Journal Watch August 2018

CHRONIC PAIN

CPM for knee or shoulder joints: Advantage only in two therapeutic indications: Patients who have had knee or shoulder surgery or who require conservative treatment can benefit from training with motor-driven continuous passive motion (CPM) devices. However, this only applies to two therapeutic indications, and in each case only to one treatment outcome. Patients with stiff shoulder have less pain with CPM treatment than with physiotherapy alone. The range of motion after total knee replacement is improved if CPM is used in addition to physiotherapy. This is the result of the final report published by the Institute for Quality and Efficiency in Health Care (IQWiG).

Most common shoulder operation is no more beneficial than placebo surgery: The Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) compared surgical treatment of shoulder impingement syndrome to placebo surgery. Two years after the procedure the study participants, both those in the group who underwent surgery and the ones in the placebo group, had equally little shoulder pain and were equally satisfied with the overall situation of their shoulder. "These results show that this type of surgery is not an effective form of treatment for this most common shoulder complaint. BMJ 

Child Abuse Linked to Fibromyalgia: A new study has shown that women Veterans being treated for fibromyalgia exhibit high rates of childhood abuse. Journal of General Internal Medicine

Acupuncture May Cut Arthralgia From Aromatase Inhibitors: Acupuncture may cut joint pain among postmenopausal women with early-stage breast cancer and aromatase inhibitor-related pain, according to a study published in the July 10 issue of the Journal of the American Medical Association.

COMPLEMENTARY & ALTERNATIVE MEDICINE

HerbList App Launched to Provide Information on Herbal Products: The National Institutes of Health's National Center for Complementary and Integrative Health (NCCIH) has announced the launch of an app for easy access to research-based information on the safety and effectiveness of herbal products. HerbList allows users to access information about the science of more than 50 popular herbs and herbal supplements, including kava, acai, ginkgo, turmeric, and others marketed for health purposes. Information on potential safety problems, side effects, and herbal-drug interactions can be also be accessed via additional links for more information. Favorite herbs can be marked for quick recall and offline accessibility.

Yoga meditation May Prevent Alzheimer’s Disease in Women: Kirtan Kriya, a form of yoga meditation, improved cognitive function and may protect women against the development of Alzheimer’s disease, according to a presentation at the Alzheimer’s Association International Conference.

Marijuana May Improve Quality of Life in Head and Neck Cancer: For patients with newly diagnosed head and neck cancer (HNC), quality of life may improve with marijuana use, according to a study published online Aug. 2 in JAMA Otolaryngology-Head & Neck Surgery.

FDA ACTION

• Approved TPOXX (tecovirimat), the first drug with an indication for treatment of smallpox.

• Requires strengthening the current warnings in the prescribing information that fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain  mental health side effects.

• Approved first targeted treatment, Tibsovo tablets, for relapsed or refractory acute myeloid leukemia (AML) with IDH1 mutation in adult patients.

• Approved the Magrace and Sentimag Magnetic Localization System for guiding sentinel lymph node biopsies in certain patients with breast cancer.

• Warns of the Dangers of 'Vaginal Rejuvenation'

• Approved segesterone acetate and ethinyl estradios, a new vaginal ring for 1 year of birth control

• Approved the first identical alternative to the EpiPen

• Permits Marketing of Brain stimulation device-transcranial magnetic stimulation- to treat obsessive compulsive disorder

PREVENTION

Mere expectation of checking work email after hours harms health of workers and families: The study demonstrates that employees do not need to spend actual time on work in their off-hours to experience harmful effects. The mere expectations of availability increase strain for employees and their significant others -- even when employees do not engage in actual work during nonwork time. Academy of Management Proceedings

Older adults who get physical can lower their heart disease risk Adults in their early 60s, who spend less time sitting and more time engaged in physical activity have healthier levels of heart and vessel disease indicators. The results from increased physical activity were found to be particularly good among women. JAHA 

Cardiac Profiles Up With Exercise, Less Sitting in Early Old Age: For adults aged 60 to 64 years, greater light physical activity (PA) and moderate-to-vigorous intensity PA and less sedentary time are associated with more favorable cardiovascular profiles, according to a study published online Aug. 8 in the Journal of the American Heart Association.

Exercise Cuts Risk of Chronic Disease in Older Adults: People who engaged in the highest levels of total physical activity were twice as lively to avoid stroke, heart disease, angina, cancer and diabetes, and be in optimal physical and mental shape 10 years later, experts found. Scientific Reports

Exercise shown to improve symptoms of patients with chronic kidney disease: Just 12 weeks of aerobic and strength-based exercise reduces symptoms and levels of fatigue in patients with chronic kidney disease. Clinical Kidney Journal

 Walking Tied to Better Quality of Life in Those With/at Risk for CVD: Walking is associated with improved quality of life (QoL) among those at risk for or living with cardiovascular disease (CVD), according to a study published in PLOS ONE. 

