All posts by medical

Pediatrics

Tina Cheng Honored as Exceptional CMO – Research Horizons – Research Horizons

Cheng was named among 180 CMOs recognized by Beckers Hospital Review as drivers of continuous improvement.

Tina Cheng, MD, MPH, B.K. Rachford Chair of Pediatrics, chief medical officer at Cincinnati Childrens and director of the Cincinnati Childrens Research Foundation, has been recognized by Beckers Hospital Review among 180 exceptional chief medical officers in health care.

The article states that Cheng, as chief medical officer, oversees clinical services across 750 beds, nearly 1.5 million outpatient visits, and 170,000 emergency and urgent care visits each year.

She serves as chair of pediatrics at the University of Cincinnati College of Medicine, where she oversees more than 1,000 faculty and medical staff. She also directs the Cincinnati Childrens Research Foundation, where she oversees nearly 500 research full-time equivalents and over 5,000 research staff.

The article says Cheng greatly contributed to Cincinnati Childrens clinical outcomes and culture of diversity, equity and inclusion, which in part led to the hospital being named the No. 1 Best Childrens Hospital by U.S. News and World Report in 2023.

Prior to joining Cincinnati Childrens, Cheng was chair of pediatrics and pediatrician-in-chief at Johns Hopkins University. She also co-led the National Institutes of Health-funded D.C.-Baltimore Research Center on Child Health Disparities for 15 years.

Cheng is an elected member of the National Academy of Medicine and co-author of many research publications, including The Next 7 Great Achievements in Pediatric Research, published in 2017 in Pediatrics.

The physician leaders highlighted by this list champion patient safety, uphold rigorous quality standards, act as liaisons between leadership teams and medical staff, manage risk and much more. These CMOs are drivers of continuous improvement, and their efforts have helped garner numerous quality and safety accolades for their respective organizations, Beckers wrote.

Beckers Healthcare developed its list based on nominations and editorial research. Leaders do not pay and cannot pay for inclusion.

Other CMOs from the Cincinnati region recognized by Beckers included:

View original post here:

Tina Cheng Honored as Exceptional CMO - Research Horizons - Research Horizons

Pediatrics

Let’s talk about childhood injury prevention | Hub – The Hub at Johns Hopkins

By Annika Weder

Unintentional injuries are a leading cause of suffering and mortality in young children, and doctors agree that many of these injury-related deaths are preventable. To address this, the American Academy of Pediatrics designed The Injury Prevention Program, or TIPP. Launched in 1983, TIPP helps pediatricians implement injury prevention counseling for parents by providing anticipatory guidance based on child development schedules including what new skills children are learning at each age, potential dangers parents should look out for, and what preventative steps they should be taking.

Despite TIPP's widespread use, until recently, no formal evaluation had been done to investigate whether TIPP effectively prevents injuries. A new study led by Eliana Perrin, Bloomberg Distinguished Professor of Primary Care in the Department of Pediatrics in the School of Medicine and in the School of Nursing, showed that the program dramatically reduces injuries in young children. The study was published April 1 in Pediatrics.

Image caption: Eliana Perrin

Image credit: Johns Hopkins School of Medicine

Perrin, whose research typically focuses on childhood obesity, says this research began by chance, when TIPP was used as the attention control for a study she was involved in on obesity prevention, the Greenlight Intervention Study. When her site was randomized into the TIPP arm instead of the obesity prevention arm, Perrin says she was determined to "make lemonade out of lemons."

"We decided to turn this cluster randomized trial of our obesity prevention program on its head and look at how effective the control was," Perrin says. "Thanks to the Centers for Disease Control and Prevention and the National Institute of Child Health and Human Development partnering to support the study of this injury prevention piece, we were able to do a rigorous job of looking at how effective TIPP is at preventing injuries in young children. And, as it turns out, it was very effective."

The study involved a cluster-randomized trial at four academic medical centerstwo implemented TIPP screening and counseling materials at all well-child checks for ages two to 24 months, and two centers implemented obesity prevention. A total of 781 parent-infant pairs were enrolled in the study. The majority of parents were Hispanic (51%) or Black (28%), and most were insured by Medicaid (87%). Over a period of four years, parents were asked to report the number of injuries since the previous visit at the recommended well-child checks at two, four, six, nine, 12, 15, 18, and 24 months of age as well as whether the injuries were serious enough to require medical attention. Injuries include cuts, burns, falls, choking, unintentional ingestions, drownings, and motor vehicle crashes.

