Journal Watch April 2019

CHRONIC PAIN

CDC Clarifies Guideline on Opioid Prescribing for Chronic Pain: The U.S. Centers for Disease Control and Prevention has clarified that the new guideline on prescribing opioids for chronic pain is not meant to limit access to appropriate pain management, for any patients who suffer from chronic pain, particularly those undergoing cancer treatment, cancer survivors with chronic pain, and individuals with painful complications of sickle cell disease. Rather, it aims to ensure that clinicians and patients consider all safe and effective treatment options. According to the CDC, the relationship between the clinician and patient should form the basis of clinical decision making, with an understanding of the patient's clinical situation, functioning, and life context as well as careful consideration of the risks and benefits associated with treatment options. Letter issued to the American Society of Clinical Oncology, the American Society of Hematology, and the National Comprehensive Cancer Network.

New IR treatment for 'tennis elbow' reduces pain and inflammation without surgery: Tennis elbow, the painful chronic condition that affects up to 3 percent of the US adult population, can be effectively treated through transcatheter arterial embolization (TAE), an image-guided, non-surgical treatment that decreases abnormal blood flow to the injured area to reduce inflammation and pain, according to new research. ScienceDaily

Acetaminophen Safe as First-Line Analgesic for Most Older Adults: Despite a potential increased risk for stroke in patients with diabetes, acetaminophen is a safe first-line analgesic for most older adults living in nursing homes. Journal of the American Geriatrics Society.

COMPLEMENTARY & ALTERNATIVE MEDICINE

Cannabis Products Used Differ for Cancer, Noncancer Patients: The forms of medical cannabis used vary for patients with and without cancer, according to a study published online March 25 in the Journal of Palliative Medicine. Cancer patients more likely to use sublingual tincture form; noncancer patients often use vaporization form.

Just 20 minutes of contact with nature will lower stress hormone levels: Taking at least 20 minutes out of your day to stroll or sit in a place that makes you feel in contact with nature will significantly lower your stress hormone levels. That's the finding of a study that has established for the first time the most effective dose of an urban nature experience. Healthcare practitioners can use this discovery to prescribe 'nature-pills' in the knowledge that they have a real measurable effect.  Frontiers in Psychology

FDA ACTION

•Aapproved the first drug specifically developed for severe depression after childbirth, Zulresso, an IV drug given over 2 ½ days.

• Permitted marketing of the first medical device to treat attention deficit hyperactivity disorder (ADHD), Monarch external Trigeminal Nerve Stimulation (eTNS) System

• Approved the first generic naloxone hydrochloride nasal spray, commonly known as Narcan, a life-saving medication that can stop or reverse the effects of an opioid overdose.

• Approved Balversa (erdafitinib), a treatment for adult patients with locally advanced or metastatic bladder cancer

• Approved new treatment Evenity (romosozumab-aqqg) for osteoporosis in postmenopausal women at high risk of fracture

• Approved Dovato (dolutegravir and lamivudine), as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults with no antiretroviral treatment history

• Expanded approved use of metastatic breast cancer treatment to include male patients

• Approved Mavenclad (cladribine) tablets to treat relapsing forms of multiple sclerosis (MS) in adults

• Approved Mayzent (siponimod) tablets to treat adults with relapsing forms of multiple sclerosis (MS),

• Approved Cimzia (certolizumab pegol) injection for treatment of adults with a certain type of inflammatory arthritis

• Approved Jatenzo (testosterone undecanoate), an oral testosterone capsule to treat men with certain forms of hypogonadism

• Approved the Optimizer Smart system for treating patients with chronic, moderate-to-severe heart failure who are not suited for treatment with other heart failure devices

PREVENTION

Exercise is more critical than diet to maintain weight loss: The study showed successful weight-loss maintainers rely on physical activity to remain in energy balance (rather than chronic restriction of dietary intake) to avoid weight regain. Successful weight-loss maintainers are individuals who maintain a reduced body weight of 30 pounds or more for over a year. March issue of Obesity 

One Hour of Activity/Week Helps Maintain Disability-Free Status: For adults with lower-extremity joint symptoms, attaining about one hour of moderate-vigorous activity per week is associated with an increased likelihood of maintaining disability-free status over four years, according to a study published online March 19 in the American Journal of Preventive Medicine.

