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AHA/ACC issues first comprehensive guidance on chest pain
Clinicians should use standardized risk assessments, clinical pathways, and tools to evaluate and communicate with patients who present with chest pain (angina), advises a joint clinical practice guideline released by American Heart Association and American College of Cardiology.
While evaluation of chest pain has been covered in previous guidelines, this is the first comprehensive guideline from the AHA and ACC focused exclusively on the evaluation and diagnosis of chest pain.
“As our imaging technologies have evolved, we needed a contemporary approach to which patients need further testing, and which do not, in addition to what testing is effective,” Martha Gulati, MD, University of Arizona, Phoenix, and chair of the guideline writing group, said in an interview.
“Our hope is that we have provided an evidence-based approach to evaluating patients that will assist all of us who manage, diagnose, and treat patients who experience chest pain,” said Dr. Gulati, who is also president-elect of the American Society for Preventive Cardiology.
The guideline was simultaneously published online Oct. 28, 2021, in Circulation and the Journal of the American College of Cardiology.
‘Atypical’ is out, ‘noncardiac’ is in
Each year, chest pain sends more than 6.5 million adults to the ED and more than 4 million to outpatient clinics in the United States.
Yet, among all patients who come to the ED, only 5% will have acute coronary syndrome (ACS). More than half will ultimately have a noncardiac reason for their chest pain, including respiratory, musculoskeletal, gastrointestinal, psychological, or other causes.
The guideline says evaluating the severity and the cause of chest pain is essential and advises using standard risk assessments to determine if a patient is at low, intermediate, or high risk for having a cardiac event.
“I hope clinicians take from our guidelines the understanding that low-risk patients often do not need additional testing. And if we communicate this effectively with our patients – incorporating shared decision-making into our practice – we can reduce ‘overtesting’ in low-risk patients,” Dr. Gulati said in an interview.
The guideline notes that women are unique when presenting with ACS symptoms. While chest pain is the dominant and most common symptom for both men and women, women may be more likely to also have symptoms such as nausea and shortness of breath.
The guideline also encourages using the term “noncardiac” if heart disease is not suspected in a patient with angina and says the term “atypical” is a “misleading” descriptor of chest pain and should not be used.
“Words matter, and we need to move away from describing chest pain as ‘atypical’ because it has resulted in confusion when these words are used,” Dr. Gulati stressed.
“Rather than meaning a different way of presenting, it has taken on a meaning to imply it is not cardiac. It is more useful to talk about the probability of the pain being cardiac vs noncardiac,” Dr. Gulati explained.
No one best test for everyone
There is also a focus on evaluation of patients with chest pain who present to the ED. The initial goals of ED physicians should be to identify if there are life-threatening causes and to determine if there is a need for hospital admission or testing, the guideline states.
Thorough screening in the ED may help determine who is at high risk versus intermediate or low risk for a cardiac event. An individual deemed to be at low risk may be referred for additional evaluation in an outpatient setting rather than being admitted to the hospital, the authors wrote.
High-sensitivity cardiac troponins are the “preferred standard” for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury, they added.
“While there is no one ‘best test’ for every patient, the guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won’t provide additional information; therefore, these tests should not be done just for the sake of doing them,” Dr. Gulati said in a news release.
“Appropriate testing is also dependent upon the technology and screening devices that are available at the hospital or healthcare center where the patient is receiving care. All imaging modalities highlighted in the guideline have an important role in the assessment of chest pain to help determine the underlying cause, with the goal of preventing a serious cardiac event,” Dr. Gulati added.
The guideline was prepared on behalf of and approved by the AHA and ACC Joint Committee on Clinical Practice Guidelines.
Five other partnering organizations participated in and approved the guideline: the American Society of Echocardiography, the American College of Chest Physicians, the Society for Academic Emergency Medicine, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance.
The writing group included representatives from each of the partnering organizations and experts in the field (cardiac intensivists, cardiac interventionalists, cardiac surgeons, cardiologists, emergency physicians, and epidemiologists), as well as a lay/patient representative.
The research had no commercial funding.
A version of this article first appeared on Medscape.com.
Clinicians should use standardized risk assessments, clinical pathways, and tools to evaluate and communicate with patients who present with chest pain (angina), advises a joint clinical practice guideline released by American Heart Association and American College of Cardiology.
While evaluation of chest pain has been covered in previous guidelines, this is the first comprehensive guideline from the AHA and ACC focused exclusively on the evaluation and diagnosis of chest pain.
“As our imaging technologies have evolved, we needed a contemporary approach to which patients need further testing, and which do not, in addition to what testing is effective,” Martha Gulati, MD, University of Arizona, Phoenix, and chair of the guideline writing group, said in an interview.
“Our hope is that we have provided an evidence-based approach to evaluating patients that will assist all of us who manage, diagnose, and treat patients who experience chest pain,” said Dr. Gulati, who is also president-elect of the American Society for Preventive Cardiology.
The guideline was simultaneously published online Oct. 28, 2021, in Circulation and the Journal of the American College of Cardiology.
‘Atypical’ is out, ‘noncardiac’ is in
Each year, chest pain sends more than 6.5 million adults to the ED and more than 4 million to outpatient clinics in the United States.
Yet, among all patients who come to the ED, only 5% will have acute coronary syndrome (ACS). More than half will ultimately have a noncardiac reason for their chest pain, including respiratory, musculoskeletal, gastrointestinal, psychological, or other causes.
The guideline says evaluating the severity and the cause of chest pain is essential and advises using standard risk assessments to determine if a patient is at low, intermediate, or high risk for having a cardiac event.
“I hope clinicians take from our guidelines the understanding that low-risk patients often do not need additional testing. And if we communicate this effectively with our patients – incorporating shared decision-making into our practice – we can reduce ‘overtesting’ in low-risk patients,” Dr. Gulati said in an interview.
The guideline notes that women are unique when presenting with ACS symptoms. While chest pain is the dominant and most common symptom for both men and women, women may be more likely to also have symptoms such as nausea and shortness of breath.
The guideline also encourages using the term “noncardiac” if heart disease is not suspected in a patient with angina and says the term “atypical” is a “misleading” descriptor of chest pain and should not be used.
“Words matter, and we need to move away from describing chest pain as ‘atypical’ because it has resulted in confusion when these words are used,” Dr. Gulati stressed.
“Rather than meaning a different way of presenting, it has taken on a meaning to imply it is not cardiac. It is more useful to talk about the probability of the pain being cardiac vs noncardiac,” Dr. Gulati explained.
No one best test for everyone
There is also a focus on evaluation of patients with chest pain who present to the ED. The initial goals of ED physicians should be to identify if there are life-threatening causes and to determine if there is a need for hospital admission or testing, the guideline states.
Thorough screening in the ED may help determine who is at high risk versus intermediate or low risk for a cardiac event. An individual deemed to be at low risk may be referred for additional evaluation in an outpatient setting rather than being admitted to the hospital, the authors wrote.
High-sensitivity cardiac troponins are the “preferred standard” for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury, they added.
“While there is no one ‘best test’ for every patient, the guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won’t provide additional information; therefore, these tests should not be done just for the sake of doing them,” Dr. Gulati said in a news release.
“Appropriate testing is also dependent upon the technology and screening devices that are available at the hospital or healthcare center where the patient is receiving care. All imaging modalities highlighted in the guideline have an important role in the assessment of chest pain to help determine the underlying cause, with the goal of preventing a serious cardiac event,” Dr. Gulati added.
The guideline was prepared on behalf of and approved by the AHA and ACC Joint Committee on Clinical Practice Guidelines.
Five other partnering organizations participated in and approved the guideline: the American Society of Echocardiography, the American College of Chest Physicians, the Society for Academic Emergency Medicine, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance.
The writing group included representatives from each of the partnering organizations and experts in the field (cardiac intensivists, cardiac interventionalists, cardiac surgeons, cardiologists, emergency physicians, and epidemiologists), as well as a lay/patient representative.
The research had no commercial funding.
A version of this article first appeared on Medscape.com.
Clinicians should use standardized risk assessments, clinical pathways, and tools to evaluate and communicate with patients who present with chest pain (angina), advises a joint clinical practice guideline released by American Heart Association and American College of Cardiology.
While evaluation of chest pain has been covered in previous guidelines, this is the first comprehensive guideline from the AHA and ACC focused exclusively on the evaluation and diagnosis of chest pain.
“As our imaging technologies have evolved, we needed a contemporary approach to which patients need further testing, and which do not, in addition to what testing is effective,” Martha Gulati, MD, University of Arizona, Phoenix, and chair of the guideline writing group, said in an interview.
“Our hope is that we have provided an evidence-based approach to evaluating patients that will assist all of us who manage, diagnose, and treat patients who experience chest pain,” said Dr. Gulati, who is also president-elect of the American Society for Preventive Cardiology.
The guideline was simultaneously published online Oct. 28, 2021, in Circulation and the Journal of the American College of Cardiology.
‘Atypical’ is out, ‘noncardiac’ is in
Each year, chest pain sends more than 6.5 million adults to the ED and more than 4 million to outpatient clinics in the United States.
Yet, among all patients who come to the ED, only 5% will have acute coronary syndrome (ACS). More than half will ultimately have a noncardiac reason for their chest pain, including respiratory, musculoskeletal, gastrointestinal, psychological, or other causes.
The guideline says evaluating the severity and the cause of chest pain is essential and advises using standard risk assessments to determine if a patient is at low, intermediate, or high risk for having a cardiac event.
“I hope clinicians take from our guidelines the understanding that low-risk patients often do not need additional testing. And if we communicate this effectively with our patients – incorporating shared decision-making into our practice – we can reduce ‘overtesting’ in low-risk patients,” Dr. Gulati said in an interview.
The guideline notes that women are unique when presenting with ACS symptoms. While chest pain is the dominant and most common symptom for both men and women, women may be more likely to also have symptoms such as nausea and shortness of breath.
The guideline also encourages using the term “noncardiac” if heart disease is not suspected in a patient with angina and says the term “atypical” is a “misleading” descriptor of chest pain and should not be used.
“Words matter, and we need to move away from describing chest pain as ‘atypical’ because it has resulted in confusion when these words are used,” Dr. Gulati stressed.
“Rather than meaning a different way of presenting, it has taken on a meaning to imply it is not cardiac. It is more useful to talk about the probability of the pain being cardiac vs noncardiac,” Dr. Gulati explained.
No one best test for everyone
There is also a focus on evaluation of patients with chest pain who present to the ED. The initial goals of ED physicians should be to identify if there are life-threatening causes and to determine if there is a need for hospital admission or testing, the guideline states.
