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Assessing Meditation Programs

Assessing Meditation Programs

Meditation programs involve learning skills about self-awareness of the mind and body. The various available mindfulness practices can focus on different aspects of self-awareness, including breathing, thoughts, bodily sensations, or a combination of these and other aspects of awareness. “Many people meditate to reduce psychological stress and stress-related health problems,” says Madhav Goyal, MD, MPH. “However, its unknown if meditation has health benefits beyond the placebo effect.” Examining Efficacy Dr. Goyal and colleagues sought to determine the efficacy of meditation programs in improving stress-related outcomes in a study published in JAMA Internal Medicine. The authors reviewed 47 randomized clinical trials that included 3,515 participants. The two types of meditation in these trials were mantra meditation and mindfulness meditation. “Our results indicated that mindfulness meditation may provide small to moderate improvements in negative aspects of psychological stress, including anxiety, depression, and pain,” says Dr. Goyal. He notes, however, that there was insufficient to low evidence that meditation had an effect on improving stress, distress, mental health-related quality of life, positive mood, attention, substance use, sleep, and weight. Meditation programs were also compared with other measures, such as exercise, progressive muscle relaxation, and cognitive-behavioral group therapy. There was insufficient evidence to show that meditation was more effective than these measures. Furthermore, the researchers found no evidence that meditation programs were better than any active treatment, such as medications, exercise, or behavioral therapies. Counseling Patients “Clinicians should know what the evidence says about the health benefits of meditation to counsel patients appropriately,” says Dr. Goyal. “We should be prepared to talk about the role that meditation programs can serve in addressing psychological...
Managing UTIs in Older Women

Managing UTIs in Older Women

Recent estimates show that urinary tract infections (UTIs) are among the most common bacterial infections occurring in the United States. There are more than 8 million annual office visits and 1 million ED visits for UTIs annually, with about 100,000 cases resulting in hospitalizations. “UTIs are twice as common among women of all ages when compared with men,” says Lona Mody, MD, MSc. “Asymptomatic bacteriuria, urinary incontinence, and symptomatic UTIs are especially prevalent in older women, but it can be difficult for clinicians to identify which patients warrant antibiotic therapy.” In an issue of JAMA, Dr. Mody and Manisha Juthani-Mehta, MD, had a clinical review published in which the authors looked at the management of asymptomatic bacteriuria and symptomatic UTIs among older community-dwelling women. The spectrum of urinary conditions can range from asymptomatic bacteriuria to symptomatic UTIs or worse (Table 1). “Many symptoms of UTIs mimic other problems that can affect older women,” explains Dr. Mody. “This can make it challenging for clinicians to know when and how to treat patients.” Making a Diagnosis The review article by Dr. Mody and Dr. Juthani-Mehta notes that asymptomatic bacteriuria is generally benign in older women. However, the diagnosis of a symptomatic UTI can be more challenging when considered in the context of chronic genitourinary symptoms, increasing cognitive impairment, and comorbidities from advancing age. When evaluating new dysuria, several factors are important, including timing, severity, and location. Worsening urinary frequency or urgency can occur for both UTIs and in urinary incontinence, making these symptoms unreliable indicators for UTIs. Conversely, new dysuria is more specific for symptomatic UTIs. If this is present, there...

Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
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