Unsurprisingly, both the number of injuries and the number of injuries requiring medical attention increased with age, with injuries recorded in only 3% of children at two months of age, and in 40% of children at 24 months of age. By far the most common cause of injury reported was falls, followed by "other" in second place and burns in third. Choking, motor vehicle crashes, poisonings, and near drownings were much less common.

What was unexpected, however, was the magnitude of the impact TIPP had on reducing reported injuries. Children who were enrolled in sites with the injury prevention program had significantly reduced parent-reported injuries compared to children at the control sites. The estimated risk of reporting injuries averaged across all ages from four months to 24 months was 30% in the control group and only 14% in the group where TIPP was used. So, the TIPP intervention was associated with a more than 50% reduction in the risk of reporting at least one injury compared to the control group.

Eliana Perrin

Bloomberg Distinguished Professor of Primary Care

"Honestly, we were surprised by the results," says Perrin. "TIPP is a pretty simple program. There's not a lot of bells or whistles. It's just bread-and-butter developmentally guided injury prevention anticipatory guidance for parents. It reminds us pediatric providers to say to parents, 'hey, in the next two months, your baby will be reaching and grabbing things, so you might want to make sure that hot coffee and the table cloth it's on are out of reach from your baby.' When we were teaching the residents to use this program, we really thought, this is so rote! So, we were not expecting the effect we saw."

This study highlights the effectiveness of primary care-based injury prevention approaches, and has important public health implications, as the rate of injury reduction could have a significant effect if TIPP were implemented widely. "We hope this paper will encourage providers to spend time counseling about injury," Perrin says. "We also hope more will adopt The Injury Prevention Program into their practice because this anticipatory guidance for parents really helps prevent injuries for young children."

Looking forward, the researchers aim to investigate the mechanisms by which TIPP leads to a reduction in injuries, as well as to investigate TIPP's impact on serious injury prevention.

"We hope to next look at whether TIPP prevents serious injuries," says Perrin. "We also hope to look at whether we can enhance TIPP to be even better and best ways to implement this program into busy practice since providers are so strapped for time."

Read this article:

Let's talk about childhood injury prevention | Hub - The Hub at Johns Hopkins

Pediatrics

More young people with depression, anxiety in Virginia | Headlines – InsideNoVa

An analysis of hospital data shows statewide emergency department visits among patients under 18 for mental health treatment have increased in recent years.

When looking at data spanning the first quarter of 2020 through the second quarter of 2023, the Virginia Hospital & Healthcare Association found that emergency department visits with anxiety and depression diagnoses increased in pediatric patients.

According to a news release from the association, the first quarter of 2023 saw the highest volume recorded, with numbers surpassing pre-pandemic levels.

On average, hospitals in the Virginia saw approximately 3,054 pediatric emergency department visits for anxiety and depression each quarter.

Two-thirds of the diagnoses were related to unspecified anxiety disorder (33%) and single episodes of unspecified major depressive disorders (33%).

About 69% of the visits were female patients. The data follows statistics seen in Northern Virginia.

Last year, a report from the Community Foundation of Northern Virginia found that youth in Northern Virginia have experienced high rates of clinical depression, anxiety and feelings of hopelessness or sadness. It also showed that girls and students in the LGBTQ community felt persistent sadness at twice the rate of their peers.

To address the increase, the report made several recommendations including, focusing on mental health outreach to at-risk youth and expanding the number of trusting, supportive adults in a teenager's life.

The statewide increase in emergency room visits also follows a trend seen nationwide. Last summer, the joint paper from the American Academy of Pediatrics, American College of Emergency Physicians and Emergency Nurses Association, said emergency rooms have been overwhelmed by a surge in mental health emergencies.

The organizations called for systemic changes and more resources, saying strategies to address challenging circumstances that affect prehospital services, the surrounding community and, ultimately, patient care are needed.

Two-thirds of the diagnoses were related to unspecified anxiety disorder (33%) and single episodes of unspecified major depressive disorders (33%).

The rest is here:

More young people with depression, anxiety in Virginia | Headlines - InsideNoVa

Internal Medicine

Patrick Hemming, MD: Depression, Anxiety Treatment by the Internal Medicine Physician – MD Magazine

This interview segment with Patrick Hemming, MD, involved a discussion of some of the major takeaways from his talk Depression and Anxiety Treatment by the Internal Medicine Physician, presented at the 2024 American College of Physicians (ACP) Internal Medicine Meeting.

