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  • October 20, 2016 9:25 AM | Deleted user
    Younger patients, having proximal stones, needing IV narcotics more likely to return

    WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- Among patients with ureteral stones, those who are younger, have proximal stones, and require intravenous narcotics for pain control are more likely to return to the emergency department within 30 days, according to a study published in the November issue of The Journal of Urology.

    Vishnu Ganesan, from the Cleveland Clinic, and colleagues reviewed the 2010 to 2013 records for 1,510 emergency department patients at a single institution with a diagnosis of urolithiasis and an associated computed tomography scan. Images were reviewed to confirm stone size, location, and degree of hydronephrosis.

    The researchers found that 164 patients (11 percent) revisited the emergency department within 30 days. The presence of a proximal ureteral stone, age less than 30 years, and the need for intravenous narcotics in the emergency department remained independently associated with an emergency department revisit, according to multivariable analysis.

    "Consideration should be given for early follow-up or intervention for these patients to prevent costly emergency department returns," the authors write.

    Full Text (subscription or payment may be required)



    Copyright © 2016 HealthDay. All rights reserved.


  • October 20, 2016 9:24 AM | Deleted user

    After bariatric surgery, women with polycystic ovary syndrome (PCOS) not only lost weight but also experienced decreases in both ovarian volume and markers of androgen excess, according to data presented at the American Society for Reproductive Medicine (ASRM) 2016 Scientific Congress & Expo.

    Researchers conducted a retrospective chart review of 33 women with PCOS who underwent bariatric surgery at the Cleveland Clinic Foundation from 2009 to 2015. Information on pre- and postoperative weight, testosterone levels, dehydroepiandrosterone (DHEAS), HbA1c, fasting glucose, BMI, weight, and ovarian volume were gleaned from medical records.

    Weight and BMI were significantly lower after bariatric surgery than before the procedure (95.7 kg vs 126.3 kg and 37.4 vs 47.5, respectively; P <.0001 for both). Similar results were seen for ovarian volume (7.7 mL vs 14.0 mL; P =.036), as well as a trend toward decreases in total testosterone (38.4 ng/dL vs 56.1 ng/dL), free testosterone (4.5 pg/mL vs 10.3 pg/mL), and DHEAS (132.9 mcg/dL vs 196.3 mcg/dL).

    “These results suggest that weight loss associated with bariatric surgery may result in resolution of the key characteristics associated with PCOS including androgen excess and ovarian enlargement,” the researchers concluded.

    “Women with PCOS experience a large set of painful, discouraging, and uncomfortable manifestations of the syndrome,” Owen K. Davis, MD, president of ASRM, said in a press release. “The study showing reduction in symptoms after bariatric surgery is encouraging, but such surgery is an extreme remedy and only appropriate for a few.”

    RELATED ARTICLES

    References

    1. Christ J, Falcone T. Abstract O-82. Changes in ovarian morphology associated with bariatric surgery among women with polycystic ovary syndrome (PCOS). Presented at: ASRM 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT.
    2. Polycystic ovary syndrome increases risk of eating disorders, PCOS symptoms diminish after bariatric surgery [press release]. Washington, DC: ASRM Office of Public Affairs; October 17, 2016. https://www.asrm.org/Polycystic_Ovary_Syndrome_Increases_Risk_of_Eating_
      Disorders_PCOS_Symptoms_Diminish_After_Bariatric_Surgery
      . Accessed October 17, 2016.


  • October 20, 2016 9:22 AM | Deleted user

    The PA Foundation IMPACT Grant Program provides funding to encourage and support PA and PA student involvement in programs that improve health, consistent with the mission, values and vision of the PA Foundation. Through the program, the Foundation seeks to support patient-focused, community-based health projects that demonstrate an impact on patient health outcomes.

    2016 Timing and Availability of Funds

    The PA Foundation will offer two grant cycles in 2016, one opening in February and the other in October.
    The second cycle will open October 15.

    Add the cycle open date to your calendar.

    October 2016 Grant Cycle – Mental Health Focus

    The PA Foundation seeks to support patient-focused, community-based health projects in the area of mental health that demonstrate an impact on patient health outcomes.

    Read the qualifications and requirements document.

    Who Can Apply?