Thorough screening in the ED may help determine who is at high risk versus intermediate or low risk for a cardiac event. An individual deemed to be at low risk may be referred for additional evaluation in an outpatient setting rather than being admitted to the hospital, the authors wrote.
High-sensitivity cardiac troponins are the “preferred standard” for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury, they added.
“While there is no one ‘best test’ for every patient, the guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won’t provide additional information; therefore, these tests should not be done just for the sake of doing them,” Dr. Gulati said in a news release.
“Appropriate testing is also dependent upon the technology and screening devices that are available at the hospital or healthcare center where the patient is receiving care. All imaging modalities highlighted in the guideline have an important role in the assessment of chest pain to help determine the underlying cause, with the goal of preventing a serious cardiac event,” Dr. Gulati added.
The guideline was prepared on behalf of and approved by the AHA and ACC Joint Committee on Clinical Practice Guidelines.
Five other partnering organizations participated in and approved the guideline: the American Society of Echocardiography, the American College of Chest Physicians, the Society for Academic Emergency Medicine, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance.
The writing group included representatives from each of the partnering organizations and experts in the field (cardiac intensivists, cardiac interventionalists, cardiac surgeons, cardiologists, emergency physicians, and epidemiologists), as well as a lay/patient representative.
The research had no commercial funding.
A version of this article first appeared on Medscape.com.
Fluoroquinolones linked to sudden death risk for those on hemodialysis
, a large observational study suggests.
However, in many cases, the absolute risk is relatively small, and the antimicrobial benefits of a fluoroquinolone may outweigh the potential cardiac risks, the researchers say.
“Pathogen-directed treatment of respiratory infections is of the utmost importance. Respiratory fluoroquinolones should be prescribed whenever an amoxicillin-based antibiotic offers suboptimal antimicrobial coverage and clinicians should consider electrocardiographic monitoring,” first author Magdalene M. Assimon, PharmD, PhD, University of North Carolina, Chapel Hill, told this news organization.
The study was published online Oct. 20 in JAMA Cardiology (doi: 10.1001/jamacardio.2021.4234).
Nearly twofold increased risk
The QT interval-prolonging potential of fluoroquinolone antibiotics are well known. However, evidence linking respiratory fluoroquinolones to adverse cardiac outcomes in the hemodialysis population is limited.
These new observational findings are based on a total of 626,322 antibiotic treatment episodes among 264,968 adults (mean age, 61 years; 51% men) receiving in-center hemodialysis – with respiratory fluoroquinolone making up 40.2% of treatment episodes and amoxicillin-based antibiotic treatment episodes making up 59.8%.
The rate of SCD within 5 days of outpatient initiation of a study antibiotic was 105.7 per 100,000 people prescribed a respiratory fluoroquinolone (levofloxacin or moxifloxacin) versus with 40.0 per 100,000 prescribed amoxicillin or amoxicillin with clavulanic acid (weighted hazard ratio: 1.95; 95% confidence interval, 1.57-2.41).
The authors estimate that one additional SCD would occur during a 5-day follow-up period for every 2,273 respiratory fluoroquinolone treatment episodes. Consistent associations were seen when follow-up was extended to 7, 10, and 14 days.
“Our data suggest that curtailing respiratory fluoroquinolone prescribing may be one actionable strategy to mitigate SCD risk in the hemodialysis population. However, the associated absolute risk reduction would be relatively small,” wrote the authors.
They noted that the rate of SCD in the hemodialysis population exceeds that of the general population by more than 20-fold. Most patients undergoing hemodialysis have a least one risk factor for drug-induced QT interval prolongation.
In the current study, nearly 20% of hemodialysis patients prescribed a respiratory fluoroquinolone were taking other medications with known risk for torsades de pointes.
“Our results emphasize the importance of performing a thorough medication review and considering pharmacodynamic drug interactions before prescribing new drug therapies for any condition,” Dr. Assimon and colleagues advised.
They suggest that clinicians consider electrocardiographic monitoring before and during fluoroquinolone therapy in hemodialysis patients, especially in high-risk individuals.
Valuable study
Reached for comment, Ankur Shah, MD, of the division of kidney diseases and hypertension, Brown University, Providence, R.I., called the analysis “valuable” and said the results are “consistent with the known association of cardiac arrhythmias with respiratory fluoroquinolone use in the general population, postulated to be due to increased risk of torsades de pointes from QTc prolongation. This abnormal heart rhythm can lead to sudden cardiac death.
“Notably, the population receiving respiratory fluoroquinolones had a higher incidence of cardiac disease at baseline, but the risk persisted after adjustment for this increased burden of comorbidity,” Dr. Shah said in an interview. He was not involved in the current research.
Dr. Shah cautioned that observational data such as these should be considered more “hypothesis-generating than practice-changing, as there may be unrecognized confounders or differences in the population that received the respiratory fluoroquinolones.
“A prospective randomized trial would provide a definitive answer, but in the interim, caution should be taken in using respiratory fluoroquinolones when local bacterial resistance patterns or patient-specific data offer another option,” Dr. Shah concluded.
Dr. Assimon reported receiving grants from the Renal Research Institute (a subsidiary of Fresenius Medical Care), honoraria from the International Society of Nephrology for serving as a statistical reviewer for Kidney International Reports, and honoraria from the American Society of Nephrology for serving as an editorial fellow for the Journal of the American Society of Nephrology. Dr. Shah has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, a large observational study suggests.
However, in many cases, the absolute risk is relatively small, and the antimicrobial benefits of a fluoroquinolone may outweigh the potential cardiac risks, the researchers say.
“Pathogen-directed treatment of respiratory infections is of the utmost importance. Respiratory fluoroquinolones should be prescribed whenever an amoxicillin-based antibiotic offers suboptimal antimicrobial coverage and clinicians should consider electrocardiographic monitoring,” first author Magdalene M. Assimon, PharmD, PhD, University of North Carolina, Chapel Hill, told this news organization.
The study was published online Oct. 20 in JAMA Cardiology (doi: 10.1001/jamacardio.2021.4234).
Nearly twofold increased risk
The QT interval-prolonging potential of fluoroquinolone antibiotics are well known. However, evidence linking respiratory fluoroquinolones to adverse cardiac outcomes in the hemodialysis population is limited.
These new observational findings are based on a total of 626,322 antibiotic treatment episodes among 264,968 adults (mean age, 61 years; 51% men) receiving in-center hemodialysis – with respiratory fluoroquinolone making up 40.2% of treatment episodes and amoxicillin-based antibiotic treatment episodes making up 59.8%.
The rate of SCD within 5 days of outpatient initiation of a study antibiotic was 105.7 per 100,000 people prescribed a respiratory fluoroquinolone (levofloxacin or moxifloxacin) versus with 40.0 per 100,000 prescribed amoxicillin or amoxicillin with clavulanic acid (weighted hazard ratio: 1.95; 95% confidence interval, 1.57-2.41).
The authors estimate that one additional SCD would occur during a 5-day follow-up period for every 2,273 respiratory fluoroquinolone treatment episodes. Consistent associations were seen when follow-up was extended to 7, 10, and 14 days.
“Our data suggest that curtailing respiratory fluoroquinolone prescribing may be one actionable strategy to mitigate SCD risk in the hemodialysis population. However, the associated absolute risk reduction would be relatively small,” wrote the authors.
They noted that the rate of SCD in the hemodialysis population exceeds that of the general population by more than 20-fold. Most patients undergoing hemodialysis have a least one risk factor for drug-induced QT interval prolongation.
In the current study, nearly 20% of hemodialysis patients prescribed a respiratory fluoroquinolone were taking other medications with known risk for torsades de pointes.
“Our results emphasize the importance of performing a thorough medication review and considering pharmacodynamic drug interactions before prescribing new drug therapies for any condition,” Dr. Assimon and colleagues advised.
They suggest that clinicians consider electrocardiographic monitoring before and during fluoroquinolone therapy in hemodialysis patients, especially in high-risk individuals.
Valuable study
Reached for comment, Ankur Shah, MD, of the division of kidney diseases and hypertension, Brown University, Providence, R.I., called the analysis “valuable” and said the results are “consistent with the known association of cardiac arrhythmias with respiratory fluoroquinolone use in the general population, postulated to be due to increased risk of torsades de pointes from QTc prolongation. This abnormal heart rhythm can lead to sudden cardiac death.
“Notably, the population receiving respiratory fluoroquinolones had a higher incidence of cardiac disease at baseline, but the risk persisted after adjustment for this increased burden of comorbidity,” Dr. Shah said in an interview. He was not involved in the current research.
Dr. Shah cautioned that observational data such as these should be considered more “hypothesis-generating than practice-changing, as there may be unrecognized confounders or differences in the population that received the respiratory fluoroquinolones.
“A prospective randomized trial would provide a definitive answer, but in the interim, caution should be taken in using respiratory fluoroquinolones when local bacterial resistance patterns or patient-specific data offer another option,” Dr. Shah concluded.
Dr. Assimon reported receiving grants from the Renal Research Institute (a subsidiary of Fresenius Medical Care), honoraria from the International Society of Nephrology for serving as a statistical reviewer for Kidney International Reports, and honoraria from the American Society of Nephrology for serving as an editorial fellow for the Journal of the American Society of Nephrology. Dr. Shah has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, a large observational study suggests.
However, in many cases, the absolute risk is relatively small, and the antimicrobial benefits of a fluoroquinolone may outweigh the potential cardiac risks, the researchers say.
“Pathogen-directed treatment of respiratory infections is of the utmost importance. Respiratory fluoroquinolones should be prescribed whenever an amoxicillin-based antibiotic offers suboptimal antimicrobial coverage and clinicians should consider electrocardiographic monitoring,” first author Magdalene M. Assimon, PharmD, PhD, University of North Carolina, Chapel Hill, told this news organization.
The study was published online Oct. 20 in JAMA Cardiology (doi: 10.1001/jamacardio.2021.4234).
Nearly twofold increased risk
The QT interval-prolonging potential of fluoroquinolone antibiotics are well known. However, evidence linking respiratory fluoroquinolones to adverse cardiac outcomes in the hemodialysis population is limited.
These new observational findings are based on a total of 626,322 antibiotic treatment episodes among 264,968 adults (mean age, 61 years; 51% men) receiving in-center hemodialysis – with respiratory fluoroquinolone making up 40.2% of treatment episodes and amoxicillin-based antibiotic treatment episodes making up 59.8%.
The rate of SCD within 5 days of outpatient initiation of a study antibiotic was 105.7 per 100,000 people prescribed a respiratory fluoroquinolone (levofloxacin or moxifloxacin) versus with 40.0 per 100,000 prescribed amoxicillin or amoxicillin with clavulanic acid (weighted hazard ratio: 1.95; 95% confidence interval, 1.57-2.41).
