Treatment-resistant hypertension outcomes | Training to provide care to transgender youths | How do economic factors and alcohol affect suicide rates?
April 27, 2017
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Treatment-resistant hypertension outcomes
Patients treated with diuretics were less likely to develop treatment-resistant hypertension than were patients treated with either calcium channel blockers or ACE inhibitors.
The American Journal of Medicine (4/2017) 
Educational Symposium Registration Now Open
Register today for Clinical Issues in Severe Asthma: Consensus and Controversies on the Road to Precision Medicine held on Tuesday, May 23 from 6:30-8:30 PM in Washington, DC. All ATS 2017 International Conference attendees are invited to attend. Register for this live activity.
Clinical Updates
Training to provide care to transgender youths
There is a paucity of educational tools to equip pediatric providers with knowledge to provide care to transgender youths. This study suggests that a transgender youth curriculum including online modules and observational learning is a viable tool that can be incorporated into pediatric training programs to address this educational need.
Journal of Adolescent Health (4/2017) 
How do economic factors and alcohol affect suicide rates?
Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. This study investigated associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides. Poverty rates were most clearly associated with population risk of suicide and were also associated with increased alcohol involvement for men aged 45-64 years. However, negative associations between economic indicators and alcohol involvement were found for other groups, suggesting that non-economic factors may have played a role in alcohol-related suicide increases.
American Journal of Preventive Medicine (4/2017) 
Static-dose vs titrated-dose misoprostol for induction of labor
The efficacy of conventional static-dose oral misoprostol solution regimen is similar to that of a titrated-dose misoprostol solution regimen for induction of labor, but with lower side effect and complication rates.
American Journal of Obstetrics & Gynecology (4/2017) 
Supervised epinephrine injections improve epinephrine self-injection comfort: A prospective study
Anxiety and discomfort related to the need to self-inject epinephrine in an emergency contributes to food-allergic adolescents' occasional failure to carry an auto-injector and may increase their risk when an anaphylactic reaction occurs. Shemesh et al., in a prospective controlled study of 60 adolescent/parent pairs, randomized the adolescents with food allergy to self-injection or control (education only). The pre-defined primary outcome was self-reported comfort level with the injection before vs. after the intervention. A supervised self-injection procedure with an empty syringe improved adolescents' comfort with self-injection and decreased anxiety related to the anticipated need to self-inject. A simple self-injection procedure (needle and empty syringe) in addition to standard training is beneficial for adolescents with food allergy who are willing to perform this maneuver.
The Journal of Allergy and Clinical Immunology: In Practice (4/2017) 
Mechanisms involved in transitioning postoperative pain to chronic pain
Conceptual mapping reveals five classes of hypotheses pertaining to pain: (1) persistent noxious signaling in the periphery; (2) enduring maladaptive neuroplastic changes at the spinal dorsal horn and/or higher central nervous system structures; (3) compromised inhibitory modulation of noxious signaling; (4) descending facilitatory modulation; and (5) maladaptive brain remodeling in function, structure, and connectivity. The authors conclude there is a need for a concerted, strategic effort toward integrating clinical epidemiology, basic science research, and current theory about pain mechanisms.
The Journal of Pain (4/2017) 
How do older people feel about long-term care options?
Do older people's expectations of available long-term care options match what is actually obtainable? In a survey vignette study completed in Switzerland, a strong opinion was that spouses should be involved in the care of a person as they became needful of care. Caution is warranted, however, as the authors say additional countries need to do such studies to understand how their older population feels about long-term care options.
Journal of the American Medical Directors Association (4/2017) 
Medical News
Study: Many cardiac ICU patients also have noncardiac conditions
A study found 16% of more than 1,000 patients admitted to a cardiac ICU over one year also had sepsis, while acute kidney failure and acute respiratory failure were each found in 30% of patients, researchers reported in the Journal of the American College of Cardiology. Data showed patients with lung or kidney failure had longer ICU lengths of stay, and lung or kidney failure or sepsis significantly increased the risk of hospital mortality.
Medscape (free registration) (4/24) 
USPSTF recommends routine BP screening for preeclampsia
The US Preventive Services Task Force published updated guidelines in the Journal of the American Medical Association that call for all pregnant women to undergo routine blood pressure monitoring at every prenatal visit to screen for preeclampsia, regardless of whether they have a history of preeclampsia or high blood pressure. Separate guidelines call for pregnant women with a higher risk of preeclampsia to take low-dose aspirin after 12 weeks of pregnancy.
Reuters (4/25) 
Obesity tied to increased type 2 diabetes risk in children, study finds
Obesity tied to increased type 2 diabetes risk in children, study finds
(John Moore/Getty Images)
A study in the Journal of the Endocrine Society showed that children with obesity had an almost four times increased risk of developing incident type 2 diabetes before reaching adulthood, compared with those with a normal body mass index. UK researchers used a cohort of 369,361 children ages 2 to 15 and found a 1.6-fold increase in diabetes risk for every 1 standard deviation increase in BMI z score.
Healio (free registration)/Endocrine Today (4/25) 
Business Practice News
Top US health systems track data, seek ways to improve care
US hospital systems are tracking data and looking for ways to improve quality of care and patient outcomes, reduce readmissions, and save money, said Jean Chenoweth of Truven Health Analytics, which released this year's 15 Top Health Systems along with IBM Watson Health. She says the trend shows value-based reimbursements are taking hold.
Modern Healthcare (tiered subscription model) (4/22) 
Increasingly popular micro-hospitals have upsides and downsides
Nineteen states are home to micro-hospitals, which typically range from 15,000 to 50,000 square feet with eight to ten hospital beds for short stays and a suite of services tailored to the needs of the local community. Advantages include shorter wait times, shorter stays and improved access to some care, but critics warn that the facilities may lack certain diagnostic or treatment capabilities and offer fewer opportunities for doctors to become proficient at less common procedures.
U.S. News & World Report (4/24) 
Patient's Perspective
Exercise may help reduce heart failure risk, study says
Physical activity may be a risk reduction factor for heart failure in adults, including for those who are obese, researchers said. Their study in the journal JACC: Heart Failure showed that compared with people who followed recommended exercise guidelines, those who did not exercise had a 39% higher risk of heart damage.
HealthDay News (4/24),  Healio (free registration)/Cardiology Today (4/24) 
I'm not young enough to know everything.
J.M. Barrie,
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