Common Sleep Myths Compromise Good Sleep & Health: People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep. These are, in fact, among the most widely held myths about sleeping that not only shape poor habits, but may also pose a significant public health threat, according to a new study publishing online in Sleep Health on April 16.  Researchers from NYU School of Medicine reviewed more than 8,000 websites to identify the 20 most common assumptions about sleep. With a team of sleep medicine experts, they ranked them based on whether each could be dispelled as a myth or supported by scientific evidence, and on the harm that the myth could cause.

Novel 5-minute workout improves blood pressure, may boost brain function: Five minutes daily of Inspiratory Muscle Strength Training lowers blood pressure, improves vascular health, boosts fitness and sharpens memory, according to preliminary results. Experimental Biology conference

Exercise Helps Prevent Cartilage Damaged Caused by Arthritis: Exercise helps to prevent the degradation of cartilage caused by osteoarthritis, Osteoarthritis and Cartilage

High-intensity interval training increases injuries, research shows. White men aged 20 to 39 were injured most, study finds: People who engage in high-intensity interval training are at greater risk for injury, especially in the knees and shoulders, a new study has found.  Journal of Sports Medicine and Physical Fitness

Ability to lift weights quickly can mean a longer life: Prolong your life by increasing your muscle power. That's the main message of a new study. 'Rising from a chair in old age and kicking a ball depend more on muscle power than muscle strength, yet most weight bearing exercise focuses on the latter,' said a study author. EuroPrevent 2019

People with a sense of oneness experience greater life satisfaction: People who believe in oneness -- the idea that everything in the world is connected and interdependent -- appear to have greater life satisfaction than those who don't, regardless of whether they belong to a religion or don't, according to new research. American Psychology Association

 

Light, physical activity reduces brain aging: The new 2018 Physical Activity-Guidelines for Americans suggest that some physical activity is better than none, but achieving greater than 150 minutes of moderate-to-vigorous (MV) physical activity per week is recommended for substantial health benefits. Using data from the Framingham Heart Study, the researchers found that for each additional hour spent in light-intensity physical activity was equivalent to approximately 1.1 years less brain aging. JAMA Network Open

 

Replacing 30 Minutes of Sitting With Activity May Cut Mortality: Replacing half an hour of daily sitting time with even light physical activity is associated with a reduction in mortality risk among less active adults, according to a study published online March 21 in the American Journal of Preventive Medicine.

Nonstick Frying Pans Can Cause Penis Size to Shrink: Teflon has its drawbacks and one of the most unusual and probably the most stunning is that PFCs in nonstick pans might shrink the size of male penises and also worsen semen quality. Journal of Clinical Endocrinology & Metabolism

Low levels of 'bad cholesterol' may actually increase stroke risk: A recent study warns that women with low levels of low-density lipoprotein cholesterol, sometimes called "bad cholesterol," may face an increased risk of bleeding stroke. They identified a similar association in relation to triglyceride levels. Neurology

NUTRITION/SUPPLEMENTS/VITAMINS

A nutty solution for improving brain health: Long-term, high nut consumption could be the key to better cognitive health in older people according to new research. In a study of 4822 Chinese adults aged 55+ years, researchers found that eating more than 10 grams of nuts a day was positively associated with better mental functioning, including improved thinking, reasoning and memory. The journal of nutrition, health & aging 

Later Dinner and No Breakfast a Killer Combination: People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack. The study found that people with the two eating habits had a four to five times higher likelihood of death, another heart attack, or angina (chest pain) within 30 days after hospital discharge for heart attack. European Journal of Preventive Cardiology

Replacing Red Meat With Nuts And Beans Can Cut Heart Disease Risk: Choose plants over red meat to keep your heart healthy. That is the recommendation of a new study that found diets with high-quality plant protein sources could help reduce cardiovascular disease risk factors, mainly lowering risks of heart attacks. Circulation

Dietary Supplement Use Not Linked to Mortality Benefits: For U.S. adults, dietary supplements are not associated with mortality benefits, according to a study published online April 9 in the Annals of Internal Medicine. Excess calcium intake correlated with elevated cancer death risk.

