Safety and efficacy of dual versus triple antithrombotic therapy | Pregnant trauma victims experience nearly twofold higher mortality compared to their nonpregnant counterparts | More than half of American adults have been obese in their lifetime
November 16, 2017
AJM: From the publisher of The American Journal of Medicine
News for physicians working in clinical settings
Top News
Safety and efficacy of dual versus triple antithrombotic therapy
In patients who may be in need of anticoagulation, choosing an antithrombotic regimen following coronary intervention is a challenge commonly encountered by clinicians. For patients in line for long-term anticoagulation who are undergoing coronary stenting, dual therapy is safer than and as effective as triple therapy. Major bleeding occurs less frequently with dual therapy. Dual therapy is equivalent to triple therapy in reducing stroke, stent thrombosis, and mortality.
The American Journal of Medicine (11/2017) 
Immunotherapy Highlights from ASCO 2017
The goal of this program is to help medical oncology and hematology-oncology physicians and advanced practitioners in community and academic settings to integrate checkpoint inhibitors into cancer treatment regimens and understand their unique safety and response profiles. Learn More!
Clinical Updates
Pregnant trauma victims experience nearly twofold higher mortality compared to their nonpregnant counterparts
Pregnant women are nearly twice as likely to die after trauma when compared to their nonpregnant counterparts, despite comparable injury severity.
American Journal of Obstetrics & Gynecology (11/2017) 
More than half of American adults have been obese in their lifetime
To study the total effects of obesity on a population, lifetime obesity status needs to be considered as well as current obesity prevalence. This study estimated prevalence and trends in lifetime obesity status, defined using the categories never, former, and current obesity. In 2013-2014, 50.8% of American males and 51.6% of American females were ever obese. Twenty-two percent of individuals who were not currently obese had formerly been obese. In addition, prevalence of several diseases was higher among the formerly obese than among the never obese.
American Journal of Preventive Medicine (11/2017) 
Depression and asthma outcomes in older adults
To determine the association of depression with asthma outcomes in older adults (age > 55), data from the National Health and Nutrition Examination Survey (NHANES) (2007-2012) were analyzed. 7.01% (n= 509) of the sample reported a physician diagnosis of asthma. Older adults with asthma and depression (n = 196) had increased asthma episodes (prevalence ratio (PR), 1.53; 95% CI, 1.00-2.35), emergency department/ urgent care visits for asthma (PR, 2.24; 95% CI, 1.15-4.34), sleep disturbances due to asthma (PR 2.75; 95% CI, 1.54-4.92), and activity limitation (PR, 1.77; 95% CI, 1.00-3.18; P= 0.05) compared to older asthmatics without depression. Screening for depression and providing supportive resources may decrease the burden of asthma among older adults.
The Journal of Allergy and Clinical Immunology: In Practice (11/2017) 
Reports of postural orthostatic tachycardia syndrome following HPV vaccination
Human papillomavirus vaccines prevent infection with certain oncogenic HPV types. A rare condition called postural orthostatic tachycardia syndrome (POTS) has emerged as a vaccine safety concern among the public, despite limited epidemiologic evidence. This review found no evidence to suggest a safety problem with POTS following HPV vaccination.
Journal of Adolescent Health (11/2017) 
MOQI: Reducing hospitalizations in nursing home residents
It is possible to reduce hospitalization rates in nursing home residents as shown by the MOQI (Missouri Quality Initiative) project. MOQI was an intervention in collaboration with the Centers for Medicaid & Medicare Services (CMS) Innovations Center. An advanced practice nurse was embedded full-time to improve care in 16 nursing homes within an 80 mile radius of a major Midwestern city. A 30% reduction in all-cause hospitalizations was achieved in a three-year period.
Journal of the American Medical Directors Association (11/2017) 
Communicating with patients about opioid tapering
Communicating with patients about opioid tapering can be difficult, particularly for patients on long-term opioids who perceive benefits and are using medications as prescribed. This study used qualitative methods to understand communication processes related to tapering. Although tapering can be challenging, helping patients understand reasons for tapering, encouraging patients to have input into the process, and assuring patients they would not be abandoned all appear to facilitate optimal communication about tapering.
The Journal of Pain (11/2017) 
Happy Holidays!
