In the first study to quantify microcephaly risk with Zika, CDC and Harvard researchers have found that babies whose mothers are infected with the virus within their first trimester run between a 1% and 13% risk of being born with microcephaly. However, the associated risk of microcephaly in women infected in their second or third trimester is much lower, with the authors characterizing it as "negligible." Researchers based their estimates on 2015-16 data on the incidence of microcephaly in babies born in one of the hardest hit regions in Brazil.

 

Source: The New England Journal of Medicine 

Florida health officials are changing the state's policy for administering costly hepatitis C drugs to Medicaid patients and will now require insurance companies to provide the drug at an earlier stage in the disease.

 

Source: Miami Herald 

A strain of E. coli resistant to colistin - the antibiotic of last resort - was identified for the first time in the U.S. in April, marking "the emergence of a truly pan-drug resistant bacteria," according to a study in Antimicrobial Agents and Chemotherapy.

Here are six things to know about colistin, this case and "super" superbugs.

 

Source: Becker's Hospital Review 

"New care delivery models for primary care are shaping the landscape of healthcare delivery, and in turn shaping patient experiences in doctors' offices around the country," Halee Fischer-Wright, MD, president and CEO of the MGMA, said in a prepared statement. "Practices are giving primary care physicians significant new responsibility for coordinating care among specialists, managing patient medications, and helping patients and caregivers manage chronic conditions. As we shift toward value-based payment, practices will continue to look to primary care and non-physician providers to lead efforts to improve patient experiences and the quality of care they provide."

 

Source: Becker's Hospital Review 

A focused update of guidelines for heart failure provides recommendations for two new medications. Released by several societies including the ACC and AHA, the new guidance recommends that clinicians prescribe the angiotensin receptor neprilysin inhibitor valsartan/sacubitril in place of an ACE inhibitor or ARB in patients with chronic symptomatic HFrEF NYHA class II or III who have tolerated those therapies, in addition to standard therapies including a beta-blocker and, for some patients, an aldosterone antagonist. The guidelines also state that doctors should not combine valsartan/sacubitril with an ACE inhibitor nor order valsartan/sacubitril for patients with a history of angioedema. (A randomized trial of heart failure patients found that valsartan/sacubitril plus standard therapy reduced heart failure hospitalizations or cardiovascular death by 20% vs. an ACE inhibitor plus standard care.) The guidance also recommends using ivabradine, which can help reduce heart failure hospitalizations, in heart failure patients with stable, chronic heart failure and reduced ejection fraction who are receiving standard care and are in sinus rhythm with a resting heart rate of 70 bpm or greater.

 

Source: Circulation

A new study looking at the impact of taking aspirin in TIA patients finds that the use of early aspirin reduces the short-term risk of a disabling or fatal stroke by as much as 80%. The authors pooled randomized data from 12 trials that encompassed close to 16,000 participants. They found that giving TIA patients early aspirin reduced patients' six-week risk of a recurring stroke by 60%, with some reduction also seen between six and 12 weeks post-TIA. However, authors noted that data didn't indicate any improvement in risk reduction after 12 weeks. "The considerable early benefit from aspirin," the authors wrote, "warrants public education about self-administration after possible TIA." In other news on aspirin, however, another study concluded that, among at-risk patients presenting to the ED, the use of aspirin compared with placebo did not reduce the risk of ARDS at 7 days.

 

Source: The Lancet

In a case drawing interest from doctors, hospitals, trial lawyers and the senior-advocacy group AARP, the Florida Supreme Court will hear arguments in October in a dispute about documents disclosed in medical-malpractice cases. Justices on Wednesday scheduled oral arguments Oct. 5 in the case, which stems, in part, from a 2004 constitutional amendment that sought to ensure broad access to records held by hospitals and other providers about "adverse" medical incidents. Such information can be useful to plaintiffs in pursuing malpractice lawsuits. But the 1st District Court of Appeal, in a Jacksonville case, ruled last year that a 2005 federal law preempted the state disclosure requirements. The ruling said the federal law created a system for health-care providers to share information about errors, with the goal of improving care and patient safety --- and also offered protections against information being used in lawsuits. The case then went to the Supreme Court, where numerous groups, including the American Medical Association, the Florida Medical Association, the Florida Justice Association and AARP, have filed friend-of-the-court briefs. In the underlying case, the family of Marie Charles filed a malpractice lawsuit alleging she suffered neurological injuries because of negligence while she was a patient at two Baptist Medical Center facilities, according to a 2014 ruling by Duval County Circuit Judge Waddell Wallace. Baptist turned over some requested documents but refused to produce others. At least part of the dispute involved information known as "patient safety work product" under the federal law. 

Source: The News Service of Florida 

June 10 & 11, 2016