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Lucas Franki is an associate editor for MDedge News, and has been with the company since 2014. He has a BA in English from Penn State University and is an Eagle Scout.
Poor outcome for PBC patient with bullous pemphigoid
A 45-year-old woman who was admitted with concurrent primary biliary cirrhosis or cholangitis (PBC) and bullous pemphigoid died 5 days after admittance, according to a case report from N.B. Guerra-Uribe, MD, and M.S. González-Huezo, MD.
The patient was admitted to the emergency department for dermatosis, which had been present for 21 days. The patient had also been diagnosed with PBC, which was in an advanced stage. Vesicular lesions had appeared on the right upper limb and disappeared spontaneously, only to reappear on the lower extremities. Examination revealed large blisters with a fibrin base and necrotic edges.
A skin biopsy showed that the lesions were subepidermal blisters with a superficial, mixed, perivascular inflammatory infiltrate consistent with bullous pemphigoid. During the hospitalization, the patient developed a catheter-related urinary tract infection, acute renal lesions, and spontaneous bacterial peritonitis. The patient developed septic shock due to the urinary tract infection and died 5 days after admittance.
“The unfortunate case of our patient reflects the delay in seeking medical attention that resulted in a fatal outcome. In addition, early disease onset is associated with a worse prognosis and a higher failed treatment rate,” the investigators wrote.
They reported having no relevant financial conflicts.
Find the full case report in the Revista De Gastroenterologia De Mexico (doi: 10.1016/j.rgmx.2015.08.004).
A 45-year-old woman who was admitted with concurrent primary biliary cirrhosis or cholangitis (PBC) and bullous pemphigoid died 5 days after admittance, according to a case report from N.B. Guerra-Uribe, MD, and M.S. González-Huezo, MD.
The patient was admitted to the emergency department for dermatosis, which had been present for 21 days. The patient had also been diagnosed with PBC, which was in an advanced stage. Vesicular lesions had appeared on the right upper limb and disappeared spontaneously, only to reappear on the lower extremities. Examination revealed large blisters with a fibrin base and necrotic edges.
A skin biopsy showed that the lesions were subepidermal blisters with a superficial, mixed, perivascular inflammatory infiltrate consistent with bullous pemphigoid. During the hospitalization, the patient developed a catheter-related urinary tract infection, acute renal lesions, and spontaneous bacterial peritonitis. The patient developed septic shock due to the urinary tract infection and died 5 days after admittance.
“The unfortunate case of our patient reflects the delay in seeking medical attention that resulted in a fatal outcome. In addition, early disease onset is associated with a worse prognosis and a higher failed treatment rate,” the investigators wrote.
They reported having no relevant financial conflicts.
Find the full case report in the Revista De Gastroenterologia De Mexico (doi: 10.1016/j.rgmx.2015.08.004).
A 45-year-old woman who was admitted with concurrent primary biliary cirrhosis or cholangitis (PBC) and bullous pemphigoid died 5 days after admittance, according to a case report from N.B. Guerra-Uribe, MD, and M.S. González-Huezo, MD.
The patient was admitted to the emergency department for dermatosis, which had been present for 21 days. The patient had also been diagnosed with PBC, which was in an advanced stage. Vesicular lesions had appeared on the right upper limb and disappeared spontaneously, only to reappear on the lower extremities. Examination revealed large blisters with a fibrin base and necrotic edges.
A skin biopsy showed that the lesions were subepidermal blisters with a superficial, mixed, perivascular inflammatory infiltrate consistent with bullous pemphigoid. During the hospitalization, the patient developed a catheter-related urinary tract infection, acute renal lesions, and spontaneous bacterial peritonitis. The patient developed septic shock due to the urinary tract infection and died 5 days after admittance.
“The unfortunate case of our patient reflects the delay in seeking medical attention that resulted in a fatal outcome. In addition, early disease onset is associated with a worse prognosis and a higher failed treatment rate,” the investigators wrote.
They reported having no relevant financial conflicts.
Find the full case report in the Revista De Gastroenterologia De Mexico (doi: 10.1016/j.rgmx.2015.08.004).
FROM THE REVISTA DE GASTROENTEROLOGIA DE MEXICO
Universal decolonization reduces CLABSI rates in large health care system
Universal decolonization of adult intensive care unit patients in a large community health system significantly reduced the incidence of central line–associated bloodstream infections (CLABSIs), according to Dr. Edward Septimus and his associates.