The authors estimate that one additional SCD would occur during a 5-day follow-up period for every 2,273 respiratory fluoroquinolone treatment episodes. Consistent associations were seen when follow-up was extended to 7, 10, and 14 days.
“Our data suggest that curtailing respiratory fluoroquinolone prescribing may be one actionable strategy to mitigate SCD risk in the hemodialysis population. However, the associated absolute risk reduction would be relatively small,” wrote the authors.
They noted that the rate of SCD in the hemodialysis population exceeds that of the general population by more than 20-fold. Most patients undergoing hemodialysis have a least one risk factor for drug-induced QT interval prolongation.
In the current study, nearly 20% of hemodialysis patients prescribed a respiratory fluoroquinolone were taking other medications with known risk for torsades de pointes.
“Our results emphasize the importance of performing a thorough medication review and considering pharmacodynamic drug interactions before prescribing new drug therapies for any condition,” Dr. Assimon and colleagues advised.
They suggest that clinicians consider electrocardiographic monitoring before and during fluoroquinolone therapy in hemodialysis patients, especially in high-risk individuals.
Valuable study
Reached for comment, Ankur Shah, MD, of the division of kidney diseases and hypertension, Brown University, Providence, R.I., called the analysis “valuable” and said the results are “consistent with the known association of cardiac arrhythmias with respiratory fluoroquinolone use in the general population, postulated to be due to increased risk of torsades de pointes from QTc prolongation. This abnormal heart rhythm can lead to sudden cardiac death.
“Notably, the population receiving respiratory fluoroquinolones had a higher incidence of cardiac disease at baseline, but the risk persisted after adjustment for this increased burden of comorbidity,” Dr. Shah said in an interview. He was not involved in the current research.
Dr. Shah cautioned that observational data such as these should be considered more “hypothesis-generating than practice-changing, as there may be unrecognized confounders or differences in the population that received the respiratory fluoroquinolones.
“A prospective randomized trial would provide a definitive answer, but in the interim, caution should be taken in using respiratory fluoroquinolones when local bacterial resistance patterns or patient-specific data offer another option,” Dr. Shah concluded.
Dr. Assimon reported receiving grants from the Renal Research Institute (a subsidiary of Fresenius Medical Care), honoraria from the International Society of Nephrology for serving as a statistical reviewer for Kidney International Reports, and honoraria from the American Society of Nephrology for serving as an editorial fellow for the Journal of the American Society of Nephrology. Dr. Shah has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Novel light therapy helmet boosts brain function
Near-infrared light delivered to the brain using a specially designed helmet appears to improve memory, motor function, and processing skills in cognitively healthy older adults, in new findings that suggest potential benefit in patients with dementia.
Studies in animals and people have shown “many positive effects” with near-infrared transcranial photobiomodulation therapy (PBM-T), study investigator Paul Chazot, PhD, department of biosciences, Durham University, United Kingdom, told this news organization.
For example, PBM-T has been shown to increase blood circulation (which keeps the brain well oxygenated), boost mitochondria function in neurons, protect neurons from oxidative stress, and help maintain neuronal connectivity, Dr. Chazot explained.
PBM-T has also been shown to reduce amyloid and phosphorylated tau load, pathological signs of Alzheimer’s disease.
“All these in combination improve memory performance and mobility,” Dr. Chazot said.
The study was published online October 18 in Photobiomodulation, Photomedicine and Laser Surgery.
Promising early data
In the study, 14 healthy adults, aged 45 to 70 years, received 6 minutes of transcranial PBM-T twice daily at a wavelength of 1,068 nanometers over 4 weeks. PBM-T was delivered via a helmet that comprised 14 air-cooled light emitting diode panel arrays. A control group of 13 adults used a sham PBM-T helmet.
Before and after active and sham treatment, all participants completed the automated neuropsychological assessment metrics (ANAM) – a computer-based tool designed to detect speed and accuracy of attention, memory, and thinking ability.
According to the research team, compared with sham PBM-T, those receiving active PBM-T showed significant improvement in motor function (finger tapping), working memory, delayed memory, and brain processing speed, the research team reports. No adverse effects were reported.
“This study complements our other recent studies, which showed improvement in memory performance with no obvious side effects,” said Dr. Chazot.
“While this is a pilot study and more research is needed, there are promising indications that therapy involving infrared light might also be beneficial for people living with dementia, and this is worth exploring,” Dr. Chazot added in a news release.
The PBM-T helmet was devised by first author Gordon Dougal, MBChB, of Maculume in the U.K., and a general practitioner based in Durham.
A recent study by Mr. Dougal, Dr. Chazot, and collaborators in the United States provides early evidence that PBM-T can improve memory in adults with dementia.
In that study, 39 patients received 6 minutes of PBM-T twice a day for 8 weeks, alongside a control group of 17 patients who received sham PBM-T.
After 8 weeks, there was about a 20% improvement in Mini-Mental State Exam (MMSE) scores in the active PBM-T group compared with roughly a 6% improvement in the control group, the researchers report in the journal Cureus.
More research needed
Reached for comment, Rebecca Edelmayer, PhD, Alzheimer’s Association senior director of scientific engagement, said using light to stimulate the brain is “an emerging technology.”
“However, ,” Dr. Edelmayer told this news organization.
“That being said, we’re starting to see companies looking at similar, noninvasive methods of stimulating the brain. For example, brain stimulation devices have been applied to other neurodegenerative diseases like Parkinson’s to try to prevent degeneration of brain cells,” Dr. Edelmayer noted.
She said more research is needed to understand how photobiomodulation might be used as a therapy or prevention for cognitive decline and dementia.
“Specifically, we need to understand what parts of the brain need to be targeted and at what point(s) in the disease course this treatment would be most impactful. If proven to be effective, this could possibly be part of an approach that’s combined with other treatments, like drugs and lifestyle interventions,” said Dr. Edelmayer.
The Alzheimer’s Association is funding a number of projects looking at noninvasive treatments for Alzheimer’s disease, including two clinical trials looking at deep brain stimulation and photobiomodulation.
Maculume provided funding for the study. Mr. Dougal is a majority shareholder in the company, which manufactures the helmet device used in the study. Dr. Chazot, study co-authors, and Dr. Edelmayer have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Near-infrared light delivered to the brain using a specially designed helmet appears to improve memory, motor function, and processing skills in cognitively healthy older adults, in new findings that suggest potential benefit in patients with dementia.
Studies in animals and people have shown “many positive effects” with near-infrared transcranial photobiomodulation therapy (PBM-T), study investigator Paul Chazot, PhD, department of biosciences, Durham University, United Kingdom, told this news organization.
For example, PBM-T has been shown to increase blood circulation (which keeps the brain well oxygenated), boost mitochondria function in neurons, protect neurons from oxidative stress, and help maintain neuronal connectivity, Dr. Chazot explained.
PBM-T has also been shown to reduce amyloid and phosphorylated tau load, pathological signs of Alzheimer’s disease.
“All these in combination improve memory performance and mobility,” Dr. Chazot said.
The study was published online October 18 in Photobiomodulation, Photomedicine and Laser Surgery.
Promising early data
In the study, 14 healthy adults, aged 45 to 70 years, received 6 minutes of transcranial PBM-T twice daily at a wavelength of 1,068 nanometers over 4 weeks. PBM-T was delivered via a helmet that comprised 14 air-cooled light emitting diode panel arrays. A control group of 13 adults used a sham PBM-T helmet.
Before and after active and sham treatment, all participants completed the automated neuropsychological assessment metrics (ANAM) – a computer-based tool designed to detect speed and accuracy of attention, memory, and thinking ability.
According to the research team, compared with sham PBM-T, those receiving active PBM-T showed significant improvement in motor function (finger tapping), working memory, delayed memory, and brain processing speed, the research team reports. No adverse effects were reported.
“This study complements our other recent studies, which showed improvement in memory performance with no obvious side effects,” said Dr. Chazot.
“While this is a pilot study and more research is needed, there are promising indications that therapy involving infrared light might also be beneficial for people living with dementia, and this is worth exploring,” Dr. Chazot added in a news release.
The PBM-T helmet was devised by first author Gordon Dougal, MBChB, of Maculume in the U.K., and a general practitioner based in Durham.
A recent study by Mr. Dougal, Dr. Chazot, and collaborators in the United States provides early evidence that PBM-T can improve memory in adults with dementia.
In that study, 39 patients received 6 minutes of PBM-T twice a day for 8 weeks, alongside a control group of 17 patients who received sham PBM-T.
After 8 weeks, there was about a 20% improvement in Mini-Mental State Exam (MMSE) scores in the active PBM-T group compared with roughly a 6% improvement in the control group, the researchers report in the journal Cureus.
More research needed
Reached for comment, Rebecca Edelmayer, PhD, Alzheimer’s Association senior director of scientific engagement, said using light to stimulate the brain is “an emerging technology.”
“However, ,” Dr. Edelmayer told this news organization.
“That being said, we’re starting to see companies looking at similar, noninvasive methods of stimulating the brain. For example, brain stimulation devices have been applied to other neurodegenerative diseases like Parkinson’s to try to prevent degeneration of brain cells,” Dr. Edelmayer noted.
She said more research is needed to understand how photobiomodulation might be used as a therapy or prevention for cognitive decline and dementia.
“Specifically, we need to understand what parts of the brain need to be targeted and at what point(s) in the disease course this treatment would be most impactful. If proven to be effective, this could possibly be part of an approach that’s combined with other treatments, like drugs and lifestyle interventions,” said Dr. Edelmayer.
The Alzheimer’s Association is funding a number of projects looking at noninvasive treatments for Alzheimer’s disease, including two clinical trials looking at deep brain stimulation and photobiomodulation.
Maculume provided funding for the study. Mr. Dougal is a majority shareholder in the company, which manufactures the helmet device used in the study. Dr. Chazot, study co-authors, and Dr. Edelmayer have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Near-infrared light delivered to the brain using a specially designed helmet appears to improve memory, motor function, and processing skills in cognitively healthy older adults, in new findings that suggest potential benefit in patients with dementia.
Studies in animals and people have shown “many positive effects” with near-infrared transcranial photobiomodulation therapy (PBM-T), study investigator Paul Chazot, PhD, department of biosciences, Durham University, United Kingdom, told this news organization.
For example, PBM-T has been shown to increase blood circulation (which keeps the brain well oxygenated), boost mitochondria function in neurons, protect neurons from oxidative stress, and help maintain neuronal connectivity, Dr. Chazot explained.