During his ACP 2024 talk, Hemming described depressive disorders, anxiety disorders, recent changes to screening guidelines, and other elements he felt internists should be made aware of in the mental health space.

I go over screening guidelines, and the screening guidelines have changed in the last year, Hemming explained. If you go by the United States Preventive Services Task Force, they now recommend that really we should be screening all patients over 18 for depression, regardless of what your practice. Just last year, the recommendation that we should screen all patients 18 to 64, for anxiety disorders, that's new and has never been recommended before.

Hemming noted that the changes to guidelines for internists are not small and they do signify larger changes occurring in the mental health space.

Quality reporting for Medicare and Medicaid now starts to look at whether we're screening and whether we're getting people set up with treatment, Hemming said. Then that impacts payment schedules and things like that, that our practices are going to directly see results from in addition to our patients who are now being screened for new things.

Hemming later expressed that, while in psychiatric practices medication is adjusted and feedback will occur more rapidly, in primary care it is less possible to do so.

(We discussed) how we are going to follow up with patients, understanding the goals of treating some targets using things like our PHQ-9 or our GAD-7 for anxiety disorders, Hemming said. And, something very important for me in this talk is to point out that although we have created numbers for these things, this is not treating blood pressure. In blood pressure, we can create a goal for systolic blood pressure of 130 and get people under that and feel pretty good about ourselves

Hemming noted that unlike traditional situations with blood pressure, if internists are treating patients with a PHQ-9 number, this is not actually not what the patient cares about. He noted that they need to understand that such a patient may be having difficulties in their personal relationships, at work, or in their sense of achievement in life.

For additional information on this interview, view the full discussion posted above.

The quotes used here were edited for the purposes of clarity. Hemming has no relationships with entities whose primary business is marketing, selling, producing, re-selling, or distributing healthcare products used by or on patients.

Continue reading here:

Patrick Hemming, MD: Depression, Anxiety Treatment by the Internal Medicine Physician - MD Magazine

Internal Medicine

UConn Health’s Dr. Rebecca Andrews Takes on New National Role – UConn Today – University of Connecticut

UConn Healths Dr. Rebecca Andrews continues her national leadership roles with the American College of Physicians, now as chair-elect of its board of regents.

Representing internal medicine physicians, related subspecialists, and medical students, the ACP is the largest medical specialty organization and the second-largest physician group in the U.S.

I am thrilled that I have been elected into the position of chair of the board of regents, Andrews says. This role guides development of organizational policy that is utilized to advocate for improvements, changes, and important issues that face our patients as well as internal medicine physicians across the country and the world.

Andrews is a professor of medicine in the UConn School of Medicine and serves as the UConn Internal Medicine Residency Programs associate program director as well as its director of ambulatory education. She is a primary care physician, director of primary care, and clinical lead for UConn Healths Patient Centered Medical Home and Comprehensive Pain Center.

The basis of every industrialized country with superb health outcomes and life expectancy is robust primary care, Andrews says. Given this is my area of passion and practice, I feel particularly positioned to be a voice for the American College of Physicians, who have been tireless in improving care quality, access and delivery for our patients with such initiatives as patients before paperwork advocating for what we all want the opportunity to provide excellent care for patients in a less burdensome system.

The board of regents is the ACPs main policy-making body. Andrews installation as chair-elect took place at the ACPs annual meeting in Boston Saturday. She starts her term as board chair next year. In that capacity her responsibilities will include overseeing policy creation, presiding over committee meetings including the boards executive committee, and maintaining fiduciary goals.

Andrews is a 2002 graduate of the UConn School of Medicine and a 2006 graduate of the internal medicine residency program that today she helps direct. Her connection with the ACP goes back more than 20 years, when she first became involved as a medical student. She later would join the ACPs early physician council. In 2010, a year after she returned to UConn Health as faculty physician, she was elected a Fellow of the College (FACP), an honorary designation that recognizes ongoing individual service and contributions to practice of medicine. She since has served on several national committees and in several leadership roles on the ACPs Connecticut chapter.

Especially now, as life expectancy has decreased for Americans for the first time in decades, righting the direction of health care is especially important, Andrews says.

Andrews joined the ACPs board of regents two years ago following a four-year term as the governor of the Connecticut chapter and a one-year term chairing the ACPs board of governors. The chair of the board of regents and the president are the ACPs two highest-level officers. The chair may act on behalf of the president when the president is unavailable.

