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Fall is here! And that means Big Pumpkin will take hold of every consumable product, Bill Belichick will rip into another batch of perfectly good hoodies, and viral respiratory infections will infiltrate half your patient panel. If you had a nickel for every patient who presented with a cold—well, you and the collective medical community would have $5.5 million/year (110 million annual visits). Now, if only you had a nickel for every antibiotic request …
After you explain to patients why antibiotics are inappropriate in their case, you likely recommend some combination of over-the-counter (OTC) antihistamines, decongestants, and analgesics for symptom relief. But do these medications really alleviate symptoms? According to the trusty Cochrane Review, generally yes, but the evidence is limited.
After a review of 30 studies (>6,000 patients), Cochrane reported a modest general benefit with the use of combinations of OTC medications on symptom alleviation for viral respiratory infections in adults and older children, but the authors call for more high-quality studies. Also, clinicians and patients must weigh the benefits against the risks of adverse effects (eg, lightheadedness, dizziness). See the FDA’s warning about nasal preparations containing phenylpropanolamine.
We know you’re eager to recommend an intervention to patients when antibiotics are not the answer, and while more studies are needed, this one at least offers up a talking point. It is that these readily available oral antihistamine-decongestant-analgesic combinations may confer modest symptom relief, but this should be balanced against the risk of adverse effects. As always, remind patients that these colds are self-limiting and likely to resolve within two weeks. And while no one wants to be sidelined with a cold, it offers an opportunity to lounge in that cutoff hoodie, sip that pumpkin spice hot cocoa, and catch up on the latest prestige TV. May we recommend House of the Dragon, The Dropout, and The Great British Bake Off?
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No Worries—USPSTF Recommends Anxiety Screening for All
MENTAL HEALTH MUSINGS
Most of us can spot a touch of “Cameron Frye” in those around us or even in ourselves. It’s that ominous voice of unease that fills our heads, even when our best friend, Ferris Bueller, shows us the “day off” of a lifetime. The ubiquity of “Camerons” in this country has led the United States Preventive Services Task Force (USPSTF) to issue an unprecedented draft recommendation on anxiety screening.
The USPSTF recommends screening all adults aged 19 to 64, including those who are pregnant or postpartum, for anxiety (B recommendation). As for those 65 and older, not enough evidence exists for the task force to make a recommendation for or against screening.
The recommendation is timely given the surge in mental health challenges since the pandemic, but much of the evidence supporting it predates the first COVID-19 case. The research shows that about 31% of adults experience anxiety in their lifetime and that the road to a diagnosis takes an average of 23 years. The data also revealed distressing but not surprising mental health disparities among races/ethnicities, which this universal screening aims to mitigate.
But not everyone is applauding the recommendation. The counterpoints the USPSTF may hear before its October 17 cutoff for public comments include (1) challenges of fitting this screening into a clinician’s expanding checklist, (2) a shortage of mental health professionals, leaving patients with a positive screen at a diagnostic dead end, and (3) concerns about overprescribing.
The USPSTF recommendation to screen a wide-ranging patient population may help start a dialogue between you and your patients and lead to more prompt diagnoses and treatments. It may also mean that you’ll have to walk a tightrope between over- and under-prescribing for anxiety disorder. As always, a positive screen does not indicate the presence of a clinical disorder; it merely marks a first step.
Exercise Prescriptions for HFpEF
We hope you’re sitting down for this scorching take: physical activity is beneficial! Well, yes, you may have come across that kernel of information at some point in your medical career, but a new study gives you yet another reason to hand out exercise prescriptions like they’re cars at an Oprah show. Exercise (or lack thereof) may directly affect patients’ chances of developing heart failure with preserved ejection fraction (HFpEF).
A literature review of HFpEF risk factors revealed that a subset of people with HFpEF have a structurally “normal” heart but that lack of exercise has diminished its size and, ultimately, output. The study showed that chronic exercise deficiency is linked with cardiac atrophy, diminished cardiac output and chamber size, and reduced cardiorespiratory fitness in patients with HFpEF. On the flip side of the coin, increasing physical activity is linked with greater cardiac mass, stroke volumes, cardiac output, and peak oxygen consumption.
So, not only does exercise indirectly help prevent HFpEF by mitigating risk factors like hypertension, metabolic syndrome, and obesity, but also it may directly help prevent HFpEF by strengthening the heart muscles. If only there were an EGOT for nonpharmacologic interventions.
Rapid-Fire COVID-19 Updates
COVID QUICK HIT
- Researchers identify antibodies that may make coronavirus vaccines unnecessary
- Long-term neurologic outcomes of COVID-19
- Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic
Teatime for a Longer Lifetime?
Teatime, anyone? If we’ve learned anything from the medical literature and from the Brits, it’s that answering that question in the affirmative is a good idea. The health benefits of tea are well documented. But until now, green tea has cornered the market on good press. Not anymore, says black tea, emerging from the shadows like Aaron Rodgers in the post-Favre era.
A prospective cohort study looked at tea habits and mortality risks in nearly 500,000 adults registered in the UK Biobank, a group with a majority commonality: an affinity for Harry Potter (we assume) and black tea. Higher tea intake—primarily black tea—was associated with a modestly lower mortality risk in those who consumed at least two cups per day. Genetic variation in caffeine metabolism did not play a role.
As with any dietary study, showing causation is a challenge. Therefore, if black tea is not your patient’s cup of tea, there is no need for them to stock up. But if black tea is already a household staple, patients should continue to consume it; the benefits seem likely, even at higher intake levels. Lastly, green tea does not hold a monopoly on healthiness, so if green tea drinkers prefer the taste of black tea, they should make the switch—guilt-free.
For some anecdotal evidence of the longevity benefits of black tea, look no further than the late Queen Elizabeth II. The longest-reigning British monarch fancied a daily serving of Earl Grey tea, a flavored tea made from—you guessed it—black tea. That’s good enough for us! Cheers!
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- FDA proposed updated definition of ‘healthy’ claim on food packages to help improve diet, reduce chronic disease
- Health workers unlikely to catch monkeypox from infected patients
- Efficacy of doxycycline for mild-to-moderate community-acquired pneumonia in adults: a systematic review and meta-analysis of randomized controlled trials
- ‘Game changer’ semaglutide halves diabetes risk from obesity
- Effectiveness of early time-restricted eating for weight loss, fat loss, and cardiometabolic health in adults with obesity: a randomized clinical trial
- Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction
- Screening for prediabetes and type 2 diabetes in children and adolescents: US Preventive Services Task Force recommendation statement
- For Black patients, nixing ‘race adjustment’ may improve kidney transplant odds, study finds
- Experimental Alzheimer’s drug shows benefits in phase 3 trial, company says
Morning Report is written by:
- Alissa Scott, Author
- Aylin Madore, MD, MEd, Editor
- Eleni Scott, MD, Editor
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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.
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