Published May 6, 2023
Morning Report — Not Your Typical Medical Newsletter
We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.
Study Spotlights Nonpharmacologic Therapy for Dementia
NEURO NEWS
Phototherapy is working its way up to the C-suite of your nonpharmacologic toolbox. This figurative “sunshine in a bottle” treats everything from skin conditions to rheumatoid arthritis, and new research suggests it may be a beacon of hope for dementia patients as well. Who knew? “I did—4.6 billion years ago,” sighs the sun. Fair enough, but we still need studies.
A light-bulb moment
Researchers assembled the results from 12 high-quality, albeit small, studies examining the effects of exposure to intense, simulated sunlight on older patients with dementia. Those in the intervention groups saw greater boosts in cognitive function than those who did not receive phototherapy. However, the therapy did little to improve symptoms of depression and sleep, a glaring shift from findings in previous studies. A handful of participants noted fleeting therapy-induced skin irritation.
The study limitations, including the heterogeneity of participants and inconsistency of timing/type of therapy, need not dim the favorable finding of phototherapy on cognition; other studies give it due credence.
Key takeaway
This study illuminates a promising nonpharmacologic therapy for dementia. What’s clear is that phototherapy may improve cognitive function in these patients; what’s still clinically murky is what type and dose are optimal. But these findings should spark more robust studies that serve up those details. While we wait, it seems reasonable to consider recommending a light therapy lamp to patients with dementia as a low-risk complementary option in addition to recommended pharmacologic agents. Or, if feasible, encourage patients to take a line from Lennon/McCartney and simply follow the sun—draw more natural light indoors or sit outdoors in direct sunlight.
Cranberries for UTI Prevention: Fact or Folklore?
INFECTIOUS FINDINGS
Big Cranberry has been pushing its “we prevent UTIs” doctrine for decades. But in 2012, that notion began to fall apart like a Theranos product claim thanks to a global Cochrane Review disproving it. Fast-forward to last month when an update of that same Cochrane Review—with insights from 26 additional studies—un-debunked the theory and placed cranberry products once again at the forefront of nonpharmacologic UTI prevention—at least for women. Big Cranberry is ocean-spraying its “I told you so” in all directions.
The 2023 Cochrane Review slid all relevant studies since the 1990s under the magnifying glass, bringing the total to 50 studies (~9,000 people). The research showed significant reductions in recurrent symptomatic, culture-verified UTIs in women (by >25%), in children (by >50%), and in people susceptible to UTIs after medical treatment (by >50%). Unfortunately, older adults in institutions, pregnant women, and people with bladder-emptying conditions saw no benefit. And researchers could not determine how cranberry products fared against antibiotics or probiotics in preventing additional UTIs. The study noted only sparse adverse effects: a few stomach pains and perhaps a loitering bitter taste—cranberries like to linger (cue ’90s guitar).
This new evidence helps crystallize the benefits of cranberry products for certain patients susceptible to UTIs. In particular, women with recurrent UTIs may reap significant benefits from downing the bitter berry in all its forms—juice, tablets, etc. Researchers couldn’t determine which formulation conferred the greatest benefit and at which dose. The important thing, they note, is accessing the proanthocyanidin (PAC) molecules within the fruit. We won’t bog you down with too much cranberry science, but these PACs inhibit p‐fimbriated Escherichia coli from finding safe harbor in the urothelial cell lining of the bladder. Big Cranberry has plenty of pamphlets on the subject if you want to learn more.
Age Before BMI in Diabetes Screening
ENDO END POINTS
When it comes to diabetes screening, experts are going full Tommy Lee Jones, calling for a “search of every gas station, residence, warehouse, farmhouse, henhouse, outhouse, and doghouse.” That’s because new study findings suggest that the current USPSTF screening recommendation (all adults 35-70 years old with overweight/obesity) fails to capture the bulk of cases. Experts propose a counterintuitive approach: eliminate BMI from screening criteria.
The USPSTF 2021 diabetes screening recommendation has marinated in real-world implementation for nearly two years, so researchers felt it was due for a clinical performance evaluation. They analyzed nationally representative data and deduced that the current recommendation, with its expanded age range, has marginally outperformed the 2015 strategy but still leaves a blind spot when screening certain patient populations. Lead investigator Dr. Matthew O’Brien noted, “All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans.” His team’s evaluation showed that screening the currently recommended age group (35-70 years) but without regard for BMI “yielded the most equitable performance across all racial and ethnic groups.”
