2 Minute Medicine Rewind November 18, 2024
1. Transcranial direct current stimulation (tDCS) combined with repetitive transcranial magnetic stimulation (rTMS) had greater efficacy in reducing depressive symptoms in participants with major depressive disorder than either tDCS + rTMS alone.Â
Evidence Rating Level: 1 (Excellent)
Noninvasive brain-stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have each been found to be effective in treating depression when applied individually. However, it remains unclear whether the combination of rTMS and tDCS offers greater efficacy in treating major depressive disorder (MDD). This study thus examined the efficacy and safety of rTMS and tDCS, both individually and in combination, in patients with MDD. This double-blind, sham-controlled randomized clinical trial included adults aged 18-65 diagnosed with MDD from three hospitals in China. Participants were randomly assigned 1:1:1:1 to one of four interventions: active tDCS + active rTMS, sham tDCS + active rTMS, active tDCS + sham rTMS, and sham tDCS + sham rTMS. Treatments were given were 5 times a week for 2 weeks and followed up for another 2 weeks. The 24-item Hamilton Depression Rating Scale (HDRS-24) was used to assess depressive symptoms (higher score indicating more severe symptoms) at baseline, end of the 2-week treatment, and during the 2-week follow-up period. Out of the 240 participants included in the study (mean [SD] age, 32.50 [15.18] years, 139 females (57.9%), 219 patients (91.3%) completed both the 2-week intervention and 2-week follow-up. From baseline to week 2, participants who received active tDCS + active rTMS had a greater reduction in mean [SD] HDRS-24 total scores compared with participants in the other three groups (active tDCS + active rTMS: 18.33 [5.39], sham tDCS + active rTMS: 14.86 [5.59], active tDCS + sham rTMS: 9.21 [4.61], and sham tDCS + sham rTMS: 10.77 [5.67]; F3,236 = 35.79; η2 = 0.31 [95% confidence interval (CI), 0.21-0.39]). Although response rates at week 4 were similar across groups, remission rates were higher for participants treated with active tDCS + active rTMS (50 [83.3%]) compared to those in the other groups (p < 0.001). No serious adverse events occurred during treatment and follow-up. Overall, this study found that the combination of tDCS + rTMS was safe and had greater efficacy in reducing depressive symptoms in participants with MDD than tDCS + rTMS alone. Future studies are needed to confirm study findings and elucidate the mechanisms underlying the synergistic effect tDCS + rTMS.
Asthma and Memory Function in Children
1. Longitudinal results found that children with earlier asthma onset had slower episodic memory development compared to children without asthma.
2. Cross-sectional results found that children with asthma performed worse on measures of episodic memory, cognitive processing speed, and cognitive inhibition and attention.
Evidence Rating Level: 2 (Good)
Asthma ranks among the most prevalent chronic diseases in children, affecting about 5 million children in the US. While rodent studies have found asthma to result in memory deficits, it is unclear whether asthma impacts memory development in children. This study thus examined whether childhood asthma was associated with lower memory and cognitive function in children. This cohort study analyzed observational data from the Adolescent Brain Cognitive Development (ABCD) Study, a multisite longitudinal study that included 11, 800 children aged 9-10 at baseline from 21 sites in the US. This study analyzed data at the baseline, 1-year follow-up, and 2-year follow-up. Children were included in the longitudinal analysis if they had asthma at both baseline and the 2-year follow-up (earlier childhood onset group), only at the 2-year follow-up (later childhood onset group), or had no history of asthma (comparison group). Children were included in the cross-sectional analysis if they had asthma at any time point or had no history of asthma. The primary outcome was episodic memory, defined as the ability to remember past events with specific details. Secondary outcomes were cognitive processing speed, and cognitive inhibition and attention. The longitudinal analysis included 474 children (earlier childhood onset group: 135 children; mean [SD] age, 9.90 [0.63] years; 76 [56%] male; later childhood onset group: 102 children; mean [SD] age 9.88 [0.59] years; 48 [47%] male; comparison group: 237 children; mean [SD] age, 9.89 [0.59] years; 121 [51%] male). While episodic memory improved over time with increasing age (change in age: β = 0.28; 95% confidence interval (CI), 0.21 to 0.35; p < 0.001), lower rates of improvements were observed in children with earlier childhood onset of asthma (change in age × earlier onset: β = −0.17; 95% CI, −0.28 to −0.05; p = 0.01) compared to the comparison group. Developmental improvements in episodic memory in children with later onset of asthma did not differ from the comparison group and no group differences were observed for processing speed, and inhibition and attention. The cross-sectional analysis included 2062 children (with asthma: 1031 children; mean [SD] age, 11.99 [0.66] years; 588 [57%] male; without asthma: 1031 children; mean [SD] age 12.00 [0.66] years; 554 [46%] male). Children with asthma had lower scores on episodic memory (β = −0.09; 95% CI, −0.18 to −0.01; p = 0.04), processing speed (β = −0.13; 95% CI, −0.22 to −0.03; p = 0.01), and cognitive inhibition and attention (β = −0.11; 95% CI, −0.21 to −0.02; p = 0.02). Overall, this study found asthma in children was linked to memory difficulties, which may be more pronounced with earlier childhood onset.Â
Safety of inpatient care in surgical settings: cohort study
1. Adverse events were identified in more than one third of patients admitted to hospital for surgery, nearly half of which were classified as major adverse events and most potentially preventable.
