Category Archives: Internal Medicine

Finding the Right Approach to Treating Asthma < Yale School of Medicine – Yale School of Medicine

Sandra Zaeh, MD, is interested in improving clinical outcomes for patients with asthma. In recent research, she found that current guideline-based asthma treatment is implemented less than 15 percent of the time for moderate to severe asthma due to various factors, including a lack of knowledge about the proper treatment approach.

In the next few months, as a newly promoted assistant professor of medicine in the Yale Department of Internal Medicine Section of Pulmonary, Critical Care, and Sleep Medicine, Zaeh will lead the recruitment of subjects from the Yale Center for Asthma and Airways Disease for a study in collaboration with Brigham and Womens Hospital. Funded by the Patient-Centered Outcomes Research Institute, the study aims to improve the quality of care for patients at risk of asthma attacks.

In an interview, Zaeh discusses the basics of asthma, different approaches to treating the inflammatory condition, and why controlling asthma is of the utmost importance to asthma physicians and pulmonologists.

Asthma is a chronic lung disease in which the bronchial airways in the lungs get narrowed and swollen, making it difficult to breathe. People with asthma can feel fine for some time, and then a trigger can cause an asthma attack, which can lead to significant health repercussions. Asthma disproportionately affects Black and Latinx people, low-income populations, and other groups.

Uncontrolled asthma with frequent exacerbations can cause adults to miss days of work and children to miss school. Asthma can impact your ability to breathe on a day-to-day basis. It can lead to hospitalizations, emergency room visits, and, in some cases, fatality.

For the past several decades, the treatment paradigm for asthma has involved control and relief medications. Controller therapy usually includes an inhaled corticosteroid that you take one to two times a day to control your symptoms. You take a reliever therapy between controller doses to minimize asthma symptoms such as cough, shortness of breath, and wheezing. The traditional reliever therapy has been albuterol, a short-acting bronchodilator that quickly opens the airways.

Interestingly, the data now supports a slightly different management strategy. The big update in asthma management is the introduction of anti-inflammatory reliever therapy for asthma. Current guidelines promote the use of the same inhaler for both control and relief for moderate to severe asthma, with a combination of an inhaled steroid and a quick-acting, long-acting beta agonist called formoterol. This approach is called SMART, or Single Maintenance and Reliever Therapy, because one inhaler does the job that two inhalers used to do.

Even though SMART is currently guideline-based care, were having difficulty implementing this approach in clinical practice. There are similar, alternative approaches that may be better for certain patients. One of those approaches, which will be tested in this study, is PARTICS, or Patient Activated Reliever-Triggered Inhaled CorticoSteroids. Every time PARTICS patients use their albuterol inhaler, theyre asked to use one puff of inhaled steroid. When they use their albuterol nebulizer as a reliever, they're asked to use five puffs of inhaled steroid. Its different than SMART because the approach uses more than one inhaler and incorporates the use of nebulizers as relievers.

Many people in the U.S. use an albuterol nebulizer as a reliever because they feel it works more effectively. The PARTICS approach incorporates those individuals.

Studied in Black and Latinx patients with moderate to severe asthma a few years ago, PARTICS was shown to reduce severe asthma exacerbations and improve asthma control and quality of life. Our study compares PARTICS to SMART, the current standard of care. The idea of the study is to test to see if the two approaches are equally effective or if one is more effective than the other.

Its important to have different asthma management approaches that can be used and tailored for each patient based on needs and preferences. For example, PARTICS is perhaps more appropriate than SMART for people who use nebulizers as their reliever. PARTICS may be more effective or better covered by insurance for some people.

Whether PARTICS or SMART, these approaches are the future of asthma management. By studying these different anti-inflammatory reliever approaches, we can improve implementation and use these therapies more efficaciously.

The more options we have to treat asthma, the better.

The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within Yale School of Medicines Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM's website, or follow them on Facebook and Twitter.

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Finding the Right Approach to Treating Asthma < Yale School of Medicine - Yale School of Medicine

Stigmatizing Language Common in Clinical Notes for Patients With SUD – Medpage Today

NEW YORK CITY -- Clinical notes for patients with substance use disorder (SUD) contained stigmatizing language -- such as "junkie," "dirty user," and "this drunk" -- on a regular basis, according to a study of electronic health records (EHR).

A preliminary analysis of clinical notes from a random sample of 2,700 patients with SUD or opioid use disorder (OUD) diagnoses showed that 84.4% (n=2,279) of patients had notes that contained stigmatizing language, according to Jyoti Pathak, PhD, of Weill Cornell Medical College in New York City.

The most common terms found among patients' notes were abuse (77.1% of patients), opioid abuse (63.8%), addict (41.9%), and substance dependence (36.4%), Pathak reported at the American Psychiatric Association annual meeting. Stigmatizing language was based on a list of terms and phrases identified by the National Institute on Drug Abuse (NIDA).

Pathak and colleagues also found that such language was applied to some patients more than others, and used by some care providers more than others.