The American College of Physicians has more than 160,000 members which include internal medicine physicians, related subspecialists, and medical students representing nearly 150 countries.

Andrews also is a member of the Gold Humanism Honor Society, a community of more than 45,000 medical students, physicians, and other leaders whove been recognized for their compassionate care.

Read more here:

UConn Health's Dr. Rebecca Andrews Takes on New National Role - UConn Today - University of Connecticut

Internal Medicine

Women are less likely to die when treated by female doctors, study suggests – Yahoo! Voices

Hospitalized women are less likely to die or be readmitted to the hospital if they are treated by female doctors, a study published Monday in the Annals of Internal Medicine found.

In the study of people ages 65 and older, 8.15% of women treated by female physicians died within 30 days, compared with 8.38% of women treated by male physicians.

Although the difference between the two groups seems small, the researchers say erasing the gap could save 5,000 womens lives each year.

The study included nearly 800,000 male and female patients hospitalized from 2016 through 2019. All patients were covered by Medicare. For male hospitalized patients, the gender of the doctor didnt appear to have an effect on risk of death or hospital readmission.

The data alone doesnt explain why women fare better when treated by other women. But other studies suggest that women are less likely to experience miscommunication, misunderstanding and bias when treated by female doctors, said lead study author Dr. Atsushi Miyawaki, a senior assistant professor of health services research at the University of Tokyo Graduate School of Medicine.

The new research is part of a growing field of study examining why women and minorities tend to receive worse medical care than men and white patients. For example, women and minority patients are up to 30% more likely to be misdiagnosed than white men.

Our pain and our symptoms are often dismissed, said Dr. Megan Ranney, dean of the Yale School of Public Health. It may be that women physicians are more aware of that and are more empathetic.

Research shows that women are less likely than men to receive intensive care but more likely to report having negative experiences with health care, having their concerns dismissed, and having their heart or pain symptoms ignored, the authors wrote in the new study. Male physicians are also more likely than female doctors to underestimate womens risk of stroke.

Part of the problem, Miyawaki said, is that medical students get limited training in womens health issues.

Dr. Ronald Wyatt, who is Black, said his 27-year-old daughter recently had trouble getting an accurate diagnosis for her shortness of breath. An emergency room physician told her the problem was caused by asthma. It took two more trips to the emergency room for his daughter to learn that she actually had a blood clot in her lungs, a potentially life-threatening situation.

There is a tendency for doctors to harbor sexist stereotypes about women, regardless of age, such as the notion that womens symptoms are more emotional or their pain is less severe or more psychological in origin, said Wyatt, former chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.

Women seem to experience fewer of these problems when treated by other women.

For example, a study published JAMA Surgery in 2021 found that women patients developed fewer complications if their surgeon was female. Another JAMA Surgery study published in 2023 found all patients had fewer complications and shorter hospital stays if they were operated on by female surgeons, who worked more slowly than their male counterparts.

Women primary care doctors also tend to spend more time with their patients, Ranney said. Although that extra attention is great for patients, it also means that women see fewer patients per day and earn less, on average, than male doctors.

Dr. Ashish Jha, dean of the Brown University School of Public Health, said several studies suggest that female doctors follow medical evidence and guidelines, and that their patients have better outcomes.

Theres lots of variation between women and men physicians, said Jha, who was not involved in the new study. Women tend to be better at communication, listening to patients, speaking openly. Patients report that communication is better. You put these things together, and you can understand why there are small but important differences.

The authors of the study said its also possible that women are more forthcoming about sensitive issues with female physicians, allowing them to make more informed diagnoses.

That doesnt mean that women should switch doctors, said Dr. Preeti Malani, a professor of medicine at the University of Michigan. For an individual patient, the differences in mortality and readmission rates seen in the new study are tiny.

It would be a mistake to suggest that people need to find physicians of the same gender or race as themselves, Jha said. The bigger issue is that we need to understand why these differences exist.

Malani said shes curious about what women doctors are doing to prevent patients from needing to be readmitted soon after discharge. How much care and thought is going into that discharge plan? Malani asked. Is that where women are succeeding? What can we learn about cultural humility and asking the right questions?

Others arent convinced that the new study proves a physicians gender makes a big difference.

Few hospitalized patients are treated by a single doctor, said Dr. Hardeep Singh, a professor at Baylor College of Medicine in Houston and a patient safety researcher at the Michael E. DeBakey VA Medical Center.

