Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown.

By 2007, opioid-related mortality in Washington State was 50% higher than the national average, with Medicaid patients showing nearly six times the mortality of commercially insured patients. Some fear that opioid dosing guidelines might restrict access to opioid therapy for patients who could benefit. However, there is evidence that high-dose opioid therapy entails significant risks without demonstrated benefit. This work reports on opioid dosing in the Washington Medicaid fee-for-service population for 273,200 adults with a paid claim for an opioid prescription between April 2006 and December 2010. These findings indicate that high-dose opioid therapy can be reduced without altering median opioid dose in a Medicaid population.

Although postconcussive symptoms for most children resolve in one to two weeks, 15% to 30% of children with a concussion experience symptoms that last at least three months. Psychological components such as pre-existing anxiety and depression influence symptomatology after concussion. In this study, noninjury factors, especially somatization and anxiety, contributed significantly to delayed symptom resolution. Primary care providers should consider referring patients with persistent symptoms to providers with expertise in pediatric behavioral health.

In a nested cohort analysis, significant variation in the placental microbiome was observed among spontaneous term and preterm births, with notable further variation in both microbiota and functional metabolic pathways among subjects with severe chorioamnionitis.

Case-based learning is a successful strategy for teaching adolescent health in an interprofessional environment. The case-based approach allows learners from different disciplines and career stages to contribute by drawing on their own unique prior experiences. Connecting case-based learning to clinical work gives learners further practice in applying new knowledge to the care of adolescents.

Making the decision about whether institutional long-term care placement is appropriate -- what do the experts think? One hundred sixty-one experts from eight European countries reviewed 14 vignettes of people with dementia. Thirty-seven percent of the recommendations were for placement in institutional long-term care, but the preferences were very different among case types, countries, and professional groups (case managers, physicians, nurses, and social workers). Patients with mobility issues, multiple care needs, and carers' wishes carried quite a bit of weight with the decision-makers.

A recent study found a substantial preventive effect of a new nasal filter for seasonal allergic rhinitis. The purpose of this study was to evaluate the usability of the nasal filter in a large population. One thousand seventy-three participants received the filters for a two-week use period and completed online questionnaires after each week of use. There were 834 filter users in week one; of these, 634 continued use in week two. Continued use was associated with higher screening scores for nasal symptoms, more severe asthma, and more dissatisfaction with usual treatment. The authors concluded that the nasal filters appear sufficiently convenient and comfortable to use and thus are clinically relevant for symptom management for many allergy sufferers.

Gastric surgery should be a standard treatment option for patients with type 2 diabetes who have a body mass index over 40 or a BMI over 30 and uncontrolled blood glucose levels, according to guidelines published in Diabetes Care and endorsed by international organizations, diabetes specialists and researchers, including the American Diabetes Association and the International Diabetes Federation. The guidelines were based on studies that showed the procedure can reduce blood glucose levels below the type 2 diabetes diagnosis threshold or improve blood glucose levels in a majority of the cases, which would allow many people to reduce or discontinue their diabetes medications.

Colon cancer rates among adults age 50 and younger rose more than 11% from 2004 to 2013, while cancers in those 50 and older dropped by close to 3%, researchers reported at Digestive Disease Week 2016. Incidence among younger adults rose nearly 1% each year, reflecting similar data from a previous study reported in the journal Cancer, which noted that younger patients have a higher risk of being diagnosed with cancer at an advanced stage.

Researchers reviewed data for more than 10,000 adults with atrial fibrillation and found that although women were more likely to experience symptoms and had a greater risk of stroke than men, they had lower odds of cardiovascular and all-cause mortality. The findings, published in JAMA Cardiology, also showed that men and women had similar rates of anticoagulant use.

Medicare's physician home-visit initiative, called Independence at Home, is showing cost savings, and the CMS is readying a second round of bonus payments for participating practices. Dr. William Zafirau, who oversees the program at the Cleveland Clinic, says Medicare reimbursement for house calls, which is similar to an office visit and does not cover travel or extra patient time, may not be enough to entice physicians to participate.

Changing IRS rules, Affordable Care Act requirements and new socioeconomic data are prompting hospitals to broaden their focus on quality to include community health, experts said. The CMS 2016 Quality Strategy calls for programs aimed at addressing social determinants of health, and a new Yale University study showed a positive link between spending on social services and better outcomes for multiple measures.

An 11-year Canadian study found neighborhood walkability can affect the risk of obesity and diabetes among residents, researchers reported in the Journal of the American Medical Association. The study divided walkability into categories such as population and residential building density, having walkable destinations, and street connectivity.