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AACN-CMC Cardiac Medicine Subspecialty Certification Study Guide |

AACN-CMC Study Guide - Cardiac Medicine Subspecialty Certification Updated: 2023

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Exam Code: AACN-CMC Cardiac Medicine Subspecialty Certification Study Guide November 2023 by team

AACN-CMC Cardiac Medicine Subspecialty Certification

CMC® is a subspecialty certification for certified nurses who provide direct care to acutely/critically ill adult cardiac patients. Nurses interested in this certification may work in areas such as cardiac care units, medical ICUs, telemetry, progressive care, heart failure clinics, home care, interventional cardiology, cardiac cath labs and/or electrophysiology units.

A current, unencumbered U.S. RN or APRN license is required.

An unencumbered license is not currently being subjected to formal discipline by any state board of nursing and has no provisions or conditions that limit the nurses practice in any way.

A current nationally accredited clinical nursing specialty certification, to which the CMC credential will be attached, is required.

Candidates must complete one of the following clinical practice hour requirement options:

Two-Year Option

Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill adult patients during the previous two years, with 875 of those hours accrued in the most exact year preceding application. Of those 1,750 hours, 875 need to be in the care of acutely/critically ill adult cardiac patients.


Five-Year Option

Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill adult patients, with 144 of those hours accrued in the most exact year preceding application. Of those 2,000 hours, 1,000 need to be in the care of acutely/critically ill adult cardiac patients.

Must be completed in a U.S.-based or Canada-based facility or in a facility determined to be comparable to the U.S. standard of acute/critical care nursing practice.

Are those spent actively providing direct care to acutely/critically ill adult patients or supervising nurses or nursing students at the bedside of acutely/critically ill adult patients, if working as a manager, educator, preceptor or APRN.

Are verifiable by your clinical supervisor or professional colleague (RN or physician). Contact information must be provided for verification of eligibility related to clinical hours, to be used if you are selected for audit.

For complete eligibility requirements.
Cardiac Medicine Subspecialty Certification
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Cardiac Subspecialty Certification
Question: 35
35. Which atrioventricular block does not impair cardiac function?
A. Hemiblock
B. First-degree block
C. Mobitz I block
D. Right bundle branch block
Answer: B
A first-degree block does not impair cardiac function. It can be caused by
hyperkalemia, quinidine, digitalis, and ischemic heart disease.
Question: 36
36. What are some causes of a third-degree AV block?
A. Certain drugs, such as quinidine and atropine
B. Age, digitalis intoxication, or myocardial infarction
C. Heart disease and damage from uncontrolled diabetes mellitus
D. Hypertension, coronary artery disease, and cardiomyopathy
Answer: B
Some causes of a third-degree AV block are age, digitalis intoxication, and
myocardial infarction. This is also called a complete heart block because no
impulses are being transmitted from the atria to the ventricles.
Question: 37
37. In particular, which type of atrioventricular block patient would be a good
candidate for the implantation of a pacemaker?
A. Hemiblocks
B. Transmural ischemic blocks
C. Posterior fascicular block
D. Third-degree block
Answer: D
In particular, a patient with a third-degree atrioventricular block would be a good
candidate for the implantation of a pacemaker. This would accommodate for the
failure of the AV node to disseminate the necessary impulse from the atria to the
Question: 38
38. What condition may be indicated very early by an EKG with ST elevations, or
tall, upright T waves?
A. Sudden cardiac death
B. Myocardial ischemia
C. Transmural myocardial infarction
D. Coronary artery disease
Answer: C
Transmural myocardial infarction may be indicated very early by an EKG with
ST elevations, or tall, upright T waves. To make a better determination, the V1
and V2 leads may be viewed to determine if ventricular hypertrophy is evident.
Question: 39
39. Which electrolyte abnormality will show shortened ventricular repolarization
and shortened QT intervals on EKG?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hypokalemia
Answer: A
The electrolyte abnormality hypercalcemia will show shortened ventricular
repolarization and shortened QT intervals on EKG.
Question: 40
40. What does the horizontal aspect of the EKG measure?
A. Voltage
B. Duration
C. Watts
D. Waveforms
Answer: B
The horizontal aspect of the EKG measures duration. The smaller squares are .04
seconds in duration and the larger ones are .20 seconds in duration.
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Medical Certification Study Guide - BingNews Search results Medical Certification Study Guide - BingNews How To Become A Phlebotomist: A Complete Guide

Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations.

