Should dogs be allowed in hospitals?

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Over the past couple of decades it has become increasingly common to find dogs lounging around offices during work hours. Now our furry friends are making their way into some hospitals around the U.S.

The American Pet Products Manufacturers Association found that 17 percent of all companies allow pets in the workplace, and 23 percent of workers believe that pets should be allowed in the workplace. A Virginia Commonwealth University study found that dogs in the workplace can lead to reduced stress and increased job satisfaction.

Even though hospitals aren’t your ordinary workplace, dogs are becoming more common on medical campuses across the U.S. for both therapy and security purposes. However, the jury is still out on whether dogs are a clean addition to hospitals or if they present a risk to patients.


Security Dogs

Security magazine recently released an interview with Rick Ortiz, Security Director/Banner Health Security K9 Unit Director. Ortiz uses K9 security every day at Banner Health facilities in Arizona and Colorado, and the healthcare company has been using dogs as a form of security since 1995.

Ortiz says that his K9 force provides “an alternative to arming security officers, thus giving us a non-lethal force.” The dogs patrol the campuses to deter criminal activity and some also are used to assist in looking for suspicious packages.

Ortiz also says other health systems across the U.S. are interested in his program and often contact him for information on how the K9 security force works. He adds that although patients and new visitors initially may be surprised by the presence of dogs, most warm up to the animals and many tend to begin to view the K9 force as therapy dogs.


Therapy Dogs in Hospitals

Official therapy dogs are also becoming a more common sight in many hospitals, and some medical facilities are even allowing long-term patients to bring their own pets to visit them in their hospital rooms.

National Geographic reports that evidence of “positive responses to such animal-assisted therapy has mostly been anecdotal. But a recent study on elderly nursing home patients now offers scientific support that brief weekly visits from man’s best friend can have a positive therapeutic impact.”

The same article talks about a golden retriever named Bo that has visited patients at Cedars-Sinai Medical Center for the past three years as part of the POOCH (Pets Offer Ongoing Care and Healing) program. Bo not only visits patients, but also helps families in waiting rooms temporarily take their minds away from their troubles.


Keeping It Clean

Bo’s owner, Marcia Strum, notes that Bo can only visit every other week, however, as he has to be thoroughly scrubbed before heading to the hospital, and more frequent washings would lead to skin problems.

Which brings up the cleanliness issue.

The New York Times reports on a Canadian study showing that dogs can easily transmit germs between patients. The study explored dogs’ capacity to carry and spread germs in the hospital: “Compared to human visitors, animals typically visit a larger number of patients and staff members and walk bare-pawed on hospital corridors, possibly making them more likely to pick up germs.”

Although this stresses the importance of our own regular hand washing at work, it also raises a question of whether the risk of spreading germs outweighs the benefits dogs offer patients.

We present the issue to you: What are your experiences with dogs guarding hospitals or visiting patients? If your workplace doesn’t allow pets, do you think it would be a good idea? Let us know in the comments below!

Warming Waters May Be Releasing Giant Plumes of Methane Off the U.S. West Coast

Warming Waters May Be Releasing Giant Plumes of Methane Off the U.S. West Coast

Scientists have detected a disproportionate number of methane bubble plumes off the Washington and Oregon coast. The warming Pacific ocean may be triggering the release of this powerful greenhouse gas, which has remained frozen beneath the seafloor for thousands of years.

The new study, which has been accepted for publication in Geochemistry, Geophysics, Geosystems, details over 160 bubble plumes observed over the past 10 years. An inordinate number of these plumes were observed at a critical depth where frozen methane “ice”, or hydrate, decomposes on account of warmer ocean temperatures. Lead researcher H. Paul Johnson from the University of Washington says these plumes are probably not coming from the seafloor sediments, but rather from decomposing frozen methane.

The downstream effects of this leaking methane aren’t entirely clear, though historically, methane has contributed to sudden and dramatic swings in the Earth’s climate. Once in the Earth’s atmosphere, methane acts as a powerful greenhouse gas. On a related note, warming-related methane emissions have also been detected in Arctic permafrost and off the Atlantic coast.

Warming Waters May Be Releasing Giant Plumes of Methane Off the U.S. West Coast

This map shows the locations of the 168 bubble plumes included in the study. (Credit: University of Washington)

It’s also not clear how much methane gas is actually getting to the surface. The researchers say that most of the deep-sea methane is getting gobbled up by marine microbes during the journey up. These microbes convert the methane into carbon dioxide, which results in low-oxygen and acidic conditions in deeper offshore waters. From there, this tainted water trickles along the coast and makes its way into coastal waterways.

