Orlando—President Barack Obama enacted the Patient Protection and Affordable Care Act (ACA) to improve the value of healthcare, with an emphasis on increasing the access of care, decreasing the cost escalation, and implementing quality measures. To help achieve those goals, physicians and hospitals must work together, according to Robert Lancey, MD, MBA, chief of cardiac surgery and codirector of the Heart Institute at the Bassett Heart Care Institute in Cooperstown, New York.

Orlando—With fewer physicians, rising healthcare costs, and an increasing population, treating patients is becoming more difficult. For instance, >24 million people in the United States ≥20 years of age have diabetes, and the total costs associated with disease were estimated at $218 billion in 2007, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Orlando—In recent years, 18 states have implemented a total of 27 large multistakeholder pilot programs examining patient-centered medical homes (PCMHs). The District of Columbia and 44 states have passed >330 laws related to PCMHs.

The latest tracking poll (May 2011) conducted by the Henry J. Kaiser Family Foundation found that overall there is little public support for cutting Medicaid spending or changing the program to a block grant to reduce the federal deficit.

Only 13% of Americans say they would support major reductions in Medicaid spending to help reduce the deficit; only 3 in 10 say they would support minor reductions in the program. More than half (53%) say they want no reductions in Medicaid spending.

Chronic obstructive pulmonary disease (COPD) may be manifested by emphysematous destruction of the lung parenchyma and elevated measures of total lung capacity, conditions often associated with exposure to tobacco smoke. is increased awareness that smoking may also result in areas of increased lung density (interstitial lung ab-normalities) seen on high-resolution computer tomography (HRCT).

The Agency for Healthcare Research and Quality (AHRQ) recently issued Statistical Brief #313 identifying the top 5 therapeutic classes of outpatient prescription drugs in 2008 for adults age ≥18 in terms of expenditures. AHRQ ranked metabolic agents, central nervous system agents, cardiovascular agents, gastrointestinal agents, and psychotherapeutic agents as the top 5 drug classifications. These drugs were ranked by total expenditures out of the 18 broad therapeutic drug classes defined in 2008.

There have been various efforts to improve awareness and to reduce substance abuse among adolescents. Studies have shown that for 18- to 19-year-old adolescents, an individual motivational interview (IMI) effectively reduces alcohol-related problems. IMI is designed to empathize, offer personalized feedback, and show the negative effects of their drinking behavior on their goals. This type of individualized intervention decreased average drinking days and high-volume intake among 13- to 17-year-old alcohol users as well.

It is well known that smoking increases the risk of most diseases and death, but some studies suggest that smoking is also associated with a lower risk of certain neurodegenerative diseases, including Parkinson’s disease. Other studies have found a link between smoking and the risk of Alzheimer’s disease (AD), the most common form of dementia; some findings suggest that smoking reduces the risk of cognitive impairment.

Diabetes mellitus is known to increase the risk of vascular diseases, but a new study found that diabetes is also associated with premature death from several forms of cancer, infectious diseases, external causes, intentional self-harm, and degenerative disorders. These latest findings were reported in the New England Journal of Medicine [2011;364(9):829-841].

While the association between diabetes and vascular diseases has been well documented, less is known about whether diabetes and hyperglycemia also increase the risk of death from cancer or other nonvascular diseases.

Overweight or obesity is a worldwide problem. An increased body mass index is associated with higher mortality, the development of coronary vascular disease, type 2 diabetes mellitus, certain types of cancer, gastrointestinal diseases, and arthritis. The impact of these diseases on healthcare costs highlights the need for strategies to address the problem, according to researchers.

In use for more than a decade, the Clinical Trials.gov registry was expanded in 2008 to include a database for reporting results. The Food and Drug Administration Amendments Act (FDAAA) mandates that summary results data for certain trials of drugs, biologics, and devices be submitted to ClinicalTrials.gov whether published or not.