Phlebotomists serve an essential, life-saving role in the healthcare system: collecting and processing blood samples from patients and donors. This in-demand role holds significant value on its own, but it’s also a great starting point for a more advanced career in healthcare.

It takes less than a year to become a phlebotomist, as it’s one of the many allied health professions that don’t require a bachelor’s degree. Phlebotomist requirements typically include a high school diploma and completion of a training program.

In turn, you gain valuable experience interacting with patients and working alongside a medical team. As you learn more about working in healthcare, you may discover related careers that match your interests.

Read on to learn how to become a phlebotomist and whether this role suits your interests.

What Is a Phlebotomist?

Phlebotomists draw blood to use for testing, donations, research or lifesaving procedures such as transfusions. Blood tests are a vital part of healthcare. Doctors order blood tests to diagnose and monitor medical conditions such as diabetes, allergies, cancer and autoimmune diseases.

Phlebotomists receive instructions on the type and quantity of samples to collect, which may include urine or other biological specimens. Before the procedure, they prepare patients and help calm any nerves. Afterward, they monitor patients for adverse effects such as bruising, dizziness or nausea.

Important Skills for Phlebotomists

Phlebotomist technicians employ different collection techniques for different patients. Most tests require venipuncture, or drawing blood from a vein. Other tests may only need a finger stick, while infants typically have blood drawn by a heel stick.

Phlebotomists should be gentle and efficient, especially if patients express discomfort about getting their blood drawn or if their veins are hard to find. They should also be methodical and organized, understanding the purpose of each trial and ensuring they collect the correct quantity.

Each trial must be clearly labeled, correctly stored and accurately entered into a database. To prevent contamination, phlebotomists sanitize their equipment and workspace. They may also update patients’ medical files.

Phlebotomist Work Environment

Most phlebotomists work full time, but their schedules depend on their employer. Some have night or weekend shifts. Phlebotomists typically work in hospitals or medical and diagnostic laboratories, but many work in ambulatory healthcare services, physician offices and outpatient care centers. They might travel between centers or visit patients’ homes.

How To Become a Phlebotomist

It takes less than a year to become a phlebotomist. While requirements vary by state, the process is generally straightforward.

Earn a High School Diploma

You can begin a career in phlebotomy with a high school diploma or the equivalent. It helps to take relevant courses in math, science, anatomy and physiology, and health.

Some phlebotomists begin working right away with on-the-job training. However, most employers prefer or require candidates to earn a phlebotomy certificate.

Complete a Phlebotomy Training Program

Phlebotomist training typically takes one to three months, depending on your program’s scope and your schedule. You can enroll in phlebotomy training classes at a community college, technical school or vocational school, and many offer flexible weekend and evening class times.

Programs incorporate classroom and hands-on education, covering medical terminology, collection techniques and safety protocol.

Some states require phlebotomists to complete their training through an approved, accredited program. Phlebotomy programs receive accreditation from professional organizations, including the American Society for Clinical Pathology and the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS).

Consider Professional Certification

Earning professional certification cements your skills and commitment to excellence. While you can choose from several certifying organizations, most require certification candidates to hold a high school diploma or GED® certificate, complete an accredited training program, demonstrate clinical experience and pass an exam.

Certified phlebotomists maintain their credentials by paying renewal dues and completing continued education credits. Keep reading to learn about different certification opportunities.

Determine State Requirements

Only four states—California, Louisiana, Nevada and Washington—require certification for phlebotomists. Other states may still stipulate that phlebotomists complete an accredited program to practice.

In California, for example, phlebotomists can pursue three levels of certification, each of which qualifies holders to perform a different collection technique.

Phlebotomist Salary and Job Outlook

Blood testing already serves an essential role in diagnosis and treatment, but demand for medical services is expected to increase as the U.S. population grows and ages. In turn, phlebotomists benefit from a steady job market.

The U.S. Bureau of Labor Statistics (BLS) projects an 8% growth in phlebotomist employment from 2022 to 2032, much higher than the 3% predicted growth across all occupations.

Phlebotomists earned a median annual wage of $38,350 in May 2022, according to the BLS. Those working in scientific research and development services reported the highest average earnings—a mean of $47,770 per year—followed closely by those in outpatient care centers and state government organizations.

Certifications for Phlebotomists

Even if your state or employer doesn’t require a professional certification, earning one can make you more marketable by demonstrating and enhancing your skills. Review the requirements for three common certifications below.