The management and staff of AJMPlus wish you and yours Happy Holidays. To give our staff time to the with family and friends, we will not publish AJMPlus on November 23rd. Your next issue of AJMPlus will arrive on November 30th. Thank you for your interest in AJMPlus.
Continuing Medical Education
New On-demand Migraine CME Activity
New On-demand Migraine CME Activity
The 18th Congress of the International Headache Society (IHC) was held in Vancouver, BC, Canada, September 7-10, 2017. The conference attracts medical professionals who are involved in the care of patients with new developments in the advancement of headache science, education, and management. In this free, online CME Conference Reporter, two experts summarize the key learnings from this year's conference focusing on migraine. Upon completing this activity, you may receive up to 1.0 AMA PRA Category 1 Credit™. Begin this activity!
Medical News
Updated heart guidelines lower threshold for hypertension
Updated heart guidelines lower threshold for hypertension
New guidelines from the American Heart Association and 10 other medical groups reduce the hypertension threshold from 140 mm Hg systolic over 90 mm Hg to 130 over 80, meaning 46% of US adults would be diagnosed with high blood pressure. The guidelines, published in the Journal of the American College of Cardiology and in Hypertension, call for patients already being treated for high blood pressure to work toward the lower goal and for adults to address early hypertension with lifestyle changes rather than medication.
The Washington Post (tiered subscription model) (11/13),  USA Today (11/14),  Medscape (free registration) (11/13) 
Study: One-hour blood glucose test may be better for predicting diabetes risk
A study in Diabetes Care showed that a one-hour blood glucose measurement had a significantly greater discriminative ability to predict the risk for type 2 diabetes at 12 years and 39 years, compared with impaired fasting glucose based on a two-hour blood glucose level. Researchers evaluated data from the Malmo Preventive Project involving 4,867 men and found that those with elevated one-hour blood glucose levels had greater risks for mortality, fatal ischemic heart disease, myocardial infarction, peripheral vascular complications and retinopathy than those with increased two-hour blood glucose levels.
Healio (free registration)/Endocrine Today (11/14) 
Sugary drink intake declining among US youths, adults
The rate of children and adults in the US who drank sugar-sweetened beverages on any given day dropped from 79.7% and 61.5%, respectively, in 2003 to 60.7% and 50% in 2014, researchers reported in the journal Obesity. The findings also showed reduced consumption of 100% fruit juice, especially among teens and those older than 40, while sugary drink intake remained highest among adolescents, blacks and Hispanics.
The New York Times (free-article access for SmartBrief readers) (11/14) 
Business Practice News
Studies reveal pervasive EHR alert fatigue among providers
Multiple studies have found that EHRs send so many insignificant prescribing alerts that health care providers simply override most of them, including important ones. A recent study in the Journal of the American Medical Informatics Association found that many overrides of alerts for patient allergies, duplicate drugs and formulary substitutions were warranted and the alerts could therefore be reduced in the inpatient setting, and physician Steve Waldren suggested that alerts be put into context relative to individual patients.
Medscape (free registration) (11/6) 
HHS retools approach to promoting value-based care
The transition to value-based care has accelerated since the passage of the Affordable Care Act, which included incentives, but the Trump administration is now implementing regulatory changes that slow or narrow the scope of some initiatives. Indicators point to more voluntary programs, rather than mandatory models, and more flexibility for health care providers.
The New York Times (free-article access for SmartBrief readers) (11/12) 
Patient's Perspective
Survey examines users' perceptions of EHRs, patient portals
Survey examines users' perceptions of EHRs, patient portals
HealtheLink surveyed 1,000 patients and hospital and IT executives across the US and found that while 60% of patients do not think their doctors spend too much time entering information on EHRs during a typical appointment, the percentage of those who said physicians spend too much time on a computer was 47% among patients who visit a doctor five or more times a year. The findings showed 72% knew their primary care physician has a patient portal but only 41% have used it.
Healthcare IT News (11/13) 
Editor's Note
AJMPlus will not publish Nov. 23
In observance of the Thanksgiving holiday in the US, AJMPlus will not publish Thursday, Nov. 23. Publication will resume Thursday, Nov. 30.
Imagination is the air of mind.
Philip James Bailey,
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