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1.
Nutritional screening and dietitian consultation rates in a geriatric evaluation and management unit.
Dent, E, Wright, O, Hoogendijk, EO, Hubbard, RE
Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2018;(1):11-16
Abstract
AIM: Nutritional screening may not always lead to intervention. The present study aimed to determine: (i) the rate of nutritional screening in hospitalised older adults; (ii) whether nutritional screening led to dietitian consultation and (iii) factors associated with malnutrition. METHODS In this prospective study of patients aged ≥70 years admitted to a Geriatric Evaluation and Management Unit (GEMU), malnutrition was screened for using the Mini Nutritional Assessment Short Form (MNA-SF) and identified using the Mini Nutritional Assessment (MNA). RESULTS Of the 172 patients participating in the study, 53 (30.8%) patients were malnourished, and 84 (48.8%) were at risk of malnutrition. Mean (SD) age was 85.2 (6.4 years), with 131 patients (76.2%) female. Nutritional screening was performed for all patients; however, it was incomplete in 59 (34.3%) because of omission of the anthropometric measurement. Overall, 62 (36.0%) of the total number of patients were seen by the dietitian, which included 26 (49%) of malnourished patients, 27 (32%) of at-risk patients and 9 (26%) of the well-nourished patients. No patients lost >1% of body weight during GEMU stay. Malnourished patients were more likely to be frail, have poor appetite, depression, and have lower levels of: albumin, cognition, physical function, grip strength and quality of life. CONCLUSIONS The full benefits of nutritional screening by MNA-SF may not be realised if it does not result in malnourished patients receiving a dietitian consultation. However, it is possible that enrichment of the foodservice with high protein/high-energy options minimised patient weight loss in the GEMU.
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2.
Detecting familial hypercholesterolemia by serum lipid profile screening in a hospital setting: Clinical, genetic and atherosclerotic burden profile.
Scicali, R, Di Pino, A, Platania, R, Purrazzo, G, Ferrara, V, Giannone, A, Urbano, F, Filippello, A, Rapisarda, V, Farruggia, E, et al
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2018;(1):35-43
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is underdiagnosed and public cholesterol screening may be useful to find new subjects. In this study, we aim to investigate the prevalence of FH patients in a hospital screening program and evaluate their atherosclerotic burden using intima-media thickness (IMT). METHODS AND RESULTS We screened 1575 lipid profiles and included for genetic analysis adults with a low-density lipoprotein (LDL) cholesterol >190 mg/dL and triglycerides <200 mg/dL and first-degree child relatives with LDL cholesterol >160 mg/dL and triglycerides <200 mg/dL. The diagnosis of FH was presumed by Dutch Lipid Clinic Network (DLCN) criteria and confirmed by the presence of the genetic variant. Mean common carotid intima-media thickness (IMT) was assessed using consensus criteria. After confirming LDL cholesterol value and excluding secondary hypercholesterolemia, 56 subjects with a DLCN ≥4 performed genetic analysis. Of these, 26 had an FH genetic variant. The proportion of patients with a mutation having a DLCN score of 6-8 was 75%; in individuals with a DLCN score >8 it was 100%. Mean IMT was higher in FH patients compared to non FH (0.73 [0.61-0.83] vs 0.71 [0.60-0.75] mm, p < 0.01). Moreover, we detected two mutations not previously described. Finally, simple regression analysis showed a correlation of IMT with LDL cholesterol >190 mg/dL and corneal arcus (p < 0.01 and p < 0.001, respectively). CONCLUSIONS A hospital screening was useful to detect FH subjects with increased atherosclerosis. Also, next-generation sequencing was able to detect new FH mutations.
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3.
Bundled HIV and Hepatitis C Testing in the Emergency Department: A Randomized Controlled Trial.
