Personalized Activity Intelligence | Pain in veterans more common than in general population | Improving pediatric residents' comfort with the pubertal exam
March 16, 2017
AJM: From the publisher of The American Journal of Medicine
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Personalized Activity Intelligence
The authors created the Personal Activity Intelligence algorithm to motivate people to become and stay physically active. Its use is associated with reduced risk of premature death from all causes, including cardiovascular disease.
The American Journal of Medicine (3/2017) 
Clinical Updates
Pain in veterans more common than in general population
This study provides national prevalence estimates of US military veterans with severe pain and compares veterans to nonveterans. Data are from the 2010-2014 National Health Interview Survey on 67,696 adults who completed the Adult Functioning and Disability Supplement. The results show that the prevalence of severe pain, defined as that which occurs "most days" or "every day" and bothers the individual "a lot," is strikingly more common in veterans than in members of the general population.
The Journal of Pain (3/2017) 
Improving pediatric residents' comfort with the pubertal exam
Assessment of pubertal development is part of routine pediatric care. However, a needs assessment found that pediatric residents demonstrated discomfort and knowledge gaps and avoided puberty examinations. An online learning module addressing these concerns was shown to improve knowledge and confidence.
Journal of Adolescent Health (3/2017) 
A review of recent years at the Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) plays an essential role in making the US and the world safer and healthier by strengthening public health systems at home and abroad, addressing health threats effectively, and implementing and documenting cost-effective interventions. The CDC's unique mandate focuses national attention on protecting and improving the health of all US citizens across a broad range of issues, from controlling disease outbreaks to making sure food and water are safe to helping people avoid leading causes of death such as heart disease, cancer, stroke, and diabetes.
American Journal of Preventive Medicine (3/2017) 
Triaging diagnostic oral food challenges to maximize safety and utility
When medical history and allergy tests such as skin prick tests (SPT) and serum food-specific IgE tests (sIgE) are insufficient to diagnose food allergy, a medically supervised oral food challenge (OFC) is required for diagnosis. This study describes a Standardized Clinical Assessment and Management Plan (SCAMP) to iteratively improve the prediction of reactions and severity. With evaluation of 2,368 OFCs, recommended sIgE and SPT thresholds were incrementally changed, and using the methodology a significant decrease was noted in the proportion of challenges directed toward higher resource locations rather than offices. The authors concluded that this method can be used to triage OFCs to high and low risk categories, with low risk using fewer feeding increments and less intensive nursing.
The Journal of Allergy and Clinical Immunology: In Practice (3/2017) 
Cerebroplacental ratio as predictor of intrauterine growth restriction
Intrauterine growth restriction accounts for a significant proportion of perinatal morbidity and mortality currently encountered in obstetric practice. The primary goal of antenatal care is the early recognition of such conditions to allow treatment and optimization of both maternal and fetal outcomes. Management of pregnancies complicated by intrauterine growth restriction remains one of the greatest challenges in obstetrics. The cerebroplacental ratio is gaining much interest as a useful tool in differentiating the at-risk fetus in both intrauterine growth restriction and the appropriate-for-gestational-age setting. The cerebroplacental ratio quantifies the redistribution of the cardiac output, resulting in a brain-sparing effect. The Prospective Observational Trial to Optimize Pediatric Health in Intrauterine Growth Restriction group previously demonstrated that the presence of a brain-sparing effect is significantly associated with an adverse perinatal outcome in the intrauterine growth restriction cohort.
American Journal of Obstetrics & Gynecology (3/2017) 
Osteoporosis screening among US women
Despite a notable increase in osteoporosis screening among women ages 50-64 and those over 80, tremendous deficiencies remain among women over 65.
The American Journal of Medicine (3/2017) 
Continuing Medical Education
Register now for live dyslipidemia symposium on March 30 in San Diego
Register Now for Live Dyslipidemia Symposium on March 30th in San Diego
A live Elsevier CME Satellite Symposium, "Developing Optimized Treatment Plans for Patients with Dyslipidemia in the Era of PCSK9 Inhibitor Therapeutics," will take place on Thursday, March 30, at the Manchester Grand Hyatt San Diego from 6:00 p.m. to 8:30 pm. Expert faculty on this panel will discuss the science of PCSK9 inhibitors and aid physicians in the best practices to get their patients at LDL-C target. Upon completion of this live activity, you may receive up to 2.00 AMA PRA Category 1 Credits™. Find out more and register!
Medical News
Many AF patients who had a stroke lacked preventive therapy
Study data showed 84% of patients with atrial fibrillation were not taking adequate clot-prevention therapy before they had a stroke, researchers reported in the Journal of the American Medical Association. The study included more than 94,000 US patients and found some were not taking any anticoagulant medicine, while others were taking only aspirin or were on an inadequate dosage of warfarin.
HealthDay News (3/14) 
CDC: Rising tide of drug-resistant fungus puts Americans at risk
Treatment-resistant Candida auris has sickened 35 US patients, 28 of them in New York, and has been detected in 18 others since the CDC warned Americans about the pathogen in June. The fungus can cause severe bloodstream infections and spreads readily in health care settings, killing an estimated 60% of those who are infected.
The Washington Post (tiered subscription model) (3/10) 
Hypoglycemia tied to increased mortality, CVD risk in diabetes
Type 2 diabetes patients who had one episode of severe hypoglycemia were at a twofold increased risk of developing cardiovascular disease or dying, compared with those who did not experience severe hypoglycemia, according to a study presented at an American Heart Association meeting. Researchers used a cohort of 1,198 adults ages 45 to 64 and found that one-third of those who had a hypoglycemic event that required an emergency department visit died within three years of that episode.
Physician's Briefing/HealthDay News (3/13) 
Business Practice News
ECRI releases list of top 10 patient safety concerns in health care
EHR information management, unrecognized patient deterioration, and clinical decision support implementation and use are among the top patient safety concerns cited by health care organizations, according to an ECRI Institute report. The list also includes patient identification, inadequate organization systems or processes to improve safety and quality, and behavioral health issues in nonbehavioral health settings.
HealthLeaders Media (3/13) 
Hospital-based physician spending may not affect quality
Hospitalist and general internist spending levels within the same hospital did not affect 30-day mortality or readmission rates, according to a report in JAMA Internal Medicine that focused on Medicare fee-for-service data. The researchers suggested policies that target physicians, such as pay-for-performance or comparison reporting, should be developed and evaluated.
Medscape (free registration) (3/13) 
Patient's Perspective
Appointment wait time affects patient satisfaction
Appointment wait time affects patient satisfaction.
Patients who had relatively long waits for scheduling and completion of consultations with specialists were more likely to report being dissatisfied with their care, according to an analysis of data from the Veterans Health Administration published in The American Journal of Accountable Care. The finding has implications for accountable care organizations as they reorganize to become more patient-centered, write Steven Pizer, Michael Davies and Julia Prentice.
The American Journal of Managed Care online (3/10) 
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