BU researcher receives NIH grant for clinical research in rheumatology

David Felson, MD, MPH, professor of medicine and epidemiology at Boston University Schools of Medicine (BUSM) and Public Health (BUSPH), was awarded a National Institute of Health (NIH) P30 Center Grant.

The five-year, $3.6 million award will allow for further clinical research in rheumatology at the Boston University Core Center for Clinical Research, and will provide broad clinical research expertise to a large multidisciplinary group of investigators whose research focuses on osteoarthritis and gout with a secondary emphasis on scleroderma, spondyloarthritis, osteoporosis and musculoskeletal pain.

The Center includes researchers from BU, Boston Children’s Hospital, the Beth Israel Deaconess Hospital, Massachusetts Institute of Technology, Northeastern University and different groups at Harvard University. This group is comprised of individuals with backgrounds in rheumatology, physical therapy, engineering, epidemiology, biostatistics, genetics, evolutionary biology and behavioral science, who critically review projects, provide methodologic guidance to research and creates new multidisciplinary collaborations.

Full story at News Medical

Exercise especially important for older people with heart disease

It is well-known that exercise is good for cardiac health, but older adults tend to fall through the cracks when it comes to rehabilitation programs. Now, a study has shown that these individuals have the most to gain.

Heart disease is the leading cause of death for both men and women in the United States, being responsible for 1 in 4 deaths. Every year, approximately 610,000 people in the U.S. die of heart disease, while about 735,000 people have a heart attack.

Adults over the age of 65 years are more likely than younger people to have heart disease because the heart changes with age. Heart disease is a significant cause of disability, according to the National Institute on Aging, who note that it affects the ability of millions of older people to be active and have a good quality of life.

Full story at Medical News Today

Caution urged in reducing opioids for pain

After years and decades in which healthcare providers were freely prescribing opioids for all sorts of painful conditions, the US Centers for Disease Control and Prevention (CDC) published guidelines to help bring down opioid prescription rates and with them, addiction and overdose-related death rates. Though these were not binding, they urged physicians to be cautious in dealing with opioids when prescribing for pain.

The result was predictable: many doctors and patients, as well as advocacy groups, reacted strongly, claiming that many patients with severe chronic pain had been on opioids for years at high doses, yet had not developed addiction. They also claimed that the guidelines had caused many such patients to go without the pain relief they required. Over 300 doctors also formalized their protests in a letter to the CDC in the first part of 2019.

In clarification, the CDC countered by saying that its guidelines were not meant to force patients or healthcare providers to suddenly stop taking opioids or sharply reduce the dosage, and called upon doctors to understand its stance properly before applying the guidelines. The new guide shows potential sources of harm to patients who are abruptly taken off opioids, and describes factors that must be kept in mind when opioid tapering is considered. The CDC has also included several tapering protocols, to reinforce the message that abruptly stopping opioid use patterns could harm the patient.  

Full story at News Medical

Wrist-worn step trackers accurate in predicting patient health outcomes

Determining how far patients with pulmonary disease can walk in six minutes has long been an effective clinical tool to help physicians determine their exercise capacity, as well as to aid in predicting health outcomes and mortality.

Now, in a new study, researchers at Intermountain Healthcare in Salt Lake City found that steps measured through a step tracker worn on the wrist can be used to estimate exercise capacity and determine the health status of patients, rather than the standardized six-minute walk distance test, which is usually conducted in a clinical setting.

Using the wrist-worn step trackers, researcher found data may be used in clinical care at higher intervals to effectively monitor patient progress and disease management. Researchers say the results are another example in how wearable and monitoring devices like Fitbits and Apple Watches can be used in patient care to improve outcomes.

Full story at Medical Xpress

Posture and Movement Coordination, Sensorimotor Integration May Affect Motor Skills in Children With Autism

The message

In children with autism spectrum disorder (ASD), problems with sensorimotor integration and difficulty in coordinating posture and arm motions may result in impaired motor planning and control. These children also exhibited fewer anticipatory postural adjustments and demonstrated more corrective control during arm movements. Compared with typically developing peers, children with ASD were less likely to use visual cues to plan for motions required to catch an item, such as a ball.

The study

To examine the interplay of sensory cues, postural demands, and arm movement during ball-catching, researchers in Taiwan asked children with and without ASD to catch a ball rolling down a ramp toward them. Of the children, 15 had ASD and 15 were typically developing age- and sex-matched peers.

