Heidi Splete, a senior writer with Elsevier Global Medical News, compiled this report. The presence of certified versus uncertified medical directors in nursing homes was associated with higher quality-of-care scores in a groundbreaking study of more than 20,000 facilities. Frederick N. Rowland, MD, PhD, CMD, of Saint Francis Hospital and Medical Center in Hartford, Conn., and his colleagues used the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting database to calculate a standard quality score for 547 facilities with certified medical directors (CMDs) and 15,230 facilities without CMDs. Facilities with a CMD had as much as 15% higher quality, the researchers found. Other factors associated with quality of care included a smaller facility size (fewer than 99 beds), not-for-profit status, and more registered nurse hours per patient-day. “I don't think anyone involved with AMDA would be surprised that having a certified medical director makes a positive difference in the quality of care provided in a facility,” Dr. Rowland said in an interview. “However, this study provides the first data-driven proof of what we have believed,” he said. Certification affects the quality of care in many ways, said Dr. Rowland. Attaining certification requires a willingness to become more deeply involved in all aspects of long-term care, he added. “I would personally advise anyone who works in the role of medical director to strongly consider working toward this certification,” he said. “I think that the greatest impact derives from a more complete understanding of the regulatory process and from the education and training in the development of processes that can improve the quality of care throughout the facility,” said Dr. Rowland. Areas of long-term care that the researchers determined were most likely to be directly influenced by the medical director included identifying ways to minimize avoidable transfers, minimizing and reporting accidents, managing pressure ulcers, and addressing quality-assurance issues related to physician performance. ▸ Source: Impact of Medical Director Certification on Nursing Home Quality of Care—Rowland et al. A 20-minute self-paced treadmill walk after dinner resulted in lower plasma glucose concentrations than a premeal walk produced in a study of 12 adults with type 2 diabetes. Previous research had shown that postprandial exercise can lower blood glucose, but no study was known to have done such a comparison in people with type 2 diabetes. The participants, all community dwelling, had an average age of 61 years. The researchers compared glucose measurements taken every 30 minutes, over 4 hours around mealtime, from days when the volunteers walked for 20 minutes before dinner, walked for 20 minutes after dinner, or did not exercise around mealtime. The glucose levels after a postdinner walk were lower than those levels taken after eating a dinner following a walk or no exercise. Total glucose over the 4 hours of testing was not significantly different among the three groups. But because postprandial hyperglycemia remains a cardiovascular risk factor, “older diabetic individuals are advised to undertake aerobic exercise after meals, including the evening one, to blunt the glycemic response resulting from meal consumption and reduce the likelihood of negative health consequences associated with postprandial glucose excursions,” the team said. The study was supported by Lifescan, a manufacturer of the glucose meters used in the study. ▸ Source: Postprandial Walking Is Better for Lowering the Glycemic Effect of Dinner than Pre-Dinner Exercise in Type 2 Diabetic Individuals—Colberg et al.