Daily ReCAP April 20, 2017

Chronic: Link Between Increased Prescriptions for Chronic Diseases and Medicaid Expansion

Findings from a new study revealed that in the first year and a half of the Affordable Care Act, the number of prescriptions filled by adults using Medicaid coverage increased by 19% in states that expanded Medicaid. Most notably, the largest increases were for medications that managed chronic conditions and for birth control. “We knew the Medicaid expansion had improved access to care, but this study gives us much more detail about what that really means for patient care,” said author Benjamin Sommers. “Medications for conditions like diabetes and heart disease can be lifesavers.” The preliminary findings will be presented at the Society of General Internal Medicine 2017 annual meeting in Washington, DC.

Acute: US Clinical Decision Rule Superior in Diagnosing Head Injuries, Help Minimize CT Scans

The Pediatric Emergency Care Applied Research Network (PECARN) clinical decision rule was found to be the most accurate in identifying children at a very low risk of traumatic brain injury, and it could help minimize CT scans for children with milder injuries. The prospective observational study included 20,137 children under 18 years of age with head injuries from 10 Australia and New Zealand tertiary hospitals. The investigators compared 3 clinical decision rules: PECARN, the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule, and the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE). The investigators sought to determine which of the 3 decision rules was superior in identifying children at very low risk of traumatic brain injury. The results of the study, published inThe Lancet, showed that all 3 options served as good options but that the PECARN was the only rule that did not miss a single patient who required neurosurgery. Although the findings show promise, the authors warned that “it will be important to relate the findings to a number of other factors before implementation, such as the baseline CT use, the effect of the rules on the projected CT rate, the baseline clinician diagnostic accuracy and experience, parental expectations, the medico-legal climate and economic considerations,” said lead investigator Franz Babl.

Preventive: Scientist Look to Virtual Realty to Improve Balance in Elderly Patients

A novel virtual reality (VR) system could one day help prevent falls in elderly patients and individuals with neurodegenerative conditions. In a study published inScientific Reports, investigators used a novel V system to create the visual illusion of loss of balance and had the participants walk on a treadmill in front of a large, curved screen depicting moving hallway. As they walked, the investigators added lateral oscillations to the video imagery so that the visual environment would make it feel as if it were swaying back and forth, or falling. Fourteen cameras were used to record the positions of 30 reflecting markers on the legs, back, and pelvis of each subject. The investigators then recorded the participants’ movements to determine how their muscles responded. “We were able to identify the muscles that orchestrate balance corrections during walking,” said investigator Jason R. Franz, PhD. “We also learned how individual muscles are highly coordinated in preserving walking balance. These things provide an important roadmap for detecting balance impairments and the risk of future falls.” The authors noted that the data could provide key reference measurements to be used in future clinical procedures. “We think there’s a big opportunity to use visual perturbations in a VR setting to reveal balance impairments that would not be detected in conventional testing or normal walking,” Franz said. “The key is to challenge balance during walking, to tease out those impairments that exist under the surface.”