Hypertension (HTN) is a chronic condition that requires careful monitoring and management. Blood pressure readings in the clinic and self-reported blood pressure readings are often too intermittent to allow for careful management. Remote patient monitoring is a solution that may have positive impacts on HTN management. Individuals at cardiac and primary care clinics were prescribed a remote patient-monitoring (RPM) program. Patients were sent blood pressure monitors that were enabled to transmit data over cellular networks. We reviewed trends in HTN management retrospectively in patients who had previously been on conventional therapy for a year and participated in RPM for a minimum of 90 days. There were 6595 patients enrolled, and the mean duration on RPM was 289 days. A total of 4370 participants (66.3%) had uncontrolled HTN, and 2476 (37.5%) had stage 2 HTN. After at least 90 days on the RPM program, the number of patients with uncontrolled HTN reduced to 2648 (40.2%, p < 0.01), and the number of patients with stage 2 HTN reduced to 1261 (19.1%, p < 0.01). Systolic blood pressure improved by 7.3 mmHg for all patients and 16.7 mmHg for stage 2 HTN. There was improvement in mean arterial pressure (MAP) in all patients with uncontrolled HTN by 8.5 mmHg (p < 0.0001). RPM is associated with improved HTN control and provides further evidence supporting telehealth programs which can aid in chronic disease management.

Concussion legislation has been enacted in all 50 of the United States, aiming to prevent mild traumatic brain injuries and the potential long-term sequelae of these injuries in youth athletics. Sports medicine providers, in addressing this major public health concern, are tasked with adhering to the established standards of medical care while also considering the legal implications. The PubMed (2011-2016) database was searched using the following search terms: concussion, sports concussion, legislation, and concussion legislation. References from consensus statements, review articles, and book chapters were also utilized. Clinical review. Level 4. The Lystedt law and its progeny have increased awareness of the signs and symptoms of sports concussion, but adherence to state legislation can pose some challenges. The presence of concussion legislation places a responsibility on the sports medicine provider to have a firm understanding of the legality of concussion management in the state(s) in which they practice.

Introduction: Smokers increasingly use e-cigarettes to try to quit smoking, even more than recommended cessation methods. However, few smokers discuss the range of cessation options with their physicians. Decision aids can inform smokers about smoking cessation options, including evidence about e-cigarettes, and encourage smokers to engage in shared decision making with their physician. Aims and Methods: This study aimed to evaluate a smoking cessation decision aid that included e-cigarette risks and benefits. Adult smokers were recruited from primary care clinics for two research phases: (1) usability and acceptability testing of the decision aid (n = 37); and (2) pre-post study that compared usual care (n = 90) with implementation of the decision aid in clinics (n = 90). For the latter, outcome measures included frequency of clinical discussions of readiness to quit, methods to quit in general, and of specific cessation methods, in addition to decisional conflict, communication satisfaction, and overall patient satisfaction. Results: Smokers indicated high usability and acceptability of the decision aid. In the pre-post evaluation, decision aid implementation was associated with higher rates of smokers: being asked if they were ready to quit smoking (89% vs. 67%, respectively; p < .001); discussing methods for smoking cessation in general (81% vs. 48%; p < .001); and discussing specific cessation methods (NRT 55% vs. 26%, p < .001; prescription medications 26% vs. 12%, p = .022). Decision aid use was also associated with higher overall patient satisfaction with the physician visit. Conclusions: Smoking cessation decision aids that incorporate information about e-cigarettes are acceptable among smokers and can lead to evidence-based clinical discussions about smoking cessation. Implications: Smokers use e-cigarettes more than recommended cessation methods when they are trying to quit smoking, yet few physicians discuss the risks and benefits of e-cigarettes with their patients who smoke. This study presents preliminary findings about the feasibility and usability of a clinically based iPad-delivered smoking cessation decision aid that integrates information about e-cigarettes. Although promising, further research with randomized designs, larger samples, and longer-term follow-up is needed to determine whether this type of intervention can effectively promote cessation of all tobacco products and, for those not ready to quit smoking, the use of e-cigarettes for harm reduction.

While uncommon, exertional-induced rhabdomyolysis is an important diagnostic consideration when encountering hyperintensity within one or more muscles on fluid sensitive sequences in conjunction with signal abnormality in the overlying superficial fascia and subcutaneous fat. The clinical history of recent extreme exercise helps distinguish this disorder from other possible diagnoses, such as cellulitis, necrotizing fasciitis, compartment syndrome, inflammatory processes and diabetic myonecrosis. Patients diagnosed with severe exertional induced rhabdomyolysis often require hospital admission for intravenous hydration and serial laboratory monitoring due to the potential risk of acute renal failure. While contributory, magnetic resonance imaging findings can be nonspecific, and therefore the clinical history is often essential in making this diagnosis.