Early invasive strategies for women with N-STEMI | Abstinence-only sex ed is inadequate | Mental health services claims and adult onset asthma in Ontario, Canada
September 14, 2017
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Early invasive strategies for women with N-STEMI
In this large contemporary observational analysis, the incidence of in-hospital mortality in women with non-ST-elevation acute coronary syndrome undergoing an early invasive strategy was compared to an initial conservative strategy. The early invasive strategy was associated with lower in-hospital mortality; this benefit was observed in women presenting with non-ST-elevation myocardial infarction but not with unstable angina.
The American Journal of Medicine (9/2017) 
Live CME Webinar: Cystic Fibrosis
Expert faculty will discuss the role of aerosolized agents for improving airway clearance, including caveats from their own extensive clinical experience in managing patients with this condition during this live, roundtable discussion. Earn up to 1.5 CME/CE credits. Click here to register.
Clinical Updates
Abstinence-only sex ed is inadequate
US policies and programs that promote abstinence only until marriage are not effective, violate adolescent rights, stigmatize or exclude many youths, and reinforce harmful gender stereotypes. Adolescent sexual and reproductive health promotion should be based on scientific evidence and understanding, public health principles, and human rights.
Journal of Adolescent Health (9/2017) 
Mental health services claims and adult onset asthma in Ontario, Canada
A group of 145,881 adult residents of Ontario, Canada, with incident physician-diagnosed asthma between 2005 and 2012 were evaluated for mental health services claims (MHSCs) in the 1 year before and 1 year after asthma diagnosis. Twenty-seven percent of patients had a MHSC in the 1 year after asthma diagnosis. The risk of emergency department visits for any mental disorders increased by 13% in the 1 year after asthma diagnosis, compared to the 1 year before (adjusted RR [aRR], 1.13; 95% CI, 1.06-1.21). The risk for outpatient physician visits for substance-related disorders increased by 21% at 1 year (aRR, 1.21; 95% CI, 1.14-1.28). The significant comorbid burden of mental disorders in adults with newly diagnosed asthma highlights the need for appropriate mental health assessment and care in such patients.
The Journal of Allergy and Clinical Immunology: In Practice (9/2017) 
Metformin's various therapeutic roles
Metformin is everywhere. Originally introduced in clinical practice as an anti-diabetic agent, its role as a therapeutic agent is expanding to include treatment of pre-diabetes, gestational diabetes, and polycystic ovarian disease. More recently, experimental studies and observations in randomized clinical trials suggest that metformin could have a place in the treatment or prevention of preeclampsia.
American Journal of Obstetrics & Gynecology (9/2017) 
Cognitive performance across 3 frailty phenotypes
How does cognitive performance change as a person becomes more frail in older age? Researchers from the Toledo Study for Healthy Aging in Spain found that regardless of which of three frailty phenotypes (Frailty Phenotype, Frailty Trait Scale, and Frailty Index) was used to measure frailty, cognitive performance declined as the degree of frailty increased. More research could decipher whether prefrail elderly cognitive impairment could be an early marker of pending transition to frailty.
Journal of the American Medical Directors Association (9/2017) 
Efficacy, side effects, and monitoring of oral cyclosporine in interstitial cystitis-bladder pain syndrome.
The use of cyclosporine for interstitial cystitis/bladder pain syndrome (IC/BPS) is a fifth-line treatment in the American Urological Association clinical guideline for IC/BPS, and the drug is potentially indicated for treatment in the patient with intolerable symptoms whose next step is surgery (removal of bladder with urinary diversion). The study evaluated the efficacy of oral cyclosporine A (CyA) in the treatment of refractory interstitial cystitis-bladder pain syndrome (IC/BPS) and to assess safety using drug level and renal function monitoring. Medication was started at 3 mg/kg divided twice daily for 3 months. At 3 months, 31% (8/26) improved by global response assessment, 15% (4/26) had >50% improvement in the ICSI score, and 19% (5/26) had an improvement in the Interstitial Cystitis Problem Index score. Mild renal toxicity was observed 3 months after the drug was stopped but all patients returned to baseline renal function in 6 months. IC/BPS can be a frustrating condition to treat and cyclosporine can be used as the last step in medical management prior to considering surgical options.
Urology (9/2017) 
Medical News
Study: Healthy but obese adults have higher cardiovascular risks
Study: Healthy but obese adults have higher cardiovascular risks
Obese adults who are metabolically healthy still are at higher risk of heart disease, cerebrovascular disease and heart failure, compared with people at a normal weight, according to a study in the Journal of the American College of Cardiology. Cardiovascular risks increased with the number of metabolic abnormalities people had, regardless of body type.
HealthDay News (9/11),  MedPage Today (free registration) (9/11) 
Postpartum depression screening useful at well-baby visits
A study in the journal Pediatrics found that screening new mothers at well-baby visits could aid in the early detection of postpartum depression and improve parenting, anxiety symptoms and mental health functioning. Doctors providing well-baby care need to be trained appropriately and pay attention to the mother-child interaction, said lead author Angarath van der Zee-van den Berg.
Medscape (free registration)/Reuters (9/8) 
Business Practice News
Studies analyze hospital discharges to nursing homes
The Medicare Payment Advisory Commission said fewer than 15% of nursing home residents were discharged from the hospital to facilities with the highest-quality ratings, while 46.8% went to facilities with quality scores lower than five or more other providers in a 15-mile radius. A study in Health Affairs found hospitals using a preferred network of nursing homes reduced readmissions by a greater percentage than those that did not use a network.
McKnight's Long-Term Care News online (9/11),  McKnight's Long-Term Care News online (9/7) 
Study: Online ratings fail to correlate with quality measures
Researchers found no correlation in a comparison of 78 specialist reviews on five online ratings sites with a group of internal quality measures, according to a study in the Journal of the American Medical Informatics Association. Co-author Dr. Brennan Spiegel, a gastroenterologist at Cedars-Sinai Medical Center in Los Angeles, where the research was conducted, said the study does not mean there is no value to online ratings, but suggests patients should not confuse the ratings with actual technical skill.
Bloomberg (9/8) 
Study: 99% of hospitals have partially or completely implemented EHRs
Researchers surveyed pharmacy directors at 1,315 hospitals in the US and found that 43.3% of hospitals completed implementation of EHR systems by 2016 and 55.7% partially implemented them, up from 33.6% that had fully or partially implemented EHRs in 2003. The findings, published in the American Journal of Health-System Pharmacy, showed that 100% of hospitals with 50 to 99 beds or at least 200 beds had implemented EHR systems, compared with 98.4% of those with less than 50 beds and those with 100 to 199 beds.
Becker's Hospital Review (9/11) 
Patient's Perspective
Report: 11.5 million Americans misuse prescription pain drugs
Data from the most recent annual National Survey on Drug Use and Health showed that of the 11.8 million Americans who misused opioid drugs in the past year, 11.5 million misused prescription pain drugs. Officials said prescription opioid misuse seems to be decreasing, but overall opioid and overdose deaths continue to increase.
Medscape (free registration) (9/11) 
Competence, like truth, beauty and contact lenses, is in the eye of the beholder.
Laurence J. Peter,
educator and writer
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