Cowan, E, Herman, HS, Rahman, S, Zahn, J, Leider, J, Calderon, Y
The western journal of emergency medicine. 2018;(6):1049-1056
Abstract
INTRODUCTION An estimated 25% of the 1.2 million individuals living with human immunodeficiency virus (HIV) in the U.S. are co-infected with hepatitis C (HCV). The Centers for Disease Control and Prevention recommends HCV testing for high-risk groups. Our goal was to measure the impact of bundled HIV and HCV testing vs. HIV testing alone on test acceptance and identification of HCV and HIV. METHODS We conducted a two-armed, randomized controlled trial on a convenience sample of 478 adult patients in the Jacobi Medical Center emergency department from December 2012 to May 2013. Participants were randomized to receive either an offer of bundled HIV/HCV testing or HIV testing alone. We compared the primary outcome, HIV test acceptance, between the two groups. Secondary outcomes included HIV and HCV prevalence, and HCV test acceptance, refusal, risk, and knowledge. RESULTS We found no significant difference in HIV test acceptance between the bundled HCV/HIV (91.8%) and HIV-only (90.6%) groups (p=0.642). There were also no significant differences in test acceptance based on gender, race, or ethnicity. A majority of participants (76.6%) reported at least one HCV risk factor. No participants tested positive for HIV, and one (0.5%) tested positive for HCV. CONCLUSION Integrating bundled, rapid HCV/HIV testing into an established HIV testing program did not significantly impact HIV test acceptance. Future screening efforts for HCV could be integrated into current HIV testing models to target high-risk cohorts.
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4.
Coronary Artery Calcium Scoring in Young Adults: Evidence and Challenges.
Saad, M, Pothineni, NV, Thomas, J, Parikh, R, Kovelamudi, S, Elsayed, D, Nairooz, R, Feit, F
Current cardiology reports. 2018;(2):10
Abstract
PURPOSE OF REVIEW This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults. RECENT FINDINGS Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56. Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be "falsely reassuring," however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.
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5.
Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice.
McDonagh, T, Damy, T, Doehner, W, Lam, CSP, Sindone, A, van der Meer, P, Cohen-Solal, A, Kindermann, I, Manito, N, Pfister, O, et al
European journal of heart failure. 2018;(12):1664-1672
Abstract
Iron deficiency is common in patients with chronic heart failure (CHF) and is associated with reduced exercise performance, impaired health-related quality of life and an increased risk of mortality, irrespective of whether or not anaemia is present. Iron deficiency is a serious but treatable condition. Several randomized controlled clinical trials have demonstrated the ability of intravenous (IV) iron, primarily IV ferric carboxymaltose (FCM), to correct iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF), resulting in improvements in exercise performance, CHF symptoms and health-related quality of life. The importance of addressing the issue of iron deficiency in patients with CHF is reflected in the 2016 European Society of Cardiology (ESC) heart failure guidelines, which recognize iron deficiency as an important co-morbidity, independent of anaemia. These guidelines recommend that all newly diagnosed heart failure patients are routinely tested for iron deficiency and that IV FCM should be considered as a treatment option in symptomatic patients with HFrEF and iron deficiency (serum ferritin < 100 µg/L, or ferritin 100-299 µg/L and transferrin saturation < 20%). Despite these specific recommendations, there is still a lack of practical, easy-to-follow advice on how to diagnose and treat iron deficiency in clinical practice. This article is intended to complement the current 2016 ESC heart failure guidelines by providing practical guidance to all health care professionals relating to the procedures for screening, diagnosis and treatment of iron deficiency in patients with CHF.
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6.
A randomized general population study of the effects of repeated health checks on incident diabetes.
