Do Religion , Spirituality and Medicine Go Together?
A 63-year-old woman with advanced cancer refuses chemotherapy, believing that prayer alone will heal her. Her oncologist struggles with the ethical dilemma—should he push for treatment, knowing it might extend her life, or respect her faith-based decision, even if it means a shorter prognosis? These are the tough realities many doctors face, where science meets belief, and the right course of action isn’t always clear.
For many patients, illness is not just a medical experience—it’s a deeply spiritual one. Research shows that up to 78% of patients with cancer consider spirituality important in their healthcare journey, and many make medical decisions based on religious beliefs. Some refuse blood transfusions, others fast despite health risks, and many look for divine intervention when medicine reaches its limits. Yet, despite this profound influence, modern medicine often treats spirituality as an afterthought, leaving a critical gap in holistic patient care.
Consider a young Muslim patient diagnosed with diabetes who insists on fasting during Ramadan, despite the dangers. His endocrinologist has two options: firmly advise against fasting or work with him to adjust his insulin schedule to minimize risks. Many physicians are trained to focus solely on medical facts, but real-world medicine isn’t always that simple. Sometimes, patient-centered care means meeting patients where they are—faith and all. Studies even show that when doctors acknowledge a patient’s religious beliefs, patients report greater satisfaction with their care. However, most physicians aren’t trained for these conversations, leading to missed opportunities for trust and collaboration.
And then there’s end-of-life care. A devout Christian man in the ICU insists that his doctors “do everything possible” to keep him alive, even as his organs fail and his suffering increases. His family clings to hope, praying for a miracle. The medical team knows that aggressive interventions may only prolong pain, but how do you tell a grieving family that their faith in divine healing won’t change the inevitable? Studies suggest that patients who receive spiritual support from their medical teams are more likely to opt for palliative care over aggressive interventions, leading to better quality of life in their final days. But when spiritual needs are ignored, patients and families may feel abandoned or misunderstood, adding emotional distress to an already difficult situation.
So, what’s the right approach? Should doctors engage with patients’ spirituality, or is that crossing a professional line? Have you faced a situation where religion shaped a medical decision in ways you didn’t expect?
Shorter Treatment Regimens Recommended for Tuberculosis
In a clinical practice guideline issued by the American Thoracic Society and published in the January issue of the American Journal of Respiratory and Critical Care Medicine, updated recommendations are presented for the treatment of tuberculosis (TB) in children and adults.
Jussi J. Saukkonen, M.D., from the Boston Veterans Administration Health Care System, and colleagues updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies are available on a regular basis. The evidence was reviewed and recommendations made.
The authors note that new recommendations for drug-susceptible TB include use of a novel four-month regimen for individuals with pulmonary TB and a shortened four-month regimen, instead of the six-month regimen, for nonsevere TB in children. Use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin are included as recommendations for drug-resistant TB. For adolescents aged 14 years and older and adults with rifampin-resistant pulmonary TB, a six-month bedaquiline, pretomanid, and linezolid regimen is as efficacious and safe as the current 15-month or longer regimen.
"There has been a quest and concerted effort to develop shorter treatments for TB, after decades of little drug development," Saukkonen said in a statement. "With recent studies we have been able to shorten the regimen durations for both drug-susceptible and drug-resistant TB for most patients, down to four and six months, respectively."
Several authors disclosed ties to the biopharmaceutical industry.
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FDA Approves Zepbound for Sleep Apnea in Patients With Obesity
The U.S. Food and Drug Administration has approved Zepbound (tirzepatide) as the first prescription medication for the treatment of obstructive sleep apnea (OSA).
In a news release published Dec. 20, the FDA stated that Zepbound, a glucagon-like peptide-1 receptor agonist, was cleared to treat moderate-to-severe OSA in patients with obesity. According to drugmaker Eli Lilly, the treatment is intended for use alongside a reduced-calorie diet and increased physical activity.
"Today's approval marks the first drug treatment option for certain patients with obstructive sleep apnea," Sally Seymour, M.D., director of the Division of Pulmonology, Allergy, and Critical Care in the FDA Center for Drug Evaluation and Research, said in a news release. "This is a major step forward for patients with obstructive sleep apnea."
"Many cases of OSA go undiagnosed and untreated, leaving millions at risk for serious health consequences," Patrik Jonsson, president of Lilly Cardiometabolic Health, said in a news release from the company. In clinical trials, he noted, nearly half of Zepbound users saw such significant improvements that their OSA symptoms resolved.
FDA approval for Zepbound in treating sleep apnea was based on two previous Eli Lilly-sponsored trials published in the New England Journal of Medicine involving nearly 470 participants, some of whom were using continuous positive airway pressure (CPAP) machines.
In one trial in which participants did not use CPAP, Zepbound reduced apnea-hypopnea index events by an average of 25 per hour after one year compared with a reduction of just five events in the placebo group. In the trial involving CPAP users, Zepbound reduced events by 29 per hour on average versus six in the placebo group.
The FDA approval is only for people with obesity, but it could help those with sleep apnea get Medicare coverage, which currently does not cover drugs just for weight loss.