"We would all agree that stigma persists in healthcare," Pathak said during a poster presentation. "Research has shown that the words that we choose in clinical documentation, in patient communication, and clinician-to-clinician documentation have consequences."

He explained that a 2022 study in the Journal of General Internal Medicine illustrated that stigmatizing language can frame the narrative around a patient's overall experience with treatment. A 2019 study in Experimental and Clinical Psychopharmacology found that patients have negative attitudes toward terms like "addict" or "substance abuser," which may negatively affect their treatment outcomes.

Pathak reported that the two age groups who experienced the most common use of stigmatizing language in their clinical notes were those ages 33-48 (32.7% of all patients) and those ages 49-64 (34.1%). Similarly, Black or African-American patients made up almost a fifth of all patients who experienced stigmatizing language in their clinical notes (18.2%), he reported.

Social workers were far more likely to write clinical notes that contained stigmatizing language. Of the 390 clinical notes written by social workers in the analysis, all but one contained stigmatizing language. Comparatively, psychiatrists used stigmatizing language in 750 out of 877 clinical notes, Pathak reported.

"This is very consistent with what has been shown in other literature," he said. "There is absolutely a need for provider education in this space."

Pathak noted that people-first language is the recommended alternative. For example, instead of using "addict" a provider can use "person with substance use disorder." Similarly, the term "substance abuser" can be replaced by "patient." He pointed out that the NIDA has resources to help mental health providers with learning and implementing the appropriate language in their clinical notes.

Pathak and colleagues collected 980,194 clinical notes from the random sample of patients with either an OUD or an SUD diagnosis from 2010 through 2023 at a major academic medical center in New York City.

Using the NIDA list of stigmatizing terms and phrases, the researchers developed a rule-based natural language processing algorithm to extract clinical notes with stigmatizing language, and analyzed the incidence rates of this language in those clinical notes. Demographic characteristics of patients who had stigmatizing language used on them were compared to those without.

The researchers reported that notes authored by female providers use SL [stigmatizing language] terms more frequently (50.0% in SL cohort vs 42.4% in no SL cohort) than those authored by male providers.

Pathak highlighted that the use of natural language processing to identify notes with stigmatizing language may open the door to the use of other artificial intelligence tools to potentially address this issue.

"[When] you write your [email in] Gmail, it autocorrects your language," he said. "Can we develop similar tools that can be embedded within your [EHR], so when you are writing your note it can provide recommendations [such as] instead of using the word 'addict,' perhaps [use] the right terminologies?"

Michael DePeau-Wilson is a reporter on MedPage Todays enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news. Follow

Primary Source

American Psychiatric Association

Source Reference: Pathak J, et al 'Words matter: Use of stigmatizing language in clinical notes of patients with opioid use disorder' APA 2024; Poster P05-090.

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Stigmatizing Language Common in Clinical Notes for Patients With SUD - Medpage Today

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This article was originally published on NBCNews.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

StudyFinds Matt Higgins contributed to this report.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Credit: Josh Milgate/Unsplash

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

Timothy Wilt, MD, MPH: Discussing Colorectal Cancer Screening Options Recommended by ACP – MD Magazine

Although the US Preventive Services Task Force updated its colorectal cancer screening recommendation to lower the screening age from 50 to 45, the American College of Physicians (ACP) still suggests starting screening at age 50, citing uncertainty about the benefits versus harms of screening asymptomatic average-risk adults 45 - 49 years of age.1,2

Additionally, ACP does not recommend certain screening tests endorsed by other organizations, again attributed to considerations regarding the burden and costs associated with different screening modalities.

In an interview with HCPLive at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Timothy Wilt, MD, MPH, professor of medicine and public health in the division of general internal medicine at the Minneapolis VA Health Care System, explained potential pros and cons to several available colorectal cancer screening options and which ones ACP does and does not recommend.

He specifically highlighted the effectiveness of fecal immunochemical (FIT) tests but pointed out they need to be repeated on a regular basis, also mentioning ACP recommends FIT testing every other year rather than annually due to similar benefits and reduced burdens and costs.

Colonoscopy is generally considered to be the gold standard for colorectal cancer screening and does not need to be done as often as other tests, but Wilt was careful to highlight the greater burden, cost, and difficulty associated with it, including the preparation, the need to undergo sedation, finding someone to drive you to and from the appointment, and the risk of harm such as perforations and bleeding.

Wilt also noted A stool-based test is only good as a triage test. If it's positive, those individuals have to go on and get a direct visualization such as a colonoscopy, and mentioned FIT and colonoscopy are the only tests ACP recommends, calling attention to various issues with stool DNA tests and CT colonography.

Although he recognized that some patients prefer to focus on other aspects of their health if they are not concerned with their current risk of colorectal cancer, Wilt said Colorectal cancer screening works. I recommend that you get screened, I recommend we begin at age 50. And do it on a regular basis, either with the FIT test every 2 years, or colonoscopy every 10 years.

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Timothy Wilt, MD, MPH: Discussing Colorectal Cancer Screening Options Recommended by ACP - MD Magazine