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Higher glucose levels might help heart failure patients with diabetes

Tight control of diabetic patients’ blood glucose levels often helps prevent them from developing complications, such as kidney disease and nerve damage. But for patients who have advanced heart failure and diabetes, significantly decreasing their glucose levels might raise their mortality risk, a study says. Diabetic patients with heart failure who had lower levels of glycosylated hemoglobin were more likely to die or need urgent heart transplantation during two years of follow-up compared with those with higher HbA1c levels, according to the study published online March 29 in The American Journal of Cardiology. One possible explanation for the finding is that patients with lower HbA1c levels might be taking an inappropriate medication to control their diabetes, such as insulin, said senior study author Tamara B. Horwich, MD. Though insulin might decrease glucose levels, it often is linked to poor health prognosis for people with heart failure, she said. “We may find that ...

Med students benefit from following patients long-term

Third-year medical students who participated in a program that allowed them to follow the same patients throughout the year performed as well or better than peers who underwent traditional clerkship training, says a study in Academic Medicine. The program was a pilot of the Harvard Medical School-Cambridge Integrated Clerkship at Cambridge (Mass.) Health Alliance, and it since has been made a full program. Instead of traditional clinical block rotations, integrated clerkship students follow a panel of patients representing a wide spectrum of medical conditions through inpatient and outpatient care. They also work continuously during the year with physicians in each of the core specialties. Students develop relationships with patients and faculty and witness the natural progression of illness and treatment outcomes, said David Hirsh, MD, lead study author and the program’s director and co-creator. “They really get to know patients in context so that they aren’t known just by ...

More physicians awarded meaningful use money

For the first time, physicians and other health professionals received more cash in Medicare meaningful use bonuses than hospitals got in a single month. However, Medicare Payment Advisory Commission data show that the vast majority of physicians have yet to collect a dime of government incentives for their use of electronic health records. In February, the latest data available, 12,365 physicians and other “eligible professionals” received $222.6 million in Medicare meaningful use incentives, compared with 84 hospitals getting $129.9 million, according to an April 5 report delivered to MedPAC. Doctors qualifying for Medicare meaningful use incentives in stages over five years can earn up to $44,000 per physician. Hospitals’ incentive terms can vary, but they start with a $2 million base payment. The number of physicians and other professionals qualifying for meaningful use in February, and the amount of incentive money they collected, was about equal to their participation ...