CME: Dietary Supplements & ED Visits

CME: Dietary Supplements & ED Visits

Herbal products, complementary nutritionals, and micronutrients are all considered to be dietary supplements. The Dietary Supplement Health and Education Act is a 1994 law that defined supplements as food rather than drugs. A consequence of this act is that manufacturers of these supplements are not required to prove that their products have benefits or demonstrate their safety. “Although these products cannot be marketed to treat or prevent disease, they are often taken to address symptoms or illnesses or to maintain or improve overall health,” says Andrew I. Geller, MD. The estimated number of supplement products has increased significantly over the past 2 decades. Recent reports show that about half of all adults in the United States have reported using at least one dietary supplement in the past month. Post-marketing reporting of adverse events from manufacturers of these supplements is required only for serious adverse events, and voluntary reporting may underestimate the adverse events associated with these products. There has been increasing public attention regarding post-marketing removal of some supplement products, which in turn has led to calls for changes in oversight.   Taking a Closer Look “Few clinical studies have examined the safety of dietary supplements that are still available on the market, and data are lacking to quantify the frequency of adverse events associated with dietary supplements in the U.S.,” says Dr. Geller. To address this issue, he and his colleagues had a study published in the New England Journal of Medicine that aimed to estimate the number of ED visits for adverse events relating to dietary supplements. They also sought to identify the associated characteristics of patients,...
CME: Guidance for Managing ACL Injuries

CME: Guidance for Managing ACL Injuries

According to the American Academy of Orthopaedic Surgeons (AAOS), about 252,000 people in the United States suffer anterior cruciate ligament (ACL) injuries each year. ACL ruptures are typically the result of traumatic sports-related contact injuries, but they can also occur during non-contact activities. People who suffer ACL injuries are at higher risk for developing arthritis later in life. Studies indicate that women are two to eight times more likely to suffer an ACL injury than men. Several patient factors may affect the choice of treatment when managing ACL injuries. These include associated injuries that patients have experienced as well as comorbidities and skeletal maturity. Other characteristics like obesity, activities, and work demands can also play a role in treatment decision-making.   Navigating Complexities Recently, the AAOS released a clinical practice guideline (CPG) on the management of ACL injuries. The guideline recommends that reconstructive surgery occur within 5 months of an ACL injury to protect the knee joint, based on moderate supportive evidence. In addition, the CPG states that autografts are preferable over allografts to repair an ACL tear in adults aged 18 to 35. In 2015, the AAOS Board of Directors approved Appropriate Use Criteria (AUC) for ACL injury prevention programs and treatment. The AAOS also released AUC checklists on postoperative rehabilitation and function to help guide patients and physicians through treatment decisions and ensure that patients safely return to sports and physical activities. The AUCs, checklists, and links to a smartphone app are available for free online at www.orthoguidelines.org/auc. “Patients who suffer ACL injuries are a diverse group, and each individual will require a tailored treatment based on their...
CME – Ulcerative Colitis Treatments: Comparing Mortality

CME – Ulcerative Colitis Treatments: Comparing Mortality

According to data from the Crohn’s & Colitis Foundation of America, ulcerative colitis (UC) is an inflammatory bowel disease that affects up to 700,000 Americans. Current medications that are used for UC—which often include corticosteroids or long-term immunosuppressant therapy—do not lead to remission for all patients, and relapse rates are high even among those who achieve remission using medical therapies. “While medical therapy is generally safe for people with UC, only about one-third of patients experience a long-term response to medications,” explains Meenakshi Bewtra, MD, MPH, PhD. Patients also must endure a trial-and-error approach until they find a medication that works for them, which can severely impact quality of life (QOL). In addition, some UC medications come with higher risks of serious side effects. As an alternative to medical therapy, patients with UC can undergo elective colectomy, a surgery which involves performing a total proctocolectomy with ileostomy and, in many cases, restorative ileal pouch anal anastomosis. “Surgery has always been an option for patients with UC, but it is often viewed as a last resort,” says Dr. Bewtra. Research shows that elective colectomy is associated with low morbidity and mortality, but it may also alter patients’ QOL following the procedure.   Assessing Survival QOL, morbidity, and mortality are important factors that drive treatment decisions for patients with UC and their physicians. Dr. Bewtra and colleagues had a retrospective study published in Annals of Internal Medicine that looked at whether or not patients with advanced UC had better survival by undergoing elective colectomy or by being treated with medical therapy. “It’s important to clarify if elective surgery for UC can...
CME: Systolic Hypertension & Cardiovascular Mortality

CME: Systolic Hypertension & Cardiovascular Mortality

Studies have shown that isolated systolic hypertension (ISH)—defined as having a systolic blood pressure (BP) of 140 mm Hg or higher with a diastolic BP less than 90 mm Hg—is associated with elevated risks for cardiovascular disease (CVD) in older adults. “There has been a sense among clinicians that ISH is a benign condition in younger people,” explains Donald M. Lloyd-Jones, MD, ScM. “This had led some experts to label ISH as pseudo-hypertension, but the data to support this belief are limited.”   A Look at Younger Patients Few studies have looked at ISH in younger patients, despite research suggesting that its prevalence has increased in younger and middle-aged adults in recent years. For a study published in the Journal of the American College of Cardiology, Dr. Lloyd-Jones and colleagues assessed the risk for CVD in 27,000 patients aged 18 to 49 who did not have diagnosed coronary heart disease and were not taking antihypertensive therapy when they were assessed at baseline. Participants in the study were classified into one of the following groups: Optimal-normal BP (systolic BP <130 mm Hg, diastolic BP <85 mm Hg). High-normal BP (systolic BP 130 to 139, diastolic BP 85 to 89 mm Hg). ISH. Isolated diastolic hypertension (systolic BP <140 mm Hg, diastolic BP ≥90 mm Hg). Systolic and diastolic hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg). With access to the Chicago Heart Association Study database and linkage to the National Death Index, the study team was able to assess follow-up data on the cause of death among participants as well as 35-year outcomes, with an average follow-up...
CME: Gender, Stress, & Acute Myocardial Infarction

CME: Gender, Stress, & Acute Myocardial Infarction

Studies have shown that women and younger patients are at increased risk for mental stress when compared with the male or older counterparts, respectively. Whether or not the same holds true for young and middle-aged patients presenting with acute myocardial infarction (AMI) has not been well established. “In general, psychosocial factors are increasingly recognized as important influences on patients’ health status and recovery after major health events,” says Xiao Xu, PhD. “However, studies focusing on AMI tend to recruit older patients. Therefore, little is known about how psychosocial factors may influence outcomes among younger people with AMI.”   A Look at Younger Patients Dr. Xu and colleagues conducted a study that looked at the implications of stress on health outcomes and recovery in younger AMI patients. Published in Circulation, the authors used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes in Young AMI Patients) study. “VIRGO is the largest prospective study that has been conducted in the relatively younger AMI patient population,” Dr. Xu explains. “When that data became available, it presented an ideal opportunity to conduct our analysis. Because the VIRGO study focused on a uniquely large sample of young and middle-age patients, we were able to look at how stress is associated with recovery at 1 month in a younger population and also assess how gender affects outcomes.” For the study, the researchers examined gender differences in stress, factors contributing to these differences, and whether these differences helped explain gender-based disparities observed in 1-month recovery after AMI. Data on more than 3,500 AMI patients aged 18 to 55 were assessed. Self-perceived psychological stress...
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