Sex differences, chest pain, and myocardial ischemia | Ambulatory blood pressure monitoring provides more information in frail older adults | Nursing home collaboration with hospice improves end of life care
May 24, 2018
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Sex differences, chest pain, and myocardial ischemia
While mental stress-induced myocardial ischemia -- as opposed to ischemia brought on by conventional stress -- is a frequent phenomenon in patients with coronary artery disease, women with stable coronary artery disease report more chest pain or angina symptoms than men. These results highlight the importance of psychosocial determinants of chest pain in daily life among women with coronary artery disease; this in turn has implications for the management of women with angina.
The American Journal of Medicine (5/2018) 
New On-demand CME Activity Dyslipidemia
The expert faculty will discuss the role of PCSK9 inhibitors for the treatment of dyslipidemia including achieving LDL-C goals, cardiovascular risk reduction and managing special patient populations. Current and emerging clinical trial data of PCSK9 inhibitors will be analyzed. Upon completing this activity, you may receive up to 1.0 AMA PRA Category 1 Credit. Click here to begin this activity!
Clinical Updates
Ambulatory blood pressure monitoring provides more information in frail older adults
In this cross-sectional study of 1,047 community-dwelling older adults, frailty and disability were associated with lower diurnal systolic blood pressure, blunted nocturnal decline of SBP, and higher nocturnal SBP regardless of conventional BP and a number of confounders. Ambulatory blood pressure monitoring may provide additional information over usual conventional BP measurements in the clinical evaluation of older individuals with frailty or disability, and may help explain the higher mortality risk with lower clinic BP among frail older adults observed in nonrandomized studies.
Journal of the American Medical Directors Association (5/2018) 
Nursing home collaboration with hospice improves end of life care
Nursing homes (NHs) collaboration with hospices appears to improve end-of-life (EOL) care. In this retrospective cohort study, the association between the attributes of NH hospice collaborations and EOL hospitalizations among dying NH residents was examined. As expected, a higher volume of hospice use in a NH was related to lower risks of EOL hospitalizations. However, this study found that having four or more Hospice providers in a NH was actually associated with higher EOL hospitalization rate.
Journal of the American Medical Directors Association (5/2018) 
Extra-fine vs fine inhaled corticosteroids (ICS) in relation to asthma control
This study compared the effectiveness of extra-fine vs. fine-particle inhaled corticosteroids administered as ICS monotherapy or ICS-long acting beta-agonist combination therapy by conducting a meta-analysis of observational real-life studies. Seven studies with 33,453 subjects aged 5 to 80 years met eligibility criteria for inclusion. Six studies used extra-fine beclomethasone propionate (efBDP) and one study both efBDP and extra-fine ciclesonide as comparators with fine-particle ICS. The overall odds of achieving asthma control were significantly higher for extra-fine ICS compared with fine-particle ICS. Overall exacerbation rate ratios and ICS dose were significantly lower for extra-fine ICS compared to fine-particle ICS. This meta-analysis demonstrates that ef-ICS have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICS.
The Journal of Allergy and Clinical Immunology: In Practice (5/2018) 
A prospective cohort study of fetal heart rate monitoring: Deceleration area is predictive of fetal acidemia
From the electronic fetal monitoring patterns studied, deceleration area is the most predictive EFM pattern for acidemia (AUC: 0.76), and combined with tachycardia for significant risk of morbidity (AUC: 0.77).
American Journal of Obstetrics & Gynecology (5/2018) 
Despite confidentiality concerns, youths on parents' plans use reproductive health services
Young adults insured as dependents on parental insurance plans and their policyholder peers have similar utilization of several reproductive health services, despite the potential for confidentiality breaches that have concerned providers and reproductive health advocates.
Journal of Adolescent Health (5/2018) 
Characteristics of counties with high levels of drug-related mortality
This study modeled associations between drug-related mortality at the county level and social determinants of health. Results revealed average mortality rates were significantly higher in counties with greater economic and family distress and economically dependent on mining. Average mortality rates were significantly lower in counties with a greater presence of religious establishments and recent in-migrants, and with economies reliant on public (government) sector employment. Health care supply factors did not contribute to between-county disparities in mortality rates.
American Journal of Preventive Medicine (5/2018) 
Continuing Medical Education
Free On-Demand CME/CE COPD Webcast Series
Free On-Demand CME/CE COPD Webcast Series
Within each focused activity of the In the Breathing Life Into COPD Management: Ongoing Monitoring, Pulmonary Rehabilitation, and Individualized Care webcast series, an expert pulmonologist and a primary care educator discuss best practices for a specific aspect of managing patients with COPD, including monitoring the disease course over time, maximizing patient function, and individualizing treatment regimens. Upon completion of this series, you may receive up to 1.0 AMA PRA Category 1 Credit™ 1.0 AANP Contact Hour. Begin this activity!
Medical News
Report: US cancer incidence, mortality rates decreasing
The Annual Report to the Nation on the Status of Cancer found cancer diagnoses and deaths in the US overall have been decreasing for men and women, mainly due to better treatments, prevention and screening in colorectal, lung and breast cancers. Prostate cancer death rates stabilized, however, after years of decline, and cases of oral and liver cancers are rising.
HealthDay News (5/22) 
More US youths developing antibiotic-resistant infections
Researchers found that the rate of cephalosporin-resistant Acinetobacter baumannii among US children ages 1 to 17 rose from 13.2% in 1999 to 23.4% in 2012, while rates of cephalosporin- and carbapenem-resistant A. baumannii increased by 3% and 8% every year, respectively, during the same period. The findings in the Journal of the Pediatric Infectious Diseases Society also showed that pediatric antibiotic-resistant infections slightly declined after 2008, but remained higher than at baseline.
Specialty Pharmacy Times (5/22) 
Patients with IBD at higher risk for Parkinson's disease
A Danish study in the journal Gut found inflammatory bowel disease was associated with about a 22% higher risk of Parkinson's disease. The findings, based on 76,477 patients with inflammatory bowel disease and 7.5 million matched controls, also showed that ulcerative colitis, not Crohn's disease, was the statistically significant risk factor for Parkinson's disease.
Family Practice News (5/22) 
Business Practice News
Physicians say hospitals not prepared for major disasters, tragedies
A poll of 1,328 emergency room doctors conducted by the American College of Emergency Physicians found that 9 in 10 respondents indicated their hospitals are insufficiently prepared for mass tragedies or major disasters. The findings underscore the need for an increased focus on medical aspects of preparedness as Congress works on major disaster preparedness legislation called the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018, said ACEP President Dr. Paul Kivela.
United Press International/HealthDay News (5/22) 
Survey: Most patients choose a doctor in part for online presence
A new survey finds that two-thirds of patients will choose a doctor in part based on the physician's web presence. "Patients depend on online sources of information moreso than ever and are using all of the digital tools available to inform themselves and make healthcare decisions," said Andrei Zimiles, CEO of, which conducted the survey.
Healthcare Dive (5/21) 
Patient's Perspective
Study: Fewer people have ideal cardiovascular health
The number of people with an ideal cardiovascular health score, based on seven lifestyle and biological measures, decreased from 8.5% to 5.9% from 1991 to 2008, according to a study in the Journal of the American Heart Association. Researchers said the decrease was due mainly to poorer scores for body mass index, blood pressure, blood glucose and cholesterol.
HealthDay News/American Heart Association (5/17) 
The basis of insincerity is the idealized image we hold of ourselves and wish to impose on others.
Anais Nin,
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