Healthcare Traveler - March 2009 - (Page 36)

Clinical Highlights Diabetes & depression RESEARCH FOR TIME CRUNCHED CLINICIANS CHF patient survival Biomarker blood test predicts 90-day outcome in heart failure N ew research suggests depression is linked to higher blood-glucose levels in people with Type II diabetes. A study published in General Hospital Psychiatry found that depressed diabetics had higher hemoglobin A1C values, on average, than similar, nondepressed diabetics, and that this difference persisted over time. Poor glycemic control is associated with a decreased quality of life, more complications, and high healthcare costs—and about 30% of diabetics have depression—so it’s important to screen diabetics for depression. Be alert for signs of depression, such as decreased pleasure, change in appetite or sleep, feeling “down” for several days, less energy, or difficulty making decisions; and refer patients to their physicians. Antidepressants and counseling have been successful in relieving depression and improving glycemic control. Jennifer L. W. Fink, RN, BSN Richardson, L. K., Egede, L. E., et al. (2008). Longitudinal effects of depression on glycemic control in veterans with Type 2 diabetes. General Hospital Psychiatry, 30(6), 509-514. A Congestive Heart Failure study compared the endothelial dysfunction marker mid-Regional pro-Adrenomedullin (MR-proADM) with standard biomarkers in predicting survival outcomes for heart failure patients. The study included 1,641 patients who arrived at 15 emergency departments with shortness of breath not related to trauma or obvious MI, and who were not on dialysis. Instead of relying on Brain-type natriuretic peptide (BNP), researchers analyzed MR-proADM. In the study, 568 acute heart failure patients and 1,073 non-heart failure patients were followed for 90 days. Among those with heart failure, MR-proADM predicted 90-day all-cause mortality significantly better than BNP or NT-proBNP (73.5% versus 60.8% and 63.6% respectively, both P<0.001). Anker, S. D., Peacock, F., et al. (2008). Midregional pro-adrenomedullin (proADM) versus BNP and NTproBNP as prognosticator in heart failure patients. Nov. 11, 2008, AHA Meeting. Photo: Getty Images/Digital Vision/Sky View flow-mediated dilation as much as aerobic activity or statin therapy. But before you trade your prescription meds for an iPod, note that the Maryland study was small (10 healthy, nonsmoking participants) and has yet to be replicated. Still, feel free to indulge your musical side. Music is a cheap and easy intervention with almost no negative side effects. Music also has proven helpful in alleviating depression and enhancing cognitive recovery after stroke. Jennifer L.W. Fink, RN, BSN Sarkamo, T., Tervaniemi, M., et al. (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain, 131(3), 866-876. More music I 36 f you needed another reason to crank the tunes: Music, it seems, may be good for the heart. A study by researchers at the University of Maryland found that listening to enjoyable music increased RN Corner Clinical Highlights… Drug Update… Healthcare Traveler March 2009 CPAP improves cognition in Alzheimer’s patients episodes of apnea per hour to 40% to 50% of those having 20 or more episodes per hour. Researchers proposed that more-severe dementia is associated with more-severe obstructive sleep apnea. To study the problem, investigators studied 52 nursing home residents with mild to moderate Alzheimer’s and concomitant obstructive sleep apnea. The patients were randomized in double-blind fashion to six weeks of therapeutic CPAP or to three weeks of placebo CPAP, followed by three weeks of therapeutic CPAP. After three weeks, the groups did not differ in changes in neuropsychological scores. However, in a paired analysis at six weeks—at which time one group had received six weeks of therapeutic CPAP and the other three weeks—both groups had significant improvement that averaged 0.077 points (P=0.01). Studies of CPAP treatment for sleep apnea in patients without dementia have demonstrated improvement in neuropsychological function. Ancoli-Israel, S., et al. (2008). Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. Journal of the American Geriatric Society, 56(11), 2076-2081. Photo: Getty Images/Digital Vision/Hans Neleman 36 38 A lzheimer’s patients have a high prevalence of obstructive sleep apnea. Estimates range from 70% to 80% of patients who have at least five www.healthcaretraveler.com http://www.healthcaretraveler.com

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Healthcare Traveler - March 2009

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