A total of 136 ICUs at 95 hospitals were included in the study. Universal decolonization was completed within 6 months. A total of 672 CLABSIs occurred in the 24 months before intervention, and 181 CLABSIs occurred in the 8 months after intervention. The CLABSI rate was 1.1/1,000 central-line days before intervention and 0.87 after intervention, a reduction of 23.5%.
No evidence of a trend over time was found in either the pre- or postintervention period. The reduction in CLABSIs post intervention was not affected after adjustment for seasonality, number of beds in the ICU, or unit type. The gram-positive CLABSI rate was reduced by 28.7% after invention, and the rate of CLABSI due to Staphylococcus aureus was reduced by 31.9%.
“This rapid dissemination and implementation program demonstrated the utility of a protocol-specific toolkit, coupled with a multistep translation program to implement universal decolonization in a large, complex organization. Doing so demonstrated that use of CHG [chlorhexidine] bathing plus nasal mupirocin in routine practice reduced ICU CLABSIs at a level commensurate with that achieved within the framework of a clinical trial. This supports the use of universal decolonization in a wide variety of acute care facilities across the United States,” the investigators wrote.
Find the full study in Clinical Infectious Diseases (doi: 10.1093/cid/ciw282).
Universal decolonization of adult intensive care unit patients in a large community health system significantly reduced the incidence of central line–associated bloodstream infections (CLABSIs), according to Dr. Edward Septimus and his associates.
A total of 136 ICUs at 95 hospitals were included in the study. Universal decolonization was completed within 6 months. A total of 672 CLABSIs occurred in the 24 months before intervention, and 181 CLABSIs occurred in the 8 months after intervention. The CLABSI rate was 1.1/1,000 central-line days before intervention and 0.87 after intervention, a reduction of 23.5%.
No evidence of a trend over time was found in either the pre- or postintervention period. The reduction in CLABSIs post intervention was not affected after adjustment for seasonality, number of beds in the ICU, or unit type. The gram-positive CLABSI rate was reduced by 28.7% after invention, and the rate of CLABSI due to Staphylococcus aureus was reduced by 31.9%.
“This rapid dissemination and implementation program demonstrated the utility of a protocol-specific toolkit, coupled with a multistep translation program to implement universal decolonization in a large, complex organization. Doing so demonstrated that use of CHG [chlorhexidine] bathing plus nasal mupirocin in routine practice reduced ICU CLABSIs at a level commensurate with that achieved within the framework of a clinical trial. This supports the use of universal decolonization in a wide variety of acute care facilities across the United States,” the investigators wrote.
Find the full study in Clinical Infectious Diseases (doi: 10.1093/cid/ciw282).
Universal decolonization of adult intensive care unit patients in a large community health system significantly reduced the incidence of central line–associated bloodstream infections (CLABSIs), according to Dr. Edward Septimus and his associates.
A total of 136 ICUs at 95 hospitals were included in the study. Universal decolonization was completed within 6 months. A total of 672 CLABSIs occurred in the 24 months before intervention, and 181 CLABSIs occurred in the 8 months after intervention. The CLABSI rate was 1.1/1,000 central-line days before intervention and 0.87 after intervention, a reduction of 23.5%.
No evidence of a trend over time was found in either the pre- or postintervention period. The reduction in CLABSIs post intervention was not affected after adjustment for seasonality, number of beds in the ICU, or unit type. The gram-positive CLABSI rate was reduced by 28.7% after invention, and the rate of CLABSI due to Staphylococcus aureus was reduced by 31.9%.
“This rapid dissemination and implementation program demonstrated the utility of a protocol-specific toolkit, coupled with a multistep translation program to implement universal decolonization in a large, complex organization. Doing so demonstrated that use of CHG [chlorhexidine] bathing plus nasal mupirocin in routine practice reduced ICU CLABSIs at a level commensurate with that achieved within the framework of a clinical trial. This supports the use of universal decolonization in a wide variety of acute care facilities across the United States,” the investigators wrote.
Find the full study in Clinical Infectious Diseases (doi: 10.1093/cid/ciw282).
