Emilia Huvinen, M.D., Ph.D., from Helsinki University Hospital in Finland, and colleagues randomly assigned individuals with a body mass index (BMI) ≥30 kg/m2 and/or prior GDM to lifestyle intervention and control groups before pregnancy or in early pregnancy; genetic and GDM data were available for 516 participants. Based on 50 risk variants for type 2 diabetes, a polygenic risk score (PRS) was calculated.
The researchers found that the PRS was associated with higher glycemic levels (fasting glucose and/or hemoglobin A1c) and a lower insulin secretion index in the second and third trimesters and at 12 months postpartum; in addition, the PRS was associated with a higher occurrence of GDM and glycemic abnormalities at 12 months postpartum. When the data were analyzed for participants who did not have GDM at the first study visit during pregnancy, an interaction was seen between the PRS and lifestyle intervention during pregnancy and postpartum. The intervention was effective in reducing the age-adjusted occurrence of GDM only among those with the highest genetic risk when the analysis was performed among women in tertiles according to PRS (odds ratio, 0.37). In the same group, the risk for glycemic abnormalities was reduced at 12 months postpartum after additional adjustment (odds ratio, 0.35).
“Including a type 2 diabetes PRS in the risk assessment may help to identify those women at highest risk and thus benefitting most from targeted intervention,” the authors write.
DENVER — Implementation of a standardized medication reconciliation training regimen may prevent prescribing errors and adverse effects from an inaccurate medication list, according to research presented at the 2019 American Academy of Physician Assistants (AAPA) Annual Meeting, held May 18 to 22, 2019 in Denver, CO.
A group of physician assistant student researchers from the University of Kentucky Markey Cancer Center, Multidisciplinary Clinic implemented a patient medication interview to ensure that information on all patient medications is captured at each office visit in the clinic. In a preimplementation review, the research team had identified that medical record technicians did not receive adequate training in conducting medication reconciliation and/or may have been unfamiliar with the patient’s electronic medical record. The team also found that during visits, patients may be unable to recall the medications they currently take and/or they do not bring medications or an updated list to share with the technician.
Interviews were categorized as thorough (technician addressed every medication), partial (technician addressed single medications or asked for specific medication changes), or none (technician did not address medications in any way). Preimplementation results found that 50% of technicians were thorough in asking questions pertaining to medication use, 35.3% conducted a partial interview, and 14.7% did not address medication use in any way. Implementing a standarized training regimen that used a script and a listing of common medications increased thorough medication reconciliation to 100% and eliminated any partial or absent questioning.
“This enhancement will provide a more thorough medication review,” the authors concluded. “It can serve as a starting ground for future studies to compare this standard interview to other methods of collecting patient medication information, and to study the accuracy of the resulting list.”
Elizabeth M. Webber, from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a targeted systematic review to update the evidence on the effectiveness of screening for COPD and COPD treatment. Data were included from three trials or analyses of pharmacologic treatment published since 2015 with 20,058 participants, 13 trials on nonpharmacologic interventions with 3,657 participants, and two large observational studies addressing the harms of pharmacologic treatment with 243,517 participants. The researchers found that the results from the clinical trials of pharmacologic therapy were consistent with the previous review, supporting the 2016 USPSTF recommendation. Across a range of outcomes, no consistent benefit was seen for any type of nonpharmacologic treatment.
Based on these findings and using a reaffirmation process, the USPSTF concludes with moderate certainty that screening asymptomatic adults for COPD has no net benefit. Consequently, the USPSTF recommends against screening asymptomatic adults for COPD (D recommendation).
“While screening for COPD in people without symptoms is not recommended, health care professionals can still help prevent their patients from getting COPD,” USPSTF Chair Carol Mangione, M.D., M.S.P.H., said in a statement. “Most cases of COPD are caused by smoking, so it’s essential health care professionals support their patients, including young people, in not starting to smoke and helping those who do smoke quit.”
Wade D, Stayer L, Wells E, Mullins D, Schuer K. Standardization of the medication reconcilliation interview. Presentation at: The American Academy of Physician Assistants Annual Meeting; May 18-22, 2019; Denver, CO. Poster 148.
This article originally appeared on Clinical Advisor