Tag: Pain

Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

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Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face.

Below are some of the latest headlines in the Immigration channel on Newswise.

Expert Commentary

Experts Available on Ending of Title 42

George Washington University Experts on End of Title 42

‘No one wins when immigrants cannot readily access healthcare’

URI professor discusses worsening child labor in the United States

Biden ‘between a rock and a hard place’ on immigration

University of Notre Dame Expert Available to Comment on House Bill Regarding Immigration Legislation, Border Safety and Security Act

American University Experts Available to Discuss President Biden’s Visit to U.S.-Mexico Border

Title 42 termination ‘overdue’, not ‘effective’ to manage migration

Research and Features

Study: Survey Methodology Should Be Calibrated to Account for Negative Attitudes About Immigrants and Asylum-Seekers

A study analyses racial discrimination in job recruitment in Europe

DACA has not had a negative impact on the U.S. job market

ASBMB cautions against drastic immigration fee increases

Study compares NGO communication around migration

Collaboration, support structures needed to address ‘polycrisis’ in the Americas

TTUHSC El Paso Faculty Teach Students While Caring for Migrants

Immigrants Report Declining Alcohol Use during First Two Years after Arriving in U.S.

How asylum seeker credibility is assessed by authorities

Speeding up and simplifying immigration claims urgently needed to help with dire situation for migrants experiencing homelessness

Training Individuals to Work in their Communities to Reduce Health Disparities

‘Regulation by reputation’: Rating program can help combat migrant abuse in the Gulf

Migration of academics: Economic development does not necessarily lead to brain drain

How has the COVID-19 pandemic affected immigration?

Immigrants with Darker Skin Tones Perceive More Discrimination

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Newswise

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May 12, 2023
What A Nutritional Psychiatrist Recommends Daily For Joint Health

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For nutritional psychiatrist, biologist, and professional chef Uma Naidoo, M.D., getting her daily dose of turmeric is a must.

As she previously wrote in her review of mindbodygreen’s turmeric potency+, “From your brain to your joints, this antioxidant botanical is a daily essential for overall health. In order to take advantage of the full curcuminoid potential of the whole turmeric root matrix, along with complementary herbs ginger and black pepper, I recommend mindbodygreen’s turmeric potency+.”*

In this pioneering formula, turmeric potency+ delivers 500 milligrams of full-spectrum turmeric root, 150 milligrams of full-spectrum ginger root, and 5 milligrams of black pepper fruit (with the additional bio-enhancer piperine).

Not only that, but you’re getting Acumin™ full-spectrum turmeric, which offers a clinically proven absorption advantage at five and six times higher bioavailability than liposomal turmeric and turmeric oil, respectively.*

And speaking of research, we should also mention if it’s joint health you’re after, the science says turmeric is a must-have. As one 2021 analysis published in the journal BMJ Open Sport & Exercise Medicine1 found, numerous studies show that turmeric supplementation can help improve joint comfort and function.

As one happy mindbodygreen customer, Millie E., writes in her review of turmeric potency+, “For my joints, this is it. Whether it’s the antioxidant or [healthy inflammatory response] actions of these botanicals, or both, my joints are a fan of turmeric potency+. So is my whole body. This mbg supplement is my new daily essential for overall health.”*

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Sarah Regan

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May 11, 2023
Music Therapy: Relief for Chronic Pain Sufferers

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Newswise — In Sörmland, Sweden, music therapy is offered as a method of treatment for people living with chronic pain. Currently, the effects of what is known as the FMT method are being investigated through a research project at Mälardalen University (MDU).

In the FMT method, (Functionally oriented Music Therapy), music experiences and movement are combined with the purpose of contributing to a person’s well-being and recuperation. During the treatment, a therapist assesses what basic functions the participant needs to develop, and with the help of musical instruments such as drums and cymbals in various formations, different movements in the body are stimulated. Today, the treatment is given through a healthcare agreement in Sörmland.

In a current research project which has been launched at MDU, researchers wish to investigate whether it is possible to find scientific evidence that the FMT method is effective in increasing well-being, improving quality of life, and if and in what way it can relieve suffering and pain in people who live with chronic pain.

“I believe it is essential to evaluate health-promoting alternative methods in the area of chronic pain, as many people in society suffer from this. This project aims to explore and evaluate an up until now unexplored treatment method for people living with long standing pain,” says Helena Lööf, Associate Professor and Senior Lecturer in Health Sciences at MDU.

The method contributed to recovery
The backdrop to the project is a pilot study which showed that the FMT method helped people affected by stroke and Parkinson’s disease to recover better.

“Pain is the most common reason for seeking primary care services. Therefore in this way, many people are affected and from a societal standpoint it is good to have a variety of support efforts. This is in line with person-centred healthcare.”

Scientific evaluation needed
“Through a care agreement with a FMT treatment centre in Eskilstuna, this method is already being used in primary care in Sörmland. But the method is not evidence-based, which is why a scientific evaluation is needed. We will evaluate the effects of FMT in people suffering from chronic pain in comparison with the standard care that is provided in local healthcare. We also wish to create a deeper understanding of the importance of music and movement in recovery.”

Today, FMT is used in habilitation, rehabilitation and psychiatric healthcare.

“If the results of the project are positive, that is, if evidence can be found that various aspects of health are affected or improved, these can be used as evidence-based support for health promotion purposes for people suffering with chronic pain.”

“And on the other hand, if the results show that FMT has no or only a minor effect, this is in itself an important contribution to new knowledge about treatment and recovery for these people. Our research team is looking forward to investigating this over the next few years,” says Helena Lööf.

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Malardalen University

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May 5, 2023
Mid-Calf Nerve Block May Enable Early Rehabilitation After Foot and Ankle Surgery, Preventing Pain While Allowing Foot Movement
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Newswise — A pilot study conducted at Hospital for Special Surgery (HSS) shows evidence that a mid-calf nerve block is a safe and effective regional anesthetic option for foot and ankle surgeries and may enable faster recovery of motor function of the ankle joint compared with a popliteal block. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.¹

“This new block provides excellent anesthesia and analgesia to foot and ankle surgeries and preserves motor function of the ankle joint. The results are very promising,” said Enrique A. Goytizolo, MD, an anesthesiologist at HSS and senior author of the study. “New protocols of early rehabilitation of foot surgeries can be instituted, since patients have no pain with movement of the foot.”

An ultrasound-guided popliteal block is the current standard anesthetic technique for foot and ankle surgeries, but the study findings show that using an ultrasound-guided mid-calf block could enable earlier rehabilitation protocols and an overall faster recovery from surgery.