FROM CLINICAL INFECTIOUS DISEASES
Binge eating most effectively treated by CBT, lisdexamfetamine, SGAs
Cognitive-behavioral therapy, lisdexamfetamine, and second-generation antidepressants are the most effective treatments for adult binge-eating disorder, a systematic review by Kimberly A. Brownley, PhD, and her associates found.
A total of 34 trials were included in the review. Patients who received therapist-led cognitive-behavioral therapy (CBT) achieved binge eating abstinence at a rate of 58.8%, compared with 11.2% of those on a wait list. Just over 40% of patients achieved abstinence on lisdexamfetamine, compared with 14.9% on a placebo, and 39.9% of patients achieved abstinence on second-generation antipsychotics (SGAs), compared with 23.6% on a placebo.
Total eating-related obsessions and compulsions were significantly reduced in patients receiving lisdexamfetamine and SGAs, and CBT significantly improved eating-related psychopathology. Body mass index was not reduced in patients receiving SGAs or CBT, but was reduced in those receiving lisdexamfetamine and topiramate, compared with placebo. Symptoms of depression were reduced by SGAs, but not by CBT.
In a related editorial, Dr. Michael J. Devlin of the New York State Psychiatric Institute and Columbia University, New York, praised the review by Dr. Brownley and her associates as an expert summary of the “current evidence on binge-eating disorder.” He went on to make the connection between eating disorders and obesity, and discuss the prospects for interventions.
“The seeds of unhealthy eating that eventually lead to obesity, disordered eating, or both often are sown during childhood or adolescence, and interventions at the community and family levels in the context of enlightened public policy likely would yield significant benefit,” Dr. Devlin wrote. “Only by understanding binge-eating disorder at various levels of analysis and through different professional lenses will we ensure that its life span is shortened, to the benefit of our own.”
Find the full study (doi: 10.7326/M15-2455) and editorial (doi: 10.7326/M16-1398) in the Annals of Internal Medicine.
Cognitive-behavioral therapy, lisdexamfetamine, and second-generation antidepressants are the most effective treatments for adult binge-eating disorder, a systematic review by Kimberly A. Brownley, PhD, and her associates found.
A total of 34 trials were included in the review. Patients who received therapist-led cognitive-behavioral therapy (CBT) achieved binge eating abstinence at a rate of 58.8%, compared with 11.2% of those on a wait list. Just over 40% of patients achieved abstinence on lisdexamfetamine, compared with 14.9% on a placebo, and 39.9% of patients achieved abstinence on second-generation antipsychotics (SGAs), compared with 23.6% on a placebo.
Total eating-related obsessions and compulsions were significantly reduced in patients receiving lisdexamfetamine and SGAs, and CBT significantly improved eating-related psychopathology. Body mass index was not reduced in patients receiving SGAs or CBT, but was reduced in those receiving lisdexamfetamine and topiramate, compared with placebo. Symptoms of depression were reduced by SGAs, but not by CBT.
In a related editorial, Dr. Michael J. Devlin of the New York State Psychiatric Institute and Columbia University, New York, praised the review by Dr. Brownley and her associates as an expert summary of the “current evidence on binge-eating disorder.” He went on to make the connection between eating disorders and obesity, and discuss the prospects for interventions.
“The seeds of unhealthy eating that eventually lead to obesity, disordered eating, or both often are sown during childhood or adolescence, and interventions at the community and family levels in the context of enlightened public policy likely would yield significant benefit,” Dr. Devlin wrote. “Only by understanding binge-eating disorder at various levels of analysis and through different professional lenses will we ensure that its life span is shortened, to the benefit of our own.”
Find the full study (doi: 10.7326/M15-2455) and editorial (doi: 10.7326/M16-1398) in the Annals of Internal Medicine.
Cognitive-behavioral therapy, lisdexamfetamine, and second-generation antidepressants are the most effective treatments for adult binge-eating disorder, a systematic review by Kimberly A. Brownley, PhD, and her associates found.
A total of 34 trials were included in the review. Patients who received therapist-led cognitive-behavioral therapy (CBT) achieved binge eating abstinence at a rate of 58.8%, compared with 11.2% of those on a wait list. Just over 40% of patients achieved abstinence on lisdexamfetamine, compared with 14.9% on a placebo, and 39.9% of patients achieved abstinence on second-generation antipsychotics (SGAs), compared with 23.6% on a placebo.
