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Vocacapsaicin Could Lessen Pain, Opioid Use Post Surgery
TOPLINE:
Compared with placebo, administration of vocacapsaicin during bunionectomy reduces pain and decreases opioid consumption in the first 96 hours after surgery, with no local or systemic toxicity.
METHODOLOGY:
- This triple-blind, randomized, placebo-controlled trial included 147 patients undergoing bunionectomy.
- Patients were randomly assigned to receive 14 mL of either 0.05 mg/mL vocacapsaicin, 0.15 mg/mL vocacapsaicin, 0.30 mg/mL vocacapsaicin, or placebo at the surgical site during wound closure. Except for the study drug, all patients received identical perioperative analgesics.
- Patients were observed for 96 hours post-surgery, with follow-up visits on days 8, 15, and 29 to monitor for pain and adverse events.
- The primary endpoint was overall levels of pain at rest through the first 96 hours after surgery for the 0.30-mg/mL vocacapsaicin group.
- The secondary endpoints included the percentage of patients who did not require opioids and total opioid consumption through 96 hours, as well as pain scores during the first postoperative week.
TAKEAWAY:
- Vocacapsaicin (0.30 mg/mL) reduced pain at rest by 33% over the first 96 hours, compared with placebo (P = .005).
- Overall, 26% of patients who received the 0.30-mg/mL dose of vocacapsaicin did not require opioids through 96 hours compared with 5% of patients receiving placebo (P = .025).
- The researchers reported no difference in the rate, type, or severity of adverse events in the four study groups, consistent with typical recovery from bunionectomy.
IN PRACTICE:
“These data suggest that intraoperative administration of vocacapsaicin may provide substantial benefits in other surgical procedures,” the authors wrote.
SOURCE:
The study was led by Steven L. Shafer, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University in Stanford, California, and published in the June 2024 issue of Anesthesiology.
LIMITATIONS:
The use of opioids was restricted from 0 to 96 hours after surgery, which did not reflect typical clinical practice. The range of vocacapsaicin concentrations tested may not have been extensive enough, as concentrations > 0.30 mg/mL might have provided better analgesia.
DISCLOSURES:
The study was supported by Concentric Analgesics. Two authors declared being employed by Concentric Analgesics. Other authors declared having several ties with many sources, including the funding agency.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
TOPLINE:
Compared with placebo, administration of vocacapsaicin during bunionectomy reduces pain and decreases opioid consumption in the first 96 hours after surgery, with no local or systemic toxicity.
METHODOLOGY:
- This triple-blind, randomized, placebo-controlled trial included 147 patients undergoing bunionectomy.
- Patients were randomly assigned to receive 14 mL of either 0.05 mg/mL vocacapsaicin, 0.15 mg/mL vocacapsaicin, 0.30 mg/mL vocacapsaicin, or placebo at the surgical site during wound closure. Except for the study drug, all patients received identical perioperative analgesics.
- Patients were observed for 96 hours post-surgery, with follow-up visits on days 8, 15, and 29 to monitor for pain and adverse events.
- The primary endpoint was overall levels of pain at rest through the first 96 hours after surgery for the 0.30-mg/mL vocacapsaicin group.
- The secondary endpoints included the percentage of patients who did not require opioids and total opioid consumption through 96 hours, as well as pain scores during the first postoperative week.
TAKEAWAY:
- Vocacapsaicin (0.30 mg/mL) reduced pain at rest by 33% over the first 96 hours, compared with placebo (P = .005).
- Overall, 26% of patients who received the 0.30-mg/mL dose of vocacapsaicin did not require opioids through 96 hours compared with 5% of patients receiving placebo (P = .025).
- The researchers reported no difference in the rate, type, or severity of adverse events in the four study groups, consistent with typical recovery from bunionectomy.
IN PRACTICE:
“These data suggest that intraoperative administration of vocacapsaicin may provide substantial benefits in other surgical procedures,” the authors wrote.
SOURCE:
The study was led by Steven L. Shafer, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University in Stanford, California, and published in the June 2024 issue of Anesthesiology.
LIMITATIONS:
The use of opioids was restricted from 0 to 96 hours after surgery, which did not reflect typical clinical practice. The range of vocacapsaicin concentrations tested may not have been extensive enough, as concentrations > 0.30 mg/mL might have provided better analgesia.
DISCLOSURES:
The study was supported by Concentric Analgesics. Two authors declared being employed by Concentric Analgesics. Other authors declared having several ties with many sources, including the funding agency.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
TOPLINE:
Compared with placebo, administration of vocacapsaicin during bunionectomy reduces pain and decreases opioid consumption in the first 96 hours after surgery, with no local or systemic toxicity.
METHODOLOGY:
- This triple-blind, randomized, placebo-controlled trial included 147 patients undergoing bunionectomy.
- Patients were randomly assigned to receive 14 mL of either 0.05 mg/mL vocacapsaicin, 0.15 mg/mL vocacapsaicin, 0.30 mg/mL vocacapsaicin, or placebo at the surgical site during wound closure. Except for the study drug, all patients received identical perioperative analgesics.
- Patients were observed for 96 hours post-surgery, with follow-up visits on days 8, 15, and 29 to monitor for pain and adverse events.
- The primary endpoint was overall levels of pain at rest through the first 96 hours after surgery for the 0.30-mg/mL vocacapsaicin group.
- The secondary endpoints included the percentage of patients who did not require opioids and total opioid consumption through 96 hours, as well as pain scores during the first postoperative week.
TAKEAWAY:
- Vocacapsaicin (0.30 mg/mL) reduced pain at rest by 33% over the first 96 hours, compared with placebo (P = .005).
