Aerobic training: Effect on arterial stiffness in metabolic syndrome | Medical contraindications to estrogen and contraceptive use among women veterans | Allergic reactions to intravenous penicillin in skin test negative patients
February 8, 2018
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Aerobic training: Effect on arterial stiffness in metabolic syndrome
Since early vascular aging may lead to overt cardiovascular disease, identification of high-cardiovascular-risk subjects without overt cardiovascular disease is essential for effective primary cardiovascular prevention. In subjects with metabolic syndrome, aerobic exercise training geared toward achieving a target heart rate is associated with a decrease in aortic stiffness, which is a surrogate marker of cardiovascular diseases. Improvement of metabolic and fitness parameters is also demonstrated.
The American Journal of Medicine (2/2018) 
New On-demand Atopic Dermatitis CME Activity
In this free CME program, expert faculty will discuss best practices for comprehensive patient evaluations and the clinical profiles of systemic treatment options for patients with moderate-to-severe disease. Upon completing this activity, you may receive up to 1.0 AMA PRA Category 1 Credit. Click here to begin this activity!
Clinical Updates
Medical contraindications to estrogen and contraceptive use among women veterans
Women Veterans have a high burden of medical contraindications to estrogen-containing hormonal contraception, and there is unmet need for contraception among women with contraindications.
American Journal of Obstetrics & Gynecology (2/2018) 
Allergic reactions to intravenous penicillin in skin test negative patients
We sought to evaluate the risk of allergic reactions to repeated doses of intravenous penicillin in patients who previously reported penicillin allergy and were found to be penicillin skin test and oral challenge negative. Thirty-two patients met our inclusion criteria between 2010 and 2016. Greater than 50% of patients received three or more courses of intravenous penicillins. The most frequently used intravenous penicillin overall was piperacillin/tazobactam. Thirty-two patients received a total of 111 courses of intravenous penicillins and none developed an immediate hypersensitivity reaction. In patients who report penicillin allergy and have negative penicillin allergy testing, repeated administration of intravenous penicillin antibiotics appears to be safe. Larger prospective studies should be performed to confirm these observations.
The Journal of Allergy and Clinical Immunology: In Practice (2/2018) 
Transgender youth fertility attitudes questionnaire
Gender specialists, transgender youths, and parents collaborated to develop a fertility attitudes questionnaire for those facing potential infertility related to medical gender treatments. The resulting instrument assesses knowledge about the risks of infertility, feelings concerning having a biological child, and knowledge of fertility preservation procedures.
Journal of Adolescent Health (2/2018) 
Are primary care providers screening for alcohol misuse?
The US Preventive Services Task Force (USPSTF) recommends that primary care providers screen all adults for alcohol misuse and conduct brief counseling interventions. This study aimed to estimate the prevalence of alcohol misuse screening among primary care providers and examined factors associated with using USPSTF-preferred screening tools. Ninety-six percent of providers reported screening for alcohol misuse, and 38% of providers who screened used a USPSTF-preferred screening tool. Provider specialty, awareness of USPSTF guidelines, and mode of screening tool administration were associated with using a preferred screening tool.
American Journal of Preventive Medicine (2/2018) 
HPV vaccine risk perceptions do not predict sexual initiation
Among sexually inexperienced adolescent women vaccinated against human papillomavirus (HPV), perceived risk of sexually transmitted infections other than HPV and perceived need for safer sexual behaviors following vaccination were not associated with initiating sexual activity, further demonstrating that HPV vaccine-related risk perceptions are unlikely to lead to riskier sexual behaviors.
Journal of Adolescent Health (2/2018) 
Triggering events and outcomes of acute heart failure
Onset of acute heart failure has been associated with increased physical activity and other behaviors that can trigger hemodynamic deterioration. To effectively discriminate high- vs low-risk patients, triggering events as well as in-hospital data of patients with acute heart failure should be taken into consideration. Telemedicine and remote patient monitoring programs may be potentially useful to prevent unfavorable behaviors and patient deterioration, consequently leading to decreased clinical events and costs.
The American Journal of Medicine (2/2018) 
Medical News
Mortality caused by hypertension increased from 2005 to 2015, study finds
Researchers found a 10.5% increase in hypertension-related mortality rates from 2005 to 2015 and said heart disease was the leading cause of death, although there was a decline in mortality from cardiovascular disease from 1979 to 2015. The American Heart Association's 2018 Heart Disease and Stroke Statistics Update, published in the journal Circulation, revealed that 45.5% of deaths in the US caused by diabetes, heart disease and stroke were attributed to poor dietary habits, such as low consumption of fruits and vegetables and high intake of sodium and sugar-sweetened drinks.
Healio (free registration)/Cardiology Today (2/1) 
CDC: Fewer children with asthma experiencing attacks
CDC researchers found that the number of US youths with asthma who had at least one asthma attack during the previous year dropped from 61.7% in 2001 to 53.7% in 2016, with declines found in boys and girls across all ages and ethnic groups. Asthma-related hospitalizations and missed school days also fell between 2003 and 2013, but researchers said more work is needed to improve asthma control, according to the report in the CDC's Vital Signs.
HealthDay News (2/6),  Healio (free registration)/Infectious Diseases in Children (2/6) 
USPSTF: Pregnant women should receive syphilis screening
Draft recommendations from the US Preventive Services Task Force call for all pregnant women to be screened for syphilis, noting evidence showing that universal screening reduced the prevalence of congenital syphilis and adverse outcomes related to maternal infection and carried minor harms. The draft guidelines, a reiteration of 2009 recommendations, will remain open for public comment until March 5.
Physician's Briefing/HealthDay News (2/6),  MedPage Today (free registration) (2/6) 
Business Practice News
Revenues higher for physicians offering wellness visit
Primary care practices that performed annual Medicare wellness visits for patients on average generated higher revenue, compared with those that did not provide the service, according to a report in Health Affairs. Trends identified in the report showed practices that adopted wellness visits were concentrated in urban areas and the Northeast, and that hospital-based practices were less likely than independent practices to offer the service.
Medscape (free registration) (2/5) 
Trump administration eyes lifetime limits on Medicaid coverage
The Trump administration is considering lifetime limits on Medicaid coverage for adults in an attempt to retain the program's coverage for children, pregnant women and adults with disabilities. Critics say the move would impose administrative burdens and put vulnerable populations in danger.
McClatchy Washington Bureau (2/7) 
Patient's Perspective
CMS calls off program meant to engage patients in care decisions
The CMS announced that it will cancel the Direct Decision Support Model, designed to allow the agency to partner with outside organizations to educate patients about their options for certain conditions that have more than one appropriate option for treatment.
Modern Healthcare (tiered subscription model) (2/5) 
For the faithful, the patient, the hermetically pure, all the important things in this world -- not life and death, perhaps, which are merely words, but the important things -- work out rather beautifully.
J.D. Salinger,
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