Total eating-related obsessions and compulsions were significantly reduced in patients receiving lisdexamfetamine and SGAs, and CBT significantly improved eating-related psychopathology. Body mass index was not reduced in patients receiving SGAs or CBT, but was reduced in those receiving lisdexamfetamine and topiramate, compared with placebo. Symptoms of depression were reduced by SGAs, but not by CBT.
In a related editorial, Dr. Michael J. Devlin of the New York State Psychiatric Institute and Columbia University, New York, praised the review by Dr. Brownley and her associates as an expert summary of the “current evidence on binge-eating disorder.” He went on to make the connection between eating disorders and obesity, and discuss the prospects for interventions.
“The seeds of unhealthy eating that eventually lead to obesity, disordered eating, or both often are sown during childhood or adolescence, and interventions at the community and family levels in the context of enlightened public policy likely would yield significant benefit,” Dr. Devlin wrote. “Only by understanding binge-eating disorder at various levels of analysis and through different professional lenses will we ensure that its life span is shortened, to the benefit of our own.”
Find the full study (doi: 10.7326/M15-2455) and editorial (doi: 10.7326/M16-1398) in the Annals of Internal Medicine.
FROM THE ANNALS OF INTERNAL MEDICINE
Plant-based therapies reduce some menopause symptoms
Plant-based therapies were associated with “modest reductions” in the frequency of hot flashes and vaginal dryness in menopause, but did not significantly reduce night sweats, according to a systematic review from Dr. Oscar H. Franco and his associates.
A total of 62 studies covering 6,653 women were included in the review. Phytoestrogen use decreased vaginal dryness scores by 0.31 and reduced the number of daily hot flashes by 1.31, but did not reduce the number of night sweats. Individual phytoestrogen interventions, such as dietary and supplementary soy isoflavones, decreased vaginal dryness scores by 0.26 and reduced the number of daily hot flashes by 0.79.
While evidence was limited, Chinese medicinal herbs had no association with a reduction in menopausal symptoms, while non-Chinese medicinal herbs reduced the number of daily hot flashes by 1.62 in one randomized controlled trial.
“This review underscores the lack of data on adverse effects associated with long-term use of plant-based therapies. Information on any detrimental health effects, typically available in long-term intervention studies, is essential, given their potential relevance to postmenopausal health,” Dr. Franco and his colleagues wrote.
Read the full study in JAMA (doi: 10.1001/jama.2016.8012).
Plant-based therapies were associated with “modest reductions” in the frequency of hot flashes and vaginal dryness in menopause, but did not significantly reduce night sweats, according to a systematic review from Dr. Oscar H. Franco and his associates.
A total of 62 studies covering 6,653 women were included in the review. Phytoestrogen use decreased vaginal dryness scores by 0.31 and reduced the number of daily hot flashes by 1.31, but did not reduce the number of night sweats. Individual phytoestrogen interventions, such as dietary and supplementary soy isoflavones, decreased vaginal dryness scores by 0.26 and reduced the number of daily hot flashes by 0.79.
While evidence was limited, Chinese medicinal herbs had no association with a reduction in menopausal symptoms, while non-Chinese medicinal herbs reduced the number of daily hot flashes by 1.62 in one randomized controlled trial.
“This review underscores the lack of data on adverse effects associated with long-term use of plant-based therapies. Information on any detrimental health effects, typically available in long-term intervention studies, is essential, given their potential relevance to postmenopausal health,” Dr. Franco and his colleagues wrote.
Read the full study in JAMA (doi: 10.1001/jama.2016.8012).
Plant-based therapies were associated with “modest reductions” in the frequency of hot flashes and vaginal dryness in menopause, but did not significantly reduce night sweats, according to a systematic review from Dr. Oscar H. Franco and his associates.
A total of 62 studies covering 6,653 women were included in the review. Phytoestrogen use decreased vaginal dryness scores by 0.31 and reduced the number of daily hot flashes by 1.31, but did not reduce the number of night sweats. Individual phytoestrogen interventions, such as dietary and supplementary soy isoflavones, decreased vaginal dryness scores by 0.26 and reduced the number of daily hot flashes by 0.79.
While evidence was limited, Chinese medicinal herbs had no association with a reduction in menopausal symptoms, while non-Chinese medicinal herbs reduced the number of daily hot flashes by 1.62 in one randomized controlled trial.
