Shake It Off

Published November 2, 2024

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.

Finding Breathing Room in O₂ Therapy

PULM PONDERINGS

Current guidelines for managing severe hypoxemia recommend long-term oxygen therapy (LTOT) for a minimum of 15 hours a day, with a push for 24-hour use. Fifteen hours can be stifling, 24 downright suffocating. Is longer truly better? Given that the guidelines stemmed from two small studies published when the M*A*S*H medical team was still healing soldiers with sarcasm, it was time to answer the question with modern data.

A breath of fresh findings

In a large multicenter trial across 20 clinics in Sweden, researchers randomly assigned 241 patients with severe, chronic hypoxemia to receive LTOT for either 24 or 15 hours per day. Both groups achieved 100% adherence to their respective therapy. After one year, researchers noted no significant difference in hospitalization or mortality rates between the 24- and 15-hour groups. Also, participants reported no benefit to quality of life or fatigue symptoms with all-day oxygen use. These findings mark a shift from the four-decades-old previous studies.

Study co-leader Dr. Josefin Sundh explains, “The older studies were small and only included patients with chronic obstructive pulmonary disease, not least because it is difficult to recruit such seriously ill individuals for a randomised study. Also, the patients included in the older studies differ from those who start oxygen therapy at home nowadays.”

Key takeaways

These results suggest that all-day oxygen therapy offers no clear advantage over 15 hours of use. Those nine extra hours of freedom could provide the breathing room patients need to adhere to their LTOT, highlighting the medical wisdom that the best medicine is the one the patient will take. While the effect on mortality rates in a larger trial remains uncertain, experts believe any differences would be minimal. These findings should reassure clinicians and the one million US patients prescribed LTOT annually.

For education on pulmonary care, check out Pri-Med's CME activity “COPD Treatment for Primary Care Providers.”

Could Simple Concussion Sign Change the Game?

NEUROLOGY NEWS

A recent study presents strong data to support the inclusion of a new concussion screening indicator in official evaluation guidelines. The spontaneous headshake after a kinematic event, or “SHAAKE”—the post-blow hallmark of every pro wrestler—could alert clinicians to a probable concussion and head off the risk of missed diagnoses.

Reconsidering "Tua time"

How could the SHAAKE inform gametime decisions? In one example, the researchers—playing “Monday morning quarterback”—argue that if the SHAAKE had been adopted as a concussion indicator in 2022, the NFL may have altered its controversial decision to allow Miami Dolphins quarterback Tua Tagovailoa back on the field after his (arguable) first of four pro concussions. 

Key takeaways

Both sideline clinicians and cartoon fans recognize a violent headshake as the telltale residue of a hard hit, but medical literature omits this simple gesture. The study authors assert that official concussion screening protocols should reflect the predictive value of the SHAAKE, and doing so could help plug the leak of missed concussion diagnoses. Concussion expert Dr. Julie Stamm offers this perspective, “It both gives the clinician more reason to take [the athlete] off the field, and if the athlete understands that shaking their head is happening because they’re having symptoms, maybe they’ll actually realize it’s a concussion if they didn’t know that before.”

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New Study Points to Acupuncture for Sciatica Relief 

PAIN PONDERINGS

While ancient healing practices like bloodletting and leech therapy have long rotted in the dumpster of medical history, acupuncture not only endures but also continues to target new ailments. A recent study in JAMA suggests that acupuncture may relieve sciatica pain, potentially delivering an alternative to more invasive treatments.

Acupuncture hits the mark

In a multicenter randomized clinical trial in China, researchers split 220 patients with herniated disc-related sciatica into two groups—one receiving real acupuncture, the other a sham version in which practitioners placed needles (with minimal penetration) into nontherapeutic spots. Both groups underwent ten sessions across four weeks. The true acupuncture group reported significantly faster and more substantial relief in both pain and daily functioning than did the sham group. The gap between the groups emerged by week two and persisted through follow-up at week 52. As for adverse events, the real acupuncture group had more minor effects, eg, slight bleeding, but neither reported any serious events.

A few sticking points

The trial’s limitations include the inability to blind acupuncturists (for obvious reasons), potentially introducing bias. Additionally, the findings may not generalize beyond Chinese populations, and relying on self-reported data for primary outcomes could further skew results.

Key takeaways 

Previous studies have alluded to acupuncture’s potential for alleviating sciatica pain, but this trial marks the first to deliver sharp, compelling evidence in its favor. “Studies like this may facilitate the adoption of acupuncture as a form of treatment by health systems and insurers,” suggest authors of an accompanying editorial. Acupuncture may provide lasting benefits for sciatica sufferers and fill the holes left by current “unsatisfying” treatments.