Full story at APTA

Puzzling paralysis affecting healthy children warns CDC

The Centers for Disease Control and Prevention (CDC) has warned that a series of rare and difficult to treat cases of paralysis are being seen in otherwise healthy children since 2018. This outbreak is 2018 may soon make a comeback in 2020 the organization warns doctors and pediatricians. The report was published in the CDC’s Vital Signs this week.

The experts have called this acute flaccid myelitis or AFM that is typically manifested as a sudden onset of weakness especially of the upper limbs followed by paralysis and lesions in and around the spinal cord as detected by MRI scans. The cause of this paralysis is unknown and is commonly seen in children.

Researchers believe that the paralysis which is similar to AFP (acute flaccid paralysis) seen with polio virus infections could be caused by a relative of the same virus.

At present the disease remains incurable and difficult to treat. For most patients the paralysis is self-limiting and often goes away on its own and many regain their muscle strength and recover the complete use of their paralyzed limbs with time. In some however the paralysis may remain constant and residual weakness may continue. In a small fraction, the paralysis may affect the respiratory muscles and lead to respiratory failure and even death, explain the researchers.

Full story at news-medical.net

‘Enhanced recovery’ protocol reduces opioid use in spinal surgery patients

A novel “Enhanced Recovery After Surgery” (ERAS) protocol developed by Penn Medicine for patients undergoing spinal and peripheral nerve surgery significantly reduced opioid use. A new study published in the Journal of Neurosurgery: Spine showed that when an ERAS protocol was employed—which optimizes patients’ surgical care before, during, and after surgery, including patient education, post-operative medications, and recovery plans—fewer patients needed pain medications one month after surgery.

Nearly 75 percent of patients at Penn Medicine who undergo spinal surgeries are opioid naïve—patients who are not chronically taking opioids on a daily basis—putting them at an increased risk for dependency following surgery. Previous studies have also shown that up to 7 percent of all patients who undergo spinal surgeries continue to take opioids one year after surgery. Part of the ERAS protocol at Penn includes a personalized, safe, and effective pain management plan to help prevent opioid dependency, which has rapidly become a public health crisis in the United States.

Full story at Medical Xpress

Can nanotech slow the progress of osteoarthritis?

There is still no cure for osteoarthritis. However, one innovative nanotechnological approach may help send therapeutic agents deeper into the affected cartilage and remain active for longer.

Predominantly a condition associated with older adults, osteoarthritis is a debilitating condition.

Affecting the cartilage in the joints of the body, osteoarthritis impacts an estimated 26 million people in the United States.

Sometimes, the condition begins with an injury or disease-related damage to the joint.

Full story at Medical News Today

New Pediatric mTBI Guidelines from CDC Take Comprehensive Approach

In light of what it describes as a “significant public health concern,” the US Centers for Disease Control and Prevention (CDC) has issued what it says are the first-ever comprehensive clinical guidelines for the diagnosis and management of mild traumatic brain injury (mTBI) in children. The 19 sets of recommendations address the condition from diagnosis through management and treatment, and cover settings including primary care, outpatient settings, inpatient care, schools, and emergency departments.

The resource, published in JAMA Pediatrics and available for free, is organized into 3 main areas—diagnostic recommendations, prognostic recommendations, and recommendations related to management and treatment—with each area containing several recommendations based on extensive literature reviews. The 46 discrete recommendations are organized into 19 topic areas, and include do’s and don’ts that cover the gamut from the use of serum testing to diagnose mTBI to the best approaches for talking with families about the injury.

Full story at APTA

Sharp increase in falls in women during midlife

Falls are not just a problem of advanced age, according to researchers in Trinity College Dublin, who have identified a sharp increase in falls after the age of 40, particularly in women.

The research, which drew on data from TILDA (the Irish Longitudinal Study on Ageing) as well as data from similar studies in Australia, Great Britain and the Netherlands, found that for women the prevalence of falls increases from the age of 40 on — 9% in 40-44 year olds, 19% in 45-49 year olds, 21% in 50-54 year olds, 27% in 55-59 year olds and 30% in 60-64 year olds.

The findings indicate that middle-age may be a critical life stage for interventions designed to prevent falls, according to the authors. The study incorporated the data from 19,207 men and women aged between 40 and 64 years. It has been recently published in the international journal PLOS ONE.

Full story at Science Daily