University of Michigan Health System

Experts warn of serious blood clot risks from common IV devices

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Experts from the University of Michigan Health System in Michigan, US have cautioned medical practitioners on the serious risks of upper extremity deep-vein thrombosis (DVT) for hospitalized patients with peripherally-inserted central catheter (PICC) lines.

PICC lines are intravenous (IV) devices inserted in a patient’s arm to provide a means of access for medicine, nutrition and to draw blood samples. These devices are usually maintained for days to months.

Dr. Vineet Chopra and colleagues studied the records of 909 adults who received PICCs at their hospital in 2012 and 2013. The PICC lines were used for long-term IV antibiotic therapy, obtaining blood samples and for providing total parenteral nutrition (TPN) in these patients. Of the 909, 268 patients developed clots associated with PICC. [Am J Med 2015; doi:10.1016/j.amjmed.2015.01.027]

PICC- associated DVT (PICC-DVT) was more likely to occur in subjects with history of venous thromboembolism (VTE) and those who underwent surgery while the PICC was in place.

Moreover, narrower PICCs and intake of both aspirin and statins were associated with low DVT risk. However, DVT prophylaxis did not show a significant reduction in the risk of PICC-DVT. Treatment for PICC-DVT included heparin bridging, low molecular weight heparin (LMWH) only, or device removal.

Based on these findings, the authors recommended that patients with PICCs be monitored for clots and advised to continue taking aspirin and statins. More importantly, PICCs should only be used when indicated.

This recommendation was supported by another paper published recently emphasizing the importance of knowing the types of venous access devices, their indications and contraindications and the relevant anatomy involved. The authors also outlined an algorithm to help clinicians in choosing the best vascular access for each patient. [Journal of Hospital Medicine 2015;doi: 10.1002/jhm.2335]

Chopra and colleagues also published a review of best practices to help reduce DVTs and ensure proper use of PICC in hospitals. Ultrasonography was found to be more specific and sensitive in detecting PICC-DVT than clinical symptoms alone. Contrast venography may also be used in cases with unremarkable ultrasonography findings and high clinical probability. PICCs that are centrally-positioned, functional and clinically necessary should not be removed in cases of concomitant DVT. The mainstay of treatment is anticoagulation with LMWH or warfarin for at least 3 months.

Teenage pregnancy increased risk for obesity .

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 According to data from the National Health and Nutrition Examination Survey, researchers have determined that teenage mothers are more likely to develop obesity later in life.

“For the first time, we’ve identified our youngest moms as a high-risk group for obesity, which we know to be one of the most debilitating, long-term health issues we face,”Tammy Chang, MD, MPH, MS, clinical lecturer at the University of Michigan Medical School and a Robert Wood Johnson Foundation Clinical Scholar, said in a press release.

Chang and colleagues used the 2001-2010NHANES to investigate associations between overweight and obesity and teenage births among women aged 20 to 59 years. The patients were included if they had at least one live birth, were not pregnant at the time of the survey or recently pregnant (unweighted, n=5,220; weighted, n=48.4 million), researchers wrote.

After performing bivariate analyses, the researchers found that women with a teen birth were significantly more likely to become overweight (RR=1.61; 95% CI, 1.37-1.90) or obese (RR=1.84; 1.56-2.16) compared with women who did not have a teen birth. Adjusted data indicate women with a teen birth continued to be more susceptible for becoming overweight (aRR=1.33; 95% CI, 1.10-1.62) or obese (aRR=1.32, 95% CI, 1.09-1.61) compared with women without a teen birth, they wrote.

“We know that teen pregnancy is tied to certain immediate risks, such as babies having low birth weight and mothers struggling to complete high school — and now we know that it is also associated with poor long-term health outcomes,” Chang said. “Obesity is a prevalent, expensive health problem with detrimental health consequences and it’s difficult to reverse, which is why it’s incredibly important to identify at-risk groups early so that we can intervene.”

The researchers suggest further studies on modifiable physiologic and sociomedical reasons behind early pregnancy and subsequent risk forobesity.

 

PERSPECTIVE

 

  • This study is unique in that it  investigates whether teen pregnancy could be a risk factor for obesity later in life. The researchers looked at data on about 5200  women aged 20 to 59.

The investigators  sought to examine the difference in the prevalence of obesity or overweight status in women who gave birth between ages 13 and 19 years  vs. those who gave birth at age 20 or later. They found that women who gave birth during their teen years were 32% more likely to be obese compared to women who gave birth at or after age 20

Clearly, this study establishes teen pregnancy as a risk factor for obesity later in life. However, we’ve  to recognize that this is an association study and it doesn’t necessarily suggest cause-and-effect link between teen pregnancy and development of obesity in later life.

The findings are not necessarily surprising because there are common sociographic factors that predispose patients to teen pregnancy as well as obesity (i.e., lower socioeconomic status, school and home environments with limited access to healthy  to healthy foods, limited places to exercise, poor understanding of health in general, or poor access to health care).

The researchers also point out that avoiding teen pregnancy might be one of the ways we can  decrease development of  obesity in adults. We often think about teen pregnancy and short-term consequences such as interruption in  education of the mother and poor access to health care and adequate resourcesbut this study  highlights a long term health risk teen pregnancy may have has on these  teens later in life.

 

Source: Endocrine Today

 

 

Cash + Peer Pressure Works for Weight Loss, Study Finds.