PBM-T has also been shown to reduce amyloid and phosphorylated tau load, pathological signs of Alzheimer’s disease.
“All these in combination improve memory performance and mobility,” Dr. Chazot said.
The study was published online October 18 in Photobiomodulation, Photomedicine and Laser Surgery.
Promising early data
In the study, 14 healthy adults, aged 45 to 70 years, received 6 minutes of transcranial PBM-T twice daily at a wavelength of 1,068 nanometers over 4 weeks. PBM-T was delivered via a helmet that comprised 14 air-cooled light emitting diode panel arrays. A control group of 13 adults used a sham PBM-T helmet.
Before and after active and sham treatment, all participants completed the automated neuropsychological assessment metrics (ANAM) – a computer-based tool designed to detect speed and accuracy of attention, memory, and thinking ability.
According to the research team, compared with sham PBM-T, those receiving active PBM-T showed significant improvement in motor function (finger tapping), working memory, delayed memory, and brain processing speed, the research team reports. No adverse effects were reported.
“This study complements our other recent studies, which showed improvement in memory performance with no obvious side effects,” said Dr. Chazot.
“While this is a pilot study and more research is needed, there are promising indications that therapy involving infrared light might also be beneficial for people living with dementia, and this is worth exploring,” Dr. Chazot added in a news release.
The PBM-T helmet was devised by first author Gordon Dougal, MBChB, of Maculume in the U.K., and a general practitioner based in Durham.
A recent study by Mr. Dougal, Dr. Chazot, and collaborators in the United States provides early evidence that PBM-T can improve memory in adults with dementia.
In that study, 39 patients received 6 minutes of PBM-T twice a day for 8 weeks, alongside a control group of 17 patients who received sham PBM-T.
After 8 weeks, there was about a 20% improvement in Mini-Mental State Exam (MMSE) scores in the active PBM-T group compared with roughly a 6% improvement in the control group, the researchers report in the journal Cureus.
More research needed
Reached for comment, Rebecca Edelmayer, PhD, Alzheimer’s Association senior director of scientific engagement, said using light to stimulate the brain is “an emerging technology.”
“However, ,” Dr. Edelmayer told this news organization.
“That being said, we’re starting to see companies looking at similar, noninvasive methods of stimulating the brain. For example, brain stimulation devices have been applied to other neurodegenerative diseases like Parkinson’s to try to prevent degeneration of brain cells,” Dr. Edelmayer noted.
She said more research is needed to understand how photobiomodulation might be used as a therapy or prevention for cognitive decline and dementia.
“Specifically, we need to understand what parts of the brain need to be targeted and at what point(s) in the disease course this treatment would be most impactful. If proven to be effective, this could possibly be part of an approach that’s combined with other treatments, like drugs and lifestyle interventions,” said Dr. Edelmayer.
The Alzheimer’s Association is funding a number of projects looking at noninvasive treatments for Alzheimer’s disease, including two clinical trials looking at deep brain stimulation and photobiomodulation.
Maculume provided funding for the study. Mr. Dougal is a majority shareholder in the company, which manufactures the helmet device used in the study. Dr. Chazot, study co-authors, and Dr. Edelmayer have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Pandemic drives uptick in need for mental health services
In 2020, amid the COVID-19 pandemic, about 1 in 5 (20.3%) U.S. adults received mental health treatment, up slightly from 19.2% in 2019, new data from the U.S. Centers for Disease Control and Prevention show.
Compared with 2019, the pandemic year of 2020 also saw an uptick in adults receiving prescription medication for a mental health problem (from 15.8% to 16.5%) or counseling or therapy from a mental health professional (from 9.5% to 10.1%), the CDC says.
The percentage of adults who had received mental health treatment in the prior year decreased with age, from 20.9% among people aged 18-44 to 20.5% among those aged 45-64 to 18.7% among those aged 65 and older.
Women were more likely than men to have received any mental health treatment (25.6% vs 14.6%), according to an analysis of 2020 data from the National Health Interview Survey (NHIS).
This is consistent with their higher prevalence of common mental health conditions, including anxiety and depression, and their greater willingness to seek out mental health care, Emily Terlizzi, MPH, and Tina Norris, PhD, with the CDC’s National Center for Health Statistics (NCHS), note in their data brief published online Oct. 20.
Non-Hispanic White adults (24.4%) were more likely than non-Hispanic Black (15.3%), Hispanic (12.65) and non-Hispanic Asian (7.7%) adults to be treated with a mental health issue.
The percentage of adults treated for a mental health problem increased as their place of residence became more rural, from 19.3% for those living in large urban areas to 21.7% among those residing in nonmetropolitan areas.
Social and emotional support
Despite rising mental health care needs, period of July to Dec. 2020, also based on NHIS data.
Social and emotional support is associated with well-being and a reduced risk of early death, NCHS researchers Peter Boersma, MPH, and Anjel Vahratian, PhD, MPH, note in their data brief.
However, social and emotional support varies by age and race/ethnicity.
Groups with lower levels of social and emotional support are Hispanic, non-Hispanic Black, and non-Hispanic Asian adults; adults neither married nor living with a partner; adults without another adult in the home; adults with less than a high school education; and adults with disabilities.
“While most adults always or usually had the emotional support they needed, 1 in 10 adults rarely or never received the social and emotional support they needed,” the authors report.
As reported by this news organization, 2020 data from the National Academies of Sciences, Engineering, and Medicine (NAS) show social isolation in older adults is a major public health concern that contributes to heart disease, depression, and premature death.
The report urged health care systems to take urgent action to address social isolation and loneliness in older adults and proposed a series of recommendations for addressing social isolation.
One recommendation was to improve awareness by including measures of social isolation and loneliness in health surveys, such as the NHIS, which began asking about perceived social and emotional support in July 2020.
A version of this article first appeared on Medscape.com.
In 2020, amid the COVID-19 pandemic, about 1 in 5 (20.3%) U.S. adults received mental health treatment, up slightly from 19.2% in 2019, new data from the U.S. Centers for Disease Control and Prevention show.
Compared with 2019, the pandemic year of 2020 also saw an uptick in adults receiving prescription medication for a mental health problem (from 15.8% to 16.5%) or counseling or therapy from a mental health professional (from 9.5% to 10.1%), the CDC says.
The percentage of adults who had received mental health treatment in the prior year decreased with age, from 20.9% among people aged 18-44 to 20.5% among those aged 45-64 to 18.7% among those aged 65 and older.
Women were more likely than men to have received any mental health treatment (25.6% vs 14.6%), according to an analysis of 2020 data from the National Health Interview Survey (NHIS).
This is consistent with their higher prevalence of common mental health conditions, including anxiety and depression, and their greater willingness to seek out mental health care, Emily Terlizzi, MPH, and Tina Norris, PhD, with the CDC’s National Center for Health Statistics (NCHS), note in their data brief published online Oct. 20.
Non-Hispanic White adults (24.4%) were more likely than non-Hispanic Black (15.3%), Hispanic (12.65) and non-Hispanic Asian (7.7%) adults to be treated with a mental health issue.
The percentage of adults treated for a mental health problem increased as their place of residence became more rural, from 19.3% for those living in large urban areas to 21.7% among those residing in nonmetropolitan areas.
Social and emotional support
Despite rising mental health care needs, period of July to Dec. 2020, also based on NHIS data.
Social and emotional support is associated with well-being and a reduced risk of early death, NCHS researchers Peter Boersma, MPH, and Anjel Vahratian, PhD, MPH, note in their data brief.
However, social and emotional support varies by age and race/ethnicity.
Groups with lower levels of social and emotional support are Hispanic, non-Hispanic Black, and non-Hispanic Asian adults; adults neither married nor living with a partner; adults without another adult in the home; adults with less than a high school education; and adults with disabilities.
“While most adults always or usually had the emotional support they needed, 1 in 10 adults rarely or never received the social and emotional support they needed,” the authors report.
As reported by this news organization, 2020 data from the National Academies of Sciences, Engineering, and Medicine (NAS) show social isolation in older adults is a major public health concern that contributes to heart disease, depression, and premature death.
The report urged health care systems to take urgent action to address social isolation and loneliness in older adults and proposed a series of recommendations for addressing social isolation.
One recommendation was to improve awareness by including measures of social isolation and loneliness in health surveys, such as the NHIS, which began asking about perceived social and emotional support in July 2020.
A version of this article first appeared on Medscape.com.
In 2020, amid the COVID-19 pandemic, about 1 in 5 (20.3%) U.S. adults received mental health treatment, up slightly from 19.2% in 2019, new data from the U.S. Centers for Disease Control and Prevention show.
Compared with 2019, the pandemic year of 2020 also saw an uptick in adults receiving prescription medication for a mental health problem (from 15.8% to 16.5%) or counseling or therapy from a mental health professional (from 9.5% to 10.1%), the CDC says.
The percentage of adults who had received mental health treatment in the prior year decreased with age, from 20.9% among people aged 18-44 to 20.5% among those aged 45-64 to 18.7% among those aged 65 and older.
Women were more likely than men to have received any mental health treatment (25.6% vs 14.6%), according to an analysis of 2020 data from the National Health Interview Survey (NHIS).
This is consistent with their higher prevalence of common mental health conditions, including anxiety and depression, and their greater willingness to seek out mental health care, Emily Terlizzi, MPH, and Tina Norris, PhD, with the CDC’s National Center for Health Statistics (NCHS), note in their data brief published online Oct. 20.
Non-Hispanic White adults (24.4%) were more likely than non-Hispanic Black (15.3%), Hispanic (12.65) and non-Hispanic Asian (7.7%) adults to be treated with a mental health issue.
The percentage of adults treated for a mental health problem increased as their place of residence became more rural, from 19.3% for those living in large urban areas to 21.7% among those residing in nonmetropolitan areas.
Social and emotional support
Despite rising mental health care needs, period of July to Dec. 2020, also based on NHIS data.
Social and emotional support is associated with well-being and a reduced risk of early death, NCHS researchers Peter Boersma, MPH, and Anjel Vahratian, PhD, MPH, note in their data brief.
However, social and emotional support varies by age and race/ethnicity.
Groups with lower levels of social and emotional support are Hispanic, non-Hispanic Black, and non-Hispanic Asian adults; adults neither married nor living with a partner; adults without another adult in the home; adults with less than a high school education; and adults with disabilities.
“While most adults always or usually had the emotional support they needed, 1 in 10 adults rarely or never received the social and emotional support they needed,” the authors report.
As reported by this news organization, 2020 data from the National Academies of Sciences, Engineering, and Medicine (NAS) show social isolation in older adults is a major public health concern that contributes to heart disease, depression, and premature death.