A popliteal block numbs the sciatic nerve at the level of the popliteal fossa, which is a diamond-shaped space behind the knee joint. A mid-calf block is placed farther down the leg, between the popliteal fossa and the ankle, and numbs the posterior tibial nerve, superficial and deep peroneal nerves, sural, and saphenous nerves. A mid-calf block provides prolonged analgesia for any foot or ankle surgery while preserving motor function of the ankle joint.

Twenty patients who were scheduled to receive foot or ankle surgery at HSS were recruited for the study. The procedures included total ankle replacement, ankle arthroscopy, bunionectomy, cheilectomy, and Achilles tendon repair. Participants were assessed in the post-anesthesia care unit (PACU) and again before discharge to record the time when the mid-calf block ended, presence of paresthesia, and any other side effects. On postoperative days 1, 2, and 7, participants were asked about their pain on a numerical rating score (NRS), their medication use, and other symptoms.

The researchers found that the median duration of analgesia from the mid-calf block was 18.2 hours, with an interquartile range of 4.5-24.0 hours. All 20 patients were able to flex their toes in the PACU.

The average pain score in the PACU was 0.8 +/- 2.1 at rest, and 1.1 +/- 2.3 with movement. Three participants were excluded for sensitivity analysis because they received additional surgery in surgical areas not covered by the mid-calf block. Among the 17 patients in the sensitivity analysis group, these scores were both 0.3 +/- 1.2 at rest and with movement.

“The mid-calf block provides reliable, consistent, and excellent anesthesia and analgesia for foot and ankle surgeries,” said Dr. Goytizolo. “Follow-up research and patient treatments following this study should include a fast-track rehabilitation program for patients who have total ankle replacement surgeries with a mid-calf block.”

The findings of this study will also inform future randomized control trials on the mid-calf block.

References
1. Marko Popovic BS, Alex Illescas MPH, Pa Thor PhD, Jacques YaDeau MD PhD, Constantine Demetracopoulos MD, Scott Ellis MD, Vincent LaSala MD, Matthew Roberts MD, Anne H. Johnson MD, Mark Drakos MD, Enrique Goytizolo MD. “Mid-Calf Block for foot and ankle surgery: A pilot study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.
About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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Hospital for Special Surgery

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April 22, 2023
Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities
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Newswise — Hollywood, Florida, April 22, 2023 — In a study conducted at Hospital for Special Surgery (HSS), researchers found that the use of peripheral nerve blocks in total knee and total hip arthroplasty were associated with a consistent reduction in risk for postoperative complications in patients with a lower comorbidity burden. In particular, the most consistent reduction in risk of complications and use of hospital resources was in older patients with no comorbidity burden. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting and were acknowledged as one of the President’s Choice Abstracts.¹

“The utility of interventions in a general population of patients might be difficult to show, but might differ by subgroups, with certain patients deriving benefit when others do not,” said Stavros G. Memtsoudis, MD, PhD MBA FCCP, an anesthesiologist at HSS and lead author of the study. “In this study, we tried to identify which subgroups might benefit most from peripheral nerve blocks in terms of a reduction in complications after joint arthroplasty.”

These findings demonstrate that comorbidities may be a factor with a greater effect on complication risk than other factors, such as age, and that peripheral nerve blocks alone may not be sufficient to consistently influence outcomes in patients with comorbidities.

These findings may also demonstrate that there may be a specific optimal baseline patient population for whom peripheral nerve blocks have the greatest impact on improving surgical outcomes: patients who are older but do not have many comorbidities. This study could help clinicians determine which surgical patients may benefit most from peripheral nerve blocks and which candidates may need additional measures to improve their outcomes.

Many total joint arthroplasty (TJA) patients are at risk for poorly controlled pain and complications. The number of these surgeries performed increases each year, underscoring the importance of finding solutions. To find out how uniformly peripheral nerve blocks can improve perioperative outcomes and pain relief in TJA patients, the researchers conducted a population-based analysis using data from TJA surgeries in the United States from January 2006 to December 2019.

Patients were divided into nine groups based on age and number of comorbidities. Age was broken down as follows: Young (Y) = younger than 65 years; Middle (M) = 65 to 75 years; and Old (O) = older than 75 years. Comorbidities were categorized as: no pre-existing comorbidity (Group 1); 1 or 2 comorbidities (Group 2); and 3 or more comorbidities (Group 3). This led to a breakdown of nine groups total: Y1, Y2, Y3, M1, M2, M3, O1, O2, and O3.

The sample included more than 2.8 million TJA cases performed in 887 hospitals. Of those, 15.5% received a peripheral nerve block. The overall rate of peripheral nerve blocks increased from 9.5% in 2006 to 18.9% in 2019. Peripheral nerve blocks were used least often in young patients with more than 3 comorbidities (13.9%) and used most often in middle-aged patients with no comorbidities (16.3%). Peripheral nerve blocks were associated with a significant reduction in the odds of respiratory complication, acute renal failure, delirium, ICU admission, high opioid consumption during hospitalization, and prolonged length of stay.

The results showed reduced odds of respiratory complications for the O1 and Y2 groups, reduced odds of acute renal failure in the Y1, O1, and M2 groups, and reduced odds of delirium in O1. The risk for ICU admission was reduced in those who received peripheral nerve blocks in all ages with no comorbidities, as well as in the Y2 and O2 groups, compared with those who did not receive a peripheral nerve block. Peripheral nerve blocks also reduced the odds of a prolonged length of stay in the Y1, M1, Y2, M2, and Y3 groups. Odds of high opioid use in patients who received a peripheral nerve block versus no peripheral nerve block were significantly reduced in all groups except for Y3 and O3.

“While peripheral nerve blocks might have the advantage of providing superior pain control versus systemic modalities as well as reducing opioid consumption, a reduction in complications might be expected in those without comorbidities,” Dr. Memtsoudis said. “However, given that peripheral nerve blocks still provide better pain control and reduce opioid use, all patients should be considered for peripheral nerve blocks.”

“Older patients without major comorbidities might represent a subgroup in which the beneficial effects of peripheral nerve blocks are most likely to be expected,” he noted. “This might be the case because major comorbidities are a bigger determinant of complications, with peripheral nerve blocks being less likely to be able to exert a substantial effect.”

Future research should include further examination of the benefits of peripheral nerve blocks. “Many questions remain unanswered, including quantification of attributable risk reduction of peripheral nerve blocks and which peripheral nerve blocks provide the biggest effect,” Dr. Memtsoudis concluded.