Eli Lilly has emphasized its commitment to accessibility, offering patient support programs, including a lower-cost vial option, to help ease financial barriers. However, without insurance, monthly costs can still exceed $1,000.
Approval of this indication for Zepbound was granted to Eli Lilly.
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San Antonio Breast Cancer Symposium, Dec. 10 to 13
The annual San Antonio Breast Cancer Symposium was held from Dec. 10 to 13 in San Antonio. Attendees included medical oncologists, radiation oncologists, researchers, and other health care professionals. The conference highlighted recent advances in the risk, diagnosis, treatment, and prevention of breast cancer, and presentations focused on emerging treatments in hard-to-treat patient populations, including patients with metastatic breast cancer.
As part of the BIG 2-04 MRC SUPREMO phase 3 clinical trial, Ian Kunkler, M.B., B.Chir., of the University of Edinburgh in the United Kingdom, and colleagues found that chest wall irradiation may be omitted among patients with intermediate-risk breast cancer who have undergone mastectomy.
For the study, patients were randomly assigned to receive chest wall irradiation after mastectomy or to omit chest wall irradiation after mastectomy. The researchers found that postmastectomy radiotherapy to the chest wall among women with one to three positive axillary nodes after an axillary clearance or negative on an axillary clearance, axillary node sample, or sentinel node biopsy was not associated with an improvement in 10-year overall survival. The investigators also found that postmastectomy radiotherapy reduced chest wall recurrence by less than 2 percent at 10 years. Furthermore, the approach did not have an impact on metastasis-free survival.
"Postmastectomy radiotherapy National Institute for Health and Care Excellence guidelines currently recommend radiotherapy in women with one to three positive nodes after mastectomy," Kunkler said. "So, our results should change guidelines and practice internationally."
As part of the phase 3 COMET study, Ann Partridge, M.D., M.P.H., of the Dana-Farber Cancer Institute and Harvard Medical School in Boston, and colleagues found that active monitoring is a reasonable approach for the management of patients with grade 1 or 2, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative low-risk ductal carcinoma in situ (DCIS), with no evidence of a higher incidence of microinvasive or invasive disease.
For the study, patients were randomly assigned to either undergo active monitoring or receive guideline-concordant care consisting of surgery with or without adjuvant radiation. During a two-year period, the authors assessed quality of life, anxiety, depression, worries about DCIS, and symptom trajectories via surveys that employed validated quality-of-life measures. Patients filled out surveys prior to randomization, at six months, at one year, and after two years.
The researchers found that the overall lived experience of women randomly assigned to active monitoring was similar to that of those selected to follow the current guideline for care, which is surgery with or without radiation. During the two years of follow-up, health-related quality of life, anxiety, depression, worry, and symptom trajectories were comparable regardless of the treatment received.
"If longer-term follow-up supports the safety of active management from a cancer outcome standpoint, this approach could be considered as an option for women with this condition," Partridge said. "It is critical that we understand how women feel when they are living with an active-monitoring approach and how it impacts their overall quality of life, psychosocial health, worries about DCIS, anxiety and depression, and other related symptoms. These data are reassuring in that respect."
In the multicenter, double-blind OlympiA study, Judy E. Garber, M.D., of the Dana-Farber Cancer Institute in Boston, and colleagues provided further support for the benefits of olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, among patients with high-risk, HER2-negative breast cancer with germline mutations in BRCA1 or BRCA2.
The authors randomly assigned 1,836 patients with BRCA-positive, HER2-negative breast cancer (1:1) to receive either olaparib or placebo for one year following completion of chemotherapy, surgery, and radiation.
The researchers found that after a median follow-up of 6.1 years, patients with high-risk, BRCA-positive breast cancer who received olaparib after standard treatment continued to have better survival outcomes than those who received placebo. The continued demonstration of the efficacy of olaparib in breast cancer patients who carry pathogenic variants in BRCA1/2 makes it important to identify these individuals when they begin their treatment, the authors noted.
"The ongoing data from the OlympiA trial are reassuring in the observations of persistent and increasing benefits in the follow-up phases, improving not only recurrence, but also overall survival. Benefits are demonstrated in both triple-negative breast cancer as well as hormone receptor-positive tumors, despite the shortened follow-up and smaller numbers in the estrogen receptor-positive group," Garber said. "These data also highlight the safety of olaparib and, therefore, the possibility of moving PARP inhibitors to the treatment of BRCA-associated breast cancers that are lower risk."
The study was supported by AstraZeneca and Merck, the manufacturers of olaparib.