The report urged health care systems to take urgent action to address social isolation and loneliness in older adults and proposed a series of recommendations for addressing social isolation.
One recommendation was to improve awareness by including measures of social isolation and loneliness in health surveys, such as the NHIS, which began asking about perceived social and emotional support in July 2020.
A version of this article first appeared on Medscape.com.
FDA clears 5-minute test for early dementia
The U.S. Food and Drug Administration has given marketing clearance to CognICA, an artificial intelligence–powered integrated cognitive assessment for the early detection of dementia.
Developed by Cognetivity Neurosciences, CognICA is a 5-minute, computerized cognitive assessment that is completed using an iPad. The test offers several advantages over traditional pen-and-paper–based cognitive tests, the company said in a news release.
“These include its high sensitivity to early-stage cognitive impairment, avoidance of cultural or educational bias, and absence of learning effect upon repeat testing,” the company notes.
Because the test runs on a computer, it can support remote, self-administered testing at scale and is geared toward seamless integration with existing electronic health record systems, they add.
According to the latest Alzheimer’s Disease Facts and Figures, published by the Alzheimer’s Association, more than 6 million Americans are now living with Alzheimer’s disease. That number is projected to increase to 12.7 million by 2050.
“We’re excited about the opportunity to revolutionize the way cognitive impairment is assessed and managed in the U.S. and make a positive impact on the health and wellbeing of millions of Americans,” Sina Habibi, PhD, cofounder and CEO of Cognetivity, said in the news release.
The test has already received European regulatory approval as a CE-marked medical device and has been deployed in both primary and specialist clinical care in the U.K.’s National Health Service.
A version of this article first appeared on Medscape.com.
The U.S. Food and Drug Administration has given marketing clearance to CognICA, an artificial intelligence–powered integrated cognitive assessment for the early detection of dementia.
Developed by Cognetivity Neurosciences, CognICA is a 5-minute, computerized cognitive assessment that is completed using an iPad. The test offers several advantages over traditional pen-and-paper–based cognitive tests, the company said in a news release.
“These include its high sensitivity to early-stage cognitive impairment, avoidance of cultural or educational bias, and absence of learning effect upon repeat testing,” the company notes.
Because the test runs on a computer, it can support remote, self-administered testing at scale and is geared toward seamless integration with existing electronic health record systems, they add.
According to the latest Alzheimer’s Disease Facts and Figures, published by the Alzheimer’s Association, more than 6 million Americans are now living with Alzheimer’s disease. That number is projected to increase to 12.7 million by 2050.
“We’re excited about the opportunity to revolutionize the way cognitive impairment is assessed and managed in the U.S. and make a positive impact on the health and wellbeing of millions of Americans,” Sina Habibi, PhD, cofounder and CEO of Cognetivity, said in the news release.
The test has already received European regulatory approval as a CE-marked medical device and has been deployed in both primary and specialist clinical care in the U.K.’s National Health Service.
A version of this article first appeared on Medscape.com.
The U.S. Food and Drug Administration has given marketing clearance to CognICA, an artificial intelligence–powered integrated cognitive assessment for the early detection of dementia.
Developed by Cognetivity Neurosciences, CognICA is a 5-minute, computerized cognitive assessment that is completed using an iPad. The test offers several advantages over traditional pen-and-paper–based cognitive tests, the company said in a news release.
“These include its high sensitivity to early-stage cognitive impairment, avoidance of cultural or educational bias, and absence of learning effect upon repeat testing,” the company notes.
Because the test runs on a computer, it can support remote, self-administered testing at scale and is geared toward seamless integration with existing electronic health record systems, they add.
According to the latest Alzheimer’s Disease Facts and Figures, published by the Alzheimer’s Association, more than 6 million Americans are now living with Alzheimer’s disease. That number is projected to increase to 12.7 million by 2050.
“We’re excited about the opportunity to revolutionize the way cognitive impairment is assessed and managed in the U.S. and make a positive impact on the health and wellbeing of millions of Americans,” Sina Habibi, PhD, cofounder and CEO of Cognetivity, said in the news release.
The test has already received European regulatory approval as a CE-marked medical device and has been deployed in both primary and specialist clinical care in the U.K.’s National Health Service.
A version of this article first appeared on Medscape.com.
No benefit from lower temps for out-of-hospital cardiac arrest
The results “do not support the use of moderate therapeutic hypothermia to improve neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest,” write the investigators led by Michel Le May, MD, from the University of Ottawa Heart Institute, Ontario, Canada.
The CAPITAL CHILL results were first presented at the American College of Cardiology (ACC) 2021 Scientific Sessions in May.
They have now been published online, October 19, in JAMA.
High rates of brain injury and death
Comatose survivors of OHCA have high rates of severe brain injury and death. Current guidelines recommend targeted temperature management at 32°C to 36°C for 24 hours. However, small studies have suggested a potential benefit of targeting lower body temperatures.
In the CAPITAL CHILL study of 367 OHCA patients who were comatose on admission, there were no statistically significant differences in the primary composite outcome of all-cause mortality or poor neurologic outcome at 180 days with mild-versus-moderate hypothermia.
The primary composite outcome occurred in 89 of 184 (48.4%) patients in the moderate hypothermia group and 83 of 183 (45.4%) patients in the mild hypothermia group — a risk difference of 3.0% (95% confidence interval [CI], 7.2% - 13.2%) and relative risk of 1.07 (95% CI, 0.86 - 1.33; P = .56).
There was also no significant difference when looking at the individual components of mortality (43.5% vs 41.0%) and poor neurologic outcome (Disability Rating Scale score >5: 4.9% vs 4.4%).
The baseline characteristics of patients were similar in the moderate and mild hypothermia groups. The lack of a significant difference in the primary outcome was consistent after adjusting for baseline covariates as well as across all subgroups.
The rates of secondary outcomes were also similar between the two groups, except for a longer length of stay in the intensive care unit in the moderate hypothermia group compared with the mild hypothermia group, which would likely add to overall costs.
The researchers note that the Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial recently reported that targeted hypothermia at 33°C did not improve survival at 180 days compared with targeted normothermia at 37.5°C or less.
The CAPITAL CHILL study “adds to the spectrum of target temperature management, as it did not find any benefit of even further lowering temperatures to 31°C,” the study team says.
They caution that most patients in the trial had cardiac arrest secondary to a primary cardiac etiology and therefore the findings may not be applicable to cardiac arrest of all etiologies.
It’s also possible that the trial was underpowered to detect clinically important differences between moderate and mild hypothermia. Also, the number of patients presenting with a nonshockable rhythm was relatively small, and further study may be worthwhile in this subgroup, they say.
For now, however, the CAPITAL CHILL results provide no support for a lower target temperature of 31°C to improve outcomes in OHCA patients, Dr. Le May and colleagues conclude.
CAPITAL CHILL was an investigator-initiated study and funding was provided by the University of Ottawa Heart Institute Cardiac Arrest Program. Dr. Le May has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
The results “do not support the use of moderate therapeutic hypothermia to improve neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest,” write the investigators led by Michel Le May, MD, from the University of Ottawa Heart Institute, Ontario, Canada.
The CAPITAL CHILL results were first presented at the American College of Cardiology (ACC) 2021 Scientific Sessions in May.
They have now been published online, October 19, in JAMA.
High rates of brain injury and death
Comatose survivors of OHCA have high rates of severe brain injury and death. Current guidelines recommend targeted temperature management at 32°C to 36°C for 24 hours. However, small studies have suggested a potential benefit of targeting lower body temperatures.
In the CAPITAL CHILL study of 367 OHCA patients who were comatose on admission, there were no statistically significant differences in the primary composite outcome of all-cause mortality or poor neurologic outcome at 180 days with mild-versus-moderate hypothermia.
The primary composite outcome occurred in 89 of 184 (48.4%) patients in the moderate hypothermia group and 83 of 183 (45.4%) patients in the mild hypothermia group — a risk difference of 3.0% (95% confidence interval [CI], 7.2% - 13.2%) and relative risk of 1.07 (95% CI, 0.86 - 1.33; P = .56).
There was also no significant difference when looking at the individual components of mortality (43.5% vs 41.0%) and poor neurologic outcome (Disability Rating Scale score >5: 4.9% vs 4.4%).
The baseline characteristics of patients were similar in the moderate and mild hypothermia groups. The lack of a significant difference in the primary outcome was consistent after adjusting for baseline covariates as well as across all subgroups.
The rates of secondary outcomes were also similar between the two groups, except for a longer length of stay in the intensive care unit in the moderate hypothermia group compared with the mild hypothermia group, which would likely add to overall costs.
The researchers note that the Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial recently reported that targeted hypothermia at 33°C did not improve survival at 180 days compared with targeted normothermia at 37.5°C or less.
The CAPITAL CHILL study “adds to the spectrum of target temperature management, as it did not find any benefit of even further lowering temperatures to 31°C,” the study team says.
They caution that most patients in the trial had cardiac arrest secondary to a primary cardiac etiology and therefore the findings may not be applicable to cardiac arrest of all etiologies.
It’s also possible that the trial was underpowered to detect clinically important differences between moderate and mild hypothermia. Also, the number of patients presenting with a nonshockable rhythm was relatively small, and further study may be worthwhile in this subgroup, they say.
For now, however, the CAPITAL CHILL results provide no support for a lower target temperature of 31°C to improve outcomes in OHCA patients, Dr. Le May and colleagues conclude.
CAPITAL CHILL was an investigator-initiated study and funding was provided by the University of Ottawa Heart Institute Cardiac Arrest Program. Dr. Le May has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
The results “do not support the use of moderate therapeutic hypothermia to improve neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest,” write the investigators led by Michel Le May, MD, from the University of Ottawa Heart Institute, Ontario, Canada.
The CAPITAL CHILL results were first presented at the American College of Cardiology (ACC) 2021 Scientific Sessions in May.
They have now been published online, October 19, in JAMA.
High rates of brain injury and death
Comatose survivors of OHCA have high rates of severe brain injury and death. Current guidelines recommend targeted temperature management at 32°C to 36°C for 24 hours. However, small studies have suggested a potential benefit of targeting lower body temperatures.
In the CAPITAL CHILL study of 367 OHCA patients who were comatose on admission, there were no statistically significant differences in the primary composite outcome of all-cause mortality or poor neurologic outcome at 180 days with mild-versus-moderate hypothermia.
The primary composite outcome occurred in 89 of 184 (48.4%) patients in the moderate hypothermia group and 83 of 183 (45.4%) patients in the mild hypothermia group — a risk difference of 3.0% (95% confidence interval [CI], 7.2% - 13.2%) and relative risk of 1.07 (95% CI, 0.86 - 1.33; P = .56).