- Overall, 26% of patients who received the 0.30-mg/mL dose of vocacapsaicin did not require opioids through 96 hours compared with 5% of patients receiving placebo (P = .025).
- The researchers reported no difference in the rate, type, or severity of adverse events in the four study groups, consistent with typical recovery from bunionectomy.
IN PRACTICE:
“These data suggest that intraoperative administration of vocacapsaicin may provide substantial benefits in other surgical procedures,” the authors wrote.
SOURCE:
The study was led by Steven L. Shafer, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University in Stanford, California, and published in the June 2024 issue of Anesthesiology.
LIMITATIONS:
The use of opioids was restricted from 0 to 96 hours after surgery, which did not reflect typical clinical practice. The range of vocacapsaicin concentrations tested may not have been extensive enough, as concentrations > 0.30 mg/mL might have provided better analgesia.
DISCLOSURES:
The study was supported by Concentric Analgesics. Two authors declared being employed by Concentric Analgesics. Other authors declared having several ties with many sources, including the funding agency.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
Quitting Smoking Boosts Life Expectancy at Any Age
TOPLINE:
Quitting smoking at any age increases life expectancy, with the most significant increases observed in younger individuals. But people who quit over age 65 can extend life expectancy.
METHODOLOGY:
- Researchers analyzed the detrimental effects of smoking and the positive impacts of cessation on life expectancy in individuals aged 35-75 years.
- Age-specific death rates by smoking status were calculated using the relative risks for all-cause mortality derived from the Cancer Prevention Study II data, 2018 National Health Interview Survey smoking prevalence data, and 2018 all-cause mortality rates.
- Life tables were constructed to obtain information on the life expectancies of people who never smoked, those who currently smoked, and those who previously smoked but quit at various ages.
- Estimates of years lost due to smoking and years gained by quitting smoking were calculated for people starting at age 35 and over 10-year increments.
TAKEAWAY:
- Compared with people who never smoked, those who smoked at ages 35, 45, 55, 65, and 75 years and continued smoking throughout their lives would lose 9.1, 8.3, 7.3, 5.9, and 4.4 years, respectively.
- People who quit smoking at ages 35, 45, 55, 65, and 75 years would have life expectancies that are shorter by 1.2, 2.7, 3.9, 4.2, and 3.7 years, respectively, than those of same-age individuals who never smoked.
- Individuals who quit smoking at ages 35, 45, 55, 65, and 75 years would experience an additional 8.0, 5.6, 3.4, 1.7, and 0.7 years of life expectancy compared with those who continued smoking.
- People who quit at ages 65 and 75 years would have a 23.4% and 14.2% chance of gaining at least 1 additional year of life.
IN PRACTICE:
“This cessation benefit is not limited to young- and middle-aged adults who smoke; this study demonstrates its applicability to seniors as well. These findings may be valuable for clinicians seeking scientific evidence to motivate their patients who smoke to quit,” the authors wrote.
SOURCE:
The study was led by Thuy T.T. Le, PhD, from the Department of Health Management and Policy at the University of Michigan School of Public Health in Ann Arbor and published online in the American Journal of Preventive Medicine.
LIMITATIONS:
The study’s estimates were according to data from 2018 and may not reflect current trends. The estimates also did not account for variability in smoking intensity among individuals.
DISCLOSURES:
The study was supported by grants from the National Cancer Institute of the US National Institutes of Health and the US Food and Drug Administration Center for Tobacco Products. The authors declared that they had no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Quitting smoking at any age increases life expectancy, with the most significant increases observed in younger individuals. But people who quit over age 65 can extend life expectancy.
METHODOLOGY:
- Researchers analyzed the detrimental effects of smoking and the positive impacts of cessation on life expectancy in individuals aged 35-75 years.
- Age-specific death rates by smoking status were calculated using the relative risks for all-cause mortality derived from the Cancer Prevention Study II data, 2018 National Health Interview Survey smoking prevalence data, and 2018 all-cause mortality rates.
- Life tables were constructed to obtain information on the life expectancies of people who never smoked, those who currently smoked, and those who previously smoked but quit at various ages.
- Estimates of years lost due to smoking and years gained by quitting smoking were calculated for people starting at age 35 and over 10-year increments.
TAKEAWAY:
- Compared with people who never smoked, those who smoked at ages 35, 45, 55, 65, and 75 years and continued smoking throughout their lives would lose 9.1, 8.3, 7.3, 5.9, and 4.4 years, respectively.
- People who quit smoking at ages 35, 45, 55, 65, and 75 years would have life expectancies that are shorter by 1.2, 2.7, 3.9, 4.2, and 3.7 years, respectively, than those of same-age individuals who never smoked.
- Individuals who quit smoking at ages 35, 45, 55, 65, and 75 years would experience an additional 8.0, 5.6, 3.4, 1.7, and 0.7 years of life expectancy compared with those who continued smoking.
- People who quit at ages 65 and 75 years would have a 23.4% and 14.2% chance of gaining at least 1 additional year of life.
IN PRACTICE:
“This cessation benefit is not limited to young- and middle-aged adults who smoke; this study demonstrates its applicability to seniors as well. These findings may be valuable for clinicians seeking scientific evidence to motivate their patients who smoke to quit,” the authors wrote.
SOURCE:
The study was led by Thuy T.T. Le, PhD, from the Department of Health Management and Policy at the University of Michigan School of Public Health in Ann Arbor and published online in the American Journal of Preventive Medicine.
LIMITATIONS:
The study’s estimates were according to data from 2018 and may not reflect current trends. The estimates also did not account for variability in smoking intensity among individuals.