References
1. Haoyan Zhong MPA, Marko Popovic BS, Jashvant Poeran MD PhD, Crispiana Cozowicz MD, Alex Illescas MPH, Jiabin Liu MD PhD, Stavros G Memtsoudis MD PhD MBA FCCP. “Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population based study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.
About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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Hospital for Special Surgery

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April 22, 2023
The 12 Best Shoes For Back Pain, Reviewed By A Podiatrist

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Our editors love this Cariuma style for its support, versatility, and durable outsole. Ideal for daily wear, these sneakers are well-cushioned enough to keep your feet comfortable and stylish enough to pair with just about anything. While only one width is available, our commerce editor, Braelyn Wood, confirms that these are accommodating for a wide foot. The shoes are made with a cushioned, ankle-hugging heel collar and the brand’s signature memory foam, which helps keep back pain at bay. Many reviewers with back and hip pain note relief from the cork insole, which provides just the right amount of cushion for long days.

Not only is the sustainable shoe made of leather sourced from LWG-certified Gold Rated tanneries (rather than cattle ranches on deforested lands), the brand also uses a more ethical rubber sourcing process, packages its products in recyclable boxes, and offsets its carbon emissions for shipping. Plus, two trees are planted for every pair of shoes sold. So you can feel as good about your impact as you do about your dissipating back pain.

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Jayla Andrulonis

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April 14, 2023
Seltzer Is Torture

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I do not like carbonated beverages, plain and simple. I won’t drink soda, and you’ll never catch me with a beer. Gin and tonics are a no. Sparkling water? A beast in disguise. Oh, the cocktail is not that fizzy, you say? I’ve heard that one before. And get your slushie out of my face. As I said, I do not like carbonated beverages. I do not like them at all.

I don’t just mean that they taste bad to me, the way soap or penicillin does. I mean that they hurt me. They inflict actual, physical pain on my mouth. The sensation is prickly, like having my tongue poked with hundreds of needles. On the handful of foolhardy occasions when I’ve dared take a sip of Coke, it’s felt like what I imagine sipping static electricity would feel like, at least until the pain subsides and I’m left with nothing but the hyper-saturated sweetness of a melted freezer pop. Even after I swallow, my mouth feels raw.

When I try to explain this aversion, people sometimes struggle to wrap their mind around it. “Even sparkling cider?” they ask incredulously. “Even cream soda?” Yes, even sparkling cider. Yes, even cream soda. Occasionally, people try to relate: “Oh, I hate carbonation too … except in champagne.” Whatever these people mean by “hate” is clearly not the same thing I mean. The specifics of the drink make no difference to me. The carbonation itself is the problem.

Part of me wonders whether this all traces back to an incident from my childhood. When I was 6 or 7 years old, I accidentally ate a piece of sushi covered in more wasabi than I’d bargained for and, in a panic, took a big gulp of water—except the water wasn’t water; it was seltzer, and I spit it all over the table. A couple of years later, I tried root beer at day camp and spat that out too. By that point, I’d pretty much learned my lesson.

Read: The medical origins of seltzer

So why am I like this? It’s not as though my mouth is hypersensitive to all tastes and sensations. I pop Sour Skittles at the movies and have a pretty high spice tolerance. My issue is more specific and, given that Americans consume more than 40 gallons of soda a person each year, very rare. But apparently I’m not the only one: On Reddit’s r/unpopularopinion forum and others like it, never-fizzers find common cause. Drinking carbonated beverages is “kinda masochist.” It’s “pure agony.” It’s like “swallowing battery acid.” “I feel like I’m drinking flesh eating bacteria,” one Redditor writes. “I swear I thought I was the only one who thinks they hurt,” another replies.

You can find dozens of posts like these online—so many, in fact, that you may begin to wonder: How many times can an unpopular opinion be posted before it ceases to qualify as an unpopular opinion? Scientists, for their part, have documented at least one instance of an anaphylactic reaction to sparkling water. That reaction was not caused by the bubbles themselves, but neither is carbonation’s distinctive mouthfeel. For a long time, people assumed that the fizzy sensation was just the tactile experience of having bubbles pop inside your mouth. Early suspicions to the contrary came from mountaineers, who reported that when they raised a toast at the summit, their bubbly champagne tasted flat. In 2013, researchers confirmed that the “bite” of carbonation is not dependent on bubbles: Even after drinking sparkling water in a pressure chamber, where bubbles cannot form, test subjects still reported feeling the slight “sting, burn, or pungency” associated with fizzy drinks, both on the tip of their tongue and at the back of their throat.

Read: The sad truth about seltzer

The source of that bite, scientists determined, is the carbonic acid formed when enzymes in the mouth break down carbon dioxide. (That process happens to be inhibited by a medication commonly taken by mountaineers to stave off altitude sickness.) The acid activates pain receptors, Earl Carstens, a neurobiologist at UC Davis, told me, so the experience of drinking a carbonated beverage should be sharp and irritating for everyone. In that sense, the weird thing is not that some people hate carbonation; it’s that anyone likes it at all. Social conditioning may play a role: We accept the pain of drinking soda because we’re taught that it’s okay. Or perhaps the mild pain is associated with a pleasurable release of endorphins, as can occur when people eat a spicy food. Both of those factors are likely in play, Carstens said.

But as my experience shows, not everyone experiences carbonic-acid pain the same way. Some people feel a refreshing tickle, others a chemical assault. No one knows why. Scientists have traced other aversions—to cilantro, for example, or tannic wines—to natural variations in human taste and smell receptors. “We are not at the same place in our knowledge of carbonation,” Emily Liman, a neurobiologist at the University of Southern California, told me. The problem faced by sodaphobes may yet turn out to have a genetic explanation, but for the moment, scientists don’t even understand exactly which cells are involved in the sensation. Pain receptors (such as the ones that detect spiciness) and taste cells (such as the ones that detect sourness) seem to play a part in feeling carbonation, Liman said, but it’s unclear exactly which cells contribute.

In short, there’s no way to know whether I’m the victim of busted mouth biology, or of some long-repressed experience that bubbles up as oral pain, or of something else entirely. In any case, hating carbonation only means that I have to do a lot of polite declining. It’s not a huge deal, yet I sometimes find myself perturbed to to be cut off from a whole sector of human experience, to dislike something that almost everyone else seems to like, and to dislike it not because of some contrarian impulse or principled objection but because of my physiology or my psychology. Best not to indulge such musings, though—they can easily give way to temptation. Last summer, after years of strict avoidance, I ordered a cider at a bar, thinking that maybe, after all these years, something had changed. Nope!