SABCS: Chest Wall Irradiation Does Not Impact Survival in Breast Cancer
MONDAY, Dec. 16, 2024 (HealthDay News) -- For patients with intermediate-risk breast cancer, chest wall irradiation after mastectomy does not influence 10-year overall survival, according to a study presented at the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
SABCS: Risk-Reducing Surgery Improves Outcomes in Young Breast Cancer Patients With BRCA Mutations
MONDAY, Dec. 16, 2024 (HealthDay News) -- Risk-reducing mastectomy and salpingo-oophorectomy are both associated with significant improvements in outcomes among young BRCA carriers with breast cancer, according to a study presented at the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
SABCS: Adding Camrelizumab to Neoadjuvant Chemo Beneficial in TNBC
FRIDAY, Dec. 13, 2024 (HealthDay News) -- The addition of camrelizumab to neoadjuvant chemotherapy improves pathological complete response for patients with early or locally advanced triple-negative breast cancer, according to a study published online Dec. 13 in the Journal of the American Medical Association to coincide with the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
SABCS: Active Monitoring Noninferior to Guideline Care for Ductal Carcinoma in Situ
FRIDAY, Dec. 13, 2024 (HealthDay News) -- For patients with ductal carcinoma in situ, active monitoring is noninferior to guideline-concordant care that involves surgery with or without adjuvant radiation, according to a study presented at the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
SABCS: Omission of Axillary Staging Noninferior for Node-Negative Breast Cancer
FRIDAY, Dec. 13, 2024 (HealthDay News) -- Omission of surgical axillary staging is noninferior to sentinel lymph-node biopsy for patients with clinically node-negative, T1 or T2 invasive breast cancer, according to a study published online Dec. 12 in the New England Journal of Medicine to coincide with the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
SABCS: Imlunestrant Tied to Improved PFS for ER-Positive, HER2-Negative Breast Cancer With ESR1 Mutations
THURSDAY, Dec. 12, 2024 (HealthDay News) -- For patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer, imlunestrant leads to significantly longer progression-free survival among those with ESR1 mutations, according to a study published online Dec. 11 in the New England Journal of Medicine to coincide with the annual San Antonio Breast Cancer Symposium, held from Dec. 10 to 13 in San Antonio.
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American College of Rheumatology, Nov. 14-19
The annual meeting of the American College of Rheumatology was held this year from Nov. 14 to 19 in Washington, D.C., and attendees included rheumatology specialists, physicians, scientists, and other health professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.
During one presentation, Chuan-Ju Liu, Ph.D., of the Yale University School of Medicine in New Haven, Connecticut, discussed how the sodium channel Nav1.7 represents a novel and actionable target to preserve joint structure and slow osteoarthritis progression, addressing not only pain but also structural deterioration.
Liu highlighted recent discoveries linking sodium channel Nav1.7 to the regulation of joint structure in osteoarthritis. He outlined how sodium channels in chondrocytes play a critical role in maintaining cartilage integrity and how targeting these channels could mitigate cartilage degeneration.
"Preclinical studies demonstrated that modulating Nav1.7 can prevent joint deterioration, suggesting a promising therapeutic approach," Liu said. "Although still in the early stages, this research points toward the potential for developing sodium channel inhibitors or modulators as disease-modifying treatments for osteoarthritis. Over time, this approach may complement or reduce reliance on existing treatments like nonsteroidal anti-inflammatory drugs, which primarily address symptoms and often have side effects."
In another presentation, Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, discussed cannabis therapy for chronic pain among patients with rheumatic diseases.
Currently, there are very few randomized clinical trials evaluating the effectiveness and safety of cannabis products. In addition, the results of these studies can vary based on dose, mode of administration, and an individual's metabolism. It is also difficult to determine how much cannabidiol (CBD) and tetrahydrocannabinol (THC) are contained within cannabis products. However, Clauw stressed that cannabis can still be a relatively safe and effective option for the treatment of chronic pain.
"Cannabis products likely have a role in treating pain but more research needs to be done regarding what cannabis products work for what types of pain," Clauw said. "We know that CBD is quite safe and legal in all of the United States and people should try that before venturing to THC, which may be helpful in some but has far more potential side effects."
Lihi Eder, M.D., of the Women's College Hospital and University of Toronto, discussed how understanding sex-related differences in psoriatic arthritis is critical to developing approaches that consider the sex of the patient in disease management.
Male and female patients with psoriatic arthritis may present differently, with female patients having more pain and disability and a lower response to biologic therapies compared with their male counterparts. Eder said that the mechanisms behind these findings remain unclear, but the differences could be related to biological mechanisms such as pain processing, immune function, and the pharmacokinetics of drugs. They could also be due to sociocultural factors, including coping mechanisms, support systems, and access to care.
"Considering sex/gender in patient care could improve outcomes. For example, use of more sensitive imaging such as ultrasound to investigate the source of pain may be more important in females and could provide insights about the cause of pain and inform therapy," Eder said. "More research is needed to identify mechanisms for the observed differences."
ACR: Inebilizumab Reduces Risk for Flares in IgG4-Related Disease
TUESDAY, Nov. 19, 2024 (HealthDay News) -- For patients with immunoglobulin G4-related disease, inebilizumab reduces the risk for flares and increases the likelihood of flare-free complete remission, according to a study published online Nov. 14 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
ACR: Colchicine No Benefit for Painful Knee Osteoarthritis
TUESDAY, Nov. 19, 2024 (HealthDay News) -- Colchicine fails to improve knee pain, function, or size of synovial effusions with painful knee osteoarthritis, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
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Tele-ICU Rounds Ineffective in Shortening ICU Stay for Patients
Daily multidisciplinary rounds conducted by a board-certified intensivist through telemedicine do not reduce intensive care unit (ICU) length of stay (LOS) in critically ill adult patients, according to a study published online Oct. 9 in the Journal of the American Medical Association to coincide with the annual congress of the European Society of Intensive Care Medicine, held from Oct. 5 to 9 in Barcelona, Spain.
