Tuesday, October 25, 2016

Mortality and the Mediterranean diet

In the UK, the Mediterranean diet was associated with lower heart disease incidence and decreased all-cause mortality. BMC Med. 2016 Sep 29;14(1):135.

Comment: This study, unlike another recent study (Ann Intern Med. 2016 Oct 4;165(7):491-500) found that all-cause mortality was decreased by the Mediterranean diet. My impression is that the majority of studies point to a significant gain in life in terms of both years and quality. Until evidence points elsewhere, the Mediterranean diet is probably the best, and most studied.

Wednesday, October 12, 2016

How to Survive Your Hospitalization: Drink Coffee

Coffee reduces the risk of death after acute myocardial infarction: a meta-analysis.

Drinking coffee regularly after an acute myocardial infarction was found to be associated with a reduced risk of mortality. Coron Artery Dis. 2016 Nov;27(7):566-72.

Comment: This study found that routine heavy coffee drinkers (over 2 cups a day) had a lower mortality after acute myocardial infarction than routine light coffee drinkers (1 to 2 cups a day), who had a lower mortality after acute myocardial infarction than noncoffee drinkers. The risk reductions observed were significant: heavy versus light (31% risk reduction), heavy vs noncoffee drinkers (46% reduction), and light vs noncoffee drinkers (21% reduction). 

Should we allow, and possibly even encourage patients after an acute myocardial infarction to drink coffee?

How to Survive Your Hospitalization: Arrive Early

Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore.

Waiting longer from symptom onset to arrival at the emergency department for people with an acute myocardial infarction is associated with higher morbidity and mortality. Emerg Med Australas. 2016 Oct 11

Comment: This research found that the factors associated with a longer symptom-to-ER time included: 
  • older age
  • diabetes mellitus
  • presenting symptoms of back and epigastric pain
  •  Malay ethnicity
 There are important implications of this research. First of all, it may likely be that older people and those with diabetes have less intense pain, and thus do not call emergency services right away. Therefore, these groups of people need to be more aware of the signs and symptoms of a heart attack, and have a low threshold for calling emergency services. Back and epigastric pain are not the "typical" symptoms of a heart attack, so having the general public more aware of this possibility, and making individual patients at high risk aware of the relationship between back pain, epigastric pain, and acute myocardial infarction may help. Certain cultures and ethnicities may also be less inclined to activate emergency services; this barrier may be overcome at least in part through improved community education about the benefits of rapid treatment in acute myocardial infarction.

The take-home message: if you have symptoms of a heart attack, activate emergency services promptly, and you will be more likely to survive and less likely to have complications in the hospital.

Sunday, October 9, 2016

How to Survive Your Hospitalization: Control Your Sugar Consumption Afterwards

After a myocardial infarction, long term prognosis is much worse for patients with an abnormal glucose tolerance test at post-hospitalization follow-up. Kardiol Pol. 2016 Oct 7

Comment: This study found that acute myocardial infarction patients had a much worse prognosis if their glucose metabolism was abnormal at a 7 month follow-up visit. This was regardless of whether or not their glucose metabolism was abnormal at hospital discharge. This study suggests that the glucose tolerance test (and likely the HgbA1c) is a strong prognostic factor. Normalizing glucose metabolism early after a myocardial infarction may have significant mortality benefits. Patients with abnormal glucose metabolism at follow-up had a 2.5 year mortality rate of 2 to 4 times that of patients with normal glucose metabolism (3% versus 6% - 11%). Diet and exercise appear to be critical factors to prolong mortality after acute myocardial infarction.

Monday, September 26, 2016

KARMEL mneumonic for high anion gap acidosis

The mnemonic MUDPILES is pretty long, so I like this one that I just came across on Wikipedia. Easy to remember!


    K — Ketoacidosis
    A — aspirin
    R — Renal failure
    M — Methanol
    E — Ethylene glycol
    L — Lactic acidosis

Dual aspirin and anticoagulant therapy in patients with atrial fibrillation.

In patients with non-valvular atrial fibrillation, there appears to be no or little benefit of aspirin therapy in addition to coumadin therapy. Dual antiplatelet and anticoagulant therapy increases major bleeding risk. J Thromb Thrombolysis. 2016 Sep 24;

Comment: There may be a role for dual antiplatelet / anticoagulant therapy in patients with non-valvular atrial fibrillation who are within 12 months of acute coronary syndrome or revascularization. However, with these exclusions in place, the researchers still found that 45% of the patients in their retrospective review were receiving both an anticoagulant and aspirin.

