Myocardial injury and infarction in the emergency unit | Predicting anti-Kell mediated hemolytic disease of the fetus and newborn, diagnostic accuracy of laboratory management | The high cost of intimate partner violence
October 18, 2018
AJM: From the publisher of The American Journal of Medicine
News for physicians working in clinical settings
Top News
Myocardial injury and infarction in the emergency unit
Diagnoses of type 2 myocardial infarction and myocardial injury are less frequently made than diagnoses of type 1 myocardial infarction, yet they account for more than half of all patients with a high troponin level presenting to emergency departments. The mortality rates for these conditions are higher than that for type 1, but type 1 myocardial infarction remains associated with excess risk of early cardiovascular mortality.
The American Journal of Medicine (10/2018) 
On-Demand CME: Clinical Issues in Severe Asthma
Expert faculty will discuss and debate a series of topics related to comprehensively evaluating and longitudinally managing patients with severe asthma, including implications of new study data presented at the 2018 American Thoracic Society International Conference. Earn up to 1.5 AMA PRA Category 1 Credits.
Click here to begin this activity!
Clinical Updates
Predicting anti-Kell mediated hemolytic disease of the fetus and newborn, diagnostic accuracy of laboratory management
Alloimmunized women with a known K-positive fetus and a titer of 4 or higher need intensive clinical monitoring.
American Journal of Obstetrics & Gynecology (10/2018) 
The high cost of intimate partner violence
This study estimated the US lifetime per victim cost and economic burden of intimate partner violence, with costs including attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Authors found the estimated population economic burden to be nearly $3.6 trillion (2014 US$) over victims' lifetimes, or $103,767 per female victim and $23,414 per male victim. Government sources pay an estimated $1.3 trillion (37%) of the lifetime economic burden.
American Journal of Preventive Medicine (10/2018) 
Depression and sexual risk among young women
This study revealed the complex interrelation between depression and sexual risk/relationships. Tailored interventions are needed to help high-risk young women manage the effects of depression on sexual decision-making and of sexual relationships on mood.
Journal of Adolescent Health (10/2018) 
ACA boosts coverage for young adults with special health care needs
Despite the importance of continuous insurance coverage for young adults with special health care needs, the impact of the Affordable Care Act (ACA) on insurance gaps for these young adults remains understudied. Findings indicate that the 2010 ACA dependent coverage provision reduced the number of insurance gaps experienced by these individuals.
Journal of Adolescent Health (10/2018) 
Trends in utilization of omalizumab for asthma
The utilization of the biologic omalizumab for asthma is reported by Molly M. Jeffery and colleagues in a large US database of administrative claims study. Characteristics of incident (no omalizumab use in the prior 12 months) and prevalent omalizumab use for asthma between 2003 and 2015 were determined and compared to a matched cohort of non-omalizumab users. The analysis identified 7,658 prevalent and 3,399 incident uses of omalizumab. Omalizumab use for asthma has been gradually decreasing following a peak shortly after its market availability. Many omalizumab users had low or very low adherence rates for inhaled corticosteroids (ICS) or combination ICS and long-acting beta-agonist in the 12 months before omalizumab initiation. The study highlighted the need for control, risk, and adherence assessments when considering omalizumab for patients with asthma.
The Journal of Allergy and Clinical Immunology: In Practice (10/2018) 
Gender diverse youths in clinical settings
Querying youths about their gender identity in clinical settings is crucial to identifying gender diverse youths who may benefit from gender-affirming medical and psychosocial supports, although barriers to doing so in adolescent settings are not well known. This study identifies barriers in clinical settings that serve adolescents and young adults.
Journal of Adolescent Health (10/2018) 
Continuing Medical Education
New Type 2 Diabetes CME/CE Series
New Type 2 Diabetes CME/CE Series
Each 15-minute module in this CME/CE-accredited CME Snapshot™ four-part series offers focused education for endocrinologists and primary care providers with actionable recommendations on injectable noninsulin antihyperglycemic agents for T2DM. For a comprehensive curriculum that provides interactive discussions on recent evidence related to glucagon-like peptide-1 receptor agonists (GLP-1 RAs), clinician learners can complete all 4 modules and receive a full hour of AMA PRA Category 1 Credit™. Begin the activity.
Medical News
CDC: More US children are not receiving recommended vaccines
The rate of US children ages 19 months to 35 months who didn't receive any recommended vaccinations rose from 0.3% in 2001 and 0.9% in 2011 to 1.3% in 2017, CDC researchers reported in the agency's Morbidity and Mortality Weekly Report. Another CDC study showed that the overall vaccination rate among those entering kindergarten held steady at nearly 95%, even though the vaccine-exemption prevalence rose for the third consecutive school year.
The Washington Post (tiered subscription model) (10/11),  NBC News/The Associated Press (10/11) 
Researchers find link between stress, sudden cardiac arrest, but not Mondays
A study published in Heart Rhythm revealed no evidence that sudden cardiac arrest was more likely to happen on Mondays, as was previously believed, and just 13.9% of 1,535 adults who died from sudden cardiac arrest died between 12 a.m. and 6 a.m. Researchers analyzed data from The Oregon Sudden Unexpected Death Study and found that increased stress levels were associated with an increased likelihood of sudden cardiac arrest at any time.
Healthline (10/15) 
Business Practice News
Hospitals reduce readmissions, hospital-acquired conditions
An American Hospital Association report found 70,000 fewer unplanned hospital readmissions from 2011 to 2015, along with a 21% reduction in hospital-acquired conditions from 2010 to 2015. Data showed a 40% decrease in central line-associated bloodstream infections from 2009 to 2014, and a 77% reduction in early elective deliveries.
Becker's Hospital Review (10/12) 
CMS proposal would require disclosure of drug prices in TV ads
The CMS released a proposed rule to require pharmaceutical firms to disclose the list prices of prescription drugs in direct-to-consumer television advertisements. CMS Administrator Seema Verma said the proposal, which would apply to all prescription drugs covered by Medicare and Medicaid except drugs with list prices of less than $35 per month, would give patients the information they need to make informed decisions.
Modern Healthcare (tiered subscription model) (10/15),  Healthcare Finance (10/15),  ThinkAdvisor (free registration) (10/15) 
Patient's Perspective
Seniors' attitudes toward discontinuing meds depend on physician involvement
Researchers analyzed data from 1,981 US Medicare beneficiaries aged 65 years and older who responded to a 10-item Medication Attitudes questionnaire on the subject of patients' attitudes on deprescribing and found that 92% of the group were open to discontinuing at least one of their medications if their physician suggested it. Findings published online in the journal JAMA Internal Medicine also indicated that nearly 67% of respondents wanted to reduce the number of drugs being taken.
Medscape (free registration) (10/15) 
Ships at a distance have every man's wish on board.
Zora Neale Hurston,
author and anthropologist
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