DISCLOSURES:
The study was supported by grants from the National Cancer Institute of the US National Institutes of Health and the US Food and Drug Administration Center for Tobacco Products. The authors declared that they had no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Quitting smoking at any age increases life expectancy, with the most significant increases observed in younger individuals. But people who quit over age 65 can extend life expectancy.
METHODOLOGY:
- Researchers analyzed the detrimental effects of smoking and the positive impacts of cessation on life expectancy in individuals aged 35-75 years.
- Age-specific death rates by smoking status were calculated using the relative risks for all-cause mortality derived from the Cancer Prevention Study II data, 2018 National Health Interview Survey smoking prevalence data, and 2018 all-cause mortality rates.
- Life tables were constructed to obtain information on the life expectancies of people who never smoked, those who currently smoked, and those who previously smoked but quit at various ages.
- Estimates of years lost due to smoking and years gained by quitting smoking were calculated for people starting at age 35 and over 10-year increments.
TAKEAWAY:
- Compared with people who never smoked, those who smoked at ages 35, 45, 55, 65, and 75 years and continued smoking throughout their lives would lose 9.1, 8.3, 7.3, 5.9, and 4.4 years, respectively.
- People who quit smoking at ages 35, 45, 55, 65, and 75 years would have life expectancies that are shorter by 1.2, 2.7, 3.9, 4.2, and 3.7 years, respectively, than those of same-age individuals who never smoked.
- Individuals who quit smoking at ages 35, 45, 55, 65, and 75 years would experience an additional 8.0, 5.6, 3.4, 1.7, and 0.7 years of life expectancy compared with those who continued smoking.
- People who quit at ages 65 and 75 years would have a 23.4% and 14.2% chance of gaining at least 1 additional year of life.
IN PRACTICE:
“This cessation benefit is not limited to young- and middle-aged adults who smoke; this study demonstrates its applicability to seniors as well. These findings may be valuable for clinicians seeking scientific evidence to motivate their patients who smoke to quit,” the authors wrote.
SOURCE:
The study was led by Thuy T.T. Le, PhD, from the Department of Health Management and Policy at the University of Michigan School of Public Health in Ann Arbor and published online in the American Journal of Preventive Medicine.
LIMITATIONS:
The study’s estimates were according to data from 2018 and may not reflect current trends. The estimates also did not account for variability in smoking intensity among individuals.
DISCLOSURES:
The study was supported by grants from the National Cancer Institute of the US National Institutes of Health and the US Food and Drug Administration Center for Tobacco Products. The authors declared that they had no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Sustained Low Lupus Disease Activity May Give Lower Risk for Flares, Organ Damage
TOPLINE:
A threshold of sustained lupus low disease activity state (LLDAS) or remission for 3 months significantly reduces the risk for damage accrual and flares in patients with systemic lupus erythematosus (SLE), with longer durations offering even greater protection.
METHODOLOGY:
- This large, prospective, multicenter study aimed to quantify the impact of sustained LLDAS on irreversible damage and flares.
- It included 3449 patients (age, ≥ 18 years; 92.2% women) with SLE from 25 centers across 12 countries, analyzing a total of 37,662 visits.
- Sustained LLDAS or remission was defined as at least two consecutive visits over > 3 months in the respective state.
- The primary outcome measured was the accrual of irreversible organ damage, with flares as a key secondary outcome.
TAKEAWAY:
- During a median follow-up of 2.8 years, 80.2% of patients achieved LLDAS at least once, with 72.7% experiencing at least one episode of sustained LLDAS.
- Sustained LLDAS for > 3 months was linked to a reduced risk for damage accrual (hazard ratio [HR], 0.60; P < .0001).
- Protection from flares also increased with all durations of sustained LLDAS > 3 months (> 3 months: HR, 0.56; P < .0001; > 36 months: HR, 0.17; P < .0001).
- Longer periods of sustained LLDAS or remission were associated with significantly higher degrees of protection.
IN PRACTICE:
“These findings support the use of these treat-to-target endpoints in clinical practice and provide a practical target to aim for in SLE treatment,” the authors wrote.
SOURCE:
The study was led by Vera Golder, MBBS, Monash University, Clayton, Australia. It was published online in The Lancet Rheumatology.
LIMITATIONS:
While the study’s large scale and multinational cohort provided robust data, its observational design limited the ability to establish causality. The predominance of Asian ethnicity among the participants may have affected the generalizability of the findings to other populations. Additionally, the median follow-up duration of 2.8 years might not have captured long-term outcomes.
DISCLOSURES:
Some authors declared receiving grants, consulting fees, payments, and honoraria and having other ties with various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
TOPLINE:
A threshold of sustained lupus low disease activity state (LLDAS) or remission for 3 months significantly reduces the risk for damage accrual and flares in patients with systemic lupus erythematosus (SLE), with longer durations offering even greater protection.
METHODOLOGY:
- This large, prospective, multicenter study aimed to quantify the impact of sustained LLDAS on irreversible damage and flares.
- It included 3449 patients (age, ≥ 18 years; 92.2% women) with SLE from 25 centers across 12 countries, analyzing a total of 37,662 visits.
- Sustained LLDAS or remission was defined as at least two consecutive visits over > 3 months in the respective state.
- The primary outcome measured was the accrual of irreversible organ damage, with flares as a key secondary outcome.
TAKEAWAY:
- During a median follow-up of 2.8 years, 80.2% of patients achieved LLDAS at least once, with 72.7% experiencing at least one episode of sustained LLDAS.
- Sustained LLDAS for > 3 months was linked to a reduced risk for damage accrual (hazard ratio [HR], 0.60; P < .0001).
- Protection from flares also increased with all durations of sustained LLDAS > 3 months (> 3 months: HR, 0.56; P < .0001; > 36 months: HR, 0.17; P < .0001).