Adriano J. Pereira, M.D., Ph.D., from the Hospital Israelita Albert Einstein in São Paulo, Brazil, and colleagues assessed whether an intervention involving daily multidisciplinary rounds and monthly audit and feedback meetings performed by a remote board-certified intensivist reduces ICU LOS versus usual care. The analysis included patients treated in 30 general ICUs in Brazil in which daily multidisciplinary rounds performed by board-certified intensivists were not routinely available (1,794 patients in the baseline period and 15,230 in the intervention period).
The researchers found that mean ICU LOS, adjusted for baseline assessment, did not differ significantly between the tele-critical care and usual care groups (8.1 versus 7.1 days). In sensitivity analyses and prespecified subgroups, results persisted. There were no statistically significant differences seen in any other secondary or exploratory outcomes, including ICU efficiency, in-hospital mortality, incidence of central line-associated bloodstream infections, ventilator-associated events, catheter-associated urinary tract infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation, and rate of patients with oxygen saturation values under that of normoxemia.
"This highlights the need but also the challenge of how to tailor telemedicine delivery models while guaranteeing a minimal adequate structure and qualifications at local sites," the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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Are we running out of medicine?
A survey by the Care Quality Commission (CQC) and Ipsos has revealed that nearly half of adult social care providers in the UK face significant challenges due to medicine shortages and unavailability of community pharmacy staff, with only 50% saying their medication support needs are fully met. Issues such as delays in medication delivery, communication problems, and insufficient pharmacy staff are causing delays in care, increasing medication errors, and even leading to unnecessary hospital admissions. The situation underscores the critical need for consistent and effective pharmacy services in care homes to ensure the well-being of vulnerable residents...Read more.
What shortages have been affecting your patients?
Good Maternity Care Increasingly Tough to Find in U.S.
In the two years since the March of Dimes' last report on the state of U.S. maternity care, more than 100 hospitals nationwide have shuttered their obstetric units, leaving more new moms with literally "Nowhere to Go" for care.
The March of Dimes' 2024 report, titled "Nowhere to Go: Maternity Care Deserts Across the U.S.," finds hospital closures have left more than 5.5 million women and their babies with no or limited access to maternity care.
"For too many families across the U.S., the ability to have a healthy pregnancy depends on where they live," March of Dimes Chief Medical Officer Dr. Amanda Williams said in a news release. "Our 2024 report underscores that maternity care is still not prioritized in our country and there is an urgent need for systemic changes to improve outcomes for moms and babies in the U.S. and to ensure that these families have access to the care they need and deserve."
With hospitals closing maternity units in over 100 counties between 2022 and 2024, more new mothers are being forced to travel long distances to access care -- if they can make the trip at all.
Overall, a third of all U.S. counties are now classified by the March of Dimes as "maternity care deserts," with no birthing facilities or obstetricians. The worst states for this are North Dakota, South Dakota, Alaska, Oklahoma and Nebraska.
Over 150,000 babies were born to women living in maternity deserts during the time period covered by the report.
All of this matters to outcomes for women and babies: Preterm births are 13% more likely in a maternity care desert, the March of Dimes said.
The number of women who have high blood pressure before they became pregnant rose by 80% between 2015 and 2022, the group noted, and the rate of pre-pregnancy hypertension is 30% higher in counties deemed maternity care deserts.
"Hypertension increases the risk for adverse outcomes such as preeclampsia, a potentially fatal condition that causes a pregnant woman’s blood pressure to rise and can lead to preterm birth, stroke, seizure and other complications," the March of Dimes noted.
Women of color are being hit especially hard.
“Black women are three times more likely to die from pregnancy-related causes -- a tragedy exacerbated by a lack of resources to care for them, let alone save them,” said Tatyana Ali, American actress ("Fresh Prince of Bel Air") and March of Dimes advocate. “As a Black birthing woman who experienced firsthand the inequities of our maternal healthcare system, we must do better for ourselves, each other and our communities. The health of moms and babies needs to be a priority in the U.S.”
Trying to ease the crisis, the March of Dimes has created a fleet of Mom and Baby Mobile Health Centers, which "focus on providing critical care to families in chronically underserved communities," the group said.
So far, these mobile health centers have been set up in Tucson, Ariz.; Phoenix; Columbus, Ohio; Washington, D.C.; and New York City, with more set to launch in Houston; Cleveland, Ohio; Southeast, Ohio; Birmingham, Ala.; and in Arizona where it will serve a tribal population.
More information
Find out more about preeclampsia at Yale Medicine.
SOURCE: March of Dimes, news release, Sept. 10, 2024
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Preclinical Blood Test IDs Risk for Respiratory Death, Incident COPD
A proteomic signature indicating increased respiratory susceptibility identifies the risk for respiratory death, incident chronic obstructive pulmonary disease (COPD), and respiratory exacerbations, according to a study published online Sept. 10 in the American Journal of Respiratory and Critical Care Medicine.