    All grant applications must be submitted by one or more PAs or PA students who are members in good standing of AAPA. Applications must be made in conjunction with a 501(c)(3) sponsoring organization, such as a nonprofit hospital or nonprofit community organization, an accredited PA Program, or an AAPA Constituent Organization. Depending upon the specific project and the potential liability it may involve, the PA Foundation reserves the right to condition approval of an application on affiliation with a sponsoring organization. In the evaluation process, preference will be given to those applicants who have not already been awarded a grant from the PA Foundation within the preceding 12 months (including both IMPACT Grants and Global Outreach Grants).

    October 2016 Evaluation Criteria

    Preference will be given to:

    1. Projects/programs focused on mental health patient education, screening/referral, and patient outcomes.
    2. Projects/programs that test new PA-led models of care in mental health, which may include screening/referral methods, and/or thatintegrate mental health education into clinical visits.
    3. Projects/programs focused on reducing stigma associated with mental health disorders.

    Proposals will be evaluated based on the following criteria:

    1. Clarity of the goals and activities of the project and alignment with designated mental health focus
    2. Demonstration of PA leadership and involvement
    3. Impact on the health of the target population

    Please note that grant funds may not be used to pay salaries or to reimburse organizations for salaries. Grant funding will not be provided to cover any indirect/administrative costs.

    2016 IMPACT Grants Requirements & Application

    Please read the grant requirements before applying for the IMPACT Grants.

    A written proposal (maximum 3 pages) addressing the following questions is required:

    1. How does this project address the mental health crisis, particularly in the areas of screening/referral, patient education, and stigma reduction?
    2. What are the characteristics of the patient population this project will serve?
    3. What points of data do you anticipate collecting during this project to measure impact?
    4. Show how other PAs or PA students will be involved in this program/project. How many will be involved and what are their roles?
    5. Indicate how PA value and/or PA utilization is critical in attaining the project objectives.
    6. Briefly summarize how the IMPACT Grant funding will improve or enhance population health of the community.
    7. What impact will this grant funding have on the success of this program/project?

    In addition to the written proposal, the following supporting materials are also required:

    1. Detailed project budget
    2. Letter of support signed by an official of the sponsoring organization

    Open date: October 15, 2016
    Deadline: November 18, 2016

    paf_impact_grant_apply_now_button

    Special Funding Opportunity

    This grant cycle also includes a special opportunity to apply for an award in the area of substance use disorders (SUD), with a focus on enhancing knowledge of SUD treatment research and promoting adoption of evidence-based SUD treatment practices.

    Learn more and apply>>

    IMPACT Grant Recipients

    Learn more>>

     

    Questions? Contact Caroline Pierce at cpierce@aapa.org or 571-319-4510.


  • October 18, 2016 9:10 AM | Deleted user

    Did you know that APAOG has a member only forum? 

    Access the forum here and post your practice questions, help a colleague with a problem or stay up to date on the latest happenings through APAOG! 

    Be sure to click 'subscribe' to stay up to date.

  • October 18, 2016 8:34 AM | Deleted user

    Journal of Clinical Outcomes Management 

    In an article recently published in the Journal of Clinical Outcomes Management, researchers found that an expanded PA hospitalist staffing model at a community hospital provided similar outcomes and a lower cost of care than a conventional one. Researchers did a retrospective study comparing two hospitalist groups at a 384-bed community hospital in Annapolis, Md. One group had an expanded PA staffing model, with three physicians and three PAs. The other group had a "conventional" staffing model, with nine physicians and two PAs.

    Between January 2012 and June 2013, researchers examined the in-hospital mortality, cost of care, readmission, length of stay and consultant use. Between the two groups, there was no statistically significant difference for in-hospital mortality, readmission, length of stay, or consultant use. Cost of care was less in the expanded PA group. In conclusion, an expanding PA staff modeling can yield a similar level of care at a lower cost.

    AAPA sees this as an important study that has broader implications for PA utilization in a hospital setting across all service lines.

    Read more

  • October 14, 2016 2:04 PM | Deleted user

    Researchers found Zika virus sequences in placenta and cord blood in newborns, supporting prior evidence of vertical transmission of Zika virus during pregnancy, according to data published inJAMA Neurology. However, the investigators did not observe changes in umbilical and cerebral blood flow.

    Previous studies have reported an increase of microcephaly cases in fetuses whose mothers were infected with Zika virus.  Amilcar Tanuri, MD, PhD, from the Federal University of Rio de Janeiro, and colleagues sought to examine the prenatal evolution and perinatal outcomes in 11 neonates with neurologic damage associated with Zika virus infection.

