Falls among patients with cirrhosis | Effect of smoking on periodontitis: A systematic review and meta-regression | Green space leads to improvement in frailty status
June 14, 2018
AJM: From the publisher of The American Journal of Medicine
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Falls among patients with cirrhosis
Falls are common in patients with cirrhosis, injuries are more serious and complicated to manage in these patients, and they are more likely to incur severe head and brain injury due to falls. Efforts to determine and alleviate preventable factors in the rising burden of cirrhosis on patients and payors are urgently needed. Subgroups at highest risk should be identified for preventive interventions.
The American Journal of Medicine (6/2018) 
New On-demand Pancreatic Cancer Learning Center
This learning center contains complimentary CME activities highlighting up-to-the-minute emerging evidence that can be applied to everyday practice. Additional resources include open access to the full text of relevant peer-reviewed articles, clinical guidelines, interactive infographics, and other materials dedicated to helping you improve patient care. You may receive up to .75 AMA PRA Category 1 Credit per module. Click here to begin this activity!
Clinical Updates
Effect of smoking on periodontitis: A systematic review and meta-regression
This systematic review analyzed 28 articles to address the association between tobacco smoking and incidence and progression of periodontitis, and included 14 of these in the meta-analysis to assess whether methodologic characteristics of the studies influence the variability between estimates. Pooled adjusted risk ratios estimated that smoking increases the risk of periodontitis by 85%. Meta-regression demonstrated that age explained 54.2% of the variability between studies, time of follow-up explained 13.5%, loss to follow-up 10.7%, criteria used to assess the periodontal status explained 2.1%, and severity of periodontitis explained 16.9%.
American Journal of Preventive Medicine (6/2018) 
Green space leads to improvement in frailty status
This study of 4,000 community-dwelling Chinese adults aged 65 and older examined whether neighborhood green space was related to frailty risk over time. Ordinal logistic regression and path analysis were used to examine associations between green space and the frailty transitions. The study concludes that older people living in neighborhoods with a higher percentage of green space were associated with improvement in frailty status, independent of a wide range of individual characteristics.
Journal of the American Medical Directors Association (6/2018) 
Sarcopenic dysphagia linked to smaller tongue muscle mass
Sarcopenic dysphagia is characterized by difficulty swallowing due to a loss of whole-body skeletal and swallowing muscle mass and function. This cross-sectional study of 55 patients recommended to undergo dysphagia assessment examined the tongue and geniohyoid muscle as well as the echo-intensity of these muscles. Tongue muscle mass was smaller and tongue muscle intensity greater in patients with sarcopenic dysphagia than in patients without the disorder.
Journal of the American Medical Directors Association (6/2018) 
Depression, anxiety and cardiovascular health in children
This study evaluated the relationship between self-reported depression and anxiety symptoms and cardiovascular disease (CVD) risk factors, cardiac autonomic function, and vascular structure and function in children and adolescents. Anxiety was not associated with CVD risk factors or vascular health. Depression was associated with HDL cholesterol, triglycerides, and metabolic syndrome cluster score; these relationships were attenuated when accounting for body fat percentage. These findings suggest that during childhood, the correlation between depression and anxiety symptomatology with CVD risk factors and vascular health may be emerging, but that excess adiposity may play a greater role.
The Journal of Pediatrics (6/2018) 
Tdap vaccination effectiveness in adolescents
Rates of adolescent pertussis disease are increasing despite high Tdap vaccine coverage. The present study shows that Tdap protection decreases significantly within 2 years of receipt regardless of type of childhood primary vaccine.
Journal of Adolescent Health (6/2018) 
Complex regional pain syndrome: Signs and symptoms
Complex regional pain syndrome may develop as a complication after limb trauma or lesions of the peripheral nervous system. Typical features are continuing pain, sensory, vasomotor, sudomotor, motor and trophic changes as well as edema. This article provides a retrospective analysis of 1,043 CRPS patients in comparison with 421 patients suffering from other pain disorders. The results could potentially facilitate a more reliable and earlier diagnosis of CRPS, a better differentiation from other pain disorders, and ultimately in a more targeted and effective therapy.
The Journal of Pain (6/2018) 
Medical News
Few adults receive all recommended preventive health services
A study in Health Affairs showed only 8% of almost 2,800 surveyed US adults older than 35 were receiving all of the 15 highly recommended preventive services with the greatest potential for enhancing their health, including osteoporosis screening, blood pressure checks, vaccinations and tobacco use counseling. "For the most people to benefit from preventive care, the health care system needs to work together to encourage innovation on how care is delivered, how we can use new technology and how we can tailor improvements to meet the needs of local communities," said study lead author Amanda Borsky of the Agency for Healthcare Research and Quality.
Reuters (6/11) 
Nonmedical exemptions for childhood vaccinations rising in some states
The number of children in kindergarten who didn't receive recommended immunizations due to their parents' philosophical or religious beliefs rose in 12 of 18 states that permitted nonmedical exemptions between 2009-2010 and 2016-2017, researchers reported in PLOS Medicine. The findings also showed that eight of the top 10 counties with the highest prevalence of nonmedical exemptions were in Idaho.
Reuters (6/12),  The Washington Post (tiered subscription model) (6/12) 
Prenatal diabetes exposure may increase later odds of type 2 diabetes
A Canadian study in JAMA Pediatrics showed that youths whose mothers had gestational diabetes or type 2 diabetes during pregnancy were more likely to develop type 2 diabetes before age 30, compared with those whose mothers didn't have diabetes. Researchers also found a faster time to type 2 diabetes among those with in utero diabetes exposure.
MedPage Today (free registration) (6/11) 
Business Practice News
Automation of some basic tasks may benefit health care practices
Automation can help improve the ordering process within EHR systems for physicians and enrich EHRs, leading to enhanced patient care and reduced physician frustration, writes Josh Gluck, a vice president at Pure Storage. Gluck notes that automation is also used to adjust staffing in health systems and generate bills more quickly.
HealthTech (6/11) 
Hospital-acquired conditions drop 8%, resulting in 8,000 fewer deaths
Figures from the Agency for Healthcare Research and Quality show that the US avoided 350,000 hospital-acquired infections, a decline of 8%, between 2014 and 2016, saving $2.9 billion in hospital costs and preventing an estimated 8,000 deaths. The CMS aims to reduce hospital-acquired infections by 20% from 2014 to 2019, which would result in 53,000 fewer deaths and save $19.1 billion in hospital spending, and CMS Administrator Seema Verma said the latest data reflect the "tremendous accomplishment by America's hospitals in delivering high-quality, affordable health care."
Healthcare Finance (6/8) 
Patient's Perspective
Combining cash incentives with fitness tracker may encourage exercise
People who received cash incentives along with a fitness tracker and personalized goals were more likely to increase their physical activity level and maintain it, even after financial rewards stopped, compared with those who received a tracking device alone, according to a study in the Journal of the American Heart Association.
ABC News (6/13) 
The only failure a man ought to fear is failure in cleaving to the purpose he sees to be best.
George Eliot,
writer and journalist
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