Jill Murphy, Associate Editor

Factors such as climate change, widening distributions of host populations, and better clinician awareness are some of the main reasons for the geographic spread of Lyme disease over the past few months, according to recent data from epocrates.

Acey Albert, MD, director of clinical content at epocrates, is board certified in internal medicine and pediatrics with 15 years of experience in outpatient primary care and medical group leadership. He was able to combine his interest of technology, medicine, and physician leadership as a part of the epocrates team.

Albert explained how there was an increased interest in Lyme disease incidence compared to 2020 among clinicians who use epocrates’ medical application this summer, which measured at a 90% increase YoY.

“This was surprising because, while we know Lyme disease is becoming more common, this was a much steeper increase than we expected,” Albert said in an interview with 

. “For comparison, CDC data showed a doubling of Lyme disease cases between 1991 and 2018, while cases over the last 3 years of data (most recently, 2019) remained relatively flat.”

The increase in Americans traveling again this year and predictions of a warmer, wetter weather pattern could have also played a major factor in the uptick of Lyme disease this past summer, according to Albert.

As for the main implications that both providers and patients should know about in the spread of Lyme disease, Albert said diagnosis of the disease is highly dependent on the patient’s location and travel history.

“By current CDC and IDSA guidelines, patients with the pathognomonic rash, erythema migrans (EM), and tick exposure in an area where Lyme disease is common can be diagnosed and treated without further testing,” Albert said in an interview with 

. “Those exposed in areas with Lyme who don’t have EM but have other symptoms require testing.”

These guidelines also focus on when to empirically treat asymptomatic patients with tick bites in areas where Lyme disease is endemic, according to Albert.

“For clinicians, the possible geographic expansion of Lyme means that more of us might need to include it in the differential diagnoses of patients experiencing a fever, headache, myalgia, and joint pain. For patients, it means that more of us should take vital protective measures when venturing outdoors,” Albert said in an interview with 

At epocrates, an issue that was addressed in the summary of Lyme guidelines was how clinicians are often confronted by patients with concerns about chronic Lyme disease at the point-of-care. This term is not usually acknowledged by gold-standard medical organizations, but clinicians are still being asked about it, according to Albert.

Symptoms such as fatigue, pain, and “brain fog” are usually seen in 10% to 15% of patients who are fully treated for the disease, according to the CDC, which is also known as post-treatment Lyme disease syndrome. However, Albert said there have been some controversies around this condition. The society that promotes “Lyme literate” clinicians who believe the condition represents chronic, persistent 

 infection, despite a scarcity of evidence supporting this assertion is an example of this issue.

“Unsurprisingly, these tests and treatment aren’t typically covered by insurance, and they’re administered in the offices of those ‘Lyme literate’ providers on a cash-pay basis. (National Institutes of Health)-funded studies show this approach is no better than placebo, and that fatal complications of long-term antibiotic treatment have been observed,” Albert said in an interview with 

. “Nonetheless, this group is surrounded by large patient advocacy groups with scientific-sounding websites, aggressive social media campaigns, legislative lobbyists, and celebrity spokespeople. As we’ve seen in COVID-19, anti-science disinformation abounds and shapes patient interactions with health care.”

As for suggestions to know about combatting Lyme disease, Albert recommends knowing the evidence-based guidelines for treatment or having a quick, point-of-care reference that summarizes this guidance. Further, keeping an eye out for newer evidence in areas that are more generalized to the rest of the country is also highly recommended. 

 in ticks around the San Francisco Bay area doesn’t necessarily mean that clinicians in Denver need to think about Lyme disease right now. That said, the study is likely to raise interest in broader investigations of the current geographic range of the disease, and clinicians should be ready to adapt,” Albert said in an interview with 

Articles

Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

New research has found that ketone supplements may be a novel strategy for protecting and improving brain health in people with obesity, according to a study published in 

Because those with obesity are known to be at a higher risk of developing cognitive impairment and neurodegenerative diseases, this study found that giving a ketone supplement 3 times a day for 14 days improves blood flow to the brain and enhanced aspects of cognitive function, such as working memory and processing speed.

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment, according to the researchers.

Volunteers included adults with obesity who consumed either a ketone supplement or a taste-matched placebo supplement 3 times per day 15 minutes before breakfast, lunch, and dinner. The participants were randomly assigned to take the supplement or the placebo for the first 14-day period before switching to the other condition for another 14-day period. All meals and snacks were provided by the researchers for both 14-day intervention periods.

Cognitive function was measured using validated tests via an iPad application and brain blood flow was measured using a duplex ultrasound of neck arteries. Following this, blood samples were taken to measure hormones that the study authors likened to fertilizer for the brain, helping neurons grow and improving cognitive function.

“Once validated with a larger group of people, we expect that these supplements can be used to protect and improve brain health in people with obesity,” said first study author Jeremy Walsh, MD, in the press release.

Ketone supplement might be a novel therapeutic for boosting brain function in obesity. EurekAlert! October 4, 2021. Accessed October 5, 2021. 

https://www.eurekalert.org/news-releases/930078

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment.

Study: Ketone Supplement May Be Therapeutic for Boosting Brain Function in Obesity

A recent clinical trial found that a telephone-delivered nursing care strategy that combined heart failure care management with depression treatment improved patients’ clinical outcomes, according to a University of Pittsburgh press release.