- Longer periods of sustained LLDAS or remission were associated with significantly higher degrees of protection.
IN PRACTICE:
“These findings support the use of these treat-to-target endpoints in clinical practice and provide a practical target to aim for in SLE treatment,” the authors wrote.
SOURCE:
The study was led by Vera Golder, MBBS, Monash University, Clayton, Australia. It was published online in The Lancet Rheumatology.
LIMITATIONS:
While the study’s large scale and multinational cohort provided robust data, its observational design limited the ability to establish causality. The predominance of Asian ethnicity among the participants may have affected the generalizability of the findings to other populations. Additionally, the median follow-up duration of 2.8 years might not have captured long-term outcomes.
DISCLOSURES:
Some authors declared receiving grants, consulting fees, payments, and honoraria and having other ties with various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
TOPLINE:
A threshold of sustained lupus low disease activity state (LLDAS) or remission for 3 months significantly reduces the risk for damage accrual and flares in patients with systemic lupus erythematosus (SLE), with longer durations offering even greater protection.
METHODOLOGY:
- This large, prospective, multicenter study aimed to quantify the impact of sustained LLDAS on irreversible damage and flares.
- It included 3449 patients (age, ≥ 18 years; 92.2% women) with SLE from 25 centers across 12 countries, analyzing a total of 37,662 visits.
- Sustained LLDAS or remission was defined as at least two consecutive visits over > 3 months in the respective state.
- The primary outcome measured was the accrual of irreversible organ damage, with flares as a key secondary outcome.
TAKEAWAY:
- During a median follow-up of 2.8 years, 80.2% of patients achieved LLDAS at least once, with 72.7% experiencing at least one episode of sustained LLDAS.
- Sustained LLDAS for > 3 months was linked to a reduced risk for damage accrual (hazard ratio [HR], 0.60; P < .0001).
- Protection from flares also increased with all durations of sustained LLDAS > 3 months (> 3 months: HR, 0.56; P < .0001; > 36 months: HR, 0.17; P < .0001).
- Longer periods of sustained LLDAS or remission were associated with significantly higher degrees of protection.
IN PRACTICE:
“These findings support the use of these treat-to-target endpoints in clinical practice and provide a practical target to aim for in SLE treatment,” the authors wrote.
SOURCE:
The study was led by Vera Golder, MBBS, Monash University, Clayton, Australia. It was published online in The Lancet Rheumatology.
LIMITATIONS:
While the study’s large scale and multinational cohort provided robust data, its observational design limited the ability to establish causality. The predominance of Asian ethnicity among the participants may have affected the generalizability of the findings to other populations. Additionally, the median follow-up duration of 2.8 years might not have captured long-term outcomes.
DISCLOSURES:
Some authors declared receiving grants, consulting fees, payments, and honoraria and having other ties with various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article appeared on Medscape.com.
Functional Limitations in Axial Spondyloarthritis Benefit From Long-term Exercise Therapy
TOPLINE:
Long-term, supervised exercise therapy significantly improves the functional ability and quality of life in patients with axial spondyloarthritis (axSpA) and severe functional limitations.
METHODOLOGY:
- This 52-week study evaluated the effectiveness of personalized exercise therapy in adults with axSpA and severe functional limitations.
- Overall, 214 participants were randomly allocated to either a personalized exercise therapy regimen or usual care for 52 weeks.
- The supervised exercise therapy regimen consisted of various exercises, patient education, goal setting, and physical activity promotion for up to 64 sessions.
- The primary endpoint was a change in the highest-ranked Patient-Specific Complaints Numeric Rating Scale (PSC1) score at 52 weeks, and secondary endpoints included measures of physical functioning and quality of life.
TAKEAWAY:
- At 52 weeks, the exercise group showed a greater improvement in the primary outcome measure (PSC1) than the usual-care group, with a mean difference of −1.8 (95% CI, −2.4 to −1.2).
- Exercise therapy led to significant improvements in functional disability and physical quality of life.
- No serious adverse events related to the intervention were reported, highlighting the safety of exercise therapy.
IN PRACTICE:
“If guided by a trained physical therapist applying a personalized approach, people with severe functional limitations due to an unfavorable course or comorbidities can be just as responsive to training as people with axSpA without severe limitations,” the authors wrote.
SOURCE:
The study was led by Maria A.T. van Wissen, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands, and published online in Rheumatology.
LIMITATIONS:
The study’s reliance on self-reported data for axSpA treatment-related medication may have compromised accuracy. Additionally, the lack of information on medication changes during the study period could affect result interpretation.
DISCLOSURES:
The study was supported by grants from the Netherlands Organization for Health Research and Development; Ministry of Health, Welfare and Sport; Royal Dutch Society for Physical Therapy; and Dutch Arthritis Society. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Long-term, supervised exercise therapy significantly improves the functional ability and quality of life in patients with axial spondyloarthritis (axSpA) and severe functional limitations.
METHODOLOGY:
- This 52-week study evaluated the effectiveness of personalized exercise therapy in adults with axSpA and severe functional limitations.
- Overall, 214 participants were randomly allocated to either a personalized exercise therapy regimen or usual care for 52 weeks.
- The supervised exercise therapy regimen consisted of various exercises, patient education, goal setting, and physical activity promotion for up to 64 sessions.
- The primary endpoint was a change in the highest-ranked Patient-Specific Complaints Numeric Rating Scale (PSC1) score at 52 weeks, and secondary endpoints included measures of physical functioning and quality of life.
TAKEAWAY:
- At 52 weeks, the exercise group showed a greater improvement in the primary outcome measure (PSC1) than the usual-care group, with a mean difference of −1.8 (95% CI, −2.4 to −1.2).