“This review underscores the lack of data on adverse effects associated with long-term use of plant-based therapies. Information on any detrimental health effects, typically available in long-term intervention studies, is essential, given their potential relevance to postmenopausal health,” Dr. Franco and his colleagues wrote.
Read the full study in JAMA (doi: 10.1001/jama.2016.8012).
FROM JAMA
Cholera vaccine dosing schedule may be suboptimal
A second dose of a bivalent whole-cell (BivWC) oral cholera vaccine – delivered 14 days after the first dose – had little effect on antigen-specific antibody–secreting cell (ASC) responses in a cohort of 21 Haitian adults, suggesting that the current cholera vaccine dosing schedule may not be optimal for boosting immune response.
Immune response to the BivWC vaccine was significant 7 days after the first dose was received. At baseline, the O-specific polysaccharide (OSP)–specific IgA ASC levels for both the Ogawa and Inaba serotypes were near 0. After 7 days, the OSP-specific IgA ASC level for the Ogawa serotype was 6.9 cells per million peripheral blood mononuclear cells and 9.5 cells per million PBMCs for the Inaba serotype. The seroconversion rate was 64% for Ogawa and 73% for Inaba.
A second vaccine dose was administered 14 days after the first dose in accordance with the medication label. However, at the second follow-up – occurring 7 days after the second dose was delivered – OSP-specific IgA ASC levels for both serotypes had fallen back to near baseline levels. Seroconversion did increase slightly for both serotypes, rising to 76% for Ogawa and 81% for Inaba.
“While the 14-day interval may allow for the delivery of two vaccine doses to people during an outbreak as quickly as possible, it is not clear whether this is a sufficient time period to generate sufficient immunologic memory in order to achieve a prime boost effect with the second vaccine dose,” the investigators said.
Read the full study in PLOS Neglected Tropical Diseases (doi:10.1371/journal.pntd.0004753).
A second dose of a bivalent whole-cell (BivWC) oral cholera vaccine – delivered 14 days after the first dose – had little effect on antigen-specific antibody–secreting cell (ASC) responses in a cohort of 21 Haitian adults, suggesting that the current cholera vaccine dosing schedule may not be optimal for boosting immune response.
Immune response to the BivWC vaccine was significant 7 days after the first dose was received. At baseline, the O-specific polysaccharide (OSP)–specific IgA ASC levels for both the Ogawa and Inaba serotypes were near 0. After 7 days, the OSP-specific IgA ASC level for the Ogawa serotype was 6.9 cells per million peripheral blood mononuclear cells and 9.5 cells per million PBMCs for the Inaba serotype. The seroconversion rate was 64% for Ogawa and 73% for Inaba.
A second vaccine dose was administered 14 days after the first dose in accordance with the medication label. However, at the second follow-up – occurring 7 days after the second dose was delivered – OSP-specific IgA ASC levels for both serotypes had fallen back to near baseline levels. Seroconversion did increase slightly for both serotypes, rising to 76% for Ogawa and 81% for Inaba.
“While the 14-day interval may allow for the delivery of two vaccine doses to people during an outbreak as quickly as possible, it is not clear whether this is a sufficient time period to generate sufficient immunologic memory in order to achieve a prime boost effect with the second vaccine dose,” the investigators said.
Read the full study in PLOS Neglected Tropical Diseases (doi:10.1371/journal.pntd.0004753).
A second dose of a bivalent whole-cell (BivWC) oral cholera vaccine – delivered 14 days after the first dose – had little effect on antigen-specific antibody–secreting cell (ASC) responses in a cohort of 21 Haitian adults, suggesting that the current cholera vaccine dosing schedule may not be optimal for boosting immune response.
Immune response to the BivWC vaccine was significant 7 days after the first dose was received. At baseline, the O-specific polysaccharide (OSP)–specific IgA ASC levels for both the Ogawa and Inaba serotypes were near 0. After 7 days, the OSP-specific IgA ASC level for the Ogawa serotype was 6.9 cells per million peripheral blood mononuclear cells and 9.5 cells per million PBMCs for the Inaba serotype. The seroconversion rate was 64% for Ogawa and 73% for Inaba.
A second vaccine dose was administered 14 days after the first dose in accordance with the medication label. However, at the second follow-up – occurring 7 days after the second dose was delivered – OSP-specific IgA ASC levels for both serotypes had fallen back to near baseline levels. Seroconversion did increase slightly for both serotypes, rising to 76% for Ogawa and 81% for Inaba.