“Current environmental changes in Washington and Oregon are already impacting local biology and fisheries, and these changes would be amplified by the further release of methane,” noted Johnson in an AGU statement.

The melting methane could also destabilize the seafloor slopes.

Results of the new study show that methane gas is leaking from all depths along the Washington and Oregon coast, but the plumes are more abundant at the critical depth of 500 meters (0.3 miles), where the decomposition of frozen methane occurs.

It’s important to point out that the researchers have yet to confirm that the plumes are actually comprised of melting methane deposits. But as study co-author Evan Solomon points out: “The results are consistent with the hypothesis that modern bottom-water warming is causing the limit of methane hydrate stability to move downslope, but it’s not proof that the hydrate is dissociating.”

The team is now performing a chemical analysis of samples emitted by sediments along the coast.

Sadly, this is yet another example of the wide-reaching effects of climate change—assuming, of course, that the researchers are correct in their assumptions. Indeed, one of the more alarming aspects of human-instigated climate change is the way it’s triggering the release of green house gases not related to human activity. These plumes, like other newly arising phenomenon (the Pacific’s warm “blob” certainly comes to mind), are a sign that thing’s aren’t right.

The 15 Most Alkalizing Superfoods + 5 Delicious Ways To Eat Them.

The hype around alkaline food and drink (like those $5 waters you see at health food stores) is based around the idea that an alkaline diet can help your body maintain its pH, which leads to overall better health and wellness.

Foods that are high on the alkaline scale have been shown to help with everything from regulating weight, to promoting longevity, helping with digestion and even preventing disease through their immune-boosting and anti-inflammatory properties.

On the opposite end, when our bodies become too acidic, we’re more likely to carry extra weight, have skin problems and be at risk for a number of various inflammatory-induced illnesses.

At the very least, alkaline foods — like fresh fruits and vegetables — are real, whole and definitely good for you.

Here are our top 15 alkaline foods:

And here’s how we’re eating them:

Serves 4

For the Coconut Quinoa

  • 1/2 head of cauliflower
  • 1 cup cooked quinoa
  • 1 tablespoon coconut oil
  • ½ cup pomegranate seeds
  • ½ cup roughly crushed walnuts
  • handful of cilantro, chopped
  • handful of arugula
  • olive oil
  • salt + pepper

For the Yogurt Tahini Dressing

  • 1 tablespoon tahini
  • 3 heaping tablespoons plain Greek yogurt
  • pinch of cumin
  • 1 small garlic clove, finely minced
  • juice of 1/2 lemon
  • ¼ cup extra virgin olive oil
  • salt + pepper


1. Pre-heat the oven to 400ºF.

2. Line a baking sheet with parchment. Tear the cauliflower into bite-sized pieces and place on the baking sheet. Season with salt and pepper and drizzle with a heaping tablespoon of olive oil. Toss to coat. Place in the oven for about 10 minutes. Remove and shake the pan to move the cauliflower around for even cooking. Place back in the oven for another 5-10 minutes until the cauliflower is slightly browned on all sides. Remove and set aside.

3. Place a large frying pan over medium high heat. Add the coconut oil and let it melt. Add the quinoa and cook for about 3-4 minutes until fragrant and toasted.

4. Make the dressing: Place all ingredients aside from olive oil and salt and pepper in a small bowl and mix together. Slowly drizzle in olive oil until incorporated. Season with salt and pepper.

5. Place the cauliflower, quinoa, walnuts and pomegranate seeds in a large mixing bowl. Pour dressing over top and mix to coat. Plate and top with arugula to your liking.