Phlebotomy Technician (PBT)

The American Society for Clinical Pathology (ASCP) offers several paths to PBT certification. Applicants must have completed an approved phlebotomy program within the past five years or have one year of full-time clinical experience. Programs may carry accreditation from NAACLS or approval by the California Department of Public Health, or they must meet minimum instruction requirements.

Applicants must pass an 80-question exam and pay a $145 application fee.

Certified Phlebotomy Technician (CPT)

To earn the National Healthcareer Association’s CPT distinction, applicants must complete a phlebotomy training program or one to two years of supervised phlebotomy technician experience.

The two-hour certification exam covers safety and compliance, patient preparation and blood collection. You can purchase a study guide or practice exam to prepare, and the exam itself costs $125.

CPTs must renew their certification every two years by completing continuing education credits and paying $179.

Phlebotomy Technician (RPT)

In addition to meeting phlebotomy education or experience requirements, RPT applicants need to complete 50 successful venipunctures and 10 skin punctures.

The American Medical Technologists (AMT) certification exam covers broad medical skills, including time management, clerical duties, legal and ethical concerns and specimen collection. The exam costs $125.

Professional Organizations for Phlebotomists

While professional organizations usually require a membership fee, joining one can pay off in the form of long-term career success. These groups provide a path to certification, create networking opportunities and help you stay abreast of new techniques or laws.

National Phlebotomy Association (NPA)

NPA supports continuing education through workshops, training programs and professional certifications, including a credential for phlebotomy instructors. The organization hosts a job board for full- and part-time positions in phlebotomy and other allied health professions.

American Society of Phlebotomy Technicians, Inc. (ASPT)

ASPT offers certification for working phlebotomy technicians and graduates of accredited programs. The organization extends its benefits to members of NHA, ASCP and AMT. Members gain access to cross-training workshops, continued education opportunities and nonprofit events. ASPT also hosts a phlebotomy refresher program and an EKG basic skills program.

Phlebotomy technicians pay a $65 exam fee and a $35 membership fee.

National Healthcareer Association (NHA)

In addition to its professional certification, NHA creates immersive learning experiences for phlebotomy technicians. Available resources, geared toward students and educators, include practice drills, interactive games and quizzes.

NHA provides a job board, résumé review services and career planning advice for allied health professionals.

Frequently Asked Questions (FAQs) About Becoming a Phlebotomist

How long does it take to become a phlebotomist?

Because becoming a phlebotomist generally does not require a college degree, you can start this career in less than a year. However, earning certification may take longer.

What is required to be a phlebotomist?

Phlebotomists need to earn a high school diploma or the equivalent. Some receive on-the-job training, but most complete a short-term phlebotomy training program. Many pursue professional certification.

How long is phlebotomy school?

Phlebotomy school takes less than a year to complete—often one to three months. The duration depends on your schedule and the program’s curriculum. Some programs incorporate more robust training or additional clinical hours.

How much does a phlebotomist get paid?

Phlebotomists made a median annual salary of $38,350 as of May 2022, the U.S. Bureau of Labor Statistics reports. The highest 10% of workers earned more than $51,610.

Wed, 15 Nov 2023 19:42:00 -0600 Kayla Missman en-US text/html
Dietitian Vs. Nutritionist: What’s The Difference?

Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations.

In a world where fast food culture dominates, dietetics and nutrition professionals play a crucial role in public health.

With their comprehensive understanding of human nutrition, dieticians and nutritionists are at the forefront of preventing and managing chronic diseases. By providing personalized strategies for making healthier food and lifestyle choices, these professionals empower their clients to implement sustainable changes. But when you compare dietitians vs. nutritionists, you’ll find these two career paths are quite different.

In this guide, we explore education requirements and professional credentials for dieticians and nutritionists. Keep reading to learn about the similarities and differences between these roles.

Dietitian vs. Nutritionist: What’s the Difference?

While the terms “dietitian” and “nutritionist” are often used interchangeably, there are important distinctions between these two careers in the nutrition field. Dieticians are strictly regulated and must undergo a rigorous process to become credentialed, whereas nutritionists don’t necessarily have to undergo any particular training, depending on the state where they practice.

Nutritionists tend to offer more generalized advice, such as nutrition counseling and meal planning; they cannot provide medical treatment. On the other hand, dieticians are qualified to treat specific medical issues, such as eating disorders, cancer and diabetes.

Below we explore each of these professions in more detail.

What Is a Dietitian?

Registered dietitians (RDs) are nutrition experts who help people Improve their quality of life through healthy food choices. These professionals may conduct nutrition research, educate about the impact of nutrition on health, administer medical nutrition therapy and recommend nutrition protocols to prevent and manage chronic health conditions.