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Dieters are more likely to stick with a weight-loss challenge when they’re competing against peers, a new study finds. Here, Everyday Health readers share what keeps them motivated.

 

If you want to slim down before swimsuit season, joining the office wellness program can motivate you to lose weight — as long as you’re competing as part of a group, researchers from the University of Michigan Health System report in the Annals of Internal Medicine.

When weight-loss awards were based on group performance rather than individual, participants lost nearly three times the amount of weight, researchers said.

The study examined two employee wellness incentive strategies among obese participants at the Children’s Hospital of Philadelphia. In the first group, individuals were offered $100 for each month they met or exceeded weight loss goals. In the second group, individuals were sorted into groups of five in which $500 was split among the participants who met their goals, meaning some could earn more than $100 if other members of the group didn’t meet their goals.

After six months, the group approach was far more successful.

Losing Weight With a Group

Now, as corporate weight loss challenges become more popular, researchers want to identify which kind of group competition is the best at encouraging weight loss.

“Approaches such as The Biggest Loser have received popular attention as ways to harness group dynamics to encourage weight loss, but the winner-take-all nature could be discouraging for everyone but the most successful person,” said lead author Jeffrey T. Kullgren, MD, in a release. “We need more data to compare how different group-based approaches stack up against each other.”

Everyday Health reader Alana He said on Facebook that the group approach works for her. “Over the last month, my friends and I have been doing a 30 day challenge — 30 minutes [of exercise] every day for 30 days,” she said. “If we miss a day, we owe a dollar. This motivation really worked for me! Only missed two days, and feeling great!”

Other readers said they love exercising with friends to stay accountable. But most report that neither cash nor peer pressure is what really makes them hit the gym and eat right — it’s the intrinsic benefits of weight loss, including self-esteem, confidence, and mental health.

“What motivates me now after losing 50+ pounds is just how much better I feel,” said GJ Dubar. “It’s hard, but it’s worth it.”

Said Pandora Williams: “Motivation and inspiration for me comes from the positive examples I see around me, from hearing others’ success stories, from seeing the changes in my body, and from other people cheering me on.”

If a group weight-loss challenge is what you need to stick to your goals, good news: Starting in 2014, the Affordable Care Act expands employers’ ability to reward employees who meet health status goals through corporate wellness programs. Rewards may include premium discounts or rebates, lower cost-sharing requirements, or extra benefits related to employer-sponsored health coverage.

 

Evidence supports optional use of RAI for papillary thyroid cancer.

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The use of radioactive iodine for the management of papillary thyroid cancer has been recommended for years, but researchers said it should not be a “blanket treatment” for all patients.

Guidelines for the management of well-differentiated thyroid cancer (WDTC) recommend routine usage of radioactive iodine (RAI) in patients with T3 disease or distant metatases, and selected use in patients with more limited disease.

However, lain J. Nixon, MBCHB, clinical fellow in the head and neck surgery department of Memorial Sloan-Kettering Cancer Center, told Endocrine Today that, due to a lack of evidence, the American Thyroid Association’s guidelines are not definitive for most patients when it comes to treatment.

“Over the years, different groups have looked at outcomes of patients who were treated with RAI. And initially, it dramatically improved patient outcomes. But, as treatment has progressed over the years and surgery is better now than it was in the 1940s, groups have discovered the  benefit is probably limited to high-risk patients,” Nixon said. “We now know that high-risk patients benefit, but low-risk patients don’t. The difficulty for clinicians is that most patients are somewhere between those two extremes, and there isn’t very good guidance about who should and should not receive RAI in that middle group.”

Nixon and colleagues conducted a review of 1,129 patients (median age of 46 years) who underwent total thyroidectomy at Memorial Sloan-Kettering Cancer Center between 1986 and 2005. After an average follow-up of 63 months, the researchers found that some patients with early primary disease (pTl/T2) and low-volume metastatic disease in the neck (pTl/T2 N1) who were managed without RAI displayed positive outcomes.

“It’s not a study that proves whether RAI works or it doesn’t,” Nixon said. “The idea of it is to give clinicians who are interested in the concept of managing patients without RAI some evidence to back up that position.”

For patients with advanced local disease (pT3/T4), some patients with pT3NO disease were safely managed without RAI. The 5-year disease-specific survival (DSS) and recurrence-free survival (RFS) rates for the pTl/T2NO group were 100% and 92%; for the pT1/T2N1, rates were 100% and 92%; and for the pT3/T4 group, rates were 98% and 87%, according to data.

Despite the traditional recommendations, the researchers suggest that RAI should be administered on a case­by-case basis through a multidisciplinary team with extensive experience in managing thyroid cancer.

“Our experience is that in properly selected patients, it’s very safe to manage them without RAI,” Nixon said. – by Samantha Costa

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Disclosure: The researchers report no relevant financial disclosures.

Perspective

 

Megan R. Haymart

  • Nixon and colleagues performed a retrospective review of 1,129 patients who underwent total thyroidectomy for thyroid cancer at a tertiary referral center between 1986 and 2005. They evaluated mortality and cancer recurrence in those patients that received radioactive iodine post thyroid surgery versus those that did not. They found that select patients do well without radioactive iodine treatment. This study suggests that it is time for the pendulum to swing. Although radioactive iodine treatment has clear benefit in high risk iodine avid patients, for many patients management with surgery alone may be adequate.
  • Source: Endocrine Today.