Hospital patients are treated by teams of physicians, especially if they need specialist care, in addition to nurses and other professionals, Singh said.

How often do you see the same doc every day in the hospital? Singh asked. The point is that its not a one-man or one-woman show. Outcomes are unlikely to depend on one individual, but rather on a clinical team and the local context of care. One name may appear on your bill, but the care is team-based.

However, Singh said his research on misdiagnoses shows that doctors in general need to do a better job listening to patients.

Jha said hed like the health system to learn what women doctors are doing right when they treat other women, then teach all physicians to practice that way.

We should train everyone to be better at generating trust and being worthy of trust, Jha said.

Wyatt said the country needs to take several steps to better care for women patients, including de-biasing training to teach doctors to overcome stereotypes. The health care system also needs to increase the number of women physicians in leadership, recruit more female doctors and do a better job at retaining them. All physicians also need more understanding of how adverse childhood experiences affect patient health, particularly for women, he said.

More than once Ive had white female patients tell me they came to be because I listened and they trusted me, Wyatt said.

This article was originally published on NBCNews.com

Read the original here:

Women are less likely to die when treated by female doctors, study suggests - Yahoo! Voices

Internal Medicine

Are female doctors the key to keeping patients alive longer? – – Study Finds

LOS ANGELES A doctors gender matters when it comes to your health. Researchers from UCLA have found that patients receiving treatment from female physicians have lower mortality rates and fewer hospital readmissions compared to those treated by male doctors. Female patients seemed to benefit the most from this female doctor effect.

The study, published in the journal Annals of Internal Medicine, analyzed Medicare claims data from 2016 to 2019 for over 700,000 patients. They found that the mortality rate for female patients was 8.15 percent when receiving care from female physicians, compared to 8.38 percent when the physician was male. While this difference may seem small, its considered clinically significant by researchers.

Male patients also fared better under the care of female doctors, though the difference was less pronounced. Their mortality rate was 10.15 percent with female physicians, compared to 10.23 percent with male physicians.

A similar pattern emerged for hospital readmission rates. Patients were less likely to return to the hospital within 30 days of discharge if a female doctor saw them during their initial visit. Researchers propose several possible explanations for their findings.

What our findings indicate is that female and male physicians practice medicine differently, and these differences have a meaningful impact on patients health outcomes, says study senior author Dr. Yusuke Tsugawa, associate professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, in a media release.

One potential factor is that male doctors might underestimate the severity of illness in their female patients. Previous research has shown that male physicians tend to downplay womens pain levels, gastrointestinal and cardiovascular symptoms, and even their risk of stroke. This could lead to delayed diagnoses or incomplete treatment.

Communication may also play a role. Female doctors might be better at communicating with their female patients, creating a more open and trusting relationship. This could make women more likely to share important health information that leads to better diagnoses and treatment plans. Also, female patients may simply feel more comfortable with female physicians, especially when it comes to sensitive examinations or detailed health discussions.

But why do female patients seem to benefit more from having a female doctor than male patients do? The UCLA team says more research is necessary to untangle this question. Dr. Tsugawa stresses that understanding how and why male and female physicians practice differently could lead to interventions that improve patient care across the board.

Further research on the underlying mechanisms linking physician gender with patient outcomes, and why the benefit of receiving the treatment from female physicians is larger for female patients, has the potential to improve patient outcomes across the board, explains Dr. Tsugawa.

The study also highlights the importance of gender equity in the medical field. Despite providing high-quality care, female physicians often earn less than their male counterparts. Dr. Tsugawa argues this pay gap should be eliminated.

It is important to note that female physicians provide high-quality care, and therefore, having more female physicians benefits patients from a societal point-of-view, explains Dr. Tsugawa.

This study is similar to what Harvard University researchers found during their 2020 survey about the care received between male and female doctors. According to the Harvard study, patients who receive care at a hospital from a female physician are less likely to die. They were also less likely to be hospitalized again compared to being seen by a male doctor.

This UCLA study doesnt mean you should switch doctors based on gender alone. Many factors contribute to the quality of care, including a physicians training, experience, and bedside manner.

However, the findings do suggest that the way male and female doctors approach patient care may differ in ways that impact health outcomes. As researchers continue to explore this fascinating topic, the hope is that the insights gained can be used to optimize medical care for everyone, regardless of the gender of the patient or the physician.