Serves 2

For the salad

  • 1 cup lacinato kale, de-stemmed and sliced thin
  • 2 scallions, sliced
  • 1 small cucumber, diced
  • 1 avocado, diced
  • handful of cilantro + parlsey, chopped
  • handful of roasted sunflower seeds

For the Broccoli Pesto

  • 1 cup raw broccoli, broken into small florets
  • handful of fresh basil
  • juice of 1/2 a lemon
  • 1/3 cup freshly grated parmesan cheese
  • 1 clove garlic
  • 1/2 cup olive oil
  • ¼ cup water
  • salt + pepper

For the Roasted Beet Hummus

  • ½ cup cooked chickpeas, rinsed and drained
  • ½ cup cooked cannellini beans, rinsed and drained
  • 1 clove garlic, chopped
  • 1/3 cup chopped roasted beets
  • 3 tablespoons lemon juice
  • 3 tablespoons extra-virgin olive oil
  • salt + pepper

To serve

  • 2 whole wheat wraps


1. Make the pesto: Put 2 cups of water into saucepan and place over medium-high heat. Bring to a boil, then add the broccoli. Turn heat down to medium to get a simmer and cook for the broccoli until fork tender, about 3-4 minutes. Drain. Place all the other pesto ingredients aside from the olive oil and salt and pepper in a food processor. Add the broccoli. Start bending on a low speed while slowly adding in the olive oil. Blend until smooth. Season with salt and pepper.

2. Make the hummus: Place all ingredients aside from olive oil and salt and pepper in a food processor. Start bending on a low speed while slowly adding in the olive oil. Blend until smooth. Season with salt and pepper.

3. Place all salad ingredients in a large mixing bowl. Pour broccoli pesto over top and toss to combine. If serving as a salad, plate the salad with the Roasted Beet Hummus and wrap on the side. If serving as a wrap, spread about a tablespoon of hummus over the wrap and place about a half a cup of the salad in the middle. Wrap it up and serve.

Serves 2


  • 2 sweet potatoes
  • ½ cup black beans, rinsed and drained
  • ½ red onion, sliced
  • 2 cups spinach
  • 2 avocados, peeled, cored and diced
  • 1 shallot, minced
  • 1 lime
  • handful of cilantro, minced
  • pinch of dried red chili flakes
  • 2 tablespoons of coconut oil
  • olive oil
  • salt + pepper


1. Make the sweet potatoes: Heat oven to 400°F. Using a fork, pierce each sweet potato all around. Place the sweet potatoes on a parchment or foil lined baking sheet. Bake for about 50 minutes, until tender. Let cool.

2. Meanwhile, place a tablespoon of coconut oil and a tablespoon of olive oil in a large frying pan over medium high heat. Add the onion and cook for a minute until fragrant. Turn down the heat to a medium low and cook for about 15 minutes until soft and caramelized. Add the black beans and spinach and season with salt and pepper to taste. Cook for about a minute until the spinach is slightly wilted and the beans are warm.

3. To make the guacamole: Place the shallot, chili flakes, cilantro and avocado in a mixing bowl. Drizzle with about 1 tablespoon of olive oil and the juice of half a lime. (Save the other half to serve). Mash with a fork until smooth. Season with salt and pepper to taste.

4. Bring it all together: Place a slit through the top of the sweet potatoes and push them down so a bit of the meat is exposed. Season flesh with salt and pepper and half a tablespoon of coconut oil on each. Top with the black bean spinach mixture and the guacamole.

Serves 4

For the soba salad

  • ¼ head green cabbage
  • ¼ head red cabbage
  • about 8 Brussels sprouts, bruised, outer layers removed
  • 1 large carrot, sliced into matchsticks
  • 8 oz buckwheat soba noodles
  • 1 scallion, sliced
  • handful sesame seeds, toasted

For the dressing

  • 1 1-inch piece of ginger, peeled and very finely minced
  • 1 tablespoon sesame oil
  • 2 teaspoons olive oil
  • 4 tablespoons tamari
  • 1 tablespoon rice vinegar
  • juice of half a lime
  • 1 teaspoon of honey
  • pinch of red pepper flakes


1. Using a mandolin (if you have one) slice the cabbages and Brussels sprouts thin (or do it manually). Place in a large mixing bowl, add carrots and set aside.

2. To make the dressing: Add all the ingredients aside from the oils and mix to combine. Slowly drizzle in the oils until incorporated.

3. To make the soba: Bring a large pot of water to a boil. Add a few pinches of salt and place soba in the water. Cook for 4-6 minutes (or according to package instructions) until tender. Drain and rinse under cold water.

4. Bring it all together: Place the noodles in the bowl with the veggies, pour the dressing over and mix to combine. Season with sea salt if needed and top with scallions and sesame seeds.