There are >31,000 hip fracture cases per year in the United States, costing an estimated $14 million to $20 billion. The number of these cases is expected to rise to 700,000 in the United States and from 1.6 million currently worldwide to 4 million by 2050.

Results of a randomized trial [Arch Pediatr Adolesc Med. 2011;165(3):262-268] show that urban children with persistent asthma have significant improvement in symptoms when treated by a school-based asthma therapy intervention compared with the usual care treatment.

In the United States, the number of students 12 to 17 years of age enrolled in special education with a diagnosis of autism spectrum disorder (ASD) increased from 15,480 in 1998 to 99,803 in 2007. Whether the increase is due to changing identification practices or a true increase in population prevalence, treated prevalence is increasing and, according to researchers, “implications of this trend for service systems are poorly understood.”

It is estimated that the 11 million caregivers in the United States providing 12.5 billion hours of care to individuals with Alzheimer’s disease are providing care valued at, but unpaid, nearly $44 billion. This unpaid value is in addition to long-term care costs of $178 billion (in 2006). The Institute of Medicine’s 2008 report, Retooling for an Aging America: Building the Health Care Workforce, stated that family members are an essential part of the healthcare workforce and should be given data, knowledge, and tools to provide high-quality care.

The Markle Foundation defines personal health records (PHRs) as an “Internet set of tools that allows people to access and coordinate their lifelong health information.” PHRs can range from applications maintained by healthcare organizations that build on a patient’s existing electronic record to stand-alone applications designed for the patient to use to supply the majority of the medical information to the PHR. The primary objective of a PHR, regardless of design, is to increase patient access to health information on a secure platform.

Clinical practice guidelines (CPGs) are usually adopted as standard of care and taught as such in training programs for healthcare providers. CPGs are important in the development of initiatives to improve quality of care and are playing an emerging role in national policy on reimbursement; CPGs also serve as the standard of care in medical malpractice cases.

For many Americans, the economic recession has also meant a loss of health insurance or higher health-related costs, according to a new report from The Commonwealth Fund; however, the Affordable Care Act (ACA) is expected to address some of these concerns in coming years. These were just a few of the findings from The Commonwealth Fund 2010 Biennial Health Insurance Survey report.

Treatments for patients with multivessel coronary artery disease include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). At the 1-year followup, the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) trial found that the rate of composite primary end point (death, myocardial infarction, stroke, or repeat revascularization) was lower with CABG compared with PCI. The largest difference was in the need for repeat revascularization.

New Orleans—A large randomized study has concluded that radial access is no less effective than femoral access for patients with acute coronary syndromes (ACS) who are undergoing procedures requiring vascular access, such as coronary angiography and percutaneous coronary intervention (PCI). The RIVAL (Radial vs Femoral Access for Coronary Intervention) trial also reported similar 30-day rates of adverse events with both approaches, with the exception of major vascular complications at the access site, which were significantly less likely to occur with radial access.

New Orleans—Through 2 years of treatment, patients who underwent percutaneous mitral valve repair had reduced mitral regurgitation (MR) and experienced meaningful clinical benefits, according to a randomized controlled trial that compared percutaneous mitral valve repair with surgery. The authors found that surgery provided more complete MR reduction, but percutaneous repair led to better safety.

Type 2 diabetes mellitus (DM) is one of the most common metabolic disorders, affecting nearly 250 million people worldwide. It is associated with major diabetes-related complications, including retinopathy, nephropathy, neuropathy, and cardiovascular disease. Individuals with type 2 DM are resistant to endogenous and exogenous insulin; both genetic and environmental factors contribute to the onset of hyperglycemia.

When compared with aspirin, apixaban, a factor Xa inhibitor, was found to significantly reduce the risk of stroke or systemic embolism in patients with atrial fibrillation who are not suitable for vitamin K antagonist therapy, according to a new double-blind study. The findings from the study were reported in the New England Journal of Medicine [2011;364(9):806-817].