There was also no significant difference when looking at the individual components of mortality (43.5% vs 41.0%) and poor neurologic outcome (Disability Rating Scale score >5: 4.9% vs 4.4%).
The baseline characteristics of patients were similar in the moderate and mild hypothermia groups. The lack of a significant difference in the primary outcome was consistent after adjusting for baseline covariates as well as across all subgroups.
The rates of secondary outcomes were also similar between the two groups, except for a longer length of stay in the intensive care unit in the moderate hypothermia group compared with the mild hypothermia group, which would likely add to overall costs.
The researchers note that the Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial recently reported that targeted hypothermia at 33°C did not improve survival at 180 days compared with targeted normothermia at 37.5°C or less.
The CAPITAL CHILL study “adds to the spectrum of target temperature management, as it did not find any benefit of even further lowering temperatures to 31°C,” the study team says.
They caution that most patients in the trial had cardiac arrest secondary to a primary cardiac etiology and therefore the findings may not be applicable to cardiac arrest of all etiologies.
It’s also possible that the trial was underpowered to detect clinically important differences between moderate and mild hypothermia. Also, the number of patients presenting with a nonshockable rhythm was relatively small, and further study may be worthwhile in this subgroup, they say.
For now, however, the CAPITAL CHILL results provide no support for a lower target temperature of 31°C to improve outcomes in OHCA patients, Dr. Le May and colleagues conclude.
CAPITAL CHILL was an investigator-initiated study and funding was provided by the University of Ottawa Heart Institute Cardiac Arrest Program. Dr. Le May has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FDA approves combo pill for severe, acute pain
enough to require an opioid analgesic and for which alternative treatments fail to provide adequate pain relief.
Celecoxib is a nonsteroidal anti-inflammatory drug and tramadol is an opioid agonist. Seglentis contains 56 mg of celecoxib and 44 mg of tramadol.
“The unique co-crystal formulation of Seglentis provides effective pain relief via a multimodal approach,” Craig A. Sponseller, MD, chief medical officer of Kowa Pharmaceuticals America, said in a news release.
Esteve Pharmaceuticals has entered into an agreement with Kowa Pharmaceuticals America to commercialize the pain medicine in the United States, with a launch planned for early 2022.
“Seglentis uses four different and complementary mechanisms of analgesia and offers healthcare providers an important option to treat acute pain in adults that is severe enough to require opioid treatment and for which alternative treatments are inadequate,” Dr. Sponseller said.
Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, the FDA will require a Risk Evaluation and Mitigation Strategy (REMS) for Seglentis.
The label states that the drug should be initiated as two tablets every 12 hours as needed and should be prescribed for the shortest duration consistent with individual patient treatment goals.
Patients should be monitored for respiratory depression, especially within the first 24 to 72 hours of initiating therapy with Seglentis.
Prescribers should discuss naloxone (Narcan) with patients and consider prescribing the opioid antagonist naloxone based on the patient’s risk factors for overdose.
Full prescribing information is available online.
A version of this article was first published on Medscape.com.
enough to require an opioid analgesic and for which alternative treatments fail to provide adequate pain relief.
Celecoxib is a nonsteroidal anti-inflammatory drug and tramadol is an opioid agonist. Seglentis contains 56 mg of celecoxib and 44 mg of tramadol.
“The unique co-crystal formulation of Seglentis provides effective pain relief via a multimodal approach,” Craig A. Sponseller, MD, chief medical officer of Kowa Pharmaceuticals America, said in a news release.
Esteve Pharmaceuticals has entered into an agreement with Kowa Pharmaceuticals America to commercialize the pain medicine in the United States, with a launch planned for early 2022.
“Seglentis uses four different and complementary mechanisms of analgesia and offers healthcare providers an important option to treat acute pain in adults that is severe enough to require opioid treatment and for which alternative treatments are inadequate,” Dr. Sponseller said.
Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, the FDA will require a Risk Evaluation and Mitigation Strategy (REMS) for Seglentis.
The label states that the drug should be initiated as two tablets every 12 hours as needed and should be prescribed for the shortest duration consistent with individual patient treatment goals.
Patients should be monitored for respiratory depression, especially within the first 24 to 72 hours of initiating therapy with Seglentis.
Prescribers should discuss naloxone (Narcan) with patients and consider prescribing the opioid antagonist naloxone based on the patient’s risk factors for overdose.
Full prescribing information is available online.
A version of this article was first published on Medscape.com.
enough to require an opioid analgesic and for which alternative treatments fail to provide adequate pain relief.
Celecoxib is a nonsteroidal anti-inflammatory drug and tramadol is an opioid agonist. Seglentis contains 56 mg of celecoxib and 44 mg of tramadol.
“The unique co-crystal formulation of Seglentis provides effective pain relief via a multimodal approach,” Craig A. Sponseller, MD, chief medical officer of Kowa Pharmaceuticals America, said in a news release.
Esteve Pharmaceuticals has entered into an agreement with Kowa Pharmaceuticals America to commercialize the pain medicine in the United States, with a launch planned for early 2022.
“Seglentis uses four different and complementary mechanisms of analgesia and offers healthcare providers an important option to treat acute pain in adults that is severe enough to require opioid treatment and for which alternative treatments are inadequate,” Dr. Sponseller said.
Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, the FDA will require a Risk Evaluation and Mitigation Strategy (REMS) for Seglentis.
The label states that the drug should be initiated as two tablets every 12 hours as needed and should be prescribed for the shortest duration consistent with individual patient treatment goals.
Patients should be monitored for respiratory depression, especially within the first 24 to 72 hours of initiating therapy with Seglentis.
Prescribers should discuss naloxone (Narcan) with patients and consider prescribing the opioid antagonist naloxone based on the patient’s risk factors for overdose.
Full prescribing information is available online.
A version of this article was first published on Medscape.com.
FDA OKs new high-dose naloxone product for opioid overdose
ZIMHI from Adamis Pharmaceuticals is administered using a single-dose, prefilled syringe that delivers 5 mg of naloxone hydrochloride solution through intramuscular or subcutaneous injection.
Naloxone is an opioid antagonist that works by blocking or reversing the effects of the opioid, including extreme drowsiness, slowed breathing, or loss of consciousness.
Opioid-related overdose deaths — driven partly by prescription drug overdoses — remain a leading cause of death in the United States.
ZIMHI “provides an additional option in the treatment of opioid overdoses,” the FDA said in a statement announcing approval.
In a statement from Adamis Pharmaceuticals, Jeffrey Galinkin, MD, an anesthesiologist and former member of the FDA advisory committee for analgesics and addiction products, said he is “pleased to see this much-needed, high-dose naloxone product will become part of the treatment tool kit as a countermeasure to the continued surge in fentanyl related deaths.”
“The higher intramuscular doses of naloxone in ZIMHI should result in more rapid and higher levels of naloxone in the systemic circulation, which in turn, should result in more successful resuscitations,” Dr. Galinkin said.
Last spring the FDA approved a higher-dose naloxone hydrochloride nasal spray (Kloxxado) for the emergency treatment of opioid overdose.
Kloxxado delivers 8 mg of naloxone into the nasal cavity, which is twice as much as the 4 mg of naloxone contained in Narcan nasal spray.
The FDA approved ZIMHI (and Kloxxado) through the 505(b)(2) regulatory pathway, which allows the agency to refer to previous findings of safety and efficacy for an already-approved product, as well as to review findings from further studies of the product.
The company plans to launch ZIMHI in the first quarter of 2022.
A version of this article first appeared on Medscape.com.
ZIMHI from Adamis Pharmaceuticals is administered using a single-dose, prefilled syringe that delivers 5 mg of naloxone hydrochloride solution through intramuscular or subcutaneous injection.
Naloxone is an opioid antagonist that works by blocking or reversing the effects of the opioid, including extreme drowsiness, slowed breathing, or loss of consciousness.
Opioid-related overdose deaths — driven partly by prescription drug overdoses — remain a leading cause of death in the United States.
ZIMHI “provides an additional option in the treatment of opioid overdoses,” the FDA said in a statement announcing approval.
In a statement from Adamis Pharmaceuticals, Jeffrey Galinkin, MD, an anesthesiologist and former member of the FDA advisory committee for analgesics and addiction products, said he is “pleased to see this much-needed, high-dose naloxone product will become part of the treatment tool kit as a countermeasure to the continued surge in fentanyl related deaths.”
“The higher intramuscular doses of naloxone in ZIMHI should result in more rapid and higher levels of naloxone in the systemic circulation, which in turn, should result in more successful resuscitations,” Dr. Galinkin said.
Last spring the FDA approved a higher-dose naloxone hydrochloride nasal spray (Kloxxado) for the emergency treatment of opioid overdose.
Kloxxado delivers 8 mg of naloxone into the nasal cavity, which is twice as much as the 4 mg of naloxone contained in Narcan nasal spray.
The FDA approved ZIMHI (and Kloxxado) through the 505(b)(2) regulatory pathway, which allows the agency to refer to previous findings of safety and efficacy for an already-approved product, as well as to review findings from further studies of the product.
The company plans to launch ZIMHI in the first quarter of 2022.
A version of this article first appeared on Medscape.com.
ZIMHI from Adamis Pharmaceuticals is administered using a single-dose, prefilled syringe that delivers 5 mg of naloxone hydrochloride solution through intramuscular or subcutaneous injection.
Naloxone is an opioid antagonist that works by blocking or reversing the effects of the opioid, including extreme drowsiness, slowed breathing, or loss of consciousness.
Opioid-related overdose deaths — driven partly by prescription drug overdoses — remain a leading cause of death in the United States.
ZIMHI “provides an additional option in the treatment of opioid overdoses,” the FDA said in a statement announcing approval.
In a statement from Adamis Pharmaceuticals, Jeffrey Galinkin, MD, an anesthesiologist and former member of the FDA advisory committee for analgesics and addiction products, said he is “pleased to see this much-needed, high-dose naloxone product will become part of the treatment tool kit as a countermeasure to the continued surge in fentanyl related deaths.”
“The higher intramuscular doses of naloxone in ZIMHI should result in more rapid and higher levels of naloxone in the systemic circulation, which in turn, should result in more successful resuscitations,” Dr. Galinkin said.
Last spring the FDA approved a higher-dose naloxone hydrochloride nasal spray (Kloxxado) for the emergency treatment of opioid overdose.
Kloxxado delivers 8 mg of naloxone into the nasal cavity, which is twice as much as the 4 mg of naloxone contained in Narcan nasal spray.
The FDA approved ZIMHI (and Kloxxado) through the 505(b)(2) regulatory pathway, which allows the agency to refer to previous findings of safety and efficacy for an already-approved product, as well as to review findings from further studies of the product.