Makes 4

For the Pilaf

  • 4-5 asparagus stalks, chopped into 1-inch pieced
  • 1 cup cooked lentils
  • ½ cup wild rice
  • 1 cup vegetable broth (chicken works fine here too)
  • 2 shallots, chopped
  • 2 stalks celery, finely chopped
  • 2 cloves garlic, minced
  • salt + pepper

For the Black Sesame Dressing

  • ½ cup sesame oil
  • 2 teaspoons toasted sesame oil
  • 1 teaspoon fresh wasabi (if you have it)
  • ½ cup tamari
  • ¼ cup rice vinegar
  • 2 tablespoons toasted black sesame seeds


1. If you have the time, soak rice in cold water for a few hours before cooking. Otherwise, just give it a good rinse.

2. Coat a large pot with olive oil and place over medium high heat. Add shallots and celery. Season with salt and pepper and cook until translucent, about one minute. Add garlic and cook for another minute, until soft.

3. Add rice and let cook for about a minute, stirring to coat the rice. Add broth and bring to boil. Reduce heat to medium and let simmer, stirring occasionally, until most of the broth is absorbed. Remove from heat. Cover for about three minutes.

4. To char the asparagus: Place asparagus pieces on a foil-line baking sheet. Season with salt, pepper and a drizzle of olive oil. Place under the broiler, checking on them and shaking the pan every minute or so. Remove when browning on all sides, about 4 minutes. Set aside.

5. To make the dressing: Place all ingredients besides oil in a small mixing bowl and whisk to combine. Slowly drizzle in oils to combine.

6. Uncover rice and fluff with fork. Add lentils, mix and season with salt and pepper to taste. Plate the rice and lentil pilaf and top with asparagus and as much dressing as you like.

Over 70,000 pregnancies are affected by mums-to-be smoking every year in Britain.

It is estimated that smoking during pregnancy is causing over 2,000 premature births, 5,000 miscarriages and 3

Pregnant Woman Smoking
Hazardous: The dangers of smoking are well known, but 11% of pregnant women refuse to quit

Tens of thousands of pregnant women are still putting their babies at risk by smoking, new figures show.

Every year more than 70,000 pregnancies are affected by mums-to-be smoking, research reveals.

Tragically, it is estimated that smoking during pregnancy is causing around 2,200 premature births, 5,000 miscarriages and 300 stillbirths every year in the UK.

And a coalition of health groups and charities will today demand the Government takes urgent action to halve rates of smoking in pregnancy.

The Smoking in Pregnancy Challenge Group is also calling for the gap to be narrowed in smoking rates between the rich and the poor.

Pregnancy and smoking

Pregnancies affectedPremature birthsMiscarriagesStillbirths010,00020,00030,00040,00050,00060,00070,00080,000

The smoking in pregnancy rate has now fallen below 11% across England but “shocking” variations remain.

The most recent figures suggest that 2.1% of women in Westminster were still smoking by the time their baby was born compared with 27.2% in Blackpool.

Some regions do not ask whether women smoke in pregnancy or collect full data.

The smoking in Pregnancy Challenge Group is made up of 20 organisations including Action on Smoking and Health, Bliss, the Faculty of Public Health, the Royal College of Midwives and the Royal College of Nursing.

The Lullaby Trust, Tommy’s and the Royal College of Obstetricians and Gynaecologists (Rcog) are also involved.

The group wants the Government to set a new national ambition to reduce smoking in pregnancy to less than 6% by 2020.

It also calling for a more robust data collection system, mandatory training for health professionals and automatic referral for pregnant smokers to specialist services unless they opt out.

Dr David Richmond, president of the Rcog, said: “We support the national ambition to halve smoking in pregnancy rates by 2020.

“As obstetricians we see first-hand the devastating effects of miscarriage, premature births and stillbirths caused by smoking in pregnancy. Stopping smoking is the most important thing a pregnant woman can do to improve her baby’s health, growth and development and reduce unnecessary pregnancy complications.

“The huge variation in smoking in pregnancy rates across the UK is shocking. The reasons why pregnant woman continue to smoke is complex and those living in the poorest parts of the country need the greatest support to help them access stop smoking services and be supported in their efforts to quit smoking for good.”

Francine Bates, chief executive of the Lullaby Trust, said: “Recent progress is great news but there is still much work to be done. Smoking in pregnancy remains the largest modifiable risk factor in sudden infant deaths, which devastates families.

“It is the most vulnerable who will be hit hardest if we do not do more to dramatically reduce the rates of smoking in pregnancy.”