2. The most common adverse events were associated with surgical procedures, followed by adverse drug events, healthcare-associated infections, and patient care events.Â
Evidence Rating Level: 2 (Good)
Adverse events during hospital admission significantly contribute to patient harm. The landmark Harvard Medical Practice Study conducted in the 1980s revealed that nearly half of the estimated incidence and preventability of adverse events during hospital care were linked with surgical procedures. Since this study, patient safety and surgical care have transformed substantially over the past decades. To ensure ongoing quality improvement in surgical care, this study aimed to provide an updated evaluation of surgical safety by estimating the incidence, severity, and preventability of adverse events during perioperative care for surgical patients. This retrospective cohort study included a random sample of 64,121 patients from 11 hospitals admitted for surgery in 2018. Adverse events were defined as unintended physical injury resulting from or contributed to by medical care that required additional monitoring, treatment, or hospital admission, or that resulted in death. Major adverse events were defined as serious, life-threatening, or fatal. All records were reviewed by trained nurses and adjudicated by physicians for the occurrence of adverse events. In total, 1,009 patients were included in a weighted random sample (mean age = 60.9 years, 95% CI 60.0 to 61.7; 519 (51.4%) female). Among the 1009 patients analyzed, at least one adverse event occurred in 383 (38.0%) (95% confidence interval (CI) 32.6 to 43.4) and at least one major adverse event occurred in 160 (15.9%) (95% CI 12.7 to 19.0). Of the 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were associated with surgical procedures (n = 292, 49.3%), followed by adverse drug events (n = 158, 26.6%), healthcare-associated infections (n = 74, 12.4%), patient care events (n = 66, 11.2%), and blood transfusion reactions (n = 3, 0.5%). Compared to adverse drug and patient care events, surgery-related adverse events were more likely to be rated as major adverse events and less likely to be preventable. Adverse events were most common in general care units (n = 289, 48.8%), followed by operating rooms (n = 155, 26.1%), intensive care units (n = 77, 13.0%), recovery rooms (n = 20, 3.3%), emergency departments (n = 11, 1.8%), and other in-hospital locations (n = 42, 7.0%). Professions most involved were attending physicians (n = 531, 89.5%), followed by nurses (n = 349, 58.9%), residents (n = 294, 49.5%), advanced level practitioners (n = 169, 28.5%), and fellows (n = 68, 11.5%). Overall, this study revealed that adverse events are still frequent and preventable in surgery. Study findings highlight the urgent need for continuous improvement in patient safety that involves all health professionals throughout perioperative care.
1. Higher added sugar intake was associated with a greater risk of osteoarthritis, particularly in females, those with low body mass index, never smoked, never consumed alcohol, had no history of hypertension, or had no history of diabetes.