Registered dieticians receive comprehensive training in nutrition science, anatomy and physiology, and biochemistry. They also develop counseling skills to support effective behavioral changes. Some RDs obtain specialty credentials in areas like sports dietetics, pediatric nutrition, gerontological nutrition, obesity and weight management, renal nutrition and oncology nutrition.

Dietitians can work in various settings including hospitals, long-term care facilities, community health centers, educational institutions, restaurants and private practices.

How To Become a Dietitian

As of January 1, 2024, first-time registered dieticians must have a master’s degree, complete a clinical internship and pass a national board examination. Additional credentialing requirements vary by state.

Earn a Master’s Degree

In the past, registered dieticians needed at least a bachelor’s degree from a dietetic program accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND). As of January 1, 2024, they need a master’s in nutrition or a related field from an ACEND-accredited program.

Complete an Accredited Internship

Students must complete a 1,200-hour supervised dietetic internship (DI) that takes eight to 24 months. There are three types of DIs.

  • ACEND-accredited DI program: The traditional option, takes place after completing a dietetics degree
  • ACEND-accredited coordinated DI program: Combines a dietetics curriculum and an internship into one, more rigorous program
  • Individualized supervised practice pathway: A more flexible option, requiring students to design their internship with an experienced supervisor or preceptor to align with their interests and career goals

Pass the National Registration Exam

After completing their DI, students must pass the registration exam for dietitians. Administered by the Commission on Dietetic Registration (CDR), the exam assesses learners’ knowledge of dietetics and nutrition. Aspiring dietitians who pass the exam earn the RD credential and become eligible for state licensure or certification to begin working in the field.

Obtain State Licensure

The following states require additional certification or licensure after earning the RD credential:

  • Alabama
  • Alaska
  • Delaware
  • District of Columbia
  • Florida
  • Illinois
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Tennessee
  • Virginia
  • Washington

Complete Continuing Education Requirements

To maintain registration with CDR, RDs must complete 75 continuing professional education units every five years, one of which must be related to ethics. The Academy of Nutrition and Dietetics offers various qualifying face-to-face learning events, recorded sessions, online certification courses, self-study programs and webinars to help RDs meet these requirements.

What Is a Nutritionist?

Nutritionists advise individuals or groups about nutrition’s impact on health. They help clients adopt healthier ways of eating, often creating customized plans based on each individual’s goals. Services typically include nutritional assessment and counseling, meal planning and developing healthy eating programs.

Although some nutritionists have formal education and credentials, others may have completed more basic certifications. Because the field is less regulated than that of dietitians, nutritionists’ level of expertise and qualifications can vary greatly.

Nutritionists may conduct nutrition research, educate about the impact of nutrition on health, administer medical nutrition therapy and recommend nutrition protocols to prevent and manage chronic health conditions.

They may work in settings such as holistic healthcare clinics, doctor’s offices, nutraceutical companies, corporate wellness centers, fitness centers, community and nonprofit organizations, and private practices.

How To Become a Nutritionist

Education requirements to become a nutritionist vary widely. Some states, including Oklahoma, Oregon, California and Colorado, don’t regulate the nutritionist title at all. In these states, anyone interested in the profession can call themselves a nutritionist as long as they aren’t providing medical care.

Other states may require you to earn a basic certification in nutrition before you can work in the field. In some cases, you may need a bachelor’s degree in nutritional science or dietetics; each state has different licensure or certification requirements.

Complete an Online Certification Program

Many organizations offer online nutrition certification programs that do not require a degree. Most of these programs can be completed in four to 10 weeks.

Consider Earning a Degree

Earning a bachelor’s degree is only sometimes required to work as a nutritionist, but regardless of your state’s requirements, completing a four-year program in nutrition, food science or dietetics can provide you with a more comprehensive understanding of the field. A degree also gives you more credibility than a basic certification alone.

Individuals seeking the Certified Nutrition Specialist (CNS)® credential must earn a graduate degree.

Obtain the Certified Nutrition Specialist Credential

To earn CNS certification—the most advanced credential available to nutrition specialists—you must have a master of science or doctoral degree in nutrition, dietetics, health science, public health, biochemistry or a related field from a program accredited by the Accreditation Council for Nutrition Professional Education.

Also, you must complete 1,000 hours of supervised practice experience and pass a certification exam.

Fulfill State Licensure or Certification Requirements

Just as certain states don’t have specific education requirements, others mandate licensure or certification for nutritionists to practice within their jurisdiction. Be sure to check your state’s particular requirements for practicing nutritionists.