StudyFinds Matt Higgins contributed to this report.

Read this article:

Are female doctors the key to keeping patients alive longer? - - Study Finds

Internal Medicine

Anne Thorndike, MD, MPH: Discussing Treatment Approaches for Patients with Obesity – MD Magazine

A recent presentation at the American College of Physicians (ACP) Internal Medicine Meeting in Boston looked at several questions regarding obesity such as how effective lifestyle interventions or pharmacologic interventions for the treatment of obesity and how for internal medicine physicians to engage in a shared decision making discussion to develop a plan.

This talk was presented at ACP by Anne Thorndike, MD, MPH, alongside 2 other presenters. Thorndike is known for her work as associate professor of medicine at the Division of General Internal Medicine of Massachusetts General Hospital as well as Harvard Medical School.

Thorndike was interviewed by the HCPLive editorial team at ACP on the topics covered in the presentation, with the initial question being what led to her decision to contribute to the presentation.

For a long time, my clinical work was actually focused on working with people to modify lifestyle behaviors to prevent obesity and cardiometabolic disease, Thorndike said. My research also focuses on nutrition and nutrition security, using different strategies to help people make healthier food choices and to exercise. So I've had a long standing interest in lifestyle modification and also I think the timing of these new medications has put lifestyle modification in a new light.

Thorndike noted that the combination of discussing new obesity medications and lifestyle changes represented a list of interesting things for clinicians to consider moving forward in helping patients to be healthier.

Later, she was asked if they highlighted any specific challenges or considerations when developing treatment plans for patients with obesity that go beyond standard guidelines.

I think that it's important to acknowledge that the strongest evidence for lifestyle modification comes from trials that showed that multicomponent behavioral interventions are the most effective way to change lifestyle and lose 5 - 10% body weight, Thorndike said. So that is one of the factors that's going to get highlighted in this talk is that multicomponent behavioral interventions can result in 5 - 10% weight loss, whereas the medications when used at the highest dose, can produce 15 - 20% weight loss.

Thorndike added, however, that it is important for patients to understand that even if one does not achieve such high weight loss numbers, one can actually achieve a lot of health benefits such as reductions in blood pressure, lipids, hemoglobin A1C, and reducing your risk for diabetes.

She added the numerous other health benefits which can involve improvement of depression symptoms, reducing sleep apnea, improving pain from knee arthritis, and reducing fatty liver.

To learn more about Thorndikes presentation, view the full interview segment posted above.

The quotes contained in this summary were edited for clarity. Thorndike has no relationships with entities whose primary business is selling, producing, marketing, re-selling, or distributing healthcare products used by or on patients.

The rest is here:

Anne Thorndike, MD, MPH: Discussing Treatment Approaches for Patients with Obesity - MD Magazine

Internal Medicine

Prolonged Medical Fasting May Benefit Pain Symptoms in Fibromyalgia – MD Magazine

Credit: Josh Milgate/Unsplash

A prolonged therapeutic fasting intervention, integrated into a multimodal medical approach, has the potential to benefit patients with fibromyalgia regarding their pain and psychosomatic symptoms, according to new research.1

Application of medically supervised fasting of a maximum of 600 kcal daily, for an average of 7 to 8 days, led to improvements in multiple disease-specific parameters, including quality of life, functionality, and pain perception, among a single-center population with fibromyalgia.

Our data suggest feasibility, safety, and potential advantages of medically supervised fasting for patients with fibromyalgia syndrome, when embedded in a multimodal therapeutic inpatient approach, wrote the investigative team, led by Daniela A. Koppold, department of internal medicine and nature based therapies, Immanuel Hospital Berlin.

Fibromyalgias complexities arise from diagnostic challenges, as no radiological or laboratory markers can confirm its presence, and clinical presentation can fluctuate between individual patients.2 Typically, diagnosis is determined through pain scales and a history of persistent pain in at least four of five body regions for 3 months. The chronic pain disorder commonly occurs concomitantly in patients with rheumatological diseases.

Given the conditions complexity, rheumatological organizational guidelines stress the importance of multimodal treatment approaches, with preference for non-pharmacological interventions over medications.3 Dietary interventions, while not yet incorporated into these guidelines, have shown an effect on quality of life and pain perception in preliminary trial data.