Evidence Rating Level: 3 (Average)
There is emerging evidence that diet contributes to the development of osteoarthritis (OA). Although excessive consumption of added sugars has been linked to increased susceptibility to various chronic illnesses, its relationship with OA remains unclear. This study thus examined the association between consumption of added sugars and OA. This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. The primary outcome was self-reported OA. The primary exposure was added sugars, which included brown sugar, cane syrup, corn syrup, corn syrup solids, dextrose, fructose, fruit syrup, honey, maple syrup, molasses, pancake syrup, raw sugar, sorghum syrup, and white sugar. Added sugar intake was estimated using 24-hour dietary recall. Participants were separated into quartile groups based on their added sugar intake (kcal): Q1 [0.000, 7.444], Q2 [7.444, 13.942], Q3 [13.942, 24.016], and Q4 [24.016, 263.793]. In total, 2,746 participants were included in the study, with 2,152 in the OA group and 594 in the non-OA group, and were weighted to represent 11,854,966 participants (mean age [SD] = 43.77 [0.27] years, mean BMI [SD] = 28.15 [0.09] kg/m2, 47.67% female, 11.08% with OA). Added sugar intake was associated with increased OA risk (OR = 1.01; 95% CI 1.00 to 1.01) even after adjusting for covariates. Additionally, the group with the highest added sugar intake (Q4) had the greatest OA risk compared to those with low added sugar intake (OR = 1.40; 95% CI 1.09 to 1.81). In the subgroup analyses, greater OA risk was observed for participants who never consumed alcohol (OR = 1.02; 95% CI 1.01 to 1.04) and those with no history of diabetes (OR = 1.02; 95% CI 1.01 to 1.04). In the group with the highest added sugar intake (Q4), participants had a greater risk of OA compared to those with low added sugar intake if they were female (OR = 1.44; 95% CI 1.02 to 2.02), had low BMI (OR = 1.88; 95% CI 1.06 to 3.33), never smoked (OR = 1.55; 95% CI 1.05 to 2.30), never consumed alcohol (OR = 3.31; 95% CI 1.42 to 7.74), had no history of hypertension (OR = 1.51; 95% CI 1.00 to 2.27), or had no history of diabetes (OR = 1.44; 95% CI 1.11 to 1.87). Overall, this study found that added sugar intake was associated with an increased risk of OA. Future longitudinal studies are warranted to examine temporal associations.Â
1. Both electroacupuncture and acupuncture alleviated symptoms of cold hypersensitivity in the hands and feet and increased quality of life compared to no treatment, with electroacupuncture showing longer-lasting improvements.
Evidence Rating Level: 1 (Excellent)
Cold hypersensitivity in the hands and feet (CHHF) is characterized by abnormal sensitivity to temperatures, resulting in discomfort, impaired daily activities, and reduced quality of life, and it is predominantly observed in women. Electroacupuncture (EA) is a modern variation of acupuncture (AC) that involves applying mild electrical currents through acupuncture needles to enhance therapeutic effects. Although AC and EA have been recommended for treating CHHF, evaluation of their efficacy in alleviating CHHF symptoms is lacking. This randomized, controlled, three-arm clinical trial evaluated the efficacy of AC and EA IN treating CHHF, and included women aged 19-59 with CHHF across 3 Korean hospitals. Participants were included and randomized 1:1:1 to either the AC treatment, EA treatment, or no-treatment (control) group. AC and EA groups received treatment twice weekly for 5 weeks. CHHF symptoms were assessed using the visual analog scale (VAS) scores, and quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores. Assessments were completed at pre-treatment, post-treatment, and follow-up (4 weeks post-treatment). Due to participants lost to follow-up, 68 out of the 72 participants included were analyzed (AC group: N = 24, mean [SD] age = 38.5 [13.9] years, BMI [SD] = 21.5 [1.66] kg/m2; EA group: N = 24, mean [SD] age = 35.3 [12] years, BMI [SD] = 21.3 [2.89] kg/m2; control group: N = 24, mean [SD] age = 42.2 [12.2] years, BMI [SD] = 20.4 [2.18] kg/m2). Immediately post-treatment, both EA and AC groups showed reduced VAS scores and increased scores in several WHOQOL-BREF domains compared to pre-treatment (p < 0.05). At follow-up, the EA group demonstrated sustained reductions in feet VAS scores and increased scores in several WHOQOL-BREF domains (p < 0.05). Interestingly, reduced VAS scores at follow-up were also observed in the control group and were attributed to natural variability of cold extremity symptoms and psychological factors. Effect size (Cohen’s d) comparisons groups revealed that immediately after treatment, VAS scores were lower in both EA (hand VAS score: d = -0.89, 95%CI = -1.48, -0.29, feet VAS score: d = -1.11 (-1.72, -0.50) and AC groups (hand VAS score: d = -0.93, 95%CI = -1.52, -0.33, feet VAS score: d = -0.77 (-1.36, -0.19) compared to the control group. At follow-up, the EA group showed sustained lower feet VAS scores (d = -0.82, 95%CI = -1.40, -0.23) and higher scores in several WHOQOL-BREF domains compared to the control group. Finally, interaction effects between group and time indicated that changes over time in the EA and AC groups were meaningfully different from those in the control group. Overall, this study found that both EA and AC treatments alleviated CHHF symptoms and improved quality of life, and that EA provided longer-lasting improvements than AC. Thus, EA and AC may be promising non-pharmacological interventions for women with CHHF. Future studies are needed to validate study findings.
Image: PD
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