- Exercise therapy led to significant improvements in functional disability and physical quality of life.
- No serious adverse events related to the intervention were reported, highlighting the safety of exercise therapy.
IN PRACTICE:
“If guided by a trained physical therapist applying a personalized approach, people with severe functional limitations due to an unfavorable course or comorbidities can be just as responsive to training as people with axSpA without severe limitations,” the authors wrote.
SOURCE:
The study was led by Maria A.T. van Wissen, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands, and published online in Rheumatology.
LIMITATIONS:
The study’s reliance on self-reported data for axSpA treatment-related medication may have compromised accuracy. Additionally, the lack of information on medication changes during the study period could affect result interpretation.
DISCLOSURES:
The study was supported by grants from the Netherlands Organization for Health Research and Development; Ministry of Health, Welfare and Sport; Royal Dutch Society for Physical Therapy; and Dutch Arthritis Society. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Long-term, supervised exercise therapy significantly improves the functional ability and quality of life in patients with axial spondyloarthritis (axSpA) and severe functional limitations.
METHODOLOGY:
- This 52-week study evaluated the effectiveness of personalized exercise therapy in adults with axSpA and severe functional limitations.
- Overall, 214 participants were randomly allocated to either a personalized exercise therapy regimen or usual care for 52 weeks.
- The supervised exercise therapy regimen consisted of various exercises, patient education, goal setting, and physical activity promotion for up to 64 sessions.
- The primary endpoint was a change in the highest-ranked Patient-Specific Complaints Numeric Rating Scale (PSC1) score at 52 weeks, and secondary endpoints included measures of physical functioning and quality of life.
TAKEAWAY:
- At 52 weeks, the exercise group showed a greater improvement in the primary outcome measure (PSC1) than the usual-care group, with a mean difference of −1.8 (95% CI, −2.4 to −1.2).
- Exercise therapy led to significant improvements in functional disability and physical quality of life.
- No serious adverse events related to the intervention were reported, highlighting the safety of exercise therapy.
IN PRACTICE:
“If guided by a trained physical therapist applying a personalized approach, people with severe functional limitations due to an unfavorable course or comorbidities can be just as responsive to training as people with axSpA without severe limitations,” the authors wrote.
SOURCE:
The study was led by Maria A.T. van Wissen, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands, and published online in Rheumatology.
LIMITATIONS:
The study’s reliance on self-reported data for axSpA treatment-related medication may have compromised accuracy. Additionally, the lack of information on medication changes during the study period could affect result interpretation.
DISCLOSURES:
The study was supported by grants from the Netherlands Organization for Health Research and Development; Ministry of Health, Welfare and Sport; Royal Dutch Society for Physical Therapy; and Dutch Arthritis Society. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Urticaria Linked to Higher Cancer Risk, Study Finds
TOPLINE:
which decreased to 6% in subsequent years, in a cohort study using Danish healthcare databases.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using data from Danish healthcare registries and compared the incident cancer risk between patients with urticaria and the risk in the general population.
- They identified 87,507 patients (58% women) with a primary or secondary first-time hospital outpatient clinic, emergency room, or inpatient diagnosis of urticaria between 1980 and 2022, who were followed for a median of 10.1 years.
- Incident cancers, including nonmelanoma skin cancer, were identified using the Danish Cancer Registry and classified by the extent of spread at the time of diagnosis.
- This study computed the absolute cancer risk within the first year of an urticaria diagnosis and standardized incidence ratios (SIRs), with 95% CIs standardized to Danish national cancer rates.
TAKEAWAY:
- For the first year of follow-up, the absolute risk for all cancer types was 0.7%, and it was 29.5% for subsequent years. The overall SIR for all types of cancer was 1.09 (95% CI, 1.06-1.11), which was based on 7788 observed cancer cases compared with 7161 cases expected over the entire follow-up period.
- Within the first year of follow-up, 588 patients with urticaria were diagnosed with cancer, for an SIR of 1.49 (95% CI, 1.38-1.62) for all cancer types.
- After the first year, the SIR for all cancer sites decreased and stabilized at 1.06 (95% CI, 1.04-1.09), with 7200 observed cancer cases.
- The risk was highest for hematological cancers in the first year, particularly Hodgkin lymphoma (SIR, 5.35; 95% CI, 2.56-9.85).
IN PRACTICE:
“Our study suggests that urticaria may be a marker of occult cancer and that it is associated with a slightly increased long-term cancer risk,” the authors wrote.
SOURCE:
The study was led by Sissel B.T. Sørensen, departments of dermatology and rheumatology, Aarhus University Hospital, Aarhus, Denmark. It was published online on June 27, 2024, in the British Journal of Dermatology.
LIMITATIONS:
The study is limited by its observational design and reliance on registry data, which may be subject to misclassification or incomplete information. In addition, the study could not assess individual patient factors such as lifestyle or genetic predispositions that may influence cancer risk, and the results may not be generalizable to other populations. Finally, the exact biologic mechanisms linking urticaria and cancer remain unclear, warranting further investigation.
DISCLOSURES:
The study did not receive any funding. The authors reported that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
which decreased to 6% in subsequent years, in a cohort study using Danish healthcare databases.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using data from Danish healthcare registries and compared the incident cancer risk between patients with urticaria and the risk in the general population.
- They identified 87,507 patients (58% women) with a primary or secondary first-time hospital outpatient clinic, emergency room, or inpatient diagnosis of urticaria between 1980 and 2022, who were followed for a median of 10.1 years.
- Incident cancers, including nonmelanoma skin cancer, were identified using the Danish Cancer Registry and classified by the extent of spread at the time of diagnosis.
