Sep 23, 2016

Fitness tech

The story

Wearable tech and virtual reality training are a huge part of fitness's present and future. New research sheds light on both.

What to wear

Hospitals and corporations are giving out FitBits like never before, but the gadget's impact on weight loss and well-being is a mystery. A trial of 500 overweight and obese young adults found that participants using wearable activity trackers lost less weight than those who didn't. All participants were provided counseling and specific diet and exercise instructions. The fitness trackers were introduced to half of the participants at 6 months into the study, but the tracker arm lost an average of 2.4 kg less weight than the the control arm after 24 months.

What to watch

Your video game obsessed teenage brother isn't always on the same page as your geriatrics attending, but they're both pumped about virtual reality (VR). A non-immersive VR program helped reduce fall rates in 300 elderly patients at high fall risk. The program used motion capture to film the participants' feet and projected the results onto a virtual obstacle course that challenged walkers to continually adjust their footsteps. Six months of VR combined with treadmill training helped cut fall rates in half compared to rates before the intervention, and significantly decreased falls compared to treadmill training alone.

Say it on rounds

When you just can't stomach Brangelina

Breaking up is hard, but breaking bones is tragic. Enter romosozumab, a monoclonal antibody against the bone inhibitor sclerostin. The FRAME trial, the drug's 7,000 patient phase III RCT, found a 73% reduction in vertebral fractures vs. placebo after 12 months of therapy. The romosozumab group had lower fracture rates and improved bone denisty scores at 2-year follow-up.

When your patient has tried everything to quit smoking

Maybe try e-cigarettes as a last ditch alternative. A cross sectional survey of British households found that increases in the prevalence of e-cigarettes were associated with higher quit attempt success rates after adjustment for confounding variables. While the observational data is far from convincing, the authors speculate that some smokers use e-cigarettes to reduce their use of nicotine replacement therapy.  

When you write a once weekly progress note

Get ready for an angry email from compliance. In diabetes, drug developers hope that patients will find once-weekly injection meds more tolerable than their daily alternatives. The latest data is from semaglutide, a weekly version of GLP-1 agonist liraglutide (Victoza). The not-yet-approved drug was linked to improved cardiovascular outcomes vs. placebo after 2-year follow-up in the 3,300 patient SUSTAIN-6 trial. The results will help drugmaker Novo Nordisk argue to the FDA that semaglutide has cardioprotective effects similar to the impressive findings from liraglutide's LEADER trial. 

Brush up

Antimicrobial resistance (AMR)

Your favorite topic on ID rounds found the spotlight at this week's United Nations General Assembly. The big bad bugs to know are carbapenem-resistant Klebsiella in the United States, superbugs with the blaNDM-1 resistance gene in India, and colistin-resistant E. coli in China. Resistance emerges from inappropriate antibiotic prescriptions, heavy use in agriculture and animal feeds, and genetic factors intrinsic to bacteria.

Numbers game

Think 2 million AMR infections in the US per year leading to 23,000 deaths at a cost in excess of $20 billion. Outpatient antibiotics account for about 60% of scripts, and 30% of these prescriptions may be inappropriate or not guideline-based. Some worry that resistance is spreading faster than drug development. Only 5 antibiotics have been approved since 2012, compared to 16 that were approved from 1983 – 1987.

What your tech friends are talking about

Facebook founder Mark Zuckerberg and his wife Dr. Priscilla Chan pledged $3 billion to help cure 'all diseases' by the end of the century. The $3 billion, which is to be given over time from the Chan Zuckerberg Initiative, is about one tenth of the NIH's 2016 budget.

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