Skaaby, T, Jørgensen, T, Linneberg, A
Endocrine. 2018;(1):122-128
Abstract
BACKGROUND It is not clear whether offering health checks to the general population can be used to prevent diabetes. Few randomized studies have had a long-term follow-up. We used a randomly selected population cohort as a randomized trial to examine the effect of repeated health checks on the 30-year incidence of diabetes. METHODS The study included all persons from 11 municipalities in Copenhagen aged 30, 40, 50, and 60 years (n = 17845). An age-stratified and gender-stratified random sample (N = 4789) was invited to participate in a maximum of three health checks between 1982 and 1994 ('intervention group'). The remaining 12994 persons were defined as the 'control group'. The health checks included a questionnaire, a physical examination including assessment of overweight and blood pressure, and blood sampling with determination of serum lipid levels. Based on the person's answers and test results, the participants were given individual information about the results, disease risk and lifestyle. Their general practitioner, too, was provided with written information on the test results. Both groups were followed in the Danish Civil Registration System, the Danish National Diabetes Register, the Cause of Death Registry, and the National Patient Registry until 31 December 2012. FINDINGS There were 2636 incident cases of diabetes and a mean follow-up time of 24.1 years. The age-adjusted and gender-adjusted hazard ratio (HR) (95% confidence interval, CI) for the intervention group versus the control group was HR = 1.07 (95% CI: 0.98, 1.16, p = 0.153). INTERPRETATION Offering repeated general health checks to the general population had no preventive effect on the development of diabetes during 30 years of follow-up.
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7.
Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part.
Brett, T, Qureshi, N, Gidding, S, Watts, GF
Atherosclerosis. 2018;:399-406
Abstract
Fifty per cent of first-degree relatives of index cases with familial hypercholesterolemia (FH) inherit the disorder. Despite cascade screening being the most cost-effective method for detecting new cases, only a minority of individuals with FH are currently identified. Primary care is a key target area to increase identification of new index cases and initiate cascade screening, thereby finding close relatives of all probands. Increasing public and health professional awareness about FH is essential. In the United Kingdom and in Australia, most of the population are reviewed by a General Practitioner (GP) at least once over a three-year period, offering opportunities to check for FH as part of routine clinical consultations. Such opportunistic approaches can be supplemented by systematically searching electronic health records with information technology tools that identify high risk patients. GPs can help investigate and implement results of this data retrieval. Current evidence suggests that early detection of FH and cascade testing meet most of the criteria for a worthwhile screening program. Among heterozygous patients the long latent period before the expected onset of coronary artery disease provides an opportunity for initiating effective drug and lifestyle changes. The greatest challenge for primary care is to implement an efficacious model of care that incorporates sustainable identification and management pathways.
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8.
Integrating lipid screening with ideal cardiovascular health assessment in pediatric settings.
Blackett, P, George, M, Wilson, DP
Journal of clinical lipidology. 2018;(6):1346-1357
Abstract
Pediatric lipid screening and management with the aim of reducing and preventing adult disease is an internationally accepted concept, and guidelines have been published in several countries. However, implementation by the practicing pediatric community in the United States has been less than expected and delays have been attributed to uncertainty among providers. Reduced screening rates have also been reported for conditions contributing to arterial wall pathology such as obesity, hypertension, and prediabetes despite accumulating evidence that detection and intervention can lead to risk reversal. Consistent with graded and evidence-based national guidelines for comprehensive cardiovascular risk assessment and management, we present how the American Heart Association ideal cardiovascular health (ICVH) model can be integrated with lipid screening, and how it can be compatible with comprehensive pediatric lipidology practice and enhanced familial hypercholesterolemia detection. Since being introduced and retrospectively validated in adults and children in cross-sectional studies, ICVH evaluates thresholds for seven ideal health metrics representing measurements of obesity, dyslipidemia, diabetes risk, and blood pressure, and includes exercise, diet, and smoking behaviors. When each metric is valued as a point, the maximum health score is 7, but national surveys have shown unacceptable low scores in adolescence. Inverse correlation of scores with arterial structural change supports use of ICVH as a collection of treatable targets forming a cardiovascular prevention construct including and supporting lipid screening in pediatric settings, but implementation in clinical practice requires more expertise and administrative support than lipid screening alone.