Deborah Arnott, chief executive of Action on Smoking and Health, said: “We know that local services to help support pregnant women quit smoking are under threat and the in-year cuts to the public health budget will only make this worse.”

Reasons To Drink Lemon Water Every Morning

Ayurveda enables you to give a jump-start for the day by focusing on morning rituals that work to align the body with nature’s rhythms, balance the doshas & foster self-esteem alongside self-discipline. Drinking lemon water first thing in the morning will have tremendous impact on your overall health.
Lemon juice provides a high amount of Vitamin C. One lemon gives 30.7 mg Vitamin C, according to theU.S. Department of Agriculture. The recommended daily amount is 75 mg for women and 90 mg for men. People who consume more Vitamin C have more efficient digestive systems than people who don’t.

Benefits of Drinking Lemon Water in the Morning:

Improves Digestion: Lemon juice helps loosen and flush out toxins from the digestive tract. Lemon juice can help ease indigestion, heartburn, and bloating. It also helps to move your bowels in the morning, hydrates your colon, and stimulates bile production.

Boosts Immune System: Lemon juice is rich in Vitamin C, which helps strengthen the immune systemand fights cold and flu.

Boosts Energy: Lemon water gives you an instant boost of energy and improves your mood right at the start of your day.

Weight Loss Aid: Although lemon water on its own is no weight loss miracle, it can definitely help you to achieve faster and long term results. Lemons assist in fighting hunger cravings, boost metabolism, and give you a stuffed feeling, making it less likely to snack in between meals.

Antibacterial and Antiviral: Lemons have antibacterial and antiviral properties. They help fight the flu, cold, and soothe a sore throat.

Boosts Brain Power: The high levels of potassium and magnesium show beneficial effects on our brain and nerve health. Lemon water can give you the boost you need to fight depression and stress.

Anti-cancer: Lemon’s antioxidants also reduce the risk of several types of cancer.

Clinical Studies of Safety and Effectiveness of Orphan Products Research Project Grant (R01)

The Food and Drug Administration (FDA) is announcing the availability of grant funds for the support of FDA’s Office of Orphan Products Development grant program. The goal of FDA’s Orphan Products Development (OPD) grant program is to support the clinical development of products for use in rare diseases or conditions where no current therapy exists or where the proposed product will be superior to the existing therapy. FDA provides grants for clinical studies on safety and/or effectiveness that will either result in, or substantially contribute to, market approval of these products. Applicants must include in the application’s Background and Significance section documentation to support the assertion that the product to be studied meets the statutory criteria to qualify for the grant and an explanation of how the proposed study will either help support product approval or provide essential data needed for product development.

Cucumber Juice To Melt Belly Fat Rapidly

Melt away even the most persistent of belly fat with this amazing drink. This easy to make juice is guaranteed to produce results in a short span if consumed regularly.
Metabolic activitiy slows down while you are sleeping and this is where the wonder elixir works magic- consume before going to bed and watch body fat; especially belly fat burn away! The cucumber and lemon in this drink are both low calorie and antioxidant rich, making it highly effective in weight loss. The ginger and aloe vera stimulates metabolism.

1 cucumber
1 lemon
1 bunch of parsley or cilantro
1 tbsp. grated ginger
1 tbsp. aloe vera juice
½ glass water

Instructions: Juice these ingredients well and drink before bedtime.

Press These Points For Wherever You Have Pain – Every Body Part Is In The Palm Of Your Hand.

Western medicine has not yet satisfactorily addressed chronic pain or discomfort in varying parts of our body. Alternative medicine can often be light-years ahead when it comes to relieving pain. Although a combination of both western and alternative medicine, is probably the most sensible route overall, it is worth looking at the benefits of an alternative form of pain resolution, such as reflexology.The principles of reflexology have led to the idea of finding the pressure points within the palm of your hand that are connected to the part of the body causing you pain. By pressing the thumb point into the corresponding part of the hand for 5 seconds, releasing for 3 seconds, pressing again and repeating this cycle for several minutes, several times a day you will get results. This methodology as well as others are demonstrated in this video. In the video you are about to watch, Dr. Oz’s guest is a reflexologist who explains that both the hands and feet can be seen as a microcosm of our entire body. Five audience members come to the stage to explain what part of their body is causing them chronic discomfort or pain. For each malady, the reflexologist explains which part of the palm is connected to the body part involved. She then demonstrates how using one hand, different forms of pressing or massaging of a particular part of the palm of the other hand will, over time, alleviate the pain experienced. The audience members in this video suffered from: (1) Constipation and bloating (2) Insomnia and exhaustion (3) Sinus congestion (4) Upper back pain (5) Low libido. The reflexologist showed them how to work on their own palms to alleviate their pain or problem. She explained what sensations they would experience as they applied pressure and massage, that would signal that they were working in the correct area. Her explanations were fascinating and easy to follow.