Salary and Job Outlook for Dietitians and Nutritionists

According to the Bureau of Labor Statistics (BLS), which lumps dieticians and nutritionists together in its reporting, demand for these professionals is projected to increase by 7% from 2022 to 2032. This is significantly faster than the average projected growth for all occupations (3%).

The BLS reports that these professionals earn a median annual wage of $66,450. The highest earners live in Washington, D.C., where dietitians and nutritionists earn a mean annual salary of $83,550.

Frequently Asked Questions (FAQs) About Dietitians vs. Nutritionists

Is a dietitian the same as a nutritionist for weight loss?

The main difference between a dietitian and a nutritionist is their training. While all dieticians are considered nutritionists, not all nutritionists are dieticians. A registered dietician is a degreed healthcare professional with specific training in nutrition and weight management advice, while the education of a nutritionist can vary widely. For evidence-based weight loss advice, it’s best to consult with a registered dietician.

Which degree is better, dietitian or nutritionist?

Say you want to work in clinical settings to provide medical nutrition therapy or specialize in treating specific health conditions. In that case, your best option is to become a registered dietician. RDs are degreed professionals who complete a rigorous training and certification process that qualifies them to give medical nutrition advice.

What can a dietitian help with?

Registered dietitians help design eating plans to manage chronic health conditions, make sure individuals are meeting their nutrient needs through various stages of life, manage food allergies and provide guidance on meal plans.

Wed, 15 Nov 2023 06:14:00 -0600 Heidi Borst en-US text/html
Microbot Medical Reveals Successful Short Term Follow Up Outcomes from its Pivotal Pre-Clinical Study

Microbot Medical Inc.

Follow up visual examination three days after the procedures using the LIBERTY Robotic Surgical System, confirms 100% success rate in reaching the targets with no adverse events

BRAINTREE, Mass., Oct. 31, 2023 (GLOBE NEWSWIRE) -- Microbot Medical Inc. (Nasdaq: MBOT), developer of the innovative LIBERTY® Robotic Surgical System, today announces additional updates regarding positive outcomes of its previously announced pivotal pre-clinical study using the LIBERTY Robotic Surgical System.

The pivotal study was conducted by three leading interventional radiologists that utilized the LIBERTY Robotic Surgical System to reach a total of 48 animal targets. In a series of visual testing, preformed 72 hours following each procedure, examination of the animals treated with the LIBERTY Robotic Surgical System showed no visual evidence of vascular injury or any other visual adverse event.

This new data follows the recently announced successful initial outcomes from the pivotal pre-clinical study. A total of 6 LIBERTY Systems were used in the study, each was used to reach a total of 8 targets. All 6 LIBERTY Systems performed flawlessly based on the initial outcomes, with 100% usability and technical success. No acute adverse events or complications were visually observed intra-operative.

The Company expects to receive the comprehensive final report later this quarter. Subject to the final report, and the completion of the verification and validation (V&V) process, the Company plans on submitting the Investigational Device Exemption (IDE) application to the FDA, in order to commence its pivotal clinical trial in humans.

"We are excited to share additional positive outcomes of our pivotal pre-clinical study. The absence of any visual evidence of vascular injury in the follow-up examination after 72 hours continues to reaffirm the safety and effectiveness of our technology. This milestone, together with the advancement of the verification and validation process, bring us one step closer to the submission of the IDE and commencing our pivotal clinical trial in humans," said Simon Sharon, Microbot’s GM & CTO.

About Microbot Medical

Microbot Medical Inc. (NASDAQ: MBOT) is a pre-clinical medical device company that specializes in transformational micro-robotic technologies, with the goals of improving clinical outcomes for patients and increasing accessibility through the natural and artificial lumens within the human body.

The LIBERTY® Robotic Surgical System aims to Improve the way surgical robotics are being used in endovascular procedures today, by eliminating the need for large, cumbersome, and expensive capital equipment, while reducing radiation exposure and physician strain. The Company believes the LIBERTY® Robotic Surgical System’s remote operation has the potential to be the first system to democratize endovascular interventional procedures.
Further information about Microbot Medical is available at