Key takeaway
Prediabetes or type 2 diabetes mellitus (T2DM) afflicts nearly half the US population, yet 81% of prediabetes cases and 23% of T2DM cases go undiagnosed. The current screening strategy fails to meet the moment and leads to disparities among Hispanic, non-Hispanic Black, and especially Asian adults. While obesity is a primary cause of diabetes, it’s not a one-size-fits-all. Experts argue that lowering and ideally eliminating BMI thresholds from diabetes screening criteria will foster a more equitable approach to mitigating this population health crisis.
Rapid-Fire COVID-19 Updates
COVID QUICK HITS
Cannabinoid Guidelines Offer High Hopes for Chronic Pain
COMPLEMENTARY AND ALT MED ADVICE
Cannabinoid-based medicine (CBM), while often a crowd favorite in the complementary and alternative medicine space, has historically undergone as little formal research as a product from Gwyneth Paltrow’s goop line. But that all changed this past month. A Canadian task force combed through 70 pain management articles (51 original studies—nearly half RCTs) to cultivate the first comprehensive set of practice guidelines for the use of CBM in chronic pain management.
A few dos and dont's from the new CBM guidelines
- Don’t use CBM as first-line treatment for any condition; other alternatives may confer greater relief and fewer side effects
- Do prescribe CBM as monotherapy, replacement, or adjunct therapy in patients with chronic pain who have not received adequate relief from first-line therapies
- Do initiate CBM at 5 mg—risks remain low within the 1 to 5 mg window
- Do use CBM instead of opioids when feasible
- Don’t “freely prescribe” CBM for patients who are not on opioids
- Do educate patients on the benefits/risks of CBM; collaborate on dosing/titration
Key takeaway
These new CBM guidelines, harvested from multiple studies, provide a trellis for prescribing this complementary and alternative medicine option. The data show that CBM appears to improve chronic pain symptoms from arthritis, fibromyalgia, HIV, and multiple sclerosis. In addition, the data suggest that for patients with chronic pain, CBM alleviates co-occurring symptoms like sleep problems, anxiety, and appetite suppression. Best of all, these guidelines take us a step closer to potentially dethroning opioids in chronic pain management. Still, questions remain regarding CBM’s efficacy and regulatory challenges of legality, safety, and quality standardization. More to come. In the meantime, the selected data behind these guidelines may pull CBM from the fringes of medicine and may help legitimize its therapeutic utility. One thing’s for sure: the evidence behind CBM is now far greater than that behind goop’s Jade egg.
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Association of daily step patterns with mortality in US adults
- Treat-to-target or high-intensity statin in patients with coronary artery disease—a randomized clinical trial
- New RSV vaccine could prevent severe illness in seniors and infants
- Limit added sugar to six teaspoons a day to improve health, urge experts
- Integrated multi-modal brain signatures predict sex-specific obesity status
- Increases in group A streptococcal infections in the pediatric population in Houston, Texas, 2022
- Screening for skin cancer: US Preventive Services Task Force recommendation statement
Morning Report is written by:
- Alissa Scott, Author
- Aylin Madore, MD, MEd, Editor
- Eleni Scott, MD, Editor
Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.
Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
Enjoying Morning Report? Subscribe & Share It With Your Colleagues!
Is Morning Report for you? It is if . . .
You're someone who needs quick-hitting, accurate medical news and you're a fun and witty healthcare professional who wants your news with some flare.
You don't just need to know about the latest metabolism study–you also need to know how it parallels an Alanis Morissette hit. If you're reading about acupuncture treatment, you need us to skip the needle puns and get right to the point. We keep things simple, but when we do get into the scientific weeds, we always remind you to check for ticks.
Subscribe to receive the Morning Report directly in your inbox the first Saturday of every month.
As a leader in CME/CE for 27+ years, Pri-Med provides evidence-based in-person and online CME/CE for primary care clinicians. Explore our education to earn credits and stay informed on the most current clinical strategies relevant to your daily practice.