds of In-Hospital Adverse Events

Cardiovascular, pneumonia, and surgery patients exposed to fully electronic health records were less likely to experience in-hospital adverse events, according to a new AHRQ study. Using 2012 and 2013 Medicare Patient Safety Monitoring System data, researchers examined the association of hospitals' electronic health records adoption and occurrence rates of in-hospital adverse events. The primary outcomes evaluated were the occurrence rates of 21 in-hospital adverse events, classified by four clinical domains: hospital-acquired infections, adverse drug events, general events (such as falls and pressure ulcers), and postprocedural events. Among the more than 45,000 patients who were at risk for nearly 350,000 adverse events in the study sample, 13% were exposed to fully electronic health records. Among all study patients, the occurrence rate of adverse events was 2.3% (7,820 adverse events). Patients exposed to fully electronic health records, however, had 17-30% lower odds of any adverse event. The study, "Electronic Health Record Adoption and Rates of In-Hospital Adverse Events," and abstract appeared in the February issue of the Journal of Patient Safety.

  
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AHRQ Study: Preventive Care Visits Increased in States That Expanded Medicaid

In states that expanded Medicaid coverage under the Affordable Care Act, preventive care visits at community health centers increased 41%, according to a new AHRQ-funded study. The study was based on electronic health record data of more than 400,000 patients at nearly 220 community health centers in five states that did expand Medicaid coverage (California, Minnesota, Ohio, Oregon, and Washington) and four states that did not (Alabama, Indiana, Montana, and North Carolina). The analysis looked at patients ages 19 to 64 who were either uninsured or had Medicaid or private insurance. Researchers compared patient visit rates during the 12-month period before Medicaid expansion (January 1 to December 31, 2013) and the 12-month period after (January 1 to December 31, 2014). In addition to the increase in preventive care visits, the rate of new patient visits climbed 14% and visits for services such as laboratory tests increased 23% in states with expanded Medicaid coverage. The study, "Utilization of Community Health Centers in Medicaid Expansion and Non-Expansion States, 2013-2014" and abstract were published in the January 13 issue of the Journal of Ambulatory Care Management.

  
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Nursing Assistants Week

The annual National Nursing Assistants Week (June 12-19, 2016) focuses on career growth and ways that nursing assistants can grow at the bedside and in the healthcare field. This 39th annual observance recognizes nursing assistants and others who provide daily care to our frail and long-term care citizens in nursing homes, home care, hospitals, hospice, independent living, and other long-term care settings. Each day of NA Week focuses on a different aspect of the theme. For more information, contact: National Network of Career Nursing Assistants | 330.825.9342 | http://www.cnanetwork.org.

  
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Food Safety

How Are Foodborne Diseases Diagnosed?

The infection is usually diagnosed by specific laboratory tests that identify the causative organism.

  
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* Bacteria such as Campylobacter, Salmonella, E. coli O157 are found by culturing stool samples in the laboratory and identifying the bacteria that grow on the agar or other culture medium.

 

* Parasites can be identified by examining stools under the microscope.

 

* Viruses are more difficult to identify, as they are too small to see under a light microscope and are difficult to culture. Viruses are usually identified by testing stool samples for genetic markers that indicate a specific virus is present.

 

 

Many foodborne infections are not identified by routine laboratory procedures and require specialized, experimental, and/or expensive tests that are not generally available. Because many ill persons do not seek attention, and of those that do, many are not tested, many cases of foodborne illness go undiagnosed, and most illnesses are not laboratory-confirmed. For example, it is estimated that 29 Salmonella illnesses occur for every one that is laboratory-confirmed and that many hospitalizations and deaths caused by Salmonella infection are not ascertained.

 

How Are Foodborne Diseases Treated?

There are many different kinds of foodborne diseases and they may require different treatments, depending on the symptoms they cause. Illnesses that are primarily diarrhea or vomiting can lead to dehydration if the person loses more body fluids and salts (electrolytes) than they take in.

 

* Replacing the lost fluids and electrolytes and keeping up with fluid intake are important.

 

* If diarrhea is severe, oral rehydration solution such as Ceralyte*, Pedialyte*, or Oralyte* should be drunk to replace the fluid losses and prevent dehydration. Sports drinks such as Gatorade* do not replace the losses correctly and should not be used for the treatment of diarrheal illness.

 

* Preparations of bismuth subsalicylate (e.g., Pepto-Bismol*) can reduce the duration and severity of simple diarrhea.

 

* If diarrhea and cramps occur, without bloody stools or fever, taking an antidiarrheal medication may provide symptomatic relief, but these medications should be avoided if there is high fever or blood in the stools because they may make the illness worse.

 

 

For more information on food poisoning, go to http://www.cdc.gov.

 

Home-Based Primary Care Interventions

Totten et al. (2016) conducted an integrative review of available evidence about home-based primary care (HBPC) for adults with serious chronic conditions. The articles reviewed included two randomized controlled trials and 17 observational studies. The researchers found moderate evidence that HBPC reduced hospitalizations and hospital days. The evidence was less strong for hospital readmissions, emergency, and specialty care. Sicker patients were found to derive the most benefit from HBPC. A positive impact on patient satisfaction and quality of life was detected but with a low strength of evidence. The full report is at https://www.effectivehealthcare.ahrq.gov/ehc/products/590/2183/home-based-care-r

  
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Mind Your Risks Raises Awareness of the Link Between High Blood Pressure and Cognitive Impairment

A growing body of scientific evidence indicates that uncontrolled high blood pressure is not only the leading cause of stroke but may also be linked to cognitive decline and dementia. The National Institutes of Health's (NIH) National Institute of Neurological Disorders and Stroke (NINDS) is launching a public health education campaign called Mind Your Risks. The campaign is designed to raise awareness about how controlling the risk factors for stroke in middle age, particularly high blood pressure, may reduce the risk of cognitive decline later in life.

  
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"We hope that this campaign will lead people to think about how they can decrease their chances of developing dementia later in life. The Mind Your Risks campaign will offer some concrete prevention steps. Controlling hypertension is at the top of the list," said Walter J. Koroshetz, M.D. director of the NINDS. NINDS is partnering with Million Hearts, an initiative by the Health and Human Services Department, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services; and also with the Administration for Community Living, and the NIH's National Institute on Aging and the National Heart, Lung, and Blood Institute.

 

For more information: http://www.mindyourrisks.nih.gov

 

AHRQ Stats Conditions Causing Limited Mobility

Severe back/neck conditions affected 7.5 million Americans in 2010, making them the most common chronic conditions limiting mobility. Arthritis/rheumatism, affecting 6.8 million, was the second most common. (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report, Chartbook on Effective Treatment.)

  
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Preventable Hospital Stays

Potentially preventable hospital stays-those that might be prevented with good outpatient care-decreased at a faster rate (19%) than overall hospital stays (8%) between 2005 and 2012. (Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #195, Trends in Potentially Preventable Inpatient Hospital Admissions and Emergency Department Visits.)

  
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Chronic Health Conditions

One in four Americans received treatment for at least two chronic health conditions such as diabetes and hypertension in 2012. Collectively, chronic care treatment accounted for 57% of all healthcare expenditures that year. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #485: Health Expenditures For Adults by Number of Treated Chronic Conditions, Race/Ethnicity, and Age, 2012.)

  
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