Gabrielle Y. Liu, M.D., from the UC Davis School of Medicine in Sacramento, California, and colleagues examined whether a proteomic risk score trained on accelerated decline in lung function can predict the risk for future respiratory disease and mortality in CARDIA, a population-based cohort starting in young adulthood. To identify accelerated and normal decline trajectories, longitudinal measurement of forced expiratory volume in 1 second percent predicted was used. Protein aptamers associated with an accelerated decline trajectory were identified. The proteomic respiratory susceptibility score was derived based on these circulating proteins and applied to the U.K. Biobank and COPDGene.
The researchers found an independent association for a higher susceptibility score with all-cause mortality (hazard ratios [HR], 1.56 and 1.75 in the U.K. Biobank and COPDGene); respiratory mortality (HR, 2.39 and 1.81 in the U.K. Biobank and COPDGene); incident COPD (HR, 1.84 in the U.K. Biobank); incident respiratory exacerbation (odds ratio [OR], 1.10 in COPDGene); and incident exacerbation requiring hospitalization (OR, 1.17 in COPDGene).
"The proteins identified in this study show promise as biomarkers for impaired respiratory health. Further study to elucidate their utility as modifiable targets for the prevention and interception of chronic lung disease in at-risk populations is warranted," the authors write.
The COPDGene study is funded by contributions from several pharmaceutical companies.
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Childhood Air Pollution Exposure Tied to Later Bronchitic Symptoms
Childhood exposure to air pollution is associated with adult bronchitic symptoms, according to a study published online June 25 in the American Journal of Respiratory and Critical Care Medicine.
Erika Garcia, Ph.D., M.P.H., from University of Southern California in Los Angeles, and colleagues evaluated associations between childhood air pollution exposure and self-reported adult bronchitic symptoms. Analysis included 1,308 participants in the Southern California Children’s Health Study.
The researchers found that at adult assessment (mean age, 32.0 years) 25 percent of participants reported bronchitic symptoms. There was an association between adult bronchitic symptoms and childhood exposures to nitrogen dioxide (NO2) and particulate matter <10 μm (PM10). Per each standard deviation increase odds were 69 percent higher for NO2 and 51 percent for PM10. Results were similar when adjusting for childhood bronchitic symptoms or asthma. Associations with NO2 and PM10 were modified by childhood asthma, with larger associations among asthmatics.
"There may be a subpopulation that is more sensitive to the effects of air pollution," Garcia said in a statement. "We may want to be especially careful to protect them from exposure, so we can improve their outcomes later in life. Reducing air pollution would have benefits not only for current asthma in children but also for their respiratory health as they grow into adulthood."
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Preoxygenation With Noninvasive Ventilation Yields Lower Hypoxemia
For critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation results in lower incidence of hypoxemia than preoxygenation with an oxygen mask, according to a study published online June 13 in the New England Journal of Medicine to coincide with the annual Critical Care Reviews Meeting, held from June 12 to 14 in Belfast, Northern Ireland.
Kevin W. Gibbs, M.D., from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues conducted a multicenter, randomized trial at 24 emergency departments and intensive care units in the United States involving critically ill adults undergoing tracheal intubation. Participants were randomly assigned to receive preoxygenation with either noninvasive ventilation or an oxygen mask (624 and 637 patients, respectively).
The researchers found that hypoxemia occurred in 9.1 and 18.5 percent of patients in the noninvasive-ventilation and oxygen-mask groups, respectively. Cardiac arrest occurred in one and seven patients (0.2 versus 1.1 percent) in the noninvasive-ventilation and oxygen-mask groups, respectively. Aspiration occurred in six and nine patients (0.9 and 1.4 percent) in the noninvasive-ventilation and oxygen-mask groups, respectively.
"These findings have important clinical implications because hypoxemia during intubation is associated with cardiac arrest and death, and in current clinical care worldwide, most critically ill adults receive preoxygenation with an oxygen mask rather than with noninvasive ventilation," the authors write.
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Race-Neutral Metrics More Accurately Predict Risk in COPD
Race-neutral metrics more accurately predict the risk for death and exacerbations in chronic obstructive pulmonary disease (COPD), according to a study published online April 11 in the American Journal of Respiratory and Critical Care Medicine.
Enrico Schiavi, M.D., from the Università Cattolica del Sacro Cuore-Roma in Italy, and colleagues examined European Respiratory Society (ERS)/American Thoracic Society (ATS) airflow obstruction severity classification in the COPDGene Study (10,108 participants). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) approach, using National Health and Nutrition Examination Survey III race-specific equations, was compared to the application of the Global Lung Initiative (GLI)-Global race-neutral equations.
The researchers found that individuals with milder disease had the lowest agreement between ERS/ATS with zGLI Global and the GOLD classification; race was a major determinant of redistribution. zGLI Global differentiated all-cause mortality risk between normal spirometry and first grade of COPD after adjustment for relevant covariates (hazard ratio, 1.23); in addition, a linear increase in exacerbation rates was seen with increasing disease severity in comparison to GOLD.