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Jacob Stern

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April 13, 2023
Por que tenho dores no ombro?
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Newswise — FAIRMONT, Minnesota — Se sentir dores no ombro após movimentar o braço, talvez você tenha um problema nele. A dor no ombro pode ser um sinal de artrite, tendinite, ruptura do manguito rotador ou instabilidade no ombro.

Independentemente da causa, o paciente deve procurar um profissional da área de ortopedia. A primeira consulta incluirá uma análise do histórico de saúde, exame físico e possivelmente um raio X para determinar a causa subjacente e extensão do problema no ombro. Em alguns casos, um exame adicional de imagem, como uma ressonância magnética (RM), pode ser necessário.

O profissional da área de ortopedia indicará as opções de tratamento e ajudará a decidir o que é melhor para você. A primeira linha de tratamento pode incluir:
- Tomar anti-inflamatórios que não necessitam de receita médica.
- Fazer repouso do ombro/braço afetado.
- Colocar gelo no ombro.
- Modificar as atividades para evitar complicações.
- Receber aplicação de injeção de esteroides.
- Fazer fisioterapia para fortalecer os músculos do ombro e braço.
Muitos estudos demonstram que as pessoas com dores no ombro respondem bem a esses tratamentos e são capazes de se restabelecer para fazer as atividades cotidianas. Porém, caso o paciente esteja sentindo dor e fraqueza, o profissional da área de ortopedia poderá recomendar uma cirurgia.

Uma das causas de dor e fraqueza é a ruptura do manguito rotador. O manguito rotador é um grupo de músculos e tendões. Ele mantém a articulação do ombro posicionada e auxilia na movimentação e força do braço. Caso o exame de ressonância magnética (RM) revele uma ruptura no manguito rotador, poderá ser necessário fazer uma cirurgia, ainda que isso não seja necessário para a maioria dos pacientes.

Normalmente, a cirurgia é ambulatorial, e o paciente pode ir para casa no mesmo dia. Neste procedimento, o cirurgião insere uma câmera minúscula (artroscópio) e ferramentas através de pequenas incisões para recolocar o tendão rasgado no osso. O paciente poderá necessitar de uma tipoia por seis semanas após a cirurgia para cicatrizar o ombro.

Após quatro a seis semanas, o paciente ainda poderá ter algumas restrições para trabalhar e talvez tenha que mudar as atividades. O profissional da área de ortopedia também poderá recomendar fisioterapia.

Independentemente de o paciente responder aos tratamentos não invasivos ou necessitar de uma cirurgia, o objetivo do profissional da área de ortopedia é aliviar a dor no ombro para que o paciente possa retomar as atividades cotidianas sem dor ou restrições.

Dr. Mark Wikenheiser, médico ortopedista no Sistema de Saúde da Mayo Clinic.  

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April 4, 2023
The Best Hand Massagers For Arthritis, Reviewed By A Physical Therapist

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Lalitha McSorley, owner and lead physical therapist at Brentwood Physiotherapy Calgary, says hand massagers can help relieve arthritis symptoms, including pain, stiffness, and inflammation. A hand massager helps alleviate these symptoms by increasing blood flow to the affected area and promoting relaxation. “However, it’s important to note that hand massagers should not be used as a substitute for medical treatment for arthritis,” she clarifies.

Although McSorley shares that hand massagers are generally safe for most people to use, she points out that those living with medical conditions, such as open wounds, infections, or circulatory issues, should avoid using massagers.

Karena Wu, physical therapist and owner of ActiveCare Physical Therapy, adds that a hand massager can be used daily, and sometimes even a few times per day. “Typically, you would use it for less time, for example 5 minutes, if you are doing it more frequently throughout your day, versus once a day at 10 to 15 minutes,” she advises.

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Brittany Natale

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April 1, 2023
Nobel Laureate and Wildlife Ecophysiologist to Speak at American Physiology Summit

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Newswise — March 28, 2023 (Rockville, Md.)— The American Physiology Summit will feature top scientists and inspiring speakers, including Nobel Laureate David Julius, PhD, and renowned wildlife ecophysiologist Terrie Williams, PhD, who will give keynote presentations.

The 2023 Summit, the flagship meeting of the American Physiological Society (APS), will be held April 20–23, 2023, in Long Beach, California. Advanced registration is recommended for reporters who would like to attend the meeting, access embargoed press materials online or join the virtual press conference on April 18 at 10:30 a.m. PDT/1:30 p.m. EDT.

For more on the science behind the biggest issues impacting life and health today, explore the meeting’s schedule at a glance, full program and game-changer sessions.

The biology behind why we feel pain

Julius will kick off the 2023 Summit with the opening keynote presentation “Gut Feelings: Probing Mechanisms of Visceral Pain,” on Thursday, April 20, at 4 p.m. He is professor and chair of the Department of Physiology and Morris Herzstein Chair in Molecular Biology and Medicine at the University of California, San Francisco.

Julius was awarded the 2021 Nobel Prize in Physiology or Medicine—jointly with Ardem Patapoutian, PhD, a professor at Scripps Research and Howard Hughes Medical Institute investigator in La Jolla, California—for discovering receptors for temperature and touch. Julius’ work has focused on identifying and understanding the molecular mechanisms involved in our senses of touch and pain. His group discovered a family of temperature-sensitive ion channel receptors that enable sensory nerve fibers to detect hot or cold temperatures. Read more about Julius.

The ever-adaptable mammalian brain

Williams will give the meeting’s closing keynote talk “The Master Switch of Life: A Daring Journey into the Untamed Brain,” on Sunday, April 23, at 11 a.m. Williams is a distinguished professor and director of the Integrative and Comparative Energetics Lab and the Marine Mammal Physiology Project at the University of California, Santa Cruz.

Williams, who has studied terrestrial and aquatic mammals for more than four decades, researches the survival physiology of animals including sea otters, narwhals, polar bears, lions and seals. Williams and her students strive to understand the ecological significance of large mammals and their exquisite physiological adaptations necessary for surviving in a world that is constantly changing due to human impacts. Read more about Williams.

To register for a press pass, please visit our Summit Newsroom and submit a press registration form.

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Physiology is a broad area of scientific inquiry that focuses on how molecules, cells, tissues and organs function in health and disease. The American Physiology Summit (APS2023) is an innovative event for scientific exchange and networking. Thousands of researchers, educators and students will come together to share the most recent advances and breakthroughs impacting the research community and the world around us. APS 2023 is the annual meeting of the American Physiological Society, whose mission is to advance scientific discovery, understand life and improve health.

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March 28, 2023
How one state beat national surgery opioid trends

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Newswise — A statewide effort to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has paid off in Michigan, a study shows.