Sunday, September 25, 2016

Using the Blockchain for Medical Record Privacy

Blockchain technology has proven its worth in financial markets; another use may be for patients to securely own, control, and share their own healthcare data. J Med Syst. 2016 Oct;40(10):218

Comment: Instead of patient data stored on different electronic medical records, an alternative would be for clinics and hospitals to have blockchain data readers which (with patient permission) will allow them to temporarily access an individuals medical data. Once the patient left the clinic and/or hospital, access to the private data would be revoked.

Friday, September 23, 2016

Combination pain medication therapy in acute postoperative pain

The combination pain medication containing dexketoprofen 25 mg with tramadol 75 mg was effective, and more effective than either alone, in the treatment of acute post-op pain. Cochrane Database Syst Rev. 2016 Sep 22;9:CD012232.

Comment: To decrease opiod use, we are going to have to come up with other safe and effective pain medications. Using a combination of an NSAID with tramadol appears to work well, and is associated with a low rate of side-effects.

Tuesday, September 20, 2016

Strategies to Improve Exercise Adherence and Enhance Physical Activity.

This review article discusses how to change your health behaviors: motivational interviewing and the transtheoretical model of behavior change. Prog Cardiovasc Dis. 2016 Sep 14. pii: S0033-0620(16)30105-0.

Comment: Some of the greatest advances in modern medicine this century likely will come from the discovery of improved ways to get people to change their habits for the better. Habit change, specifically in the area of diet and exercise, is a critical component of health and longevity.

Friday, September 16, 2016

B-Group Vitamins: Chemoprevention?

The author of this article hypothesizes that folic acid, vitamins B2, B6 and B12 may have an important role in the prevention of serious diseases, including cancer. Adv Clin Exp Med. 2016 May-Jun;25(3):561-568.

Comment: This is a theoretical hypothesis only, so individuals must weight hypothetical benefits vs known risks. I generally take a well rounded multivitamin daily which includes these B vitamins without megadosing.

Friday, September 9, 2016

Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care.

Behavioral modification techniques and strategies are rarely incorporated into neurologic rehabilitation programs. Curr Opin Neurol. 2016 Sep 6.

Comment: It is critical that we teach people how to successfully adopt new habits when they are undergoing rehabilitation. As Aristotle said: "We are what we repeatedly do. Excellence, then, is not an act, but a habit."

Friday, August 19, 2016

The Effect of Regular Exercise on Insulin Sensitivity in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

This meta-analysis found that regular exercise increases insulin sensitivity. Diabetes Metab J. 2016 Aug 2.

Comment: By increasing insulin sensitivity, the need for insulin decreases and theoretically more patients with Type II diabetes could avoid insulin and be maintained on oral antiglycemics, simply by engaging in regular exercise.

Mediterranean diet and colorectal cancer risk: a pooled analysis of three Italian case-control studies.

The Mediterranean diet was found to be associated with a lower risk of colorectal cancer in this study of 3745 colorectal cancer cases and 6804 hospital controls. Br J Cancer. 2016 Aug 18

Comment: The Mediterranean diet is perhaps the most thoroughly studied diet, and consistently has shown multiple health benefits in terms of cancer and cardiovascular disease in addition to overall mortality.

Thursday, August 18, 2016

Correlation between physical activity and sedentary behavior with healthy and unhealthy behaviors in Italy and Tuscan region: a cross sectional study.

Among teenagers, increased use of screen based media is associated with negative health behaviors such as physical activity but also associated with a decreased use of tobacco. 

Comment: Use of screen based media generally involves sitting down or lying down. The use of the screen based media likely represents a surrogate marker for physical inactivity.

J Prev Med Hyg. 2013 Mar;54(1):41-8

Tuesday, August 16, 2016

The Secret Ingredient for Good Health

Could App Technology be the Answer to Successful Goal Achievement?

A friend of mine on LinkedIn recently posted that dream attainment was as simple as following a three step process:
  1. A dream that is written down with a date becomes a goal
  2. A goal broken down into steps becomes a plan
  3. A plan backed by action makes your dreams come true
Isn't that great! All we have to do is follow that three step formula and our dreams will come true! Right? Too often the answer is not right, but wrong.

For decades the science of personal achievement has focused on goals. Set your goal! Affirm it! Visualize it! Then get to work and your dream will come true!

Could goal fulfillment be as simple as this? Well, in my experience, Scrooge put it best: "Bah, Humbug!"

Goals are great. Dreams are fantastic. But frequently we miss our target, and sleep through our dream. Why is this? Is our plan wrong? Are we not taking enough action? Is it just bad luck?

The answer frequently is all of the above, or none of the above. The reason we miss our goal and lose out on our dreams is because we are focusing exclusively on the wrong things: actions and plans. The missing and critical ingredient has been left out.