"The Brigham has already shifted to using race-neutral equations when interpreting pulmonary function tests, but not all labs across the U.S. have made these changes," senior author Craig Hersh, M.D., M.P.H., from Brigham and Women's Hospital in Boston, said in a statement. "Producing more data that replicates these results will allow us to continue to improve care for patients living with COPD."
The COPDGene study has been supported by the COPD Foundation through contributions made by pharmaceutical companies.
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American College of Physicians, April 18-20
The annual meeting of the American College of Physicians (Internal Medicine Meeting) was held from April 18 to 20 in Boston and was attended by internists, adult medicine specialists, subspecialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing primarily on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.
During one workshop, Gregg D. Simonson, Ph.D., of the International Diabetes Center at HealthPartners Park Nicollet in St. Louis Park, Minnesota, discussed how continuous glucose monitors (CGMs) lead to improved diabetes management and provided internal medicine physicians with the knowledge, skills, and confidence to incorporate CGMs into their practice.
Simonson noted that interpreting and acting on the CGM data and reports is critical for success. As such, the International Diabetes Center HealthPartners Institute created the Ambulatory Glucose Profile report to organize critical CGM metrics and data into a clinically useful single-page report. This allows an individual with diabetes and their care team to quickly determine what actions (i.e., lifestyle and medication changes) might be needed to improve their diabetes management.
During the workshop, all attendees were provided the opportunity to apply a CGM sensor and wear it for 10 to 14 days so they could learn firsthand the usefulness of this technology. Practical CGM tips were provided, including management of skin irritation and techniques to improve sensor adhesion. The attendees were also given detailed information on documentation, billing, and coding for CGMs.
"Workshop attendees received the International Diabetes Center HealthPartners Institute's Clinician CGM Guided Management (CCGM) of Patients with T2DM on Insulin booklet and instruction on how to use the information and guidelines it contains to effectively manage individuals treated with basal, basal-bolus, or premixed insulin regimens," Simonson said. "To reinforce key points of the workshop, all participants were provided a CGM Case Study Workbook to complete while working in small groups. Facilitated discussion provided an opportunity to share best practices and ask questions of the faculty."
During another presentation, John M. Inadomi, M.D., of the Spencer Fox Eccles School of Medicine at the University of Utah in Salt Lake City, provided an update in gastroenterology, including insight on proton pump inhibitors (PPIs), metabolic dysfunction-associated steatotic liver disease (MASLD), and colorectal cancer screening.
Inadomi discussed the multitude of adverse effects that have been attributed to PPIs, including kidney disease, cardiovascular events, bone fractures, and infections, but said clinicians should not stop PPIs for fear of adverse effects. Rather, they should decide on the basis of whether their patient has an appropriate indication for long-term PPI use.
Inadomi also noted that MASLD can now be categorized into metabolic syndrome or nonmetabolic syndrome. Metabolic syndrome steatotic liver disease is further categorized as MASLD (no or little alcohol use), MetALD (moderate alcohol use: two to three drinks per day for women or three to four drinks per day for men), or alcoholic liver disease (more than three drinks for women and more than four for men). According to Inadomi, a variety of lifestyle changes (weight loss, healthy diet, exercise, cholesterol reduction, and controlling diabetes) are effective to reduce steatosis, and now pharmacologic therapy (glucagon-like peptide-1 receptor agonists) has shown efficacy in reducing liver steatosis.
"Colorectal cancer screening adherence is still far below the national goal of 80 percent in all populations. Most guidelines recommend initiating screening in average-risk adults at age 45 years (with the exception of the ACP guideline that continues to recommend starting at age 50 years)," Inadomi said. "Average-risk screening should be performed with existing tests (FIT [fecal immunochemical test], FIT/DNA, colonoscopy), and the future of blood-based biomarker screening depends on whether it is possible to increase their sensitivity for advanced polyps, and dramatically reduce their costs."
Kristine E. Ensrud, M.D., M.P.H., of the University of Minnesota in Minneapolis, discussed what primary care clinicians should know about osteoporosis drug treatment.
Ensrud noted that the goal of osteoporosis drug treatment is to reduce the risk for clinical or symptomatic fractures. Bisphosphonates, including alendronate, risedronate, and zoledronate, are the first-line pharmacologic treatments for postmenopausal osteoporosis. Treatment with these antiresorptive agents reduces the risk for vertebral and nonvertebral fractures, including hip fracture. Denosumab is an alternative antiresorptive agent for initiation of osteoporosis drug treatment. The bisphosphonate ibandronate and the selective estrogen receptor modulator raloxifene are U.S. Food and Drug Administration-approved for the treatment of postmenopausal osteoporosis; however, according to Ensrud, they are rarely prescribed because while these medications reduce the risk for vertebral fractures, they have no effect on the risk for nonvertebral fractures, including hip fracture.