After watching this I will try a few of the methods demonstrated for things that I need relief from. Let us know what you think about reflexology after watching the video. Have you ever tried it and had success? Will you give it a try?
Watch the video.URL:

Psychedelic Mushroom Compound Found to Grow and Repair Brain Cells .

You may know them as “shrooms”, “Magic mushrooms”, psilocybic mushrooms, or you may not know them at all. They are a natural plant that, like marijuana, is banned by the U.S. Government. But like marijuana, these mushrooms may not be without medical properties. Like marijuana, they could deserve a place on natural medicine shelves for their ability to treat depression, eradicate mental illness, and improve cognition – not in police evidence rooms.

According to research from the University of South Florida, psilocybin, the active component within psychedelic mushrooms, is able to grow new brain cells—potentially offering treatment for mental illness and improving cognition.

The study, published in Experimental Brain Research, says psilocybin is able to bind to special receptors in the brain that stimulate healing and growth. In the case of these mushrooms, brain cell growth occurs. In mice, the researchers found psilocybin to actually help repair damaged brain cells and cure or relieve PTSD and depression.

Lead researcher, Dr. Juan R. Sanchez-Ramos, tested the effects of psilocybin by training mice to fear an electric shock when they heard a noise associated with the shock. Then, by giving them psilocybin, the mice were able to stop reacting to the noise-trigger much faster than those mice not treated with the mushroom compound.

“The proposition that psilocybin impacts cognition and stimulates hippocampal neurogenesis is based on extensive evidence that serotonin (5-hydroxytryptamine or 5-HT) acting on specific 5-HT receptor sub-types (most likely the 5-HT2A receptor) is involved in the regulation of neurogenesis in hippocampus,” says Dr. Sanchez-Ramos according toNaturalNews. “The in vitro and in vivo animal data is compelling enough to explore whether psilocybin will enhance neurogenesis and result in measurable improvements in learning.”

Other research also shows that this same compound could greatly help with depression, helping the majority of participants in one study achieve great well-being.

Psilocybin is referred to as a “nootropic” agent, or one that has numerous functions in the brain that can improve hippocampus health. The hippocampus is part of the brain responsible for learning as well as converting short-term memory to long-term memory. New brain cells in the hippocampus from the psilocybin translates into a healthier and sharper brain overall.

The research on psychedelic mushrooms is limited—far more limited than the research on marijuana. Because these mushrooms are known for causing hallucinations, unguarded self-treatment isn’t recommended. However, this plant, like marijuana, does not deserve a place in the Schedule I classification of illegal substances. Like marijuana, the U.S. government has determined ‘shrooms as having no medicinal value’—an obviously-flawed determination.

Cryptogenic Stroke: Getting at the ‘Unknown Unknowns’

The U.S. Preventive Services Task Force (USPSTF) finalized its grade A recommendations for blood pressure screening of adults with few changes, citing “substantial” net benefit in preventing stroke, heart failure, and other risks.

The one change in the final version, released online in the Annals of Internal Medicine, was a slight softening of the recommendation to use ambulatory blood pressure monitoring (ABPM) to confirm diagnosis of hypertension measured in-office.

“The USPSTF acknowledges the current barriers to implementation of its recommendation, including the availability and affordability of ABPM,” the task force wrote. “In response, it revised the final recommendation to include home blood pressure monitoring as an alternative method for confirmation of a diagnosis of hypertension when ABPM is not feasible.”

The USPSTF also offered details on how that diagnostic confirmation should be implemented and the industry standards for home blood pressure monitors.

The following is the MedPage Today story outlining the recommendations from when the draft was released on Dec. 22, 2014:

In a draft recommendation statement, the U.S. Preventive Services Task Force is calling for ambulatory blood pressure measurement to confirm hypertension before diagnosis in a draft statement that also advocated more frequent hypertension screening for many adults.

One exception to the grade A recommendation for out-of-office confirmation of hypertension: cases for which therapy should begin immediately.