Vitamin D may help fight colorectal cancer: A new study concludes that high doses of vitamin D may help hinder the growth of advanced colorectal cancer in combination with chemotherapy. JAMA

TREATMENT

Hormonal treatment may trigger depression in men with prostate cancer: Men who receive anti-hormonal treatment after having their prostate removed are 80% more likely to suffer from depression than men who don't receive this treatment. This leads researchers to suggest that patients receiving androgen deprivation therapy should be monitored for post-surgical depression. This is presented at the European Association of Urology congress in Barcelona. 

Behavioral therapy generally more effective than pharmacologic therapies for urinary incontinence: Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve outcomes for women with either stress or urgency urinary incontinence (UI). Behavioral therapy, alone or in combination with other interventions, was found to be generally more effective than pharmacologic therapies alone. Findings from a systematic evidence review and network meta-analysis of clinical outcomes of nonpharmacologic and pharmacologic interventions for UI are published in Annals of Internal Medicine.

Deep brain stimulation provides sustained relief for severe depression: Patients suffering from severe, treatment-resistant depression can benefit not only acutely but also the long-term from deep brain stimulation. Thin electrodes were used to stimulate a deep seated part of the reward system in the brains of 16 patients. This led to a significant reduction of ratings of depression severity in all patients, it was reduced by half on average. For half of the study participants it was even reduced below the level regarded as the threshold for a depression requiring treatment. Most of the patients experienced those positive stimulation effects within the first week, and they lasted throughout the course of the one-year study. The study was published online in the Nature journal Neuropsychopharmacology on Thursday, 14 March 2019. 

Tilt Training Prevents Fainting: Tilt training effectively prevents fainting, according to research presented today at EHRA 2019, a European Society of Cardiology (ESC) congress.1 The program also improved quality of life, reduced the worry and fear about future fainting and enabled patients to return to work.

Canagliflozin Seems Effective for Patients With T2DM, Kidney Disease: Canagliflozin is associated with a reduced risk for renal and cardiovascular events for patients with type 2 diabetes and kidney disease, according to a study published online April 14 in the New England Journal of Medicine

Normalizing BP in Elderly With Hypertension May Up Mortality: Normalized blood pressure (BP) is associated with an increased risk for all-cause mortality for older adults during hypertension treatment, with increased risk seen in octogenarians and those with previous cardiovascular events, according to a study recently published in the European Heart Journal. Blood pressure values less than 140/90 mm Hg were tied to increased mortality risk for octogenarians.

 

Over Half of Patients Have Suboptimal Response to Statins: More than half of patients initiating statin therapy have a suboptimal low-density lipoprotein cholesterol (LDL-C) response within 24 months. Suboptimal responders have increased risk for incident cardiovascular disease Heart. 

Could this brain stimulation technique reverse memory decline? New research suggests that transcranial magnetic stimulation could reverse age-related memory loss. In fact, the technique restored the memory of senior participants to the level of young adults. Neurology

OTHER

Doctors Unclear on Legal Obligations in Caring for Patients With Disability: Practicing physicians might not understand their legal responsibilities when caring for people with disability, which may contribute to inequalities in their care, according to a study published online April 1 in Health Affairs.

Most Diabetes Phone Apps Lack Education, Support Functions: Most diabetes apps miss opportunities to improve care and health outcomes by not providing real-time decision support or situation-specific education on blood glucose self-management, according to a research letter published in the April 16 issue of JAMA.

Why Do Doctors Over treat? Medical education is built on the assumption that the more procedures or treatments doctors see and do, the more competent they'll be when they're independent. It can feel tempting to do more rather than less. "It's totally natural to think more information is just going to be better." "Eventually it leads to patients feeling less well than they actually are, if you uncover things that are meaningless but abnormal." NPR