“While the 14-day interval may allow for the delivery of two vaccine doses to people during an outbreak as quickly as possible, it is not clear whether this is a sufficient time period to generate sufficient immunologic memory in order to achieve a prime boost effect with the second vaccine dose,” the investigators said.
Read the full study in PLOS Neglected Tropical Diseases (doi:10.1371/journal.pntd.0004753).
FROM PLOS NEGLECTED TROPICAL DISEASES
Long-acting Opioids Increase Cardiovascular Deaths in Noncancer Patients
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
FROM JAMA
Long-acting opioids increase cardiovascular deaths in noncancer patients
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
Long-acting opioids increased the risk of all-cause mortality in patients with chronic noncancer pain, based on 22,912 new episodes of long-acting opioid prescription and an equal number of control prescriptions during an average follow-up of 176 days and 128 days respectively.
In the follow-up period, 185 people given long-acting opioids and 87 in the control group died. The hazard ratio for total mortality in the opioid group was 1.64, according to Wayne Ray, Ph.D., of Vanderbilt University, Nashville, and his associates.
Out-of-hospital deaths accounted for 154 deaths in the opioid group and 60 in the control group, with a hazard ratio of 1.9. The hazard ratio in the opioid group for out-of-hospital deaths other than unintentional overdose was 1.72. Cardiovascular events were the most common cause of death, accounting for 79 deaths in the opioid group and for 53 deaths in the control group. The hazard ratio for cardiovascular death was 1.65.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other nonoverdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the investigators noted.
Find the full study in JAMA (doi: 10.1001/jama.2016.7789).
FROM JAMA
Infants fed with large bottles gain more weight
Infants from low-income families fed with large-size bottles were significantly heavier at age 6 months than infants fed using smaller bottles, according to Dr. Charles Wood of the University of North Carolina at Chapel Hill and his associates.
Of 865 infants, 386 were fed exclusively through bottles; 171 infants were fed using a bottle with a volume greater than 6 ounces, 208 infants were fed using a bottle with a volume less than 6 ounces, and data was missing for the rest of the infants. Infants fed with large bottles were 0.21 kg heavier, had 0.24 units more change in weight-for-age z score, and had 0.31 units more change in weight-for-length z score.
Most of the infants who were exclusively bottle fed were either black or Hispanic, accounting for 41% and 35% of study participants, respectively. More than half of households of bottle-fed infants had an income of less than $20,000 a year, and a similar number of parents had a high school diploma or less. The primary caregiver in most households was the mother, and 86% received assistance from the Special Supplemental Nutrition Program for Women, Infants, and Children.
“Given the complexity of infant growth, future research should consider influences such as feeding practices and should include rigorous measurement of intake and body composition. Nearly all parents use a bottle to feed their infant at some point during their infancy, and further efforts to more completely understand the mechanisms linking bottle-feeding, development of satiety responsiveness, and obesity risk may also inform obesity prevention interventions,” the investigators concluded.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-4538).
Infants from low-income families fed with large-size bottles were significantly heavier at age 6 months than infants fed using smaller bottles, according to Dr. Charles Wood of the University of North Carolina at Chapel Hill and his associates.
Of 865 infants, 386 were fed exclusively through bottles; 171 infants were fed using a bottle with a volume greater than 6 ounces, 208 infants were fed using a bottle with a volume less than 6 ounces, and data was missing for the rest of the infants. Infants fed with large bottles were 0.21 kg heavier, had 0.24 units more change in weight-for-age z score, and had 0.31 units more change in weight-for-length z score.
Most of the infants who were exclusively bottle fed were either black or Hispanic, accounting for 41% and 35% of study participants, respectively. More than half of households of bottle-fed infants had an income of less than $20,000 a year, and a similar number of parents had a high school diploma or less. The primary caregiver in most households was the mother, and 86% received assistance from the Special Supplemental Nutrition Program for Women, Infants, and Children.
“Given the complexity of infant growth, future research should consider influences such as feeding practices and should include rigorous measurement of intake and body composition. Nearly all parents use a bottle to feed their infant at some point during their infancy, and further efforts to more completely understand the mechanisms linking bottle-feeding, development of satiety responsiveness, and obesity risk may also inform obesity prevention interventions,” the investigators concluded.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-4538).
