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A New Approach to Essential Tremor

A New Approach to Essential Tremor

Essential tremor (ET) is the most common movement disorder in the United States, afflicting an estimated 10 million Americans. “Although the condition does not shorten life expectancy, ET can have a dramatic effect on quality of life, functional activities, mood, and socialization,” says Binit B. Shah, MD. “Medications and/or surgery for ET can be effective for some patients, but many still have disabling tremors and some may wish to avoid surgery because of its invasiveness.” Testing a New Treatment Dr. Shah and colleagues have experimented with using ultrasound energy, a scalpel-free alternative treatment option for ET. For a study published in the New England Journal of Medicine, they assessed the safety and efficacy of MRI-guided focused ultrasound thalamotomy to treatment of medication-refractory ET. The prospective, sham-controlled trial included 76 patients with moderate-to-severe ET, with 75% of participants receiving the focused ultrasound guided by MRI. The remaining 25% of participants served as the control group and received a sham procedure. Results of the analysis showed that patients receiving the scalpel-free approach had dramatic improvements that continued throughout the study period. “Recipients of the treatment had their ET improve by 47% at 3 months and 40% at 12 months,” says Dr. Shah. “They also reported major improvements in quality of life.” Conversely, the control group that received the sham procedure exhibited no significant improvements. “The most important findings of our study were that patients receiving focused ultrasound had significant gains in improvements in disabilities and quality of life for an extended period of time,” Dr. Shah says. “The most commonly reported side effects among those receiving focused ultrasound were gait disturbances...
Mayo Clinic: Mental Activities May Protect Against Mild Cognitive Impairment

Mayo Clinic: Mental Activities May Protect Against Mild Cognitive Impairment

Mayo Clinic researchers have found that engaging in mentally stimulating activities, even late in life, may protect against new-onset mild cognitive impairment, which is the intermediate stage between normal cognitive aging and dementia. The study found that cognitively normal people 70 or older who engaged in computer use, craft activities, social activities and playing games had a decreased risk of developing mild cognitive impairment. The results are published in the Jan. 30 edition of JAMA Neurology. Researchers followed 1,929 cognitively normal participants of the population-based Mayo Clinic Study of Aging in Olmsted County, Minn., for an average duration of four years. After adjusting for sex, age and educational level, researchers discovered that the risk of new-onset mild cognitive impairment decreased by 30% with computer use, 28% with craft activities, 23% with social activities, and 22% with playing games. “Our team found that persons who performed these activities at least one to two times per week had less cognitive decline than those who engaged in the same activities only two to three times per month or less,” says Yonas Geda, M.D., psychiatrist and behavioral neurologist at Mayo Clinic’s Arizona campus and senior author of the study. Related Articles Women’s Cognitive Decline Begins Earlier Than Previously Believed A systematic review of cognitive effects of exercise in depression Cognitive Training Can Positively Affect Perception of Tinnitus Cognitive Stress Reduces Levodopa Effect in Parkinson’s The benefits of being cognitively engaged even were seen among apolipoprotein E (APOE) ε4 carriers. APOE ε4 is a genetic risk factor for mild cognitive impairment and Alzheimer’s dementia. However, for APOE ε4 carriers, only computer use and social...
Physician-Hospital Integration is More Complex than Expected