Safe Harbor

Statements to future financial and/or operating results, future growth in research, technology, clinical development, and potential opportunities for Microbot Medical Inc. and its subsidiaries, along with other statements about the future expectations, beliefs, goals, plans, or prospects expressed by management, constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and the Federal securities laws. Any statements that are not historical fact (including, but not limited to statements that contain words such as “will,” “believes,” “plans,” “anticipates,” “expects” and “estimates”) should also be considered to be forward-looking statements. Forward-looking statements involve risks and uncertainties, including, without limitation, market conditions, risks inherent in the development and/or commercialization of potential products, including LIBERTY, the outcome of its studies to evaluate LIBERTY, whether the Company’s core business focus program and cost reduction plan are sufficient to enable the Company to continue to focus on its LIBERTY technology while it stabilizes its financial condition and seeks additional working capital, any failure or inability to recruit physicians and clinicians to serve as primary investigators to conduct regulatory studies which could adversely affect or delay such studies, uncertainty in the results of pre-clinical and clinical trials or regulatory pathways and regulatory approvals, disruptions resulting from new and ongoing hostilities between Israel and the Palestinians, such as employees of Microbot and its vendors and business partners being called to active military duty, any lingering uncertainty resulting from the COVID-19 pandemic, need and ability to obtain future capital, and maintenance of intellectual property rights. Additional information on risks facing Microbot Medical can be found under the heading “Risk Factors” in Microbot Medical’s periodic reports filed with the Securities and Exchange Commission (SEC), which are available on the SEC’s web site at Microbot Medical disclaims any intent or obligation to update these forward-looking statements, except as required by law.

Investor Contact:

Michal Efraty

Mon, 30 Oct 2023 20:25:00 -0500 en-US text/html
Study Analyzes Consumption Patterns of Medical Cannabis Patients

A study published in Health Economics revealed insights into medical cannabis patients’ patterns of product choice, cannabinoid product ratios, and doses. The results published in Science Direct highlighted trends in the CBD and THC content of dispensed products and dosing among medical cannabis patients. The researchers examined the qualifying conditions, age, and types of cannabis products used to understand consumption trends. 

The study found that dosages differed by age group. They were also lower than recommended for conditions with Food and Drug Administration-approved products. The findings point to closer monitoring of age-related influences and drug interactions for patients using cannabis products.

University of Minnesota researchers analyzed data from roughly 50% of all registered Minnesota medical cannabis users between June 2016 and November 2019. Patients had one of the 14 qualifying conditions at the time of this study, including cancer, glaucoma, HIV/AIDS, Tourette syndrome, amyotrophic lateral sclerosis, epilepsy, inflammatory bowel disease, and autism. The study revealed significant age-related differences in dosages among patients with the same diagnosis. The study highlighted the need for further research efforts that take into consideration varied dosages and medical cannabis formulations for specific patient populations.  

The researchers used past research as a basis for studying the impact of these factors on cannabis use patterns. Study author Dr. Angela Birnbaum explained, “Our past data shows blood concentrations of CBD and THC can vary widely among patients and according to the fat content in food, indicating possible inconsistent exposure that could lead to variations in response and unanticipated side effects.” The research study indicated a need for closer regulation and research of medical cannabis formulations for particular patient populations.

More research on clinically significant side effects associated with specific CBD and THC dosages is needed to inform policy and practice. In addition, the long-term effects of cannabis and risks for older patients who use multiple medications to minimize adverse drug interactions. 

Source: Health Economics, Science Direct, University of Minnesota

Wed, 08 Nov 2023 22:00:00 -0600 text/html
Study reveals why some people develop PTSD and others don't

A new study has revealed that the body’s hormone stress response is why some people develop post-traumatic stress disorder following trauma exposure, and others don’t. The finding could lead to more targeted treatments for the condition.

Some people develop post-traumatic stress disorder (PTSD) following exposure to a traumatic event or events, causing notable impairments such as intrusive thoughts, avoiding behaviors, sleep disturbance and hypervigilance.

Crucial to identifying the condition early, and treating it effectively, is understanding why some people, and not others, develop PTSD. Now, a new study by researchers at the Swiss Federal Institute of Technology Lausanne (EPFL) has shown why a subset of people are more vulnerable, and it has to do with the body’s stress hormone response.

“There are considerable differences in the levels of glucocorticoids that individuals release to the bloodstream when stressed,” said Carmen Sandi, one of the study’s corresponding authors. “Low glucocorticoid levels are frequently observed in PTSD patients following trauma exposure and were initially suspected to be a consequence of trauma exposure.”

Glucocorticoids are steroid hormones produced by the adrenal glands, which sit atop each kidney. The essential glucocorticoid the body produces is cortisol, the primary stress hormone that works with certain parts of the brain to control mood, motivation, and fear. Following the fight-or-flight response, if the brain continues to perceive something as dangerous, it triggers a pathway that results in the release of cortisol.

