Kevin L. ZACHAROFF MD, FACIP, FACPE, FAAP
Dr. Zacharoff sketches the background history of Prescription Drug Monitoring Programs, and offers an assessment of how well they are performing and how they can be improved. Watch the segment for recommendations on what you need to know to successfully engage these tools in your prescribing practice.
Liana SELDiN DPM
Ilene R. ROBECK MD
Darren MCCOY FNP-BC, CPE
- Spinal Risk Factors in Women Can Be Successfully Addressed
Results of a new study indicate that gender-specific differences in human spinal structure are present from birth. The findings, published online in advance of publication in Journal of Pediatrics suggest that the observed difference may be an evolutionary response to the differing demands on the female spinal column during pregnancy. The difference could also contribute to women’s higher incidence of scoliosis and osteoporosis, as well as greater susceptibility for fractures later in life. The authors note, however, that the likelihood of these events can be mitigated with exercise and nutrition, suggesting the importance of individualized health care early in life. The study, involving 35 newborn boys and girls, used MRI to measure vertebral cross-sectional dimensions, a key structural determinant of the vertebra’s strength. The researchers found that the vertebrae were 10.6% smaller on average in newborn females than in males. The mechanisms underlying the observed structural difference were not identified in the research, but the authors postulate a series of complex interactions of sex steroids, growth hormone, and insulin-like growth factor. Read a news story about the investigation, with link to the journal article, here.
- Study May Contribute to Body of Knowledge on Migraine Comorbidities
Findings published in the online edition of Neurology®, July 22 issue, report that older migraine sufferers who also smoke may be a greater risk of stroke. The study, authored by Teshamae Monteith, MD, of the University of Miami Miller School of Medicine, additionally references earlier research finding that women younger than 45 who experience migraine with aura are also at increased risk of stroke. In the current study conducted by a team from both the University of Miami and Columbia University, 1,292 migraine sufferers with an average age of 68 were tracked for an average of 11 years to see who developed heart attacks or stroke. Of those, 187 had migraine without aura and 75 had migraine with aura. A total of 294 strokes, heart attacks and deaths were recorded during the study period. Lead author Monteith noted that “Statistically, we could not rule out the possibility that the relationship between migraine and stroke in smokers was due to chance, however, we believe the association is consistent with other studies.” She added that the findings provide additional support for encouraging smoking cessation among people who experience migraine. Read more about the findings here. The journal abstract may be read here.
- There’s Room for Improvement in Treatment of South Asian Patients
A new study appearing in the American Journal of Hospice and Palliative Medicine finds that healthcare providers in the US exhibit gaps in cultural awareness with respect to treating South Asian patients for end of life pain. This disconnect results in greater dissatisfaction in this patient population with the care they are receiving. The researchers, from the University of Missouri, write that their findings provide the opportunity for clinicians to refine their delivery of care to South Asian patients and their families, noting the trend to increasing diversity in the US patient population. The study finds that South Asians living in the US are more reluctant than other ethnic populations to either report pain or to seek medications to treat pain that accompanies end of life. The authors write that providers in these patients’ home countries do not routinely ask patients about pain or use the pain scales that are common in the US. Patients, in turn, are reluctant to disclose pain to avoid being perceived as weak or as inordinately burdening others. The authors suggest that providers engage community resources such as social workers and religious leaders to facilitate better communication with these patients about available medications and other treatment modalities for pain. Link to a slide presentation on topical and transdermal analgesics at the end of life. Link to a slide presentation on practical medication tips at end of life. Watch an interview with Dr. Mary Lynn McPherson, as she talks about medication management in advanced illness. To read more about conclusions and recommendations from the above study, click here. The American Journal of Hospice and Palliative Medicine abstract may be read here.
- Better Assessment and Palliative Care Needed for Older Adults
New research conducted by a team from University of California San Francisco highlights the prevalence of chronic pain in older adults with dementia who live at home. The study appears online and will be published next month in Journal of the American Geriatrics Society. Lead author Lauren Hunt, RN, MSN, and PhD candidate at UCSF School of Nursing, undertook the study to test her own observations of the correlation between dementia and pain. “I was motivated to conduct this research study to understand the issue from the broader national prospective” Hunt relates. “It turns out that pain is very common in this population and is frequently severe enough to limit activities.” Dementia, including Alzheimer’s afflicts more than 4.5 million Americans, with the number expected to triple in the next 25 years. More than 75% of older adults with dementia live in private homes, and as most studies of the population have been conducted in nursing homes, little is known about their health as it relates to pain. The UCSF team engaged the National Health and Aging Trends Study (NHATS) in which in-home measurement of physical and cognitive function of Medicare enrollees is assessed. The study found that, of patients with dementia, two-thirds reported pain and 43% had pain severe enough to limit activities. Only 27% of respondents without dementia were similarly affected. Risk factors for pain in the study cohort included arthritis, heart and lung disease, less than a high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Among those reporting pain, 30% rarely or never took any relieving medications. The authors conclude that their findings highlight the need for “creative solutions” to ensure that pain is adequately managed in this population. Link to articles about palliative care, here. Read a news story about the study here. The journal abstract, with link to the full article may be read here.
Department of Public Health and Community Medicine
Tufts Medical Center