In less than two years, the effort led to a 56% reduction in the amount of opioids patients received after having six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.

Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.

The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.

Importantly, the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.

“Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” said Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the new analysis. “Reducing those trends is a key part of addressing our national opioid problems.”

A statewide team effort

The achievement was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.

“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.

Making Michigan the safest place for surgery

The team showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.

Their analysis spans almost four years before the prescribing guidelines were deployed statewide, and nearly two years afterward, from 2013 to mid-2019.

They focused on patients covered by traditional Medicare, who had not filled an opioid prescription for a year before their operation, and who had not had a second operation in the six months after their index operation.

The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had minimally invasive gallbladder removal or appendix removal, minor or major hernia repairs, removal of part of the colon (colectomy), or hysterectomy.

Those six types of operations were the first ones that focused on when developing and implementing prescribing guidelines based on opioid prescription fills and surveys of patients undergoing surgery. They were first published in October 2017, and have been added to ever since with guidelines for other types of surgical and dental procedures. The opioid prescribing engagement network recently published its first pediatric surgery prescribing guidelines.

The 70 hospitals across Michigan where the guidelines were deployed account for the majority of surgical care in the state. The non-Michigan patients were a 20% sample of all traditional Medicare patients who had the same operations in the same timeframe.

The researchers looked for signs of new persistent use of opioids, which means a patient filled an opioid prescription immediately after surgery, and then also filled at least one more opioid prescription in the three months after surgery, and another up to six months after surgery. They also looked at the total amount of opioids that patients received in the six months after their operation.

Because opioid prescribing in general was trending downward in the mid-2010s, the researchers looked at differences between Michigan and national trends to see if there was any difference.

Michigan outperforms the nation

Michigan patients had a larger decrease in the rate of new persistent opioid use than their non-Michigan counterparts, with the two drops differing by about half a percentage point.

This was driven especially by a 2.76 percentage-point reduction among those having colon surgery, and smaller but significant reductions among those having gallbladder and minor hernia operations. Patients having other operations had either no difference between Michigan and the rest of the nation, or a slight increase in Michigan for appendectomy.

On the whole, Michigan surgical patients saw a faster drop in the size of the opioid prescriptions they filled, compared with those in other states having the same operations in the same time period.

The difference was nearly 56 mg of opioids by the end of the study period, with significant drops in all types of surgery except laparoscopic appendectomy. Michigan patients started at about 200 mg morphine equivalents, and dropped to 89 mg morphine on average, while non-Michigan patients started at 218 mg morphine and dropped to 154 mg morphine.

The size of dispensed opioid prescriptions to Michigan surgical patients was actually already lower than national surgical opioid prescribing before the guidelines, though persistent opioid use after surgery was higher in Michigan at 3.4% compared with 2.7%.

When the researchers excluded cancer patients, or patients with substance issues, Michigan still outperformed the rest of the country in decreasing persistent use and reducing the size of prescriptions dispensed to patients.

Michigan’s colon surgery patients had the biggest drop in both the amount of opioids they received and their chance of developing persistent use.

The researchers also did additional comparisons of Michigan with a group of Midwestern states, and with Indiana and Wisconsin, as well as doing analyses that excluded cancer patients and patients who had previously been diagnosed with a substance use disorder. In all these cases, Michigan performed better than the nation.

Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.

In addition to Howard and Brummett, the study’s authors are Andrew Ryan, Ph.D., formerly of the U-M School of Public Health, Hsou Mei Hu, Ph.D., M.B.A., of OPEN; Craig S. Brown, M.D., M.S., of Surgery; and OPEN co-directors Jennifer Waljee, M.D., M.P.H., M.S., Mark Bicket, M.D., Ph.D. and Michael Englesbe, M.D. Many of the authors are members of IHPI and the Center for Healthcare Outcomes and Policy.

Paper cited: “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of Surgery. DOI: 10.1097/SLA.0000000000005792

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Michigan Medicine – University of Michigan

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March 24, 2023
Doctor learns how to walk again after biking accident

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BYLINE: Valerie Goodwin

Newswise — Like many during the early stages of the COVID-19 pandemic, Joseph Kolars, M.D., professor of medicine in the Division of Gastroenterology and Hepatology at the University of Michigan and his wife, Candace Kolars would take nice weather days as an opportunity to get outside and be active.

In December 2020, the Kolars were taking one of their usual bike rides through Gallup Park in Ann Arbor when they noticed a runner had fallen on a slippery bridge. The pair quickly hit their brakes but proceeded to fall off their bikes. While Candace Kolars was unharmed, Joseph Kolars was in a lot of pain and couldn’t stand up.

After calling 911, EMS arrived to find that not only could Joseph Kolars not stand, but his helmet was cracked. He was quickly whisked away to the University of Michigan Health System Emergency Department for evaluation.

Joseph Kolars had numerous tests run on both his head and his legs. The results revealed that while his helmet had protected his head, his pelvis and femur absorbed the full brunt of the fall.

A series of x-rays and CT scans showed that Joseph Kolars’s right femur had broken through the joint capsule, gone up through his pelvis, which shattered in the process. The staff at the ED quickly started trying to control Kolars’ pain while putting him into traction to pull his femur out of his pelvic area.

“I don’t remember much from the ED, but I do remember them doing everything they could to make me feel comfortable,” said Joseph Kolars. “Everyone who helped me was very efficient.”

After all the ED tests were run, Jaimo Ahn, M.D., an orthopaedic surgeon at Michigan Medicine, assessed the damage of the injury and started working on a plan of operation for Joseph Kolars.

While his injury was severe, Ahn was able to quickly identify the injury as a “high energy” acetabular fracture, a type of fracture that has been researched for decades. Within 24 hours of arriving to the ED, Ahn was able to start working with Joseph Kolars on a plan of action for surgery.

Fixing an injury like this requires a lot of surgical trauma to the body. Almost all surgeries require cutting through muscles and tissues to get to the desired location. The larger the incision, the more trauma, blood loss, risk of infection, and more difficult recovery.

“Surgery is just controlled trauma to the body,” said Ahn. “The less trauma we can cause, the easier it is for the patient to recover.”

Ahn proposed a hybrid procedure that would have a smaller incision and less risk and an easier recovery.

“Dr. Ahn presented this alternative method with lots of confidence,” said Joseph Kolars. “His confidence in the procedure is what convinced me this was the right choice and that it would pan out well.”

This procedure used more indirect methods to bring the pieces back together. Pins were used during the procedure to help steady the bones so they could be put back in place and guide the fixation metal to where it needs to go. The plates and screws were left in the pelvis to help hold the bone where it needs to be and steady the area so Joseph Kolars could start walking again during recovery.