Physician-Hospital Integration is More Complex than Expected

Current research has focused on the overall trend of tighter integration, but it has not examined the more granular level of how hospitals transition between integration forms according to the study’s authors. More physicians are contracting with hospitals through different types of agreements, but the shift to tighter physician-hospital integration is more complex than expected, according to new research from Rice University’s Baker Institute for Public Policy. The Affordable Care Act and changing economic conditions have encouraged an increase in the integration of physicians with hospitals, or the level of contractual control hospitals have with physicians. The paper, “The Integration and De-integration of Physicians and Hospitals Over Time,” examines trends in physician-hospital integration at 4,727 hospitals using the 2008-2013 American Hospital Association annual survey data. It designates four forms of integration based on the type of contractual relationship a hospital has with physicians from least to most tightly integrated: independent practice associations, open physician-hospital organizations, closed physician-hospital organizations and fully integrated organizations. The paper was co-authored by Marah Short, associate director of the Baker Institute’s Center for Health and Biosciences; Vivian Ho, the chair in health economics at the institute and director of the Center for Health and Biosciences; and Ayse McCracken, president of eNNOVATE Health Ventures. The researchers examined the overall changes in the number and percentage of hospitals engaged in varying forms of physician-hospital integration and the transitions between these integration forms by hospitals over time. Between 2008 and 2013, the share of hospitals with physicians on salary rose from 44 to 55% of all facilities. Looser forms of physician-hospital integration, such as joint contractual networks with...
What Primary Care Providers Should Know About Diabetic Neuropathy

What Primary Care Providers Should Know About Diabetic Neuropathy

New guidelines equip physicians with better information on the condition. An estimated 60 to 70 percent of people with diabetes develop some form of diabetic neuropathy, or the chronic nerve damage diabetes causes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. With so many people affected, researchers at Michigan Medicine led a group of internationally recognized endocrinologists and neurologists from both sides of the Atlantic and teamed up with the American Diabetes Association to craft a new position statement on the prevention, treatment and management of the condition. The statement provides recommendations for physicians on the overall prevention of diabetic neuropathy, noting that preventing this complication is a key component of diabetes care because treatments to reverse the underlying nerve damage are lacking. It also delves into various diabetic neuropathies and suggests guidelines to manage and treat each. Related Articles Characterisation of Immune and Neuroinflammatory Changes Associated with Chemotherapy-Induced Peripheral Neuropathy Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy Peroneal neuropathy in giant cell arteritis Increased Fall Risk With Subclinical Peroneal Neuropathy The ADA last released a statement on diabetic neuropathy in 2005. This update better reflects the current landscape of diabetic neuropathy care. After establishing the classification system, the research team provides recommendations for overall prevention of diabetic neuropathy, including: In type 1 diabetes, work to effectively control glucose as soon as possible to prevent or delay the development of DSPN and CAN. In type 2 diabetes, work to effectively control glucose to prevent or slow the progression of DSPN. With type 2 diabetes, consider a multifactorial approach with targeting...
Food and Antibiotics May Change Microorganisms in Gut, Causing IBS

Food and Antibiotics May Change Microorganisms in Gut, Causing IBS

Study finds more disease contributors in addition to stress and genetics. A recent review of research suggests that changes to the microorganisms (microbiota) in the gastrointestinal (GI) tract may be a cause of irritable bowel syndrome (IBS). The review article is published in the American Journal of Physiology—Gastrointestinal and Liver Physiology. IBS is common—up to 20 percent of middle-aged North Americans suffer from IBS and chronic bowel disorder characterized by abdominal pain, gas, diarrhea or constipation or both. The disorder has been thought to be caused primarily by a combination of emotional stress, environmental factors and genetics. Related Articles Irritable bowel syndrome and diet The possible role of gastrointestinal endocrine cells in the pathophysiology of irritable bowel syndrome Review Suggests Yoga Beneficial in Irritable Bowel Syndrome The Role of Visceral Hypersensitivity in Irritable Bowel Syndrome: Pharmacological Targets and Novel Treatments A research team from the Mayo Clinic in Rochester, Minn., analyzed studies about gut microbiota and IBS. This review led the team to make new observations about the development of the disease. Among the findings: • Diet can change the makeup of bacteria in the GI tract, potentially contributing to symptoms in patients with IBS; • Antibiotic use, which can disrupt gut microbiota is associated with IBS; • Changes in the gut microbiota may influence the ability of the GI tract to contract to move waste through the system; and • Changes in the gut microbiota can impair communication networks between the immune, nervous and endocrine systems, predisposing people to IBS symptoms....
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