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Clostridum difficile disease: diagnosis, pathogenesis and treatment update

by jmiller on May 16, 2017

“New and emerging strategies for C difficile, infection treatment include monoclonal antibodies, vaccines, probiotics, biotherapeutics, and new antibiotics.  A successful C difficile prevention and eradication program requires a multidisciplinary approach that includes early disease re4cognition, implementation of guidelines for monitoring adherence to environmental control, judicious hand hygiene, evidence-based treatment and management strategies, and a focused antibiotic stewardship program.  Surgeons are an important part of the clinical team in the management of C difficile infection prevention and treatment.  (Surgery, article in press)  Click here to read full text.

Albumin and surgical site infection risk in orthopaedics: meta-analysis

by jmiller on May 16, 2017

This article (BMC Surgery, April), concludes “that the meta-analysis demonstrated that an albumin level <3.5 g/dl had an almost 2.5 fold increased risk of SSI in orthopaedics,   Click here to read full-text.

Screening for thyroid cancer: USPSTF Recommendation Statement

by jmiller on May 16, 2017

The article concludes:  “The USPSTF recommends against screening for thyroid cancer in asymptomatic adults.”  (JAMA, May 9)  Click here to read full text.

In the news: Risk of acute myocardial infarction with NSAIDS in real world use: bayesian meta-analysis of individual patient data

by jmiller on May 16, 2017

What this study adds:   (BMJ, May 3)  “Using a Bayesian meta-analysis of individual patient data and studying real world settings, it is shown that all traditional NSAIDS, including naproxen, appear to be associated with an increased risk of acute myocardial infarction.  The risk with celecoxib does not seem to be greater than that with traditional NSAIDS.  Onset of risk occurs in the first week.  Short term use for 8-30 days at a high dose (celecoxib>200 mg, diclofenac >100 mg, and naproxen >750 mg) is associated with the greatest harms, without obvious further increases in risk beyond the first 30 days.”  Click here to read full text.

Collaborative Care Network Update

by Medical Staff Office on April 19, 2017

Chaired by Robert Hanley, MD, of Anne Arundel Urology, the Collaborative Care Network (CCN) is our local, physician-led platform that allows the health system to join forces with independent and employed physicians to share data, resources and opportunities to improve care, create efficiencies, and demonstrate the value that an integrated, cohesive medical community can deliver. The CCN is the platform that helps practices prepare for voluntary, local Advanced Alternative Payment Models (AAPMs) as they become available over time.

The CCN’s board, committees and staff have worked tirelessly to build our foundation. In the past year we have:

  • Signed 630 members, representing 73 primary care and specialty practices within our community.
  • Hosted educational events to prepare our medical community for MACRA, MIPS and AAPMs.
  • Provided care coordination resources to our membership such as:
    • On-call care management.
    • Behavioral health navigation.
    • Care alerts.
    • Community-based care management.
    • Home-based primary care services.
  • Engaged in conversations with commercial insurers to discuss value-based and shared savings contracts for CCN members.
  • Developed clinical integration measures to help us learn about the populations we serve, set the foundation for and identify opportunities for clinical transformation, and demonstrate the value of our network.
  • Created data analytics tools and processes for collecting shared data.
  • Prepared for participation and success in AAPMs being developed at the federal and state levels.

The CCN will continue to aggressively move forward to accomplish our objectives:

  • AAHS and clinicians together taking responsibility for the cost and quality of care for populations.
  • Better coordination of care across settings and clinicians.
  • More effective management of chronic disease by both clinicians and patients.
  • Measurable improvement in health outcomes.
  • Successful performance in pay-for-value programs.
  • Building a “community of practice” recognized and preferred by patients.


For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at or 443-481-6619.

In the news: A 12-week cycling training regimen improves gait and executive functions concomitantly in people with Parkinson’s disease

by jmiller on April 13, 2017

“AET (aerobic exercise training) using stationary bicycle can independently improve gait and cognitive inhibition in sedentary PD patients.  Given that increases in walking speed were obtained through increases in cadence, with no change in step length, our findings support that gait improvements are specific to the type of motor activity practiced during exercise (i.e. pedaling).  In contrast, the improvements seen in cognitive inhibition were, most likely, not specific to the type of training and they could be due to indirect action mechanisms (i.e. improvement of cardiovascular capacity).  These results are also relevant for the development of targeted AET interventions to improve functional autonomy in PD patients.  (Frontiers in Human Neuroscience, Jan).  Click here to read full text.

“Increase in the inceidence of diabetes and its implications”; “Incidence trends of type 1and type 2 diabetes among youths, 2002-2012″ and “Mortality and cardiovascular disease in Type 1 and Type 2 diabetes”

by jmiller on April 13, 2017

These three articles are inter-related (NEJM Apr 13).  “Although it is not surprising that the incidence of type 2 diabetes among youths is increasing, the differing rates among racial and ethnic groups is somewhat unexpected.  The authors note that some subgroups of youths in the US have had a significant increase in the prevalence of obesity, which may be a contributing factor..  Of even more concern is the fact that the incidence of type 1 diabetes appears to be increasing, with apparent disparities among ethnic groups that are not likely to be explained by the obesity epidemic.  As a consequence of this trend and of the aging and growth of the population, even though mortality and the rate of cardiovascular disease are decreasing among persons with diabetes, the4 overall adverse effect of diabetes on public health is actually increasing.  The number of years that are lived with disability has increased by 32.5% and now ranks 6th among leading causes of the burden of the disease.  Click here to read full text.

Who decides when a patient can’t? Statutes on alternate decision makers

by jmiller on April 13, 2017

“The estimated prevalence of decisional incapacity approaches 40% among adult medical inpatients and residential hospice patients and exceeds 90% among adults in some intensive care units.  Unfortunately, the rate of completion of advance directives in the general U.S. population hovers around 20 to 29%, creating uncertainty about who will fill the alternate decision-maker role for many patients. There is much state-to-state variability.  This article examines the complex nature of alternate decision makers.  (NEJM Apr.13)  Click here to view full-text.

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