"To minimize the risk of long-term potential harms such as atypical femoral fractures, discontinuation of bisphosphonates should be considered in patients with a BMD (bone mineral density) T score of −2.5 or above after three to five years of oral bisphosphonate treatment or two to three years of intravenous bisphosphonate treatment," Ensrud said. "Treatment with medications with anabolic effects (teriparatide, abaloparatide, romosozumab) should be considered in patients adherent to therapy with bisphosphonates or denosumab who experience treatment failure defined as multiple or disabling fracture on therapy. In addition, treatment-naive patients at very high risk of fracture (i.e., BMD T score −3.5 or less, recent disabling fracture and BMD T score −2.5 or less, or multiple prior fractures) are potential candidates for anabolic agents. Primary care clinicians should consider referring these types of patients to a subspecialist with expertise in the management of metabolic bone disease."
ACP: Time-Restricted Eating May Not Aid Weight Loss, Glycemic Measures
TUESDAY, April 23, 2024 (HealthDay News) -- Time-restricted eating is not associated with weight loss or glycemic improvements compared with a usual eating pattern when calories are held constant in both groups, according to a study published online April 19 in the Annals of Internal Medicine to coincide with presentation at the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 18 to 20 in Boston.
ACP: Recommendations Developed for Newer Type 2 Diabetes Medications
MONDAY, April 22, 2024 (HealthDay News) -- In a clinical guideline issued by the American College of Physicians and published online April 19 in the Annals of Internal Medicine, recommendations are presented regarding newer pharmacologic treatments for adults with type 2 diabetes. Details of the guideline were also presented at the Internal Medicine Meeting, the annual meeting of ACP, held from April 18 to 20 in Boston.
ACP: Next-Generation Antibiotics Underused for Gram-Negative Infections
MONDAY, April 22, 2024 (HealthDay News) -- Clinicians frequently treat gram-negative infection with older, generic antibiotics, despite recent approval of next-generation, gram-negative antibiotics, according to a study published online April 19 in the Annals of Internal Medicine to coincide with the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 18 to 20 in Boston.
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Two-Thirds of Survivors of the Most Severe COVID-19 Face Impairment at One Year
FRIDAY, April 26, 2024 (HealthDay News) -- Nearly two-thirds of survivors of severe COVID-19 discharged to long-term acute care hospitals have persistent impairments at one year, according to a study published online April 10 in Critical Care Medicine.
Anil Makam, M.D., from the University of California San Francisco, and colleagues investigated impairments among hospitalized adults discharged to one of nine long-term acute care hospitals (LTACHs; March 2020 to February 2021) for prolonged severe COVID-19 illness who survived one year. The analysis included 156 individuals who completed surveys.
The researchers found that 61.3 percent of respondents rated their prior health as good. The median length of stay in LTACHs was 57 days. Additionally, three-quarters (77 percent) required mechanical ventilation for a median of 26 days and 42 percent had a tracheostomy. At the time of the survey, nearly two-thirds of respondents (64 percent) had a persistent impairment, including physical (57 percent), respiratory (49 percent; 19 percent on supplemental oxygen), psychiatric (24 percent), and cognitive impairments (15 percent). Persistent debility from hospital-acquired complications, including mononeuropathies and pressure ulcers, were reported. Recovery was attributed to exercise/rehabilitation, support, and time. While 78.7 percent did not return to their usual health, participants expressed gratitude for recovering, despite life-altering effects. Nearly all (99 percent) returned home, and 60 percent of previously employed individuals returned to work.
"The long-lasting impairments we observed are common to survivors of any prolonged critical illness, and not specific to COVID, and are best addressed through multidisciplinary rehabilitation," Makam said in a statement.
Abstract/Full Text (subscription or payment may be required)
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New Federal Rule Means Hospitals Need Written Consent for Pelvic, Prostate Exams
MONDAY, April 1, 2024 (HealthDay News) -- In a letter sent to teaching hospitals and medical schools across the country, the U.S. Department of Health and Human Services said Monday that written consent must be obtained from patients before performing sensitive procedures such as pelvic and prostate exams.
The agency noted that it "is aware of media reports, as well as medical and scientific literature, highlighting instances where, as part of medical students’ courses of study and training, patients have been subjected to sensitive and intimate examinations -- including pelvic, breast, prostate or rectal examinations -- while under anesthesia without proper informed consent being obtained prior to the examination."
"It is critically important that hospitals set clear guidelines to ensure providers and trainees performing these examinations first obtain and document informed consent from patients before performing sensitive examinations in all circumstances," the agency stressed in its letter.
The HHS also issued a new set of guidelines clarifying a longstanding requirement that hospitals must obtain written informed consent as a condition for being reimbursed by Medicare and Medicaid.
"While we recognize that medical training on patients is an important aspect of medical education, this guidance aligns with the standard of care of many major medical organizations, as well as state laws that have enacted explicit protections as well," the HHS noted. "Informed consent is the law and essential to maintaining trust in the patient-provider relationship and respecting patients’ autonomy."
But that hasn't always been happening.
In 2020, a New York Times investigation found that hospitals, doctors and doctors in training sometimes conducted pelvic exams on women who were under anesthesia, even when those exams were not medically necessary and when the patient had not authorized them. Sometimes these exams were done solely to educate medical trainees.
“Patients who are participating in future clinicians’ education should be aware, should have the opportunity to consent, should be given the same opportunity to participate in that education that they would be given if they were awake and fully clothed,” Ashley Weitz, who underwent an unauthorized pelvic exam while she was under sedation in an emergency room, told the Times. “We can only expect to have better trust in medicine when both patients and providers can expect a standard of care that prioritizes patient consent.”