Infants from low-income families fed with large-size bottles were significantly heavier at age 6 months than infants fed using smaller bottles, according to Dr. Charles Wood of the University of North Carolina at Chapel Hill and his associates.
Of 865 infants, 386 were fed exclusively through bottles; 171 infants were fed using a bottle with a volume greater than 6 ounces, 208 infants were fed using a bottle with a volume less than 6 ounces, and data was missing for the rest of the infants. Infants fed with large bottles were 0.21 kg heavier, had 0.24 units more change in weight-for-age z score, and had 0.31 units more change in weight-for-length z score.
Most of the infants who were exclusively bottle fed were either black or Hispanic, accounting for 41% and 35% of study participants, respectively. More than half of households of bottle-fed infants had an income of less than $20,000 a year, and a similar number of parents had a high school diploma or less. The primary caregiver in most households was the mother, and 86% received assistance from the Special Supplemental Nutrition Program for Women, Infants, and Children.
“Given the complexity of infant growth, future research should consider influences such as feeding practices and should include rigorous measurement of intake and body composition. Nearly all parents use a bottle to feed their infant at some point during their infancy, and further efforts to more completely understand the mechanisms linking bottle-feeding, development of satiety responsiveness, and obesity risk may also inform obesity prevention interventions,” the investigators concluded.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-4538).
FROM PEDIATRICS
Behavioral interventions better than sleep education for infants
Graduated extinction and bedtime fading significantly reduced nocturnal wakefulness in infants and maternal stress, according to Michael Gradisar, Ph.D., of Flinders University, Adelaide, South Australia, and his associates.
For the study, a group of 43 infants aged 6-16 months received either graduated extinction, bedtime fading, or sleep education. Compared with the control group of sleep education, sleep latency was significantly decreased in both the graduated extinction and bedtime fading groups. A significant reduction in number of awakenings and wake after sleep onset was seen in the graduated extinction group.
Maternal stress decreased over time in all groups, however, compared with the control group; stress was moderately reduced in the graduated extinction group and was significantly reduced in the bedtime fading group. After 12 months, no significant difference in parent-child attachment was seen between the control and noncontrol groups.
“Our data suggest introducing bedtime fading will provide quick results for improving sleep-onset latency. Graduated extinction may then be introduced to reduce nocturnal wakefulness during the night (if needed). Our data suggest sleep education alone may not be enough to help most families with an infant who has a sleep problem,” the investigators noted.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-1486).
Graduated extinction and bedtime fading significantly reduced nocturnal wakefulness in infants and maternal stress, according to Michael Gradisar, Ph.D., of Flinders University, Adelaide, South Australia, and his associates.
For the study, a group of 43 infants aged 6-16 months received either graduated extinction, bedtime fading, or sleep education. Compared with the control group of sleep education, sleep latency was significantly decreased in both the graduated extinction and bedtime fading groups. A significant reduction in number of awakenings and wake after sleep onset was seen in the graduated extinction group.
Maternal stress decreased over time in all groups, however, compared with the control group; stress was moderately reduced in the graduated extinction group and was significantly reduced in the bedtime fading group. After 12 months, no significant difference in parent-child attachment was seen between the control and noncontrol groups.
“Our data suggest introducing bedtime fading will provide quick results for improving sleep-onset latency. Graduated extinction may then be introduced to reduce nocturnal wakefulness during the night (if needed). Our data suggest sleep education alone may not be enough to help most families with an infant who has a sleep problem,” the investigators noted.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-1486).
Graduated extinction and bedtime fading significantly reduced nocturnal wakefulness in infants and maternal stress, according to Michael Gradisar, Ph.D., of Flinders University, Adelaide, South Australia, and his associates.
For the study, a group of 43 infants aged 6-16 months received either graduated extinction, bedtime fading, or sleep education. Compared with the control group of sleep education, sleep latency was significantly decreased in both the graduated extinction and bedtime fading groups. A significant reduction in number of awakenings and wake after sleep onset was seen in the graduated extinction group.
Maternal stress decreased over time in all groups, however, compared with the control group; stress was moderately reduced in the graduated extinction group and was significantly reduced in the bedtime fading group. After 12 months, no significant difference in parent-child attachment was seen between the control and noncontrol groups.