- This study computed the absolute cancer risk within the first year of an urticaria diagnosis and standardized incidence ratios (SIRs), with 95% CIs standardized to Danish national cancer rates.
TAKEAWAY:
- For the first year of follow-up, the absolute risk for all cancer types was 0.7%, and it was 29.5% for subsequent years. The overall SIR for all types of cancer was 1.09 (95% CI, 1.06-1.11), which was based on 7788 observed cancer cases compared with 7161 cases expected over the entire follow-up period.
- Within the first year of follow-up, 588 patients with urticaria were diagnosed with cancer, for an SIR of 1.49 (95% CI, 1.38-1.62) for all cancer types.
- After the first year, the SIR for all cancer sites decreased and stabilized at 1.06 (95% CI, 1.04-1.09), with 7200 observed cancer cases.
- The risk was highest for hematological cancers in the first year, particularly Hodgkin lymphoma (SIR, 5.35; 95% CI, 2.56-9.85).
IN PRACTICE:
“Our study suggests that urticaria may be a marker of occult cancer and that it is associated with a slightly increased long-term cancer risk,” the authors wrote.
SOURCE:
The study was led by Sissel B.T. Sørensen, departments of dermatology and rheumatology, Aarhus University Hospital, Aarhus, Denmark. It was published online on June 27, 2024, in the British Journal of Dermatology.
LIMITATIONS:
The study is limited by its observational design and reliance on registry data, which may be subject to misclassification or incomplete information. In addition, the study could not assess individual patient factors such as lifestyle or genetic predispositions that may influence cancer risk, and the results may not be generalizable to other populations. Finally, the exact biologic mechanisms linking urticaria and cancer remain unclear, warranting further investigation.
DISCLOSURES:
The study did not receive any funding. The authors reported that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
which decreased to 6% in subsequent years, in a cohort study using Danish healthcare databases.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using data from Danish healthcare registries and compared the incident cancer risk between patients with urticaria and the risk in the general population.
- They identified 87,507 patients (58% women) with a primary or secondary first-time hospital outpatient clinic, emergency room, or inpatient diagnosis of urticaria between 1980 and 2022, who were followed for a median of 10.1 years.
- Incident cancers, including nonmelanoma skin cancer, were identified using the Danish Cancer Registry and classified by the extent of spread at the time of diagnosis.
- This study computed the absolute cancer risk within the first year of an urticaria diagnosis and standardized incidence ratios (SIRs), with 95% CIs standardized to Danish national cancer rates.
TAKEAWAY:
- For the first year of follow-up, the absolute risk for all cancer types was 0.7%, and it was 29.5% for subsequent years. The overall SIR for all types of cancer was 1.09 (95% CI, 1.06-1.11), which was based on 7788 observed cancer cases compared with 7161 cases expected over the entire follow-up period.
- Within the first year of follow-up, 588 patients with urticaria were diagnosed with cancer, for an SIR of 1.49 (95% CI, 1.38-1.62) for all cancer types.
- After the first year, the SIR for all cancer sites decreased and stabilized at 1.06 (95% CI, 1.04-1.09), with 7200 observed cancer cases.
- The risk was highest for hematological cancers in the first year, particularly Hodgkin lymphoma (SIR, 5.35; 95% CI, 2.56-9.85).
IN PRACTICE:
“Our study suggests that urticaria may be a marker of occult cancer and that it is associated with a slightly increased long-term cancer risk,” the authors wrote.
SOURCE:
The study was led by Sissel B.T. Sørensen, departments of dermatology and rheumatology, Aarhus University Hospital, Aarhus, Denmark. It was published online on June 27, 2024, in the British Journal of Dermatology.
LIMITATIONS:
The study is limited by its observational design and reliance on registry data, which may be subject to misclassification or incomplete information. In addition, the study could not assess individual patient factors such as lifestyle or genetic predispositions that may influence cancer risk, and the results may not be generalizable to other populations. Finally, the exact biologic mechanisms linking urticaria and cancer remain unclear, warranting further investigation.
DISCLOSURES:
The study did not receive any funding. The authors reported that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Reducing Unnecessary Antibiotics for Conjunctivitis
TOPLINE:
More than two thirds of children with conjunctivitis received antibiotics within a day of their initial ambulatory care visit; however,
METHODOLOGY:
- Researchers evaluated the frequency of topical antibiotic treatment and its association with subsequent health care use among commercially insured children with acute infectious conjunctivitis in the United States.
- This cohort study analyzed data from the 2021 MarketScan Commercial Claims and Encounters Database, including 44,793 children with conjunctivitis (median age, 5 years; 47% girls) and ambulatory care encounters.
- The primary exposure was a topical antibiotic prescription dispensed within 1 day of an ambulatory care visit, with outcomes assessed 2-14 days after the visit.
- The primary outcomes were ambulatory care revisits for conjunctivitis and same-day dispensation of a new topical antibiotic, and secondary outcomes included emergency department revisits and hospitalizations.
TAKEAWAY:
- Topical antibiotics were dispensed within a day of an ambulatory care visit in 69% of the cases; however, they were less frequently dispensed following visits to eye clinics (34%), for children aged 6-11 years (66%), and for those with viral conjunctivitis (28%).
- Ambulatory care revisits for conjunctivitis within 2 weeks occurred in only 3.2% of children who had received antibiotics (adjusted odds ratio [aOR], 1.11; 95% CI, 0.99-1.25).
- Similarly, revisits with same-day dispensation of a new antibiotic were also rare (1.4%), with no significant association between antibiotic treatment and revisits (aOR, 1.10; 95% CI, 0.92-1.33).
- Hospitalizations for conjunctivitis occurred in 0.03% of cases, and emergency department revisits occurred in 0.12%, with no differences between children who received antibiotics and those who did not.