The CT scan that was done before surgery allowed Ahn to see every fracture in full detail down to the millimeter. This allowed for more precise placements of the surgical hardware when it came to the procedure and piecing the pelvic bone back together.

“Some people would describe fracture care as a mix of carpentry and gardening,” said Ahn. “The carpentry aspect is using a hard material that we need to be able to position and fix into place. We are still working with a living organism and need to make sure there is ample blood flow to support what is being done, that is the gardening.

Getting back on the bike

After surgery, Joseph Kolars spent six days in the hospital before being discharged. Even though his wife could not visit due to COVID-related restrictions, she felt kept in the loop about what was going on.

“Dr. Ahn kept good communication with Candace Kolars and was able to inspire confidence in her that this procedure was the right choice,” said Joseph Kolars. “We were both very impressed with the communication from all the staff. Candace Kolars felt like she was being kept in the loop on everything as if she was there.”

Candace Kolars would receive regular phone calls and facetimes from Ahn, the staff, and Joseph Kolars himself to be kept up to date with the care that he was receiving.

Ahn and Joseph Kolars both mentioned that it is not always easy for doctors to be good patients.

“We have a tendency as doctors to feel like we should be leading the critical treatment decisions,” said Ahn. “Joseph Kolars did a great job of being an engaged patient rather than directing care and that engagement can make a real positive difference.”

Before being discharged from the hospital, physical therapy and occupational therapy teams created a specialized plan for Joseph Kolars’s recovery at home. Due to the nature of the injury, Joseph Kolars couldn’t ride in a car, so the therapists were sent to his house one to three times per week help with rehabilitation.

Joseph Kolars was unsure if he would be able to walk again or make a full recovery due to the severity of the injury. Thanks to his care teams, he was able to walk again by April of 2021. Today, Joseph Kolars and his wife still enjoy riding their bikes for as far as 40 miles.

“The care I received from everyone during my stay in the hospital and after was phenomenal,” said Joseph Kolars. “I’m extremely grateful for everyone who worked on my case.”

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Michigan Medicine – University of Michigan

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March 9, 2023
I Struggled With Panic Attacks — Then I Tried Psychedelic Therapy

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After the hives, I started feeling chronically exhausted—I didn’t even have the energy to reach over and grab a glass of water from my nightstand. Then, I found out I had a fibroid on my uterus that was the size of a grapefruit. I was also experiencing a lot of pain in my jaw, back, neck, and really all of my joints.

At this point, as someone who had been immersed in the wellness world for some time, something in me said these symptoms were all tied together. I thought there was no way I could be experiencing all of these bizarre one-offs.

However, none of the doctors I saw offered me any clear answers. I had the hives all over my body for nine months, and the dermatologists I consulted told me it was eczema, and offered me steroid cream.

My experience with chronic illness also came with anxiety, PTSD, and panic attacks—so I was coping with these mental challenges at the same time as my physical symptoms.

I ended up reaching out to a Lyme specialist who ran a variety of tests and diagnosed me with Lyme, co-infections, mold toxicity, parasites, and gut health issues. From there, I quickly started trying all kinds of alternative therapies: ozone, stem cells, hyperbaric chamber, supplements, IVs, and so many different modalities. And I’ve spent the last six years supporting my body through diet, supplements, holistic medicine, mindset, and psychedelics.

Then, last year I had a baby. During the postpartum period, my physical and mental health issues started flaring back up again, and that’s when I started looking into new options.

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Jordan Younger

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February 18, 2023
A ‘self-managed’ virtual reality exercise session may provide short-term pain relief for women with endometriosis

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Newswise — A virtual reality (VR) exercise session may be as effective as telehealth appointments at providing short-term pain relief for women diagnosed with endometriosis, according to the results of a new health study.

Endometriosis is a debilitating disease affecting approximately 10% of women of reproductive age worldwide.

Pain management usually involves both pharmacological and surgical interventions but there is increasing interest in the benefits of exercise to reduce symptoms for many women.

With Australians facing hurdles in accessing immediate face-to-face exercise sessions, Exercise Physiologist and Senior Lecturer Dr Joyce Ramos in the College of Nursing and Health Sciences, colleagues at the Flinders University Caring Futures Institute, SHAPE Research Centre, College of Medicine and Public Health, and Western Colorado University have assessed the benefits of self-managed exercises delivered through VR technology.

Twenty-two Australian women experiencing pelvic pain due to endometriosis were included in three groups for the study which consisted of a VR exercise group, telehealth exercise group and a control group. The visual analogue scale (VAS) was used to assess the severity of their pelvic pain.

The results show that increases in pain experienced by the virtual reality and telehealth participants may not be as severe as those in the control group, suggesting that both digital health interventions may reduce pelvic pain experienced by women diagnosed with endometriosis.

Flinders University Exercise Physiologist, Senior Lecturer, and study author, Dr Joyce Ramos, says this is the first randomised controlled study to compare the potential benefits of a single telehealth appointment and VR-delivered exercise session on pelvic pain in women with mild-to-moderate endometriosis.

‘Our study suggests that a single bout of a ‘self-managed’ VR-delivered exercise may be as effective as a single session of supervised telehealth-delivered exercise in providing immediate relief from pelvic pain associated with endometriosis,’ says Dr Ramos

‘These findings are consistent with a previous study which demonstrated that a 10-to-20-minute VR session was able to alleviate pain in participants with chronic pain and endometriosis. The previous study results show the VR group had a 36.7% reduction in global pain scores during the intervention period when compared to the control group.’

‘However, it should be noted that there was no statistically significant difference in pain scores between all three groups in our study. Nevertheless, this pilot study provides important information on the potential benefits of these digital health interventions, and the feasibility of a larger and more expensive full-scale study on assessing future treatment options,’ says Dr Ramos.

‘A plausible mechanism to explain the pain-relieving effect of VR- and telehealth-delivered exercise interventions may be their capacity to alter how pain is processed in the central nervous system (CNS). So, performing a task that consumes a lot of attention and resource, such as exercise, reduces the capacity for the processing of pain.’

‘The availability of an efficacious self-managed digital health tool is particularly important among those with busy lifestyles or those who live in rural and remote areas with limited access to synchronous healthcare.

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February 10, 2023
People With Autism May Feel Pain More Intensely: Study

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By Cara Murez

HealthDay Reporter

TUESDAY, Jan. 31, 2023 (HealthDay News) — People who have autism feel pain at a higher intensity than others, which is the opposite of what many believe to be true, new research suggests.