The company plans to launch ZIMHI in the first quarter of 2022.
A version of this article first appeared on Medscape.com.
Telehealth a game changer for addiction treatment?
Providing addiction treatment remotely via telehealth has the potential to boost patients’ engagement in treatment by improving access and convenience. However, whether telehealth results in better retention or other outcomes than in-person treatment remains an open question, new research indicates.
“Telehealth really might be a game changer for getting people into addiction treatment, but we still need more research to confirm the benefits of telehealth and to determine under what conditions telehealth is best used,” study investigator Tami L. Mark, PhD, said during a press briefing held by the American Psychiatric Association.
The study was published online October 13 in Psychiatric Services ahead of the organization’s first-ever Mental Health Services Conference, which will be held online October 14-15.
COVID turned on the telehealth light switch
“COVID-19 was like turning on a light switch for telehealth,” said Dr. Mark, with the nonprofit research institute RTI International, in Rockville, Maryland.
“Before the COVID-19 public health emergency and stay-at-home order that the governor of California issued in March of 2020, only about 1 in 4 addiction service providers in California offered any type of telehealth. By July 2020, almost 100% were offering telehealth,” she noted.
This was possible through relaxation of federal and state regulations that had previously constrained use of telehealth for addiction treatment. Policymakers and payers are now considering which of these changes should be maintained.
For the study, investigators used mixed qualitative and quantitative methods to assess the efficacy of telehealth for addiction treatment and to gain insights from practitioners regarding their experiences during the pandemic.
They reviewed eight published studies that compared addiction treatment via telehealth with in-person treatment.
Seven found telehealth treatment to be as effective but not more effective than in-person treatment in terms of retention, satisfaction with treatment, therapeutic alliance, and substance use. Most of the studies were small (less than 150 patients).
However, one large study from Canada showed that telehealth facilitated methadone prescribing and improved retention.
The researchers also conducted an online survey in 2020 of 100 California addiction treatment practitioners and interviewed 30 California addiction professionals and other stakeholders.
Survey respondents indicated that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment.
They were less sure about the relative effectiveness of managing medication via telehealth, group counseling, and intake assessments.
Remote challenges
Many of the practitioners interviewed for the study noted that telehealth reduces the time and cost to patients of participating in treatment and that it offers an opportunity for clinicians to observe patients’ home environment and engage patients’ families.
Others felt strongly that patients with substance use disorders need personal relationships and connectedness, which are hard to establish virtually.
They also noted that it is more difficult to sense how a patient is doing when meeting virtually and that it can be challenging to keep patients focused online.
“Providers seem to be moving to a hybrid approach where telehealth is used for some patients and some services but not others,” Dr. Mark said.
“Additional research is needed to determine how best to tailor telehealth to each patient’s circumstances and the best mix of in-person and telehealth services,” she added.
Speaking at the briefing, Lisa Dixon, MD, MPH, editor of Psychiatric Services, said the research “tackles arguably the most important issue in psychiatry today – telehealth.”
“The pandemic brought it to the forefront more quickly than otherwise, but appreciation of its potential positive and negative impacts, I think, was inevitable,” said Dr. Dixon.
“Research has taught us a lot, as has our experience, but we have a long way to go in understanding telehealth and addiction treatment. I really like this article because it appreciates some of the unique issues with the treatment for substance use as opposed to other mental health challenges,” said Dr. Dixon.
Funding for the study was provided by the Patient-Centered Outcomes Research Institute. Dr. Mark and Dr. Dixon have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Providing addiction treatment remotely via telehealth has the potential to boost patients’ engagement in treatment by improving access and convenience. However, whether telehealth results in better retention or other outcomes than in-person treatment remains an open question, new research indicates.
“Telehealth really might be a game changer for getting people into addiction treatment, but we still need more research to confirm the benefits of telehealth and to determine under what conditions telehealth is best used,” study investigator Tami L. Mark, PhD, said during a press briefing held by the American Psychiatric Association.
The study was published online October 13 in Psychiatric Services ahead of the organization’s first-ever Mental Health Services Conference, which will be held online October 14-15.
COVID turned on the telehealth light switch
“COVID-19 was like turning on a light switch for telehealth,” said Dr. Mark, with the nonprofit research institute RTI International, in Rockville, Maryland.
“Before the COVID-19 public health emergency and stay-at-home order that the governor of California issued in March of 2020, only about 1 in 4 addiction service providers in California offered any type of telehealth. By July 2020, almost 100% were offering telehealth,” she noted.
This was possible through relaxation of federal and state regulations that had previously constrained use of telehealth for addiction treatment. Policymakers and payers are now considering which of these changes should be maintained.
For the study, investigators used mixed qualitative and quantitative methods to assess the efficacy of telehealth for addiction treatment and to gain insights from practitioners regarding their experiences during the pandemic.
They reviewed eight published studies that compared addiction treatment via telehealth with in-person treatment.
Seven found telehealth treatment to be as effective but not more effective than in-person treatment in terms of retention, satisfaction with treatment, therapeutic alliance, and substance use. Most of the studies were small (less than 150 patients).
However, one large study from Canada showed that telehealth facilitated methadone prescribing and improved retention.
The researchers also conducted an online survey in 2020 of 100 California addiction treatment practitioners and interviewed 30 California addiction professionals and other stakeholders.
Survey respondents indicated that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment.
They were less sure about the relative effectiveness of managing medication via telehealth, group counseling, and intake assessments.
Remote challenges
Many of the practitioners interviewed for the study noted that telehealth reduces the time and cost to patients of participating in treatment and that it offers an opportunity for clinicians to observe patients’ home environment and engage patients’ families.
Others felt strongly that patients with substance use disorders need personal relationships and connectedness, which are hard to establish virtually.
They also noted that it is more difficult to sense how a patient is doing when meeting virtually and that it can be challenging to keep patients focused online.
“Providers seem to be moving to a hybrid approach where telehealth is used for some patients and some services but not others,” Dr. Mark said.
“Additional research is needed to determine how best to tailor telehealth to each patient’s circumstances and the best mix of in-person and telehealth services,” she added.
Speaking at the briefing, Lisa Dixon, MD, MPH, editor of Psychiatric Services, said the research “tackles arguably the most important issue in psychiatry today – telehealth.”
“The pandemic brought it to the forefront more quickly than otherwise, but appreciation of its potential positive and negative impacts, I think, was inevitable,” said Dr. Dixon.
“Research has taught us a lot, as has our experience, but we have a long way to go in understanding telehealth and addiction treatment. I really like this article because it appreciates some of the unique issues with the treatment for substance use as opposed to other mental health challenges,” said Dr. Dixon.
Funding for the study was provided by the Patient-Centered Outcomes Research Institute. Dr. Mark and Dr. Dixon have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Providing addiction treatment remotely via telehealth has the potential to boost patients’ engagement in treatment by improving access and convenience. However, whether telehealth results in better retention or other outcomes than in-person treatment remains an open question, new research indicates.
“Telehealth really might be a game changer for getting people into addiction treatment, but we still need more research to confirm the benefits of telehealth and to determine under what conditions telehealth is best used,” study investigator Tami L. Mark, PhD, said during a press briefing held by the American Psychiatric Association.
The study was published online October 13 in Psychiatric Services ahead of the organization’s first-ever Mental Health Services Conference, which will be held online October 14-15.
COVID turned on the telehealth light switch
“COVID-19 was like turning on a light switch for telehealth,” said Dr. Mark, with the nonprofit research institute RTI International, in Rockville, Maryland.
“Before the COVID-19 public health emergency and stay-at-home order that the governor of California issued in March of 2020, only about 1 in 4 addiction service providers in California offered any type of telehealth. By July 2020, almost 100% were offering telehealth,” she noted.
This was possible through relaxation of federal and state regulations that had previously constrained use of telehealth for addiction treatment. Policymakers and payers are now considering which of these changes should be maintained.
For the study, investigators used mixed qualitative and quantitative methods to assess the efficacy of telehealth for addiction treatment and to gain insights from practitioners regarding their experiences during the pandemic.
They reviewed eight published studies that compared addiction treatment via telehealth with in-person treatment.
Seven found telehealth treatment to be as effective but not more effective than in-person treatment in terms of retention, satisfaction with treatment, therapeutic alliance, and substance use. Most of the studies were small (less than 150 patients).
However, one large study from Canada showed that telehealth facilitated methadone prescribing and improved retention.
The researchers also conducted an online survey in 2020 of 100 California addiction treatment practitioners and interviewed 30 California addiction professionals and other stakeholders.
Survey respondents indicated that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment.
They were less sure about the relative effectiveness of managing medication via telehealth, group counseling, and intake assessments.
Remote challenges
Many of the practitioners interviewed for the study noted that telehealth reduces the time and cost to patients of participating in treatment and that it offers an opportunity for clinicians to observe patients’ home environment and engage patients’ families.
Others felt strongly that patients with substance use disorders need personal relationships and connectedness, which are hard to establish virtually.
They also noted that it is more difficult to sense how a patient is doing when meeting virtually and that it can be challenging to keep patients focused online.
“Providers seem to be moving to a hybrid approach where telehealth is used for some patients and some services but not others,” Dr. Mark said.
“Additional research is needed to determine how best to tailor telehealth to each patient’s circumstances and the best mix of in-person and telehealth services,” she added.
Speaking at the briefing, Lisa Dixon, MD, MPH, editor of Psychiatric Services, said the research “tackles arguably the most important issue in psychiatry today – telehealth.”
“The pandemic brought it to the forefront more quickly than otherwise, but appreciation of its potential positive and negative impacts, I think, was inevitable,” said Dr. Dixon.
“Research has taught us a lot, as has our experience, but we have a long way to go in understanding telehealth and addiction treatment. I really like this article because it appreciates some of the unique issues with the treatment for substance use as opposed to other mental health challenges,” said Dr. Dixon.
Funding for the study was provided by the Patient-Centered Outcomes Research Institute. Dr. Mark and Dr. Dixon have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Many scientists face serious threats for speaking about COVID: Survey
, according to a survey published in Nature.
The survey of 321 scientists, largely from the United States, the United Kingdom, and Germany, found that 22% were threatened with physical or sexual violence and that 15% received death threats.
More than one quarter of scientists surveyed said they “always” or “usually” received comments from trolls or were personally attacked after speaking out about COVID-19. More than 40% suffered emotional or psychological distress as a result.
Some scientists said the experience of being trolled online or receiving personal attacks had a chilling effect on their willingness to speak to the media in the future.
Even scientists who had a high profile before the COVID-19 pandemic said in the Nature article that the abuse was a “new and unwelcome phenomenon tied to the pandemic.”