While low glucocorticoid levels and a smaller hippocampus, the area of the brain involved in long-term memory formation and memory retrieval, were originally thought to result from trauma, they’re currently viewed as potential risk factors for PTSD. However, establishing their causal role in the condition has proven difficult.

“The possibility that this could be a trait constituting a preexisting PTSD risk factor has been an outstanding open question for many years, but tackling it has been challenging due to the difficulties of both collecting biological measures before trauma exposure and having access to relevant animal models in which the causal role of these traits can be investigated," said Sandi.

To examine how a reduced hormonal response to stress might be linked to PTSD symptoms, the researchers used rats that had been genetically modified to mimic humans with a blunted response to cortisol. They measured the volume of different brain regions, trained rats to associate a cue with fear, recorded their sleep patterns, and measured their brain activity.

The researchers discovered that decreased responsiveness to glucocorticoids led to several pivotal PTSD vulnerability traits, including impaired fear extinction (in male rats), reduced hippocampal volume, and rapid-eye-movement sleep (REMS) disturbances. Fear extinction is a process by which a conditioned fear response diminishes over time; problems with fear extinction mark PTSD. REMS is crucial for memory consolidation, and people with PTSD often experience REMS disturbances. From this, the researchers concluded these traits are biologically interconnected and not independent risk factors.

Next, the rats were given the equivalent of cognitive behavioral therapy to reduce their learned fears and then administered corticosterone, the murine version of cortisol. The researchers noted that both excessive fear and REM sleep disturbances abated. In addition, increased levels of the fight-or-flight neurotransmitter norepinephrine in the brain returned to normal.

“Our study provides causal evidence of a direct implication of low glucocorticoid responsiveness in the development of PTSD symptomatology following exposure to traumatic experiences, i.e., impaired fear extinction,” Sandi said. “In addition, it shows that low glucocorticoids are causally implicated in the determination of other risk factors and symptoms that were until now only independently related to PTSD.”

The study’s findings open the door to potential treatment for people with PTSD.

“Our research illuminates previously elusive aspects of PTSD, revealing that blunted corticosteroid responsiveness not only predicts but may also contribute causally to core PTSD symptoms,” the researchers said. “This suggests potential benefits of glucocorticoid treatments for patients with diminished glucocorticoid responsiveness.”

The study was published in the journal Biological Psychiatry.

Source: EPFL

Tue, 07 Nov 2023 11:26:00 -0600 en-US text/html
High blood insulin levels linked to pancreatic cancer in new study

A new study has found a link between high blood insulin levels, frequently seen in people with obesity and type 2 diabetes, and pancreatic cancer. The researchers say their findings may lead to new cancer prevention strategies and targeting treatments to slow or prevent the progression of the cancer.

Obesity and type 2 diabetes (T2D) are among the risk factors for pancreatic cancer, and pancreatic ductal adenocarcinoma (PDAC) is one of the most prevalent, aggressive, and lethal pancreatic cancers. However, the mechanisms by which T2D and obesity contribute to PDAC have remained unclear.

Now, a new study by researchers at the University of British Columbia in Canada has shed light on the role that insulin and its receptors play in the development of PDAC.

“Alongside the rapid increase in both obesity and type 2 diabetes, we’re seeing an alarming rise in pancreatic cancer rates, said James Johnson, one of the corresponding authors of the study. “These findings help us understand how this is happening and highlight the importance of keeping insulin levels within a healthy range, which can be accomplished with diet, exercise and, in some cases, medications.”

The pancreas performs exocrine and endocrine functions. Acinar cells (exocrine) synthesize, store, and secrete enzymes into the small intestine that help digest food, whereas beta cells (endocrine) make the hormone insulin, which regulates blood glucose levels. Insulin is thought to bind to its own receptor on the acinar cell, stimulating enzyme secretion.

T2D results from a combination of ineffective and insufficient insulin, leading to insulin resistance and high blood insulin (hyperinsulinemia) as the body produces more of the hormone to bring down high blood glucose levels (hyperglycemia). It’s commonly accepted that in obesity, elevated free fatty acid levels cause insulin resistance, which, because of the resulting hyperglycemia, also leads to hyperinsulinemia.

Using mice models, the researchers examined what was happening in the pancreatic acinar cells when the animals were hyperinsulinemic.