“Our data suggest introducing bedtime fading will provide quick results for improving sleep-onset latency. Graduated extinction may then be introduced to reduce nocturnal wakefulness during the night (if needed). Our data suggest sleep education alone may not be enough to help most families with an infant who has a sleep problem,” the investigators noted.
Find the full study in Pediatrics (doi: 10.1542/peds.2015-1486).
FROM PEDIATRICS
Binge-eating disorder more common than thought, rarely diagnosed
Binge-eating disorder is significantly more common using DSM-5 criteria than previously estimated, but the disorder is very rarely formally diagnosed, according to Nicole Cossrow, Ph.D., and her associates.
In a survey of 22,397 respondents of the 2012 and 2013 National Health and Wellness Survey, 344 people had symptoms matching binge-eating disorder (BED) criteria in the DSM-5. Women accounted for just over 70% of BED cases. Compared with non-BED respondents, respondents with BED were more likely to be younger, have a high body mass index, and have lower self-esteem as assessed by the Rosenberg Self-Esteem Scale, the investigators reported.
The 12-month BED prevalence rate in the U.S. population using DSM-5 criteria is 1.64%, compared with the 1.15% estimated by the DSM-IV-TR. Of the 344 respondents who met the DSM-5 criteria for BED in the past 12 months, only 11 had been diagnosed with BED.
The low rate of BED diagnosis “may be due to the fact that BED was not a distinct disorder in DSM-IV-TR and would have been diagnosed as eating disorder not otherwise specified. Nonetheless, this low diagnosis rate emphasizes the need to improve awareness and recognition of BED among patients and health care providers,” Dr. Cossrow and her associates noted.
Find the full study in the Journal of Clinical Psychiatry (doi: 10.4088/JCP.15m10059).
Binge-eating disorder is significantly more common using DSM-5 criteria than previously estimated, but the disorder is very rarely formally diagnosed, according to Nicole Cossrow, Ph.D., and her associates.
In a survey of 22,397 respondents of the 2012 and 2013 National Health and Wellness Survey, 344 people had symptoms matching binge-eating disorder (BED) criteria in the DSM-5. Women accounted for just over 70% of BED cases. Compared with non-BED respondents, respondents with BED were more likely to be younger, have a high body mass index, and have lower self-esteem as assessed by the Rosenberg Self-Esteem Scale, the investigators reported.
The 12-month BED prevalence rate in the U.S. population using DSM-5 criteria is 1.64%, compared with the 1.15% estimated by the DSM-IV-TR. Of the 344 respondents who met the DSM-5 criteria for BED in the past 12 months, only 11 had been diagnosed with BED.
The low rate of BED diagnosis “may be due to the fact that BED was not a distinct disorder in DSM-IV-TR and would have been diagnosed as eating disorder not otherwise specified. Nonetheless, this low diagnosis rate emphasizes the need to improve awareness and recognition of BED among patients and health care providers,” Dr. Cossrow and her associates noted.
Find the full study in the Journal of Clinical Psychiatry (doi: 10.4088/JCP.15m10059).
Binge-eating disorder is significantly more common using DSM-5 criteria than previously estimated, but the disorder is very rarely formally diagnosed, according to Nicole Cossrow, Ph.D., and her associates.
In a survey of 22,397 respondents of the 2012 and 2013 National Health and Wellness Survey, 344 people had symptoms matching binge-eating disorder (BED) criteria in the DSM-5. Women accounted for just over 70% of BED cases. Compared with non-BED respondents, respondents with BED were more likely to be younger, have a high body mass index, and have lower self-esteem as assessed by the Rosenberg Self-Esteem Scale, the investigators reported.
The 12-month BED prevalence rate in the U.S. population using DSM-5 criteria is 1.64%, compared with the 1.15% estimated by the DSM-IV-TR. Of the 344 respondents who met the DSM-5 criteria for BED in the past 12 months, only 11 had been diagnosed with BED.
The low rate of BED diagnosis “may be due to the fact that BED was not a distinct disorder in DSM-IV-TR and would have been diagnosed as eating disorder not otherwise specified. Nonetheless, this low diagnosis rate emphasizes the need to improve awareness and recognition of BED among patients and health care providers,” Dr. Cossrow and her associates noted.
Find the full study in the Journal of Clinical Psychiatry (doi: 10.4088/JCP.15m10059).
FROM THE JOURNAL OF CLINICAL PSYCHIATRY