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FOR THE PRESS

Annals of Internal Medicine Tip Sheet
September 12, 2017


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. Study confirms that sedentary time is a significant risk factor for all-cause mortality*

Frequent movement breaks throughout the day could potentially mitigate the effects of prolonged sitting

*Video available for download: HD video soundbites of experts discussing their findings available at http://www.dssimon.com/MM/ACP-sedentary-study.
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0212
Editorial: http://annals.org/aim/article/doi/10.7326/M17-2181

Excessive sedentary time, whether accumulated throughout the day or accrued in prolonged, uninterrupted bouts, is a significant risk factor for all-cause mortality, regardless of exercise habits. Taking movement breaks every 30 minutes throughout the day could help to mitigate the negative health effects of too much sitting. These findings suggest that physical activity guidelines should target reducing and interrupting sedentary time in addition to setting daily goals for moderate- to vigorous-intensity physical activity. The study is published in Annals of Internal Medicine.

Adults are sedentary for an alarming 9 to 10 hours per day. Previous studies showing a link between sedentary behavior and death have relied on self-reporting to evaluate the total volume of sedentary time and did not examine whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance.

Researchers at Columbia University Medical Center, NewYork-Presbyterian/Weill Cornell Medical Center and other institutions studied a national cohort of 7,985 black and white adults aged 45 years or older to examine the association between sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. Sedentary time was objectively measured using a hip-mounted accelerometer. All-cause mortality was the primary outcome, defined as any death after completion of the accelerometer protocol, regardless of cause.

The data showed that sedentary behavior accounted for about 12.3 hours per day over a 16-hour waking day. Mean sedentary bout length was 11.4 minutes. Over a median follow-up of 4 years, 340 participants died. Greater total sedentary time and longer mean sedentary bout duration each had a dose-dependent association with higher risk for all-cause mortality that did not vary by age, sex, race, BMI, or participant exercise habits. Participants who kept their sitting bouts to less than 30 minutes had the lowest risk for death. According to the authors, these findings suggest that taking a break from sitting every half hour could help to mitigate the negative effects of sedentary time.

2. Bulk of opioid use in the U.S. concentrated among 10 percent of patients

Abstract: http://annals.org/aim/article/doi/10.7326/M17-1408

A small proportion (10 percent) of opioid users account for the vast majority of opioid use in the United States. These findings suggest that efforts to reduce prescription opioid abuse should focus on the top users, rather than taking a population-based approach. The brief research report is published in Annals of Internal Medicine.

Deaths from prescription opioids have sharply increased in the United States. In response, the Centers for Disease Control and Prevention (CDC) recently issued recommendations for opioid prescribing for chronic pain. What’s missing from these guidelines and other public health efforts to prevent opioid misuse is information about the distribution opioid use across the population.

Researchers at the Stanford University Medical Center studied pharmacy data for privately insured adults without cancer who were enrolled for at least one year between 2001 and 2013 and filled at least one prescription for an opioid during that time. The data showed that the top 10 percent of patients accounted for the most opioid use. Further research aimed at characterizing this population, analyzing the incidence of opioid-related adverse events, and identifying approaches to reduce its use could be most effective in reducing total population-level events.

3. Low dose IVIg not effective for relieving pain in patients with moderate to severe CRPS

Abstract: http://annals.org/aim/article/doi/10.7326/M17-0509
Editorial: http://annals.org/aim/article/doi/10.7326/M17-1943

Treatment with two low doses of intravenous immunoglobulin (IVIg) over 6 weeks had no clinically important effect on the intensity of pain for patients with complex regional pain syndrome (CRPS), a rare posttraumatic pain condition. The results of a phase 3 randomized, controlled trial are published in Annals of Internal Medicine.

Approximately 15 percent of patients with CRPS still have symptoms one year after onset that severely impact quality of life. For these patients, prognosis is poor and drug therapy for pain relief is rarely effective. Two small trials have suggested that low-dose IVIg may improve symptoms in patients with CRPS.

A team of investigators led by researchers at the Pain Research Institute, Institute of Translational Medicine at the University of Liverpool Clinical Sciences Centre sought to confirm the efficacy of low-dose IVIg in reducing CRPS pain. They identified 111 adult patients who had CRPS from 1 to 5 years. The patients were randomly assigned to receive an intervention of either IVIg, 0.5 g/kg of body weight, or visually indistinguishable placebo of 0.1 percent albumin in saline on days 1 and 22 after randomization. Pain intensity was measured daily between days 6 and 42.

Over the 6-week trial, no patient in the active group reported substantial pain reduction. No patient experienced more than 50 percent pain reduction while taking IVIg, in contradistiniction to results from earlier studies. These results suggest that alternative analgesic technologies are needed to allow treatment of CRPS.

Also in this issue:

Treatment of Type 1 Diabetes: Synopsis of the 2017 American Diabetes Association Standards of Medical Care in Diabetes

James J. Chamberlain, MD; Rita Rastogi Kalyani, MD, MHS; Sandra Leal, PharmD, MPH; Andrew S. Rhinehart, MD; Jay H. Shubrook, DO; Neil Skolnik, MD; and William H. Herman, MD, MPH
Clinical Guidline
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1259

Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

Arabella L. Simpkin, MD, MMSc; Jatin M. Vyas, MD, PhD; and Katrina A. Armstrong, MD, MSCE
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0163

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