People 40 and older as well as higher-risk groups should be re-screened every year after a normal blood pressure finding, while others can be screened every 3 to 5 years, the draft statement recommended.

Guidelines have generally advocated every 2 or 5 years for screening intervals, so the shift to annual screening for so many patients will be a major shift, John P. Higgins MD, MBA, MPhil, chief of cardiology at Lyndon B. Johnson General Hospital in Houston, toldMedPage Today.

Change for Practice

American College of Cardiology president-elect Kim A. Williams Sr., MD, chief of cardiology at Rush University Medical Center in Chicago, praised the change to ambulatory confirmation of hypertension.

“This will help solve problems of overestimation of blood pressure in the clinic with the ‘office hypertension’ phenomenon and, in my experience, fully engages patients in the control of the blood pressure,” he told MedPage Today. “When you measure it, you don’t ignore it.”

But just how ambulatory monitoring can be operationalized on a large scale remains to be seen, he noted.

Most physician offices don’t actually have the equipment for ambulatory monitoring,John Bisognano, MD, PhD, director of outpatient cardiology services at the University of Rochester Medical Center in Rochester, N.Y., and president-elect of the American Society of Hypertension, told MedPage Today.

“The guidelines, if put into play, will really have a big change on this because there will be an expectation that every physician’s office, every hypertension specialist’s office, will have one of these devices or many of these devices to confirm the diagnosis of hypertension,” he said.

American Heart Association president Elliott Antman, MD, of Brigham and Women’s Hospital and Harvard University, agreed that the change could present a challenge, although perhaps less so than in the past.

“It makes great sense to perform ambulatory blood pressure monitoring,” he toldMedPage Today. “This has been known for quite a while. The problem was that it has been difficult to implement because of the lack of equipment to do this.”

“Now it’s easier to do,” he said, pointing to the increasing availability of smartphone and table-connected digital wrist or arm-cuff blood pressure devices that patients can use at home and simply email the results to their physician.

Ambulatory monitoring hasn’t been prominent in joint guidelines from the organizations, Antman noted. But he predicted that could change, too.

“It’s quite likely we will see revision to the definition of what constitutes hypertension and of whether treatment has been effective in controlling hypertension,” he suggested in an interview, adding “the hypertension guideline is in the process of being updated. So I know that there will be interest in evaluating ambulatory blood pressure monitoring as part of those recommendations.”

Ambulatory confirmation of hypertension before initiating treatment is already the standard in British practice, Jackson T. Wright Jr., MD, PhD, director of the Clinical Hypertension Program at University Hospitals Case Medical Center in Cleveland, noted in an editorial in the Annals of Internal Medicine.

“Availability of this diagnostic method in the U.S. is currently hindered by the reluctance of insurers to reimburse for it,” he noted. “This review for the U.S. Preventive Services Task Force will hopefully lead to greater availability of ambulatory blood pressure monitoring.”

The Rationale

A supporting evidence review published simultaneously online in the Annals showed that ambulatory blood pressure monitoring was better at predicting long-term cardiovascular outcomes.

Each 10-mmHg higher 24-hour ambulatory systolic blood pressure was associated with 28% to 40% higher risk of fatal or nonfatal events independent of in-office blood pressure measurements across 11 studies meta-analyzed.

The review found that 5% to as many as 65% of patients found to be hypertensive in the office across 27 studies fell in the normal range on confirmatory testing outside the office.

Those with so-called white-coat hypertension had cardiovascular outcomes similar to those normotensive on initial in-office screening, Margaret A. Piper, PhD, MPH, of the Kaiser Permanente Center for Health Research in Portland, and colleagues found.

While the review identified little risk of harm from ambulatory blood pressure monitoring — sleep disturbance, discomfort, and restrictions in daily activities during use of the device — there is potential harm of unnecessary treatment if it’s not used, they noted.

The review wasn’t able to determine a single best interval for repeat screening. The studies showed variably high incidence of hypertension using different intervals of up to 6 years, with higher yield at shorter intervals for those on the high end of the normal blood pressure range and those in certain higher-risk groups.

The USPSTF ended up recommending annual rescreening for the following groups:

  • People ages 40 and older
  • People with blood pressure in the 130/85 to 139/89 mmHg range on the initial screen
  • African Americans
  • Obese or overweight individuals

The screening interval for younger adults without such risk factors after an initial screening with normal blood pressure should be every 3 to 5 years, the draft recommendations said.