The prevailing belief is that those with autism are indifferent to pain, possibly because of a tendency for self-harm. However, “this assumption is not necessarily true,” said Dr. Tami Bar-Shalita, of the Sackler Faculty of Medicine at Tel Aviv University in Israel.

“We know that self-harm could stem from attempts to suppress pain, and it could be that they hurt themselves in order to activate, unconsciously, a physical mechanism of ‘pain inhibits pain,’” Bar-Shalita said in a university news release.

The researchers wanted to know whether people with autism hurt more than the general population.

About 10% of the general population suffer from sensory modulation dysfunction, Bar-Shalita explained. That means a level of sensory hypersensitivity that can interfere with normal daily functioning, such as having trouble ignoring or adapting to buzzing or flickering lights or humming of air conditioners or fans.

Past studies have found that people with this sensory modulation dysfunction experience more pain, Bar-Shalita said. This dysfunction occurs in people with autism at a rate of 70% to 90%. It is one of the criteria used to diagnose autism and is associated with autism severity.

The study included 52 adults with high-functioning autism and 52 healthy people. Researchers used psychophysical tests to evaluate pain to examine the link between stimulus and response.

A researcher, using a computer, would control the duration and intensity of stimulus. The person examined was asked to rank the intensity of the pain on a scale of 0 to 100.

The study found that people with autism hurt more and that their pain suppression mechanism is less effective.

“The prevalent belief was that they are supposedly ‘indifferent to pain’, and there are reports that medical and other professional staff treated them accordingly. The results of our study indicate that in most cases, the sensitivity to pain of people with autism is actually higher than that of most of the population, while at the same time they are unsuccessful at effectively suppressing painful stimuli,” Bar-Shalita said.

“We hope that our findings will benefit the professionals and practitioners handling this population and contribute to the advancement of personalized treatment,” Bar-Shalita said.

The study was funded by the Israel Science Foundation. Findings were published in the journal PAIN .

More information

The U.S. Centers for Disease Control and Prevention has more on autism spectrum disorder.

SOURCE: Tel Aviv University, news release, Jan. 29, 2023

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January 31, 2023
Incorrectly recorded anesthesia start times cost medical centers and anesthesia practices significant revenue

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Newswise — ORLANDO, Fla. — Inaccurately recording the start of anesthesia care during a procedure is common and results in significant lost billing time for anesthesia practices and medical centers, suggests a study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

The anesthesia start time (AST) must be documented from a computer logged into the electronic health record (EHR), and typically occurs once the patient is in the operating room (OR). However, the anesthesiologist meets with the patient prior to their arrival in the OR and begins tasks that are vital to the procedure — such as administering pre-medication and attaching monitors — and that time typically is not recorded. Depending on the patient and procedure, adding two to five minutes to the AST when logging it would account for the preparation and transit time, researchers say.

“These seemingly minor inaccuracies of recorded AST can cost medical centers and anesthesia practices hundreds of thousands of dollars in lost revenue,” said Nicholas Volpe Jr., M.D., MBA, lead author of the study and an anesthesiology resident physician at Northwestern University McGaw Medical Center, Chicago. “We suspect most anesthesiologists are unaware that they aren’t recording AST accurately. It’s not a result of negligence, but rather reflects that workflow hasn’t been optimized for accuracy.”

For the study, the researchers analyzed 40,312 procedures involving anesthesia — which occurred between November 1, 2021 and October 31, 2022 — at a single academic center. In 27,771 of the cases (68.74%), AST was recorded as starting once the patient was in the OR, without factoring in the preparation time. Using the national average charge for anesthesia time, the missing time translated to $638,671.57 in lost revenue for the year, the researchers determined.*

“Logging AST is one of the many new tasks that anesthesiologists learn when starting a new role,” said Dr. Volpe. “Transitioning from an internship to clinical anesthesia practice involves learning a significant amount of new information, and understanding the importance of an accurately recorded AST may seem like a relatively minor issue compared to important patient-care information.”

Several approaches could help address inaccurate AST documentation, including educating anesthesiologists on how to improve their AST recording practices and providing visual reminders such as signs in the OR, Dr. Volpe said. Also, an AST capture function could be built into the EHR mobile application so that AST can be noted by anesthesiologists on the way to the OR, or the EHR could automatically add two minutes to the AST log time, he said. The researchers plan to roll out some of those initiatives in the spring and determine if they are effective.

*The projected savings are theoretical and not linked to billing at the institution where the study was conducted.

# # #

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.

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January 27, 2023
Additional anesthesiology residency positions may help hospitals save costs, address projected workforce shortages of anesthesia care professionals
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Newswise — ORLANDO, Fla. — Expanding anesthesiology residency programs — even in the absence of federal funding — may help medical institutions save staffing costs and address projected shortages of anesthesia care professionals, suggests a first-of-its-kind study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

In the wake of the COVID-19 pandemic, hospital expenses are rising as health care staff leave medicine and their positions are filled often using costly temporary workers or paying other staff members for overtime or extra shifts.

“There is a projected shortage of anesthesia care professionals in the next three to five years, and a third of the physician anesthesiologist workforce is older than 60¹,” said Lauren Nahouraii, M.D., lead author of the study and an anesthesiology and perioperative medicine resident physician at the University of Pittsburgh Medical Center. “Adding extra anesthesiology residency positions can help address the issue, and our research suggests it also may be cost effective for the institution.”

Physicians who graduate from medical school pursue residencies in their desired specialties at U.S. medical institutions through the Accreditation Council for Graduate Medical Education (ACGME). The federal government provides funds for those residencies, capping the positions available at each medical institution. While the U.S. Congress has made provisions for ACGME-qualified institutions to offer additional residency positions, they may not receive federal funding. Anesthesiology residency positions usually fill up every year. In the 2022 match, 1,182 medical students (44% of applicants) seeking an anesthesiology residency did not match, suggesting there aren’t enough positions, she said.

In the study, the researchers compared the cost of anesthesiology residents vs. nurse anesthetists, factoring in actual work hours and supervision ratios. They determined expanding the program to include more residents is financially beneficial as the cost per hour of clinical coverage for residents was $29.14, whereas paying nurse anesthetists to work overtime was $181.12 per hour of clinical coverage and paying nurse anesthetists to take on extra shifts was $255.31 per hour of clinical coverage. The researchers concluded that over three years, the addition of three residency positions resulted in a cost savings of between $440,000 and $730,000 for the first year, $840,000 and $1.4 million for the second year, and $1.2 million and $1.9 million for the third year. The analysis factored in the cost of those three additional residents, who weren’t supported by federal funding.