Perspectives on USPSTF A-Fib Screening Recommendation: The U.S. Preventive Service Task Force published a final recommendation on Aug. 7 citing insufficient evidence to assess the benefits and harms of screening for atrial fibrillation (AF) with electrocardiography (ECG) in asymptomatic, older adults. A series of editorials published in the JAMA network journals offer additional perspectives, with recognition of the need to develop a national screening strategy.

'Good' Cholesterol May Not Be So in Postmenopausal Women: Elevated high-density lipoprotein cholesterol (HDL-C) may not always be cardioprotective in postmenopausal women, according to a study published online July 19 in Arteriosclerosis, Thrombosis, and Vascular Biology.

Some Bacteria Now More Tolerant of Alcohol-Based Sanitizers: Some types of bacteria are developing tolerance of alcohol-based hand sanitizers used in hospitals, according to a study published in the Aug. 1 issue of Science Translational Medicine. The introduction of these sanitizers into hospitals led to reductions in staph infections in patients and certain kinds of drug-resistant bacteria, but there was a rise in enterococcal infections, NPR reported. Worldwide, enterococci account for 10 percent of bacterial infections acquired in the hospital. In North America and Europe, they are a leading cause of sepsis.

Greater Weight Loss Benefits Metabolic Health People who lose more than a fifth of their body weight more than double their likelihood of good metabolic health, compared with those who only lose a relatively small amount, according to a study published in Mayo Clinic Proceedings.

 NUTRITION/SUPPLEMENTS/VITAMINS

Study finds average salt consumption safe for heart health: New research shows that for the vast majority of individuals, sodium consumption does not increase health risks except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt. Fewer than five per cent of individuals in developed countries exceed that level. The large, international study also shows that even for those individuals there is good news. Any health risk of sodium intake is virtually eliminated if people improve their diet quality by adding fruits, vegetables, dairy foods, potatoes, and other potassium rich foods. The Lancet 

A Diverse Diet May Not Be the Healthiest One: Encouraging people to eat a wide variety of foods to ensure they meet all their dietary needs may backfire, according to a new scientific statement from the American Heart Association that provides an overview of recent scientific studies. There is some evidence that a wider variety of food options in a meal may delay people's feeling of satiation (fullness), increasing the amount of food they eat. Limited evidence suggests that greater dietary diversity is associated with eating more calories, poor eating patterns and weight gain in adults. Instead of telling people to eat a variety of foods, the statement authors conclude that dietary recommendations should emphasize adequate consumption of plant foods, such as fruit, vegetables, beans and whole grains, low-fat dairy products, non-tropical vegetable oils, nuts, poultry and fish, and limit consumption of red meat, sweets and sugary drinks. Circulation

Review Addresses Nutritional Hype for Popular Foods: While many dietary patterns, foods, and nutrients receive substantial media attention and are hyped as having cardiovascular benefits, some have evidence for these benefits and others do not, according to a review published in the July 31 issue of the Journal of the American College of Cardiology. The researchers found evidence of harm and recommend limiting or avoiding added sugars and energy drinks. They found a lack of evidence of harm or benefit for dairy products and fermented food and seaweed. They found evidence of benefit for legumes, moderate habitual coffee consumption, tea, mushrooms, alcohol in recommended amounts, plant or marine omega-3 fatty acids, and vitamin B12 supplements for those who are deficient.

Nut Intake Reduces HbA1c Among Adults With T2DM:Nut intake reduces hemoglobin A1c (HbA1c) among individuals with type 2 diabetes, according to a study published in the August issue of Diabetologia. "Nut intake as a replacement for carbohydrate consumption improves glycemic control and lipid risk factors in individuals with type 2 diabetes.”

Moderate carbohydrate intake may be best for health, study suggests: The observational study of more than 15,400 people from the Atherosclerosis Risk in Communities Study (ARIC) in the USA found that diets both low (< 40% energy) and high (>70% energy) in carbohydrates were linked with an increase in mortality, while moderate consumers of carbohydrates (50-55% of energy) had the lowest risk of mortality. The Lancet

Both Abstinence and High Alcohol Use Linked to Dementia: Abstinence in midlife and consumption of more than 14 units of alcohol per week are associated with increased risk of dementia, according to a study published online Aug. 1 in The BMJ.