    The researchers observed the infants from gestation to 6 months in Paraiba, Brazil. Seven infants were female, and the median maternal age at delivery was 25 years. Ten of the 11 women included in the study presented with symptoms of Zika during the first half of pregnancy, but all 11 women had Zika infection confirmed in several tissues by serology or polymerase chain reaction.

    The investigators used intrauterine ultrasonography and magnetic resonance imaging to confirm brain damage, and they performed histopathologic analysis on placenta and brain tissue in infants who died. They also investigated the Zika virus genome in several tissues and performed genome sequencing for phylogenetic analysis.

    The perinatal mortality rate was 27.3%. The median cephalic perimeter at birth was 31 cm, which was lower than the limit to consider a microcephaly case.  The researchers observed neurologic impairments in all patients, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence.

    The Zika virus genome was identified in both maternal and neonatal tissues, including amniotic fluid, cord blood, placenta, and brain tissue. In addition, phylogenetic analyses revealed an intrahost variation between Zika virus sequences of some postmortem tissues.

    The researchers concluded that amniotic fluid may be valuable for prenatal diagnosis of Zika virus. They did not note changes in umbilical and cerebral blood flow, and they also note that microcephaly could be a consequence of several brain injuries.

    “Based on confirmed [Zika virus] ZIKV-associated cases of microcephaly reported by the Brazilian Ministry of Health, the northeastern region of Brazil has a 10 times larger incidence of confirmed cases compared with the rest of Brazil as well other Latin American countries where ZIKV circulates,” the study authors noted. “This fact suggests that there must be some additional unknown factor to enhance ZIKV fetal infection in this region. Coinfections as well as environmental factors should be explored to clear this unexpected finding.”

    Reference

    1. Suely de Oliveira Melo A, Aguiar RS, Amorim MMR, et al. Congenital Zika virus infection: Beyond neonatal microcephaly. JAMA Neurol. 2016; doi: 10.1001/jamaneurol.2016.3720.


  • October 14, 2016 1:40 PM | Deleted user

    Neil Silverman, MD will provide an update on Zika Virus to APAOG members and non-members on November 10, 2016.

    APAOG Members: Be sure you are logged in to receive the member rate! Not a member? Sign up today!

    Lecture Objectives:

    1. To understand the evolving epidemiology of Zika currently, including its implications in the US

    2. To appreciate the unique risks of Zika infection during pregnancy and their impact on the fetus and newborn

    3. To understand current testing protocols for diagnosing Zika infection

    4. To better counsel couples planning pregnancy regarding risks of travel to Zika-endemic areas  


  • October 12, 2016 11:16 AM | Deleted user

    Helping women who want to delay or avoid pregnancy during the Zika virus outbreak is a primary strategy to reduce Zika-related adverse pregnancy and birth outcomes, including microcephaly and severe fetal brain defects. 

    The best way to reduce the risk of unintended pregnancy is for sexually active women and their partners to correctly and consistently use effective birth control. 

    Long-acting reversible contraception (LARC), specifically IUDs and implants, is the most effective type of reversible birth control. LARC can be inserted or implanted in a woman and remains highly effective at preventing pregnancy for many years. 

    LARC is safe for most women to use, including female adolescents. To increase access to and availability of LARC, state and jurisdictional level-strategies can be implemented by state, local, and territorial agencies, health systems, and healthcare providers. 

    Download the resource here for more information.

  • October 07, 2016 12:20 PM | Deleted user

    Dorothy L. Tengler
    Thursday, October 06, 2016

    About 85 percent of menopausal women report at least one of the symptoms of menopause, which occurs due to a complex series of hormonal changes. The most common symptoms, often lasting for several years, include:

    • sleep disorder (insomnia, waking and sleeping difficulties)
    • sexual dysfunctions (reduced libido, urogenital disorders)
    • depressive disorders and irritability
    • hot flashes and excessive sweating
    • discomfort associated with muscle, joint pain (discomfort of bone-joint system, osteoporosis)

    In some women, these symptoms are so severe that they affect their social and daily lives.

    Although some women go through premature menopause at age 40, the average age of onset for natural menopause is 51 in the United States. However, 1 in every 10 women experiences natural menopause by age 45.

    In a study published recently in the journal Menopause, researchers at the University of Pittsburgh School of Medicine found that women who experience hot flashes and night sweats early in life were more likely to die from cardiovascular disease. The research suggests menopausal symptoms in younger midlife women may mark adverse changes in dysfunction of the endothelium, or lining of the blood vessels, placing them at risk for heart disease.