Some scientists reported anonymously that they were hesitant to speak about some topics after witnessing the abuse received by others.
“Shocking” results require action
An editorial in Nature calls the results of the survey “shocking” and says institutions at all levels must do more to “protect and defend scientists, and to condemn intimidation.
“Intimidation is unacceptable on any scale, and the findings should be of concern to all those who care about scientists’ well-being. Such behavior also risks discouraging researchers from contributing to public discussion — which would be a huge loss, given their expertise, during the pandemic,” the editorial states.
“Scientists and health officials should expect their research to be questioned and challenged, and should welcome critical feedback that is given in good faith. But threats of violence and extreme online abuse do nothing to encourage debate — and risk undermining science communication at a time when it has never mattered more,” the editorial concludes.
A number of scientists weighed in on the survey in a statement from the U.K. nonprofit organization, Science Media Center.
“Undoubtedly there is a danger that scientists who have themselves been, or had colleagues who have been attacked in ways that disturb one’s equilibrium, may decide to disengage from the media. This will be sad and result in overall harm,” warned Stephen Evans, MSc, with the London School of Hygiene and Tropical Medicine.
Simon Clarke, PhD, with the University of Reading, who responded to the Nature survey, said he is “glad to see so many fellow scientists took the time to reflect on their experiences.”
Dr. Clarke said he is “shocked and saddened to hear that so many fellow scientists have experienced death threats or threats of physical or sexual violence, simply for doing their job trying to communicate the scientific facts that are so important for society in understanding and responding to this global health emergency.”
Dr. Clarke said he too has had some “bad experiences after appearing in the media, particularly after calling out conspiracy theorists and some politicians, who seem to dislike having their pet theories debunked. I have on occasion been threatened with various forms of death, violence and lifelong imprisonment. I am fortunate to have felt able to ignore the threats I’ve received, but I know that some colleagues have had far worse experiences.”
Michael Head, PhD, with the University of Southampton, said there’s been “a huge amount of abuse aimed at everyone contributing to the pandemic response. This has included NHS frontline staff, and also scientists and academics providing thoughts and explanatory comments to the public.
“I myself have received plenty of abuse throughout the pandemic. For those of us who have been pulling apart anti-vaccine misinformation from pre-pandemic times, the presence of these attempts at intimidation is very wearying, but not surprising,” said Dr. Head.
“As a white, male academic, I would imagine I’m far less likely to receive abuse than a scientist making similar points but from a different demographic,” he said.
Susan Michie, FMedSci, with the University College London, said the findings of harassment and abuse of scientists during the pandemic align closely with what she and many U.K. women colleagues who have been prominent in speaking to the media have endured.
“The online abuse occurs most intensively after media engagements and especially after those that address restrictions to social mixing, the wearing of face masks or vaccination,” Dr. Michie said.
“This abuse has not put off many women colleagues I know from speaking to the media,” she said. “I think this is because they are well established in their careers and/or brave and very committed to communicating scientific understanding.
“They have also set up a variety of networks to support each other. However, I am concerned that it discourages early career scientists, especially young women and young women from minoritized ethnic backgrounds, from engaging with the media,” she said.
A version of this article first appeared on Medscape.com.
, according to a survey published in Nature.
The survey of 321 scientists, largely from the United States, the United Kingdom, and Germany, found that 22% were threatened with physical or sexual violence and that 15% received death threats.
More than one quarter of scientists surveyed said they “always” or “usually” received comments from trolls or were personally attacked after speaking out about COVID-19. More than 40% suffered emotional or psychological distress as a result.
Some scientists said the experience of being trolled online or receiving personal attacks had a chilling effect on their willingness to speak to the media in the future.
Even scientists who had a high profile before the COVID-19 pandemic said in the Nature article that the abuse was a “new and unwelcome phenomenon tied to the pandemic.”
Some scientists reported anonymously that they were hesitant to speak about some topics after witnessing the abuse received by others.
“Shocking” results require action
An editorial in Nature calls the results of the survey “shocking” and says institutions at all levels must do more to “protect and defend scientists, and to condemn intimidation.
“Intimidation is unacceptable on any scale, and the findings should be of concern to all those who care about scientists’ well-being. Such behavior also risks discouraging researchers from contributing to public discussion — which would be a huge loss, given their expertise, during the pandemic,” the editorial states.
“Scientists and health officials should expect their research to be questioned and challenged, and should welcome critical feedback that is given in good faith. But threats of violence and extreme online abuse do nothing to encourage debate — and risk undermining science communication at a time when it has never mattered more,” the editorial concludes.
A number of scientists weighed in on the survey in a statement from the U.K. nonprofit organization, Science Media Center.
“Undoubtedly there is a danger that scientists who have themselves been, or had colleagues who have been attacked in ways that disturb one’s equilibrium, may decide to disengage from the media. This will be sad and result in overall harm,” warned Stephen Evans, MSc, with the London School of Hygiene and Tropical Medicine.
Simon Clarke, PhD, with the University of Reading, who responded to the Nature survey, said he is “glad to see so many fellow scientists took the time to reflect on their experiences.”
Dr. Clarke said he is “shocked and saddened to hear that so many fellow scientists have experienced death threats or threats of physical or sexual violence, simply for doing their job trying to communicate the scientific facts that are so important for society in understanding and responding to this global health emergency.”
Dr. Clarke said he too has had some “bad experiences after appearing in the media, particularly after calling out conspiracy theorists and some politicians, who seem to dislike having their pet theories debunked. I have on occasion been threatened with various forms of death, violence and lifelong imprisonment. I am fortunate to have felt able to ignore the threats I’ve received, but I know that some colleagues have had far worse experiences.”
Michael Head, PhD, with the University of Southampton, said there’s been “a huge amount of abuse aimed at everyone contributing to the pandemic response. This has included NHS frontline staff, and also scientists and academics providing thoughts and explanatory comments to the public.
“I myself have received plenty of abuse throughout the pandemic. For those of us who have been pulling apart anti-vaccine misinformation from pre-pandemic times, the presence of these attempts at intimidation is very wearying, but not surprising,” said Dr. Head.
“As a white, male academic, I would imagine I’m far less likely to receive abuse than a scientist making similar points but from a different demographic,” he said.
Susan Michie, FMedSci, with the University College London, said the findings of harassment and abuse of scientists during the pandemic align closely with what she and many U.K. women colleagues who have been prominent in speaking to the media have endured.
“The online abuse occurs most intensively after media engagements and especially after those that address restrictions to social mixing, the wearing of face masks or vaccination,” Dr. Michie said.
“This abuse has not put off many women colleagues I know from speaking to the media,” she said. “I think this is because they are well established in their careers and/or brave and very committed to communicating scientific understanding.
“They have also set up a variety of networks to support each other. However, I am concerned that it discourages early career scientists, especially young women and young women from minoritized ethnic backgrounds, from engaging with the media,” she said.
A version of this article first appeared on Medscape.com.
, according to a survey published in Nature.
The survey of 321 scientists, largely from the United States, the United Kingdom, and Germany, found that 22% were threatened with physical or sexual violence and that 15% received death threats.
More than one quarter of scientists surveyed said they “always” or “usually” received comments from trolls or were personally attacked after speaking out about COVID-19. More than 40% suffered emotional or psychological distress as a result.
Some scientists said the experience of being trolled online or receiving personal attacks had a chilling effect on their willingness to speak to the media in the future.
Even scientists who had a high profile before the COVID-19 pandemic said in the Nature article that the abuse was a “new and unwelcome phenomenon tied to the pandemic.”
Some scientists reported anonymously that they were hesitant to speak about some topics after witnessing the abuse received by others.
“Shocking” results require action
An editorial in Nature calls the results of the survey “shocking” and says institutions at all levels must do more to “protect and defend scientists, and to condemn intimidation.
“Intimidation is unacceptable on any scale, and the findings should be of concern to all those who care about scientists’ well-being. Such behavior also risks discouraging researchers from contributing to public discussion — which would be a huge loss, given their expertise, during the pandemic,” the editorial states.
“Scientists and health officials should expect their research to be questioned and challenged, and should welcome critical feedback that is given in good faith. But threats of violence and extreme online abuse do nothing to encourage debate — and risk undermining science communication at a time when it has never mattered more,” the editorial concludes.
A number of scientists weighed in on the survey in a statement from the U.K. nonprofit organization, Science Media Center.
“Undoubtedly there is a danger that scientists who have themselves been, or had colleagues who have been attacked in ways that disturb one’s equilibrium, may decide to disengage from the media. This will be sad and result in overall harm,” warned Stephen Evans, MSc, with the London School of Hygiene and Tropical Medicine.
Simon Clarke, PhD, with the University of Reading, who responded to the Nature survey, said he is “glad to see so many fellow scientists took the time to reflect on their experiences.”
Dr. Clarke said he is “shocked and saddened to hear that so many fellow scientists have experienced death threats or threats of physical or sexual violence, simply for doing their job trying to communicate the scientific facts that are so important for society in understanding and responding to this global health emergency.”
Dr. Clarke said he too has had some “bad experiences after appearing in the media, particularly after calling out conspiracy theorists and some politicians, who seem to dislike having their pet theories debunked. I have on occasion been threatened with various forms of death, violence and lifelong imprisonment. I am fortunate to have felt able to ignore the threats I’ve received, but I know that some colleagues have had far worse experiences.”
Michael Head, PhD, with the University of Southampton, said there’s been “a huge amount of abuse aimed at everyone contributing to the pandemic response. This has included NHS frontline staff, and also scientists and academics providing thoughts and explanatory comments to the public.
“I myself have received plenty of abuse throughout the pandemic. For those of us who have been pulling apart anti-vaccine misinformation from pre-pandemic times, the presence of these attempts at intimidation is very wearying, but not surprising,” said Dr. Head.
“As a white, male academic, I would imagine I’m far less likely to receive abuse than a scientist making similar points but from a different demographic,” he said.
Susan Michie, FMedSci, with the University College London, said the findings of harassment and abuse of scientists during the pandemic align closely with what she and many U.K. women colleagues who have been prominent in speaking to the media have endured.
“The online abuse occurs most intensively after media engagements and especially after those that address restrictions to social mixing, the wearing of face masks or vaccination,” Dr. Michie said.
“This abuse has not put off many women colleagues I know from speaking to the media,” she said. “I think this is because they are well established in their careers and/or brave and very committed to communicating scientific understanding.
“They have also set up a variety of networks to support each other. However, I am concerned that it discourages early career scientists, especially young women and young women from minoritized ethnic backgrounds, from engaging with the media,” she said.
A version of this article first appeared on Medscape.com.