In this observational study, Koppold and colleagues assessed the feasibility and impact of prolonged therapeutic fasting embedded into a multimodal treatment setting on inpatients with fibromyalgia.1 Participants, recruited from February 2018 to December 2020 at the investigators institution in Germany, completed questionnaires at hospital admission and discharge, and 3, 6, and 12 months later.

The Fibromyalgia Impact Questionnaire (FIQ), a validated questionnaire specifically used for the symptomatic presentations of fibromyalgia, was used to determine the feasibility and effectiveness of prolonged therapeutic fasting in fibromyalgia management. An improvement of 14% is acknowledged as the minimal clinically important difference (MCID) in the FIQ.

For analysis, baseline values (V0) and vital signs were compared with measurements at later visits (V1 to V4) through unadjusted t-tests. Overall, the study population comprised 168 female and 8 male patients exhibiting fibromyalgia and following a therapeutic fasting intervention during the study period. Of this population, 90% fasted, lasting between 3 and 12 days, with an average of 7.6 days.

Upon analysis, Koppold and colleagues identified a significant improvement in fibromyalgia manifestations in the FIQ. The FIQ total score dropped from 58.3 11.1 to 44.6 15.5 between admission and discharge, a reduction of 13.7 13.9 points (P <.001). Translating to a decrease of 23.5%, investigators noted the marked reduction in the total score is larger than the MCID of 14%.

These strong improvements in the total score occurred due to large effects in the Overall and Symptoms subscores (P <.0001), as well as a slight benefit in the Function subscore (P = .0328) and a clinically significant effect in the pain subscore (P <.0001).

Reductions in pain (1.1 2.5; P <.001) and improvements in quality of life (WHO-5, +4.9 12.3; P <.001) identified in V1 were sustained across the entire study period of one year. On the other hand, improvements in mindfulness (P <.001), anxiety (P <.0001), and depression (P <.0001) observed during inpatient treatment were not sustained over the long term.

Safety data showed no serious adverse events were reported during the inpatient stay for any participant. Given the potential for positive effects on presentations of fibromyalgia, Koppold and colleagues suggested the need to study prolonged medical fasting in outpatient settings and whether the duration of the fast could show similar effects.

In general, if a safe and feasible intervention of 510 days were able to lower disease burden in FMS in the medium and long term, giving it further attention seems worthwhile, they wrote.

References

See more here:

Prolonged Medical Fasting May Benefit Pain Symptoms in Fibromyalgia - MD Magazine

Internal Medicine

Discussing Ways to Approach Improving Obesity Care with Melanie Jay, MD – MD Magazine

In this interview segment, Melanie Jay, MD, MS, general internist and associate professor at NYU Langone Health, spoke on additional takeaways from her conference presentation on advancing equity in obesity care, given at the 2024 American College of Physicians (ACP) Internal Medicine Meeting.

Jay, who is board-certified in obesity medicine, spoke with the HCPLive editorial team about several different topics connected to obesity. First, Jay was asked whether her talk covered glucagon-like peptide-1 receptor agonists (GLP-1-RAs) such as Ozempic as a topic of interest.

We didn't go into the different GLP-1-receptor agonists that are so popular like semaglutide and tirzepatide, Jay said. We had one question about whether we can think about obesity like addiction and what the overlaps are. So then I did a little discussion about how in the brain, we have both homeostatic mechanisms that regulate how hungry we are, and how much we're eating and our metabolism. Then there's hedonic mechanisms, as well, that are pleasure centers. The GLP-1s, I think, work on both.

Jay noted the importance and necessity of additional research on such a topic, adding the unique finding that there had been evidence suggesting GLP-1 receptor agonists led to fewer cravings for alcohol among users.

Later, Jay was asked about the role she sees technology playing in the future of obesity care, especially in terms of personalized treatment plans and patient engagement.

I think telehealth, for instance, since-COVID has blossomed everywhere, Jay said. And weight management, because we want to check in a lot with our patients and follow them to make it convenient for people, making it so that follow up care can really be delivered in telehealth. It always is good to examine our patients the first time, but in follow up, we can check in with them via telehealth and they don't have to leave their jobs or get child care to come in and get adequate care.

Jay also noted that patient-generated health datas best integration is still being researched, adding that it is important to figure out the interface likely to make it so that there is not an increased workload but engagement is improved.

To learn more information from this conference interview, view the video posted above.

The quotes contained in this discussion were edited for the purposes of clarity. Jay had no relevant disclosures.

View post:

Discussing Ways to Approach Improving Obesity Care with Melanie Jay, MD - MD Magazine