    The Women's Ischemia Syndrome Evaluation enrolled women referred for coronary angiography for suspected myocardial ischemia. A total of 254 women — aged more than 50 years, postmenopausal, with both ovaries and not taking hormone therapy — underwent a baseline evaluation and were followed annually. A subset of participants underwent brachial artery ultrasound for flow-mediated dilation (FMD).

    Researchers noted that women who had hot flashes before age 42 were more likely to have lower FMD, suggesting adverse endothelial changes and higher mortality rates.

    This connection is important because heart disease is the leading cause of death for women in the U.S., killing 289,758 women in 2013 — about 1 in every 4 female deaths. Even with no symptoms, women may still be at risk for heart disease. In fact, almost two-thirds (64 percent) of women who die suddenly of coronary heart disease had no previous symptoms.

    Despite increases in awareness over the past decade, only 54 percent of women recognize that heart disease is their number 1 killer.

    Although studies have linked vasomotor symptoms (VMS) to markers of cardiovascular disease risk, few have considered clinical cardiovascular events. Dr. Rebecca C. Thurston, Ph.D., professor of psychiatry at Pittsburgh School of medicine, noted that future research may help predict midlife women at increased risk of cardiovascular disease, which would enable early prevention strategies.

    Original Post: http://exclusive.multibriefs.com/content/an-alarming-link-between-early-menopause-and-cardiovascular-disease/medical-allied-healthcare


  • October 05, 2016 2:56 PM | Deleted user

    By David Templeton / Pittsburgh Post-Gazette

    Amid the growing surge of Zika research, the University of Pittsburgh School of Medicine has announced early success with two experimental vaccines that prevented the pups of immunized female mice from becoming infected with the virus.

    Both vaccines, with one more effective than the other, succeeded in producing an immune response to the virus that was transferred from mother to her pups. That would represent an important goal in a human vaccine, given the severe neurological birth defects including microcephaly (an abnormally small head) and Guillan-Barre syndrome that the viral infection can cause.

    “We’ve not only developed a promising vaccine candidate to move toward larger pre-clinical and, eventually, human clinical trials, but also a delivery format that would be inexpensive to produce and distribute to hundreds of thousands of people,” said Andrea Gambotto, an associate professor of surgery at the medical school who was senior author of the study, published online Monday in the EBioMedicine journal.

    Congress recently allocated $1.1 billion for Zika research, money that Pitt researchers hope to tap to advance their vaccines to human clinical trials, potentially within a year, Dr. Gambotto said.

    The Pitt focus is creating a vaccine given to the mother that protects the fetus and newborn against birth defects. So far, so good.

    “Pups born to mice immunized with [the one Pitt vaccine] were all protected against lethal challenge infection without weight loss or neurological signs,” while 50 percent of the pups born to dams immunized with the second Pitt virus were protected, the study says.

    One vaccine involved a standard injection. The other used crystals affixed to a patch similar to a Band-Aid to keep them in contact with the skin until they dissolved.

    The vaccines generate an immune response against an antigen — a protein — on the outer shell of the virus. The Pitt study describes the immunization as “a promising candidate vaccine” for the prevention of Zika virus disease.

    Bites from mosquitoes of the Aedes species represent the key method of viral transmission, with sexual transmission also possible. Various South American, Central American and Caribbean nations are experiencing epidemic levels of infection, while Florida has reported Zika infections contracted from local mosquitoes. The virus already has spread to 50 nations, with 6,400 cases in the United States and its territories, the National institute of Health reports.

    The National Institute of Allergy and Infectious Diseases currently is working on five Zika vaccines, with the Aug. 2 launch of a human clinical trial.

    Once a vaccine is developed, it typically is tested in mice then monkeys. If successful, the next step is three phases of human clinical trials to determine safety and effectiveness before it goes before the U.S. Food and Drug Administration for approval. Even if the institute’s vaccine proceeds on the current fast track, its effectiveness on humans won’t be clear until early to mid-2018, said institute director Anthony S. Fauci. Consider, however, that vaccines typically take seven to 10 years to be developed and approved.

    Developing a Zika virus poses no serious difficulties in vaccine science, given that similar flavivirus vaccines already have been developed for yellow fever and several types of encephalitis.

    Besides the five NIH vaccines, pharmaceutical companies, universities and others also have reported their development of vaccines.

    “The more shots on goal you have, the better the chance of getting a vaccine,” Dr. Fauci said. “If history holds true, there should be an effective vaccine against Zika.”

    David Templeton: dtempleton@post-gazette.com or 412-263-1578.


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