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9.
Diabetes primary prevention program: New insights from data analysis of recruitment period.
Gagliardino, JJ, Elgart, JF, Bourgeois, M, Etchegoyen, G, Fantuzzi, G, Ré, M, Ricart, JP, García, S, Giampieri, C, González, L, et al
Diabetes/metabolism research and reviews. 2018;(1)
Abstract
BACKGROUND Primary Prevention of Diabetes Program in Buenos Aires Province evaluates the effectiveness of adopting healthy lifestyle to prevent type 2 diabetes (T2D) in people at high risk of developing it. We aimed to present preliminary data analysis of FINDRISC and laboratory measurements taken during recruitment of people for the Primary Prevention of Diabetes Program in Buenos Aires Province in the cities of La Plata, Berisso, and Ensenada, Argentina. METHODS People were recruited through population approach (house-to-house survey by FINDRISC in randomized areas) and opportunistic approach (FINDRISC completed by participants during consultations for nonrelated prediabetes/diabetes symptoms in public and private primary care centres of cities involved). In people with FINDRISC score ≥ 13 points, we evaluated blood concentrations of HbA1c , creatinine, lipids, and an oral glucose tolerance test (OGTT). RESULTS Approximately 3415 individuals completed the FINDRISC populational survey and 344 the opportunistic survey; 43% of the 2 groups scored over 13 points; 2.8 and 75.4% of them, respectively, took the prescribed OGTT. Approximately 53.7% of the OGTT showed normal values and 5.2% unknown T2D. The remaining cases showed 69.5% impaired fasting glucose, 13.6% impaired glucose tolerance, and 16.9% both impairments. HbA1c values showed significant differences compared with normal glucose tolerance (4.96 ± 0.43%), prediabetes (5.28 ± 0.51%), and T2D (5.60 ± 0.51%). Participants with prediabetes and T2D showed a predominant increase in low-density lipoprotein-cholesterol values. In prediabetes, >50% showed insulin resistance. CONCLUSIONS People with prediabetes/T2D had dyslipidemia associated with insulin resistance, which promotes the development of T2D and cardiovascular disease. Thus, it merits its appropriate treatment.
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10.
[Experimentation of targeted cardio-neurovascular risk screening in pharmacies].
Aly, P, Tempremant, G, Houppermans, S, Maes-Patinier, F, Vanbockstael, V, Lemdani, M
Sante publique (Vandoeuvre-les-Nancy, France). 2018;(6):777-783
Abstract
OBJECTIVES Pharmacists' involvement in the screening of cardio-neurovascular diseases could enhance the prevention of cardio-neurovascular risk factors. This research-action assesses the pertinence of targeted screening for cardio-neurovascular risk in pharmacies. METHODS This study was carried out within Lens-Hénin over the course of four months. The model included: the tracking of patients, excluding those with known cardio-neurovascular disease, with risk factors according to their age, sex, weight, family history of cardio-neurovascular diseases, smoking status; Screening for cardio-neurovascular risk with blood pressure measuring, blood total cholesterol, HDL cholesterol and the glycaemia by capillary blood sampling as well as the abdominal perimeter and the BMI. Patients were oriented according to results of screening. RESULTS 471 patients were screened, 218 (46%) had at least two risks, 236 (50%) had a cholesterol value greater than or equal 2 g/L, 176 (37.4%) had a blood pressure greater than or equal to limit value l, 104 (22%) patients had a BMI value greater than or equal to 30 kg/m2, 217 (46%) had an abdominal perimeter value greater than or equal to limit value and 17 (5.3%) patients had impaired fasting blood glucose. 373 (79%) patients were moved toward their general practitioner and at least 68 (18%) consulted. CONCLUSION This research-action of targeted screening for cardiovascular risk in pharmacies proves to be relevant. The reproduction of a similar study in other territories is under consideration.