May 19, 2017

Muscle tone

The story

Just like the perfect combo – think summertime elective with a bonus paycheck – can make magic happen in residency, the right mix of exercise can decrease frailty in elderly adults. New research explores.

The background

When the elderly lose weight, they tend to lose muscle and bone mass, too. It puts the obese in a pickle: obesity leads quickly to physical frailty, but weight loss may compound the problem and lead to an increased risk of fracture. In previous studies, weight loss and exercise were shown to improve physical function, but the combination only slowed, rather than reversed, progression to frailty.

The resistance

A combination of weight loss, aerobic training, and resistance training increased the functional status of obese elderly adults, says a 6-month RCT of 160 patients. Resistance and aerobic training together worked synergistically to improve physical performance outcomes more than either type of training alone, and the resistance training helped prevent the loss of lean body mass seen in aerobic training. The combination program helped improve physical performance test scores by 20%. A 2-minute video has more, including rotund blobs getting their walk on. 

The takeaway

Adding strength training to aerobic exercise makes both more effective and can help your elderly obese patients preserve their muscle and bone mass. Sell it to them as a key way to prolong their independence.

Say it on rounds

When you drop a call in the hospital dead zone

Let's hope it was nothing important. In an observational study of 1,000 women seeking telemedicine abortion in Ireland, 95% were able to successfully terminate their pregnancy. Complications were infrequent, and almost all of the women advised to seek local medical attention complied. Since Irish abortion laws are among the world's most restrictive, telemedicine looks like a viable option for women in countries with tough abortion laws but high quality local healthcare.

When your attending can't figure out how to print a patient list

Some are better than others with instructions. A prospective study of inhaler adherence in 250 COPD patients found that, despite lessons, only 6% of patients used their inhaler correctly 1 month after hospital discharge. Another 25% used their inhaler regularly but made frequent errors. On the whole, estimated actual adherence was 23% of that expected if inhaler doses were taken correctly and on time.
Amer J Rest Crit Care Med

When you lie down for a nap on a quiet work day

It's easy to predict when you'll get paged, and it's easy to guess which cirrhotics will get acute kidney injury (AKI). A prospective study of 600 cirrhotic patients found that high baseline serum creatinine predicted risk of developing in-hospital AKI. Change in creatinine during an AKI episode was the strongest factor associated with 30-day mortality. The findings highlight chronic kidney disease as an important contributor to cirrhosis morbidity.

Brush up


Cholera is well known for its spectacular flow rates. Despite advances in sanitation and hygiene, the disease persists in endemic areas and kills up to 100,000 patients per year. After a 1 - 5 day incubation period, the bug’s exotoxin induces intestinal fluid secretion, and the resulting diarrhea can cause severe dehydration within hours. Treat with aggressive rehydration, though azithromycin and ciprofloxacin have also been shown to improve symptoms and limit fecal spread. With appropriate management, case fatality is much less than 1%.

What's the evidence

For cholera vaccination in travelers? A 2016 RCT of 200 adult volunteers overly eager to ingest V. cholerae found that a single-dose, live-attenuated vaccine reduced moderate-to-severe diarrhea after ingestion compared to placebo (6% vs. 59%, respectively). The FDA approved the vaccine, Vaxchora, for US travelers going to high-risk areas.

What your family planning friends are talking about

Broken clinic printers may make you a skeptic of printing technology, but trust us, it gets more sophisticated. Researchers used 3D printing to create mouse ovaries that, after implantation, led to live births. The technique could one day be used to combat infertility.

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