“We found that hyperinsulinemia directly contributes to pancreatic cancer initiation through insulin receptors in acinar cells,” said Anni Zhang, the study’s lead author. “The mechanism involved increased production of digestive enzymes, leading to heightened pancreatic inflammation.”

The researchers propose that this inflammation leads to the development of precancerous cells. Their findings may pave the way for new cancer prevention strategies and therapeutic approaches that target insulin receptors on acinar cells.

“We hope this work will change clinical practice and help advance lifestyle interventions that can lower the risk of pancreatic cancer in the general population,” said Janel Kopp, co-corresponding author. “This research could also pave the way for targeted therapies that modulate insulin receptors to prevent or slow the progression of pancreatic cancer.”

The researchers also say their findings may have implications for other cancers associated with obesity and T2D, where elevated insulin levels may also play a contributing role.

“Colleagues in Toronto have shown similar connections between insulin and breast cancer,” Johnson said. “In the future, we hope to determine whether and how excess insulin might contribute to other types of obesity- and diabetes-driven cancers.”

The study was published in the journal Cell Metabolism.

Source: University of British Columbia

Sun, 05 Nov 2023 10:00:00 -0600 en-US text/html
Medicare Advantage seniors have better health outcomes, study finds

Medicare Advantage plans — which currently face significant regulatory scrutiny for inflating healthcare costs and denying seniors’ care — are driving better outcomes for their beneficiaries than traditional Medicare, a new study suggests.

Researchers from health data company Inovalon and Harvard Medical School compared outcomes data for beneficiaries in MA and original Medicare, and found MA members had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use.

In MA, the government contracts with private payers to manage the care of Medicare seniors. Multiple studies have found enrollment in MA is associated with lower healthcare utilization, including for post-acute care

However, past research has generally found a more modest association than the new analysis.

The Harvard and Inovalon researchers argued prior studies have often been “restricted to narrow sets of quality measures and limited trial populations.”

They said their study instead evaluates a broad set of measures for a nationally representative group — and adjusts for underlying population differences between traditional Medicare and MA, which is more likely to include socioeconomically disadvanted people.

“Previous comparisons of quality under MA vs. [fee-for-service Medicare] may have underestimated outcomes in MA by not fully accounting for the greater socioeconomic disadvantages faced by MA members,” the researchers wrote.

Enrollment in MA has increased dramatically to more than 30 million people — over half of all Medicare beneficiaries. Nearly six in 10 beneficiaries are expected to be MA members by 2030.

The plans are popular in part because they can offer more supplemental benefits than traditional Medicare, like dental and hearing services, or subsidized transportation and gym memberships.

Yet as MA grows, there is a debate raging in the health policy world over the future of the program, which is increasingly weighing on Medicare’s financial solvency.

Spending on MA has snowballed: Plans were overpaid almost $10 billion a year from 2017 to 2020, according to one study. Another piece of research estimates the U.S. could be on the hook for $75 billion in overpayments this year.

Critics blame factors like insurers upcoding the disease severity of their members and inflated bonus payments in quality programs.

Proponents of MA point to research, like the new study, finding that plans result in better health outcomes than traditional Medicare. For their analysis, Harvard and Inovalon researchers analyzed beneficiary data in the year after seniors joined either traditional Medicare or MA, and controlled for patient characteristics.

They found seniors in traditional Medicare had a 3.8 times higher rate of readmission to the hospital after 30 days than seniors in MA. Traditional Medicare had a 1.7 times higher rate of avoidable hospitalization overall. Rates of high-risk medication usage were 1.4 times higher in traditional Medicare.

MA and traditional Medicare had similar rates of medication adherence.

The researchers said the results boost findings from their earlier report that found MA had lower overall utilization than traditional Medicare, and that lower utilization was driven by fewer inpatient visits.

Other health policy researchers say lower utilization in MA raises red flags, due to health plans curbing medical costs by delaying or denying needed healthcare. Such care restrictions could be contributing to MA beneficiaries with greater health needs disenrolling at higher rates than healthier seniors.

The Harvard and Inovalon researchers argued their findings suggest the reduction in inpatient visits comes from reduced preventable and readmission visits. That would mean lower MA utilization is due to improved care quality, rather than care rationing on the part of plans.

Lawmakers on the Hill have grown increasingly skeptical of MA payment denials. During a May hearing of the Senate Permanent Subcommittee on Investigations, senators expressed bipartisan support for paring back the use of prior authorizations to restrict care, especially payers’ use of algorithms in coverage determinations. Government watchdogs found last year that 18% of MA payment denials should have been approved under Medicare coverage rules.

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