IN PRACTICE:
“Given that antibiotics may not be associated with improved outcomes or change in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted,” the authors wrote.
SOURCE:
The study was led by Daniel J. Shapiro, MD, MPH, of the Department of Emergency Medicine at the University of California, San Francisco, and published online on June 27, 2024, in JAMA Ophthalmology.
LIMITATIONS:
The major limitations of the study included the inability to distinguish scheduled visits from unscheduled revisits, incomplete clinical data such as rare complications of conjunctivitis, and the inability to confirm the accuracy of the coded diagnosis of infectious conjunctivitis, especially in children who did not receive a thorough eye examination.
DISCLOSURES:
This study did not declare receiving funding from any sources. One author reported receiving grants from several sources outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
More than two thirds of children with conjunctivitis received antibiotics within a day of their initial ambulatory care visit; however,
METHODOLOGY:
- Researchers evaluated the frequency of topical antibiotic treatment and its association with subsequent health care use among commercially insured children with acute infectious conjunctivitis in the United States.
- This cohort study analyzed data from the 2021 MarketScan Commercial Claims and Encounters Database, including 44,793 children with conjunctivitis (median age, 5 years; 47% girls) and ambulatory care encounters.
- The primary exposure was a topical antibiotic prescription dispensed within 1 day of an ambulatory care visit, with outcomes assessed 2-14 days after the visit.
- The primary outcomes were ambulatory care revisits for conjunctivitis and same-day dispensation of a new topical antibiotic, and secondary outcomes included emergency department revisits and hospitalizations.
TAKEAWAY:
- Topical antibiotics were dispensed within a day of an ambulatory care visit in 69% of the cases; however, they were less frequently dispensed following visits to eye clinics (34%), for children aged 6-11 years (66%), and for those with viral conjunctivitis (28%).
- Ambulatory care revisits for conjunctivitis within 2 weeks occurred in only 3.2% of children who had received antibiotics (adjusted odds ratio [aOR], 1.11; 95% CI, 0.99-1.25).
- Similarly, revisits with same-day dispensation of a new antibiotic were also rare (1.4%), with no significant association between antibiotic treatment and revisits (aOR, 1.10; 95% CI, 0.92-1.33).
- Hospitalizations for conjunctivitis occurred in 0.03% of cases, and emergency department revisits occurred in 0.12%, with no differences between children who received antibiotics and those who did not.
IN PRACTICE:
“Given that antibiotics may not be associated with improved outcomes or change in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted,” the authors wrote.
SOURCE:
The study was led by Daniel J. Shapiro, MD, MPH, of the Department of Emergency Medicine at the University of California, San Francisco, and published online on June 27, 2024, in JAMA Ophthalmology.
LIMITATIONS:
The major limitations of the study included the inability to distinguish scheduled visits from unscheduled revisits, incomplete clinical data such as rare complications of conjunctivitis, and the inability to confirm the accuracy of the coded diagnosis of infectious conjunctivitis, especially in children who did not receive a thorough eye examination.
DISCLOSURES:
This study did not declare receiving funding from any sources. One author reported receiving grants from several sources outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
More than two thirds of children with conjunctivitis received antibiotics within a day of their initial ambulatory care visit; however,
METHODOLOGY:
- Researchers evaluated the frequency of topical antibiotic treatment and its association with subsequent health care use among commercially insured children with acute infectious conjunctivitis in the United States.
- This cohort study analyzed data from the 2021 MarketScan Commercial Claims and Encounters Database, including 44,793 children with conjunctivitis (median age, 5 years; 47% girls) and ambulatory care encounters.
- The primary exposure was a topical antibiotic prescription dispensed within 1 day of an ambulatory care visit, with outcomes assessed 2-14 days after the visit.
- The primary outcomes were ambulatory care revisits for conjunctivitis and same-day dispensation of a new topical antibiotic, and secondary outcomes included emergency department revisits and hospitalizations.
TAKEAWAY:
- Topical antibiotics were dispensed within a day of an ambulatory care visit in 69% of the cases; however, they were less frequently dispensed following visits to eye clinics (34%), for children aged 6-11 years (66%), and for those with viral conjunctivitis (28%).
- Ambulatory care revisits for conjunctivitis within 2 weeks occurred in only 3.2% of children who had received antibiotics (adjusted odds ratio [aOR], 1.11; 95% CI, 0.99-1.25).
- Similarly, revisits with same-day dispensation of a new antibiotic were also rare (1.4%), with no significant association between antibiotic treatment and revisits (aOR, 1.10; 95% CI, 0.92-1.33).
- Hospitalizations for conjunctivitis occurred in 0.03% of cases, and emergency department revisits occurred in 0.12%, with no differences between children who received antibiotics and those who did not.
IN PRACTICE:
“Given that antibiotics may not be associated with improved outcomes or change in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted,” the authors wrote.
SOURCE:
The study was led by Daniel J. Shapiro, MD, MPH, of the Department of Emergency Medicine at the University of California, San Francisco, and published online on June 27, 2024, in JAMA Ophthalmology.
LIMITATIONS:
The major limitations of the study included the inability to distinguish scheduled visits from unscheduled revisits, incomplete clinical data such as rare complications of conjunctivitis, and the inability to confirm the accuracy of the coded diagnosis of infectious conjunctivitis, especially in children who did not receive a thorough eye examination.
DISCLOSURES:
This study did not declare receiving funding from any sources. One author reported receiving grants from several sources outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Study Links Suicide to Missed Early Care After Discharge
TOPLINE:
A study found that patients who die by suicide within a year after discharge from inpatient mental health care are less likely to have primary care consultation in the first 2 weeks, highlighting a gap during the high-risk transition period.