Image you are baking a wonderful loaf of sourdough bread. You have your flour, the whole grains, the nuts, and the spices. Put it in a pan and what happens? Nothing, unless you also add some yeast starter. That yeast is the critical ingredient that makes the sourdough bread materialize. Without it, you can have a great goal, with a deadline and a plan. You've taken action. But your dream didn't materialize. Was it because you didn't visualize your dream strongly enough? Of course not. You just needed one more ingredient, the yeast.

Goal and dream achievement can also be thought of as just like starting a fire. You can have your goal -- a fire! -- and a deadline -- now! -- and then make up a plan with action. But if your plan doesn't include some sort of ignition system, you won't achieve your dream of a warm fire. You need to have that critical ingredient of a spark to ignite the tinder to get the fire going.

So what do we need in order to achieve our dreams and our goals? What is our critical ingredient?

Some people take the mystical approach, stating that the magic ingredient is all in your mind, that if you only visualize strongly enough, you will achieve your goals. Well, visualizing good things is fantastic. Picturing a bright future inspires us to action, and strengthens our mood. By positively visualizing our future, we will tend to move in that direction. Yet this is not enough.

Likewise, the Spartan approach is to focus on actions. That if only we work long enough, or practice long enough, we will achieve our dream. This approach, also known as the 10,000 hour principle, is also fantastic. Hard work is absolutely necessary to achieve many if not the vast majority of our most desired goals, our biggest dreams. Practice doesn't always make perfect, but it does make us better.

So we have a dream, we have a goal with a deadline and a plan. We are taking tons of action. Then why don't we achieve all of our goals when we do this? Frequently, the answer is as simple as our boring, routine, even mundane habits.

Our habits are what drives our actions in a consistent direction.

Our habits are the strongest manifestation of our visualizations.

Our habits create our greatest successes, and our biggest failures in life.

So are you ready to work on your habits? Do you want to get the positive results from a strong, good habit? Of course you do! Everybody does!

Yet this critical ingredient -- the power of a good habit -- can be tremendously difficult to achieve. We need a tool, a personal achievement app, that will help us create good habits, and break bad ones. We need a specific, precise tool that will work virtually every time. Not a hammer when we want to tighten a bolt, or a wood saw when we really need a metal saw. We need the right tool for the job.

And that tool is.... an app!

The app can be as simple as Benjamin Franklin's character checklist, which he used centuries ago to help him develop positive virtues. Or, the app can be a simple download that you install on your smart phone. I've written checklists for habit development, but have found that smart phone apps work much better, by leaps and bounds. Habit app technology is truly a breakthrough in health and medicine.

Do you want to live longer? Then develop the habit of walking. There's no guarantees, but walking regularly will greatly increase your chances of a long, healthy life.

Want to keep your mind strong well into your 70's, 80's, 90's and beyond? Again, our DNA plays a major role in this, as does random chance, but if we develop the dual habits of physical exercise and mental exercise then we are much more likely to achieve this goal.

The habit app I've been using lately is Strides. There's a free version available that works great for me, and accomplishes everything I need from the technology. It reminds me of what I need to do, and shows a nice, soothing green image when I do the activity I'm working on turning into a habit. If I don't do that activity, then it shows me an unpleasant red image.

How simple is that? Green for good -- keep going! -- and red to tell us to stop.

Habits are the critical ingredient, so why not give it a try? Get an app for your smart phone. There are plenty of good ones out there, however, you can't go wrong by starting with the Strides app. Get started with a simple, but powerful activity that you'd like to turn into a habit. Perhaps you want to drink more water every day, or go jogging regularly a few times a week. Maybe you want to smile more and think more positively. Making simple actions habitual can revolutionize your life.

Make creating new habits your new habit. It works!

Tuesday, August 9, 2016

Thursday, July 7, 2016

First-Year Evaluation of Mexico's Tax on Nonessential Energy-Dense Foods: An Observational Study.

This study found decreased consumption of non-essential energy dense foods after a sales tax was imposed upon the items.  (PLoS Med. 2016 Jul 5;13(7):e1002057.)
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Monday, March 21, 2016

Effect of Combined Use of Calcium and Vitamin B6 on Premenstrual Syndrome Symptoms: a Randomized Clinical Trial.

In this study of 76 women, premenstrual syndrome was decreased by taking calcium 500 mg and vitamin B6 40 mg twice a day. Taking only vitamin B6 also decreased symptoms, but was not as effective at taking both calcium and vitamin B6.  (J Caring Sci. 2016 Mar 1;5(1):67-73.)
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