Video CME/CE: Understanding the Righteous Mind – With ZDoggMD

Video CME/CE: Understanding the Righteous Mind – With ZDoggMD

Read all the “front matter” information to the right, watch the video below, then click the link at the bottom right to complete the post-test and obtain credits. Release Date: December 14, 2016 Expiration Date: December 14, 2017   View...
CME/CE: Knee Osteoarthritis: Guidelines for Surgery

CME/CE: Knee Osteoarthritis: Guidelines for Surgery

According to current estimates, 27 million adults in the United States—or more than 10% of the adult population—have clinical osteoarthritis, a condition that ranks among the leading causes of hospitalization. Recent estimates show that approximately 9.9 million adults have symptomatic osteoarthritis (OA) of the knee. With life expectancy rates continuing to rise, it is anticipated that the prevalence of knee OA will increase in the coming years. The number of people older than age 65 is expected to increase to more than 77 million by the year 2040. The burden of OA of the knee is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. OA is the most frequent cause of disability among U.S. adults, and the burden is increasing due to the rising disease prevalence as well as higher expectations among patients to receive effective treatment. OA is the leading indication for joint replacement surgery. About 905,000 knee and hip replacements were performed in 2009, costing the healthcare system $42.3 billion. These estimates factor together direct medical, long-term medical, home modification, and nursing home costs.   OA Risk Factors & Disease Clinical studies have identified several factors that increase risks for developing OA of the knee to the point that surgery is required. These include joint degeneration over time due to hereditary vulnerability, large body mass, certain occupations, past joint traumas, and prior intraarticular damage. Knee OA also takes an emotional and physical toll on patients. Older adults with OA of the knee tend to visit their physicians more frequently and experience more functional limitations than others in the same age group....
CME/CE: Disparities in Older Patients with Diabetes

CME/CE: Disparities in Older Patients with Diabetes

Studies show that the prevalence of type 2 diabetes among adults aged 65 and older in the United States ranges between 20% and 25%. However, controversy has surrounded the most appropriate approaches to treating and managing diabetes in older adults, particularly with regard to identifying therapeutic targets for A1C and the control of other cardiovascular risk factors. In addition, research suggests there are disparities in risk factor control among racial and ethnic minorities with diabetes when compared with whites who have the disease. “Diabetes continues to be a major public health problem among older racial and ethnic minorities,” says Hermes J. Florez, MD, MPH, PhD. There are important factors to consider when managing this older patient group and developing treatment targets. These include the potential for adverse effects when using pharmacologic treatment, risks for hypoglycemia, and individual comorbidities, among other factors.   A Closer Look For a study published in Diabetes Care, investigators assessed data from the Atherosclerosis Risk in Communities (ARIC) study (2011–2013), which involved non-institutionalized, community-dwelling older adults with diabetes. The cross-sectional analysis involved more than 5,000 participants aged 67 to 90 with and without diagnosed diabetes who attended the fifth visit of the ARIC study. The authors evaluated the prevalence of glycemic, lipid, and blood pressure (BP) control overall and by race. The study also investigated correlates of meeting treatment targets and whether or not racial differences in risk factor control could be explained by demographic and clinical characteristics. Stringent risk factor targets were defined as having an A1C of less than 7%, an LDL cholesterol (LDL-C) level of less than 100 mg/dL, and a BP...
CME/CE: Treating Asthma in Older Women

CME/CE: Treating Asthma in Older Women

Among older individuals, women are significantly more likely than men to report having asthma and also have a 30% higher asthma-related mortality rate. In addition, women are nearly twice as likely to visit the emergency department for asthma when compared with men. Older women have been shown to have the highest hospitalization rates among all people with asthma (Figure). “However, little is known regarding why older women are more likely to suffer from the adverse events of asthma,” says Alan P. Baptist, MD, MPH. To better understand the specific issues that are unique to older women with asthma, Dr. Baptist and colleagues conducted a literature review and published their findings in Annals of Allergy, Asthma, & Immunology.   Unique Factors Menopause and hormone replacement are unique features among older women that may play a role in how asthma affects them differently from others. “Adult women experience the most asthma exacerbations around age 50, which is also the average age of menopause,” explains Dr. Baptist. “Studies also show that hormonal changes during the menstrual cycle often play a large role in asthma symptoms. Although we can’t say menopause and asthma symptoms are definitely related, we did find data suggesting this may be the case.” Dr. Baptists and colleagues also found that women with no history of asthma who were started on hormone replacement therapy were more likely to develop asthma than women who did not. “Conversely, among women who had asthma, hormone replacement actually improved symptoms and decreased asthma exacerbations,” Dr. Baptist says. “Hormone replacement therapy has many side effects, but it may be worthwhile to consider it in some...
CME: Making the Case for Increasing DSME/S Use

CME: Making the Case for Increasing DSME/S Use

According to recommendations from the American Diabetes Association, all individuals with diabetes should receive diabetes self-management education and support (DSME/S) when they are diagnosed with the disease and as needed thereafter. Recently, the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics released a joint position statement on DSME/S. Published in Diabetes Care and available at http://care.diabetesjournals.org, the document aims to enhance patients’ experiences with diabetes care and education, improve overall health, and reduce diabetes-associated healthcare costs. “Currently, there is no consistency with regard to when and how patients with diabetes are referred to DSME/S by their healthcare providers,” says Maggie Powers, PhD, RD, CDE, who was lead author of the joint position statement. “Healthcare providers may also not fully recognize the benefits of DSME/S or how it should be utilized. The joint position statement addresses both of these considerations.” Research shows that DSME/S can improve A1C levels and have a positive effect on other clinical, psychosocial, and behavioral aspects of diabetes, says Jo Ellen Condon, RD, CDE. “Ultimately, DSME/S helps inform, empower, and engage patients to manage the disease on their own and with their healthcare providers,” she says. “Studies show that DSME/S can help lower A1C levels with just one patient visit to these services. Diabetes is a disease that requires patients to be proficient in many self-management skills, and DSME/S is critical to laying the foundation for long-term management. It helps patients become effective self-managers and assists them with important daily decisions about food, exercise, and medications.”   A Helpful Blueprint The joint position statement arms healthcare teams with...
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