More information
The U.S. Department of Health and Human Services has more on patient privacy under HIPAA (Health Insurance Portability and Accountability Act).
SOURCES: U.S. Department of Health and Human Services, letter, April 1, 2024; New York Times
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Novel Criteria Validated for Pediatric Sepsis, Septic Shock
MONDAY, Jan. 29, 2024 (HealthDay News) -- The Phoenix Criteria are valid for identifying sepsis and septic shock in children, according to two studies published online Jan. 21 in the Journal of the American Medical Association to coincide with the Society of Critical Care Medicine annual Critical Care Congress, held from Jan. 21 to 23 in Phoenix.
Luregn J. Schlapbach, M.D., Ph.D., from the University Children's Hospital Zurich, and colleagues evaluated and updated criteria for sepsis and septic shock in children. The researchers developed new criteria for sepsis and septic shock based on data from an international survey, systematic review, an analysis of more than 3 million pediatric health care encounters, and a consensus process. The authors found that sepsis can be identified by a Phoenix Sepsis Score of ≥2 points in children with suspected infection, indicating life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. In-hospital mortality was 7.1 and 28.5 percent higher in higher- and lower-resource settings, respectively, for children with versus without a Phoenix Sepsis Score of at least 2 points. Children with sepsis who had cardiovascular dysfunction, indicated by at least one cardiovascular point in the Phoenix Sepsis Score, were defined as having septic shock.
L. Nelson Sanchez-Pinto, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues derived and validated novel criteria for pediatric sepsis and septic shock in a multicenter, international, retrospective cohort study. The researchers found that a four-organ system model performed best among the 172,984 children with suspected infection in the first 24 hours (development set, 1.2 percent mortality). For predicting mortality in the validation sets, the integer version of that model, the Phoenix Sepsis Score, had areas under the precision recall curve of 0.23 to 0.38 and areas under the receiver operating characteristic curve of 0.71 to 0.92.
"These criteria are better than the old ones at identifying children with infections at higher risk of poor outcomes and are globally applicable, including in low-resource settings," Sanchez-Pinto said in a statement.
Several authors from both studies disclosed ties to industry.
Abstract/Full Text - Schlapbach
Abstract/Full Text - Sanchez-Pinto
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Physician Compensation Rises 17% Since 2018 as Shortages Persist
Physician compensation is on the rise as healthcare organizations confront persistent clinician shortages and record levels of burnout.
physician compensation rose yet again, with the average physician salary growing from $299,000 in 2018 to $352,000 in this year’s report. That is an over 17 percent increase during the period and a 4 percent increase compared to last year’s average physician salary. Meanwhile, the gender pay gap in healthcare closed a little for physicians. Women doctors in primary care earn 19 percent less than their male counterparts compared to 25 percent less in 2018. Women specialists make 36 percent less versus 31 percent in 2022. The racial pay gap, however, did not budget, according to the report. African American and Black physicians continued to earn about 13 percent less than their White peers. Latinx and Hispanic physicians also make less than White physicians, on average.
Overall, physicians spend 15.5 hours per week on paperwork and administration. Of that, 9 hours are on EHR documentation, the report states. Among the specialties with the most paperwork are physical medicine and rehabilitation (19 hours), critical care (18 hours), internal medicine (18 hours), nephrology (18 hours), and neurology (18 hours). Family medicine physicians also spend an average of 17 hours per week on paperwork and administration.Notably, these specialties are not among the top earning areas in this year’s report. Top earners based on average salary include plastic surgery ($619,000), orthopedics ($573,000), cardiology ($507,000), urology ($506,000), and gastroenterology ($501,000)...Read more
What do you think contributes to the rise in physician compensation?
NEJM Announces New AI Journal
Artificial intelligence (AI) has gained recent public prominence with the release of deep-learning models that can generate anything from art to term papers with minimal human intervention. This development has reinvigorated discussion of the existing and potential roles of AI in all aspects of life and medicine stands out as one in which there is tremendous potential along with equally substantial challenges.
Given the enormous interest to consider some aspect of AI applied to medicine, a new journal, NEJM AI will be launched in 2024, aiming to provide a forum for high-quality evidence and resource sharing for medical AI along with informed discussions of its potential and limitations. As a medical journal, two new publishing challenges for NEJM AI is faced. The first is the breadth of potential AI applications. Second, expertise in the field of AI and machine learning is closely linked to commercial applications.
Medicine is much different from other areas where AI is being applied. AI enables new discoveries and improved processes in the entire health care continuum; ethical, governance, and regulatory considerations are critical. Because of concerns about both utility and safety, a level of rigor in testing similar to that used in other areas of medicine will be required. However, this can also present challenges, such as the “dataset shift” that can result when there is a mismatch between the data set with which an AI system was developed and the data on which it is being deployed. This summer, NEJM AI will begin evaluating studies that bring careful methodology to understanding how to use AI and machine learning approaches in medicine...Read more
What are your thoughts on the arrival of AI into medicine?