TREATMENT

Cognitive and Motor Training Combined May Slow or Reverse the Progress of Dementia: Research published in Dementia and Geriatric Disorders found that just 30 minutes of visually-guided movements per week can slow and even reverse the progress of dementia. Those in the early stages of dementia who were exposed to 30 minutes a week to a game which used rules to make visually-guided movements, were able to slow down the progress of dementia and for some, even reverse their cognitive function to healthy status. “These results suggest that even in the earliest stages of neurodegeneration, the aging brain has enough neuroplasticity left that if you can train it on this kind of thinking and moving task, it will improve their cognitive skills.”

Rivaroxaban Effective for Atrial Fibrillation, VTE in Morbidly Obese: Morbid obesity does not appear to compromise the efficacy or safety of anticoagulation treatment with the direct oral anticoagulants (DOAC) rivaroxaban, according to a retrospective analysis of more than 600 obese patients presented here at the International Society on Thrombosis and Haemostasis (ISTH) 64th Annual Scientific and Standardization Committee (SSC) Meeting.

Depression, Antidepressants Are Associated With an Increased Risk of VTE: In the first review of its kind, new research has found that depression and the use of antidepressants are each associated with an increased risk of venous thromboembolism (VTE). The study, published in the Annals of Medicine, also showed that each of the various classes of antidepressant medications are associated with an increased risk of VTE. 

Tamsulosin Does Not Appear to Promote Urinary Stone Passage: Tamsulosin does not significantly increase the urinary stone passage rate compared with placebo, according to a study published online June 18 in JAMA Internal Medicine. Findings do not support tamsulosin treatment for symptomatic urinary stones <9 mm="" span="">

Flu Vaccine Cuts Mortality in Rheumatoid Arthritis Patients: Patients with rheumatoid arthritis (RA), particularly elderly patients, who receive the influenza vaccine have significantly lower morbidity and mortality, according to a study published in the June issue of the International Journal of Rheumatic Diseases.

Benzodiazepines Associated With Increased Risk of Alzheimer’s Disease: The use of benzodiazepines and related drugs is associated with a modestly increased risk of Alzheimer’s disease, according to a study published in Acta Psychiatrica Scandinavica. The risk increase was similar with both benzodiazepines and related drugs regardless of their half-life. 

Triple Combo Blood Pressure Pill Can Improve BP Control: Treatment with a pill combining low doses of three antihypertensive drugs results in an increased proportion of patients with mild-to-moderate hypertension achieving their target blood pressure (BP), according to a study published in the Aug. 14 issue of the Journal of the American Medical Association.

CAREGIVING

Men Take Care of Their Spouses Just as Well as Women. Men respond to their spouse's illness just as much as women do and as a result are better caregivers in later life than previous research suggests Journals of Gerontology, Series B

OTHER

New Tick Species Spreading in the United States: The first new tick species to appear in the United States in 50 years is spreading rapidly in the east and has been confirmed in seven states and the suburbs of New York City. In its home range, the Asian longhorned tick (Haemaphysalis longicornis) carries a virus that kills 15 percent of its victims, but is considered a greater threat to livestock than to humans, The New York Times reported.

More Than 40% of Women With Asthma May Develop COPD More than 4 in 10 women with asthma may go on to develop chronic obstructive pulmonary disease (COPD), according to a study published in the Annals of the American Thoracic Society. In addition to smoking, the study identified obesity, rural residence, lower education levels, and unemployment as significant risk factors for ACOS. The researchers speculate that these factors indicative of low socioeconomic status may result in suboptimal access to care, undertreatment of asthma, and poor compliance to medications, all of which lead to more frequent asthma attacks. These attacks, in turn, may lead to airway remodelling that increases the chances of developing asthma and COPD overlap syndrome (ACOS).

Patient Portals Don’t Appear to Have Much Traction: Patient portals have not taken off as expected, according to an article published in Medical Economics. Portals enable patients to view their health records and lab results online, share the information with other providers, and exchange secure messages with their physician's office. But both anecdotal reports from physicians and some government reports have found that few patients are actually using them.

Most Postmenopausal Bleeding Not Associated with Cancer: Most women with postmenopausal bleeding (PMB) will not be diagnosed with endometrial cancer, according to a review published online Aug. 6 in JAMA Internal Medicine.

National Guideline Clearinghouse Offline Due to Funding Cuts: The National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) websites were taken down on July 16 when funding for these federal databases ended, according to an announcement by the Agency for Healthcare Research and Quality (AHRQ).