The Hopeful Heart trial involved a first of its kind “blended” collaborative care model for treating heart failure and depression. Under the blended model, medical nurses were trained to deliver depression and heart failure care under guidance of a study cardiologist, psychiatrist, and primary care physician.

“Heart failure is one of the most common cardiovascular diseases in the United States, and it’s growing even more prevalent as the population ages,” said lead author Bruce Rollman, MD, MPH, UPMC endowed chair and professor of medicine at Pitt, in the press release. “I’m very excited about our results because they show that we can successfully train medical nurses to deliver effective depression care as part of heart failure care management they may already be delivering, and that this pragmatic approach can significantly improve patients’ mood and help them regain a better quality of life.”

Few studies have examined the benefits of depression treatment on the recovery of heart failure patients, which prompted the researchers to test a telephone-delivered blended model of collaborative care. Medical nurses trained in depression care had weekly care-review conference calls with a study psychiatrist and a study cardiologist, after which they relayed treatment recommendations to patients and their primary care physicians.

The study nurses then monitored patients via regular telephone calls and made recommendations for adjustments in care depending on the patients’ responses to treatment.

“Collaborative ‘blended’ care model provides extra layers of emotional and educational support for patients and their families,” said co-author Amy Anderson, MS, clinical coordinator for the Hopeful Heart Trial at Pitt, in the press release. “When we sit in on case review sessions with doctors and nurses, we end up learning a great deal about these patients’ lives; it becomes personal. So, it is always very rewarding to see these patients overcome hurdles and improve over time.”

The trial analyzed 756 participants with heart failure from 8 Pittsburgh-area hospitals, including 629 patients who screened positive for depression. The 12-month follow-up showed that blended care patients reported better mental health-related quality of life, including fewer limitations in social activities, improved general well-being, higher energy and less fatigue, and improved mood compared to patients receiving usual care and improved mood compared to those who received collaborative care for heart failure alone, according to the study.

The research team expressed hope that this approach to patient care could be implemented more broadly, as both patients and health care workers have become more accustomed to telemedicine than ever before.

“Depression often goes unrecognized and untreated in heart failure patients, and we are encouraged that our integrated approach to addressing depression was not only effective, but that it can be easily scaled up and expanded nationally,” Rollman said in the press release. “A ‘blended’ collaborative care that is built on existing systems of care also may enable organized health care systems such as UPMC to deliver effective first-line care for depression and other mental health conditions to patients with complex medical conditions.”

Integrated treatment for depression and heart failure improves quality of life and mood. UPMC. August 30, 2021. August 31, 2021. 

https://www.upmc.com/media/news/083021-rollman-hopeful-heart

The Hopeful Heart trial involved a first of its kind “blended” collaborative care model for treating heart failure and depression.

Study Finds Integrated Treatment for Depression, Heart Failure Improves Quality of Life and Mood

A new study from researchers at the University of Cambridge and Addenbrooke’s Hospital found that most patients who contracted COVID-19 while in the hospital did so from other patients rather than from health care workers.

The research team analyzed data between March and June 2020 and identified 5 wards at Addenbrooke’s Hospital in which multiple individuals, including patients and health care workers, tested positive for COVID-19 within a short period of time, insinuating an inner outbreak may occurred, according to the study.

The team used new statistical methods that combine viral genome sequence data with clinical information about the locations of individuals to help look at where the data were consistent with transmission occurring between individuals in the hospital.

The results of the study showed that the patients who were infected in the hospital were mostly infected by other patients rather than by the hospital staff, according to the authors. Additionally, out of 22 cases in which the patients were infected in the hospital, 20 were the result of the virus spreading between patients, according to the study.

“The fact that the vast majority of infections were between patients suggests that measures taken by hospital staff to prevent staff transmitting the virus to patients, such as the wearing of masks, were likely to have been effective,” said lead study author Chris Illingworth, MD, in a press release. “But it also highlights why it is important that patients themselves are screened for COVID-19 regularly, even if asymptomatic, and wear face masks where possible.”

In contrast, health care workers were almost as likely to be infected by patients as they were by other health care workers, according to the study. Further, a trend was found toward individuals either infecting no one else or infecting multiple other people, with just over one-fifth of patients causing 80% of the infections.

“Preventing new cases of hospital-based infection is a critical part of our work.Here we have shown that analyzing clinical and viral genome sequence data can produce insights that inform infection control measures, which are so important for protecting patients and health care workers alike,” said co-lead author William Hamilton, MD, in the press release.

Hospital-acquired COVID-19 tends to be picked up from other patients, not from healthcare workers. University of Cambridge. August 24, 2021. Accessed August 25, 2021. 

https://www.cam.ac.uk/research/news/hospital-acquired-covid-19-tends-to-be-picked-up-from-other-patients-not-from-healthcare-workers

Jill Murphy, Associate Editor

Articles

Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

Study: Ketone Supplement May Be Therapeutic for Boosting Brain Function in Obesity

Study Finds Integrated Treatment for Depression, Heart Failure Improves Quality of Life and Mood

Study: Hospital-acquired COVID-19 Picked Up Through Other Patients Rather Than Health Care Workers