“While institutions gain greater financial benefit if they can obtain federal funding for their anesthesiology residencies, our findings suggest they might consider expanding their residency positions even if they do not receive that funding,” said Dr. Nahouraii. “Given our study may be the first investigation and description of these cost savings, adding anesthesiology residency positions may quickly catch on across anesthesiology departments, as long as they are committed to maintaining the integrity of the educational mission of residency training.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.
1. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-age-specialty-2021
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January 27, 2023
Reducing anesthetics during surgery decreases greenhouse gases without affecting patient care, study shows
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Newswise — ORLANDO, Fla. — Anesthesiologists can play a role in reducing the greenhouse gas emissions that contribute to global warming by decreasing the amount of anesthetic gas provided during procedures without compromising patient care, suggests new research being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

Inhaled anesthetics used during general anesthesia are estimated to be responsible for 0.01% to 0.10% of the total worldwide carbon dioxide equivalent emission. For example, an hour of surgery using the inhaled anesthetic desflurane is equivalent to driving up to 470 miles, according to one study.¹ Carbon dioxide is the primary greenhouse gas that traps heat in the Earth’s atmosphere, contributing to global warming.

“Global warming is affecting our daily life more and more, and the reduction of greenhouse gas emissions has become crucial,” said Mohamed Fayed, M.D., M.Sc., lead author of the study and senior anesthesia resident at Henry Ford Health in Detroit. “No matter how small each effect is, it will add up. As anesthesiologists, we can contribute significantly to this cause by making little changes in our daily practice — such as lowering the flow of anesthetic gas — without affecting patient care.”

While most general anesthesia procedures require high fresh gas flow (FGF) at the beginning and end of the procedure to achieve the desired effect quickly, it is safe and effective to lower the flow during the rest of the procedure, Dr. Fayed said. As part of the initiative to reduce FGF overall, the researchers educated anesthesiologists at their institution about the benefits of dialing down the anesthetic gas flow during the procedure, including through departmental presentations, newsletter articles, posters placed in work areas and emails. They also removed desflurane from their operating rooms because it produces the most significant carbon dioxide emissions from among the existing inhaled anesthetics.

In the study of more than 13,000 patients, the authors set a goal of an average FGF of 3 liters per minute (L/min) or less for procedures. In March 2021, prior to the intervention, authors determined that FGF was 5-6 L/min in many cases, and only 65% of cases achieved an FGF of3 L/min or less. By July 2021, they recorded an average FGF of 3 L/min or less in 93% of cases. The researchers now are aiming to reduce the FGF to less than 2 L/min throughout the system.

The initiative is part of a quality improvement project called the Multicenter Perioperative Outcome Group, which includes more than 60 anesthesia practices. The ultimate goal is to measure actual carbon footprints from anesthetic agent waste for each surgical case, Dr. Fayed noted, but that will require significant modifications and costs.

Provided through a mask, inhaled anesthetics such as desflurane, sevoflurane and isoflurane are given to patients during general anesthesia so that they are unconscious during a major operation, such as open-heart surgery. Another inhaled anesthetic, nitrous oxide, sometimes is given during childbirth or during dental procedures. Inhaled anesthetics are not used for patients who undergo sedation, which is typically used for minimally invasive procedures, such as colonoscopies. Nor is it used during regional anesthesia, which is used for childbirth or surgeries of the arm, leg or abdomen and numbs only part of the body with the patient remaining aware.

“For a long time, there was a notion that the greenhouse effect caused in health care settings was an inevitable and unavoidable cost of providing patient care,” said Dr. Fayed. “But we have learned that reducing anesthetic gas flow is one of the many ways health care can lessen its contribution to the global warming crisis, along with reducing waste, turning off lights and equipment when not in use and challenging practice habits, as long as they don’t compromise patient care.”

Masakatsu Nanamori, M.D., is the lead attending physician on the study.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522493/#:~:text=Using%20desflurane%20for%201%20hour,driving%2C%20according%20to%20the%20study.&text=The%20optimal%20(lowest%20environmental%20impact,it%20would%20minimize%20anesthetic%20use
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January 27, 2023
Study Finds Inadequate Fiber Could Be The Cause Of Your Migraines

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For this study, researchers from China wanted to look at how dietary fiber impacted the prevalence and severity of migraines and headaches in participants. To do so, they analyzed existing data on fiber and headaches from the National Health and Nutrition Examination Survey.

And based on their findings, it would appear fiber might play more of a role in headaches than we previously thought. Namely, the researchers saw that there was a significant association between the two, with more dietary fiber leading to a decrease in severe headaches and migraines.

For every increase of 10 grams of fiber per day, there was an 11% decrease in the prevalence of headaches and migraines, the researchers observed.

“To the best of our knowledge, no previous study has examined the relationship between dietary fiber and severe headache or migraine,” the study authors note in their research, adding, “Increasing the intake of fiber-rich foods might protect from severe headache or migraine.”

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Sarah Regan

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January 26, 2023
The 10 Best Shoes For Knee Pain Of 2023, Reviewed By A Podiatrist

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When it comes to finding the right shoes to combat knee pain, Sharkey has a few suggestions:

Know your foot type. The key to a truly comfortable pair of shoes is knowing your unique needs. “Those with flatter feet should look for shoes with arch stability or motion control, while those with higher arches should look for more neutral shoes with cushioning,” Sharkey clarifies. If you’re uncomfortable in your shoes and aren’t sure what type you need, it’s worth seeing a podiatrist for an evaluation.

Good arch support. Even if you don’t have specific arch-related issues, support for the soft area between the heel and the ball (AKA the arch) of your foot is important for alignment and pressure relief. “A well-supported arch means the foot is functioning optimally, which will reduce stress and strain on the knee,” says Sharkey.

Durability. Quality kicks don’t always come cheap, so it’s important to pick shoes with good feedback for durability—and to replace them when needed. “Shoes break down over time and lose their support,” warns Sharkey. “Make sure your shoes are replaced regularly for optimal support, especially pairs used for daily use and exercise. The general rule of thumb is that shoes should be replaced every 500 miles or every 6 to 8 months.”

Look for the proper fit (and easy returns). “Wearing shoes that are too narrow or too small will not provide adequate support,” Sharkey adds. That’s why it’s important to know the return policy for the brand you choose. Most of the picks on our list offer wide and narrow models, and are fair about offering free returns within a reasonable amount of time—just make sure you’re aware of the differences between the brand’s return policy and that of third-party vendors such Amazon or Zappos.

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Jamey Powell

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January 21, 2023