METHODOLOGY:
- Researchers used a nested case-control study design, analyzing the records of 613 people who died by suicide within a year of being discharged from an inpatient psychiatric facility in England between 2001 and 2019.
- Of these, 93 (15.4%) died within 2 weeks of discharge.
- Each patient was matched with up to 20 control individuals who were discharged at a similar time but were living.
- Researchers evaluated primary care consultations after discharge.
TAKEAWAY:
- People who died by suicide within a year were less likely to have had a primary care consultation within 2 weeks of discharge (adjusted odds ratio [aOR], 0.61; P = .01).
- Those who died by suicide had higher odds for a consultation in the week preceding their death (aOR, 1.71; P < .001) and the prescription of three or more psychotropic medications (aOR, 1.73; P < .001).
- Evidence of discharge communication between the facility and primary care clinician was infrequent, highlighting a gap in continuity of care.
- Approximately 40% of people who died within 2 weeks of discharge had a documented visit with a primary care clinician during that period.
IN PRACTICE:
“Primary care clinicians have opportunities to intervene and should prioritize patients experiencing transition from inpatient care,” the authors wrote.
SOURCE:
The study was led by Rebecca Musgrove, PhD, of the Centre for Mental Health and Safety at The University of Manchester in England, and published online on June 12 in BJGP Open.
LIMITATIONS:
The study’s reliance on individuals registered with the Clinical Practice Research Datalink may have caused some suicide cases to be excluded, limiting generalizability. Lack of linked up-to-date mental health records may have led to the omission of significant post-discharge care data. Incomplete discharge documentation may undercount informational continuity, affecting multivariable analysis.
DISCLOSURES:
The study was supported by the National Institute of Health and Care Research. Some authors declared serving as members of advisory groups and receiving grants and personal fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
A study found that patients who die by suicide within a year after discharge from inpatient mental health care are less likely to have primary care consultation in the first 2 weeks, highlighting a gap during the high-risk transition period.
METHODOLOGY:
- Researchers used a nested case-control study design, analyzing the records of 613 people who died by suicide within a year of being discharged from an inpatient psychiatric facility in England between 2001 and 2019.
- Of these, 93 (15.4%) died within 2 weeks of discharge.
- Each patient was matched with up to 20 control individuals who were discharged at a similar time but were living.
- Researchers evaluated primary care consultations after discharge.
TAKEAWAY:
- People who died by suicide within a year were less likely to have had a primary care consultation within 2 weeks of discharge (adjusted odds ratio [aOR], 0.61; P = .01).
- Those who died by suicide had higher odds for a consultation in the week preceding their death (aOR, 1.71; P < .001) and the prescription of three or more psychotropic medications (aOR, 1.73; P < .001).
- Evidence of discharge communication between the facility and primary care clinician was infrequent, highlighting a gap in continuity of care.
- Approximately 40% of people who died within 2 weeks of discharge had a documented visit with a primary care clinician during that period.
IN PRACTICE:
“Primary care clinicians have opportunities to intervene and should prioritize patients experiencing transition from inpatient care,” the authors wrote.
SOURCE:
The study was led by Rebecca Musgrove, PhD, of the Centre for Mental Health and Safety at The University of Manchester in England, and published online on June 12 in BJGP Open.
LIMITATIONS:
The study’s reliance on individuals registered with the Clinical Practice Research Datalink may have caused some suicide cases to be excluded, limiting generalizability. Lack of linked up-to-date mental health records may have led to the omission of significant post-discharge care data. Incomplete discharge documentation may undercount informational continuity, affecting multivariable analysis.
DISCLOSURES:
The study was supported by the National Institute of Health and Care Research. Some authors declared serving as members of advisory groups and receiving grants and personal fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
A study found that patients who die by suicide within a year after discharge from inpatient mental health care are less likely to have primary care consultation in the first 2 weeks, highlighting a gap during the high-risk transition period.
METHODOLOGY:
- Researchers used a nested case-control study design, analyzing the records of 613 people who died by suicide within a year of being discharged from an inpatient psychiatric facility in England between 2001 and 2019.
- Of these, 93 (15.4%) died within 2 weeks of discharge.
- Each patient was matched with up to 20 control individuals who were discharged at a similar time but were living.
- Researchers evaluated primary care consultations after discharge.
TAKEAWAY:
- People who died by suicide within a year were less likely to have had a primary care consultation within 2 weeks of discharge (adjusted odds ratio [aOR], 0.61; P = .01).
- Those who died by suicide had higher odds for a consultation in the week preceding their death (aOR, 1.71; P < .001) and the prescription of three or more psychotropic medications (aOR, 1.73; P < .001).
- Evidence of discharge communication between the facility and primary care clinician was infrequent, highlighting a gap in continuity of care.
- Approximately 40% of people who died within 2 weeks of discharge had a documented visit with a primary care clinician during that period.
IN PRACTICE:
“Primary care clinicians have opportunities to intervene and should prioritize patients experiencing transition from inpatient care,” the authors wrote.
SOURCE:
The study was led by Rebecca Musgrove, PhD, of the Centre for Mental Health and Safety at The University of Manchester in England, and published online on June 12 in BJGP Open.
LIMITATIONS:
The study’s reliance on individuals registered with the Clinical Practice Research Datalink may have caused some suicide cases to be excluded, limiting generalizability. Lack of linked up-to-date mental health records may have led to the omission of significant post-discharge care data. Incomplete discharge documentation may undercount informational continuity, affecting multivariable analysis.
DISCLOSURES:
The study was supported by the National Institute of Health and Care Research. Some authors declared serving as members of advisory groups and receiving grants and personal fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.