Imparied Sleep and Pain Sensitivity

painA recent study in PAIN, the official publication of the International Association for the Study of Pain has demonstrated that in people who suffer from both insomnia and chronic pain there is a strong negative effect on pain tolerance and that these individuals may benefit from treatments targeting both conditions.

The study included more than 10,400 adults from a large, ongoing Norwegian health study. Self-reported sleep measures provided information on, sleep duration, sleep onset latency, and sleep efficiency, as well as frequency and severity of insomnia. The main outcome measure was pain sensitivity tests, including assessment of cold-pressor pain tolerance. The researchers found that all sleep parameters, except sleep duration, were significantly associated with reduced pain tolerance. The study also looked at other factors potentially affecting sleep impairment and pain perception, including chronic (persistent or recurring) pain and psychological distress (such as depression and anxiety).

Pain sensitivity increased with both the frequency and severity of insomnia. For example, compared with individuals who reported no insomnia, rates of reduced pain tolerance were 52 percent higher for subjects reporting insomnia more than once weekly versus 24 percent for those with insomnia once monthly. Pain sensitivity was also linked to sleep latency, although not to total sleep time. The relationships were unchanged after adjustment for age and sex. The effect was smaller, but still significant, after further adjustment for psychological distress.

Sleep and Pain Sensitivity in Adults

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April Is Alcohol Awareness Month

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and The National Council on Alcoholism and Drug Dependence (NCADD) recognize April as alcohol awareness month. This is a time to learn about alcohol and the health and social problems caused by drinking too much. Both organizations encourage the public to dedicate this month to understanding how excessive drinking can affect health and to evaluating their own drinking habits.

With this year’s NCADD theme, “For the Health of It: Early Education on Alcoholism and Addiction,” the month of April 2015 will be filled with local, state, and national events aimed at educating people about the treatment and prevention of alcoholism, particularly among our youth, and the benefits of providing early education to give kids a better understanding of the impact that alcohol can have on their lives.

NIAAA website

NCADD website

Posted in Addiction, Alcohol | Comments Off

Less Than Half Of Alzheimer’s Patients/Caregivers Told Diagnosis

AlzThe Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures report found that only 45 percent of people with Alzheimer’s disease or their caregivers say they were told the diagnosis by their doctor. In contrast, more than 90 percent of people with the four most common cancers (breast, colorectal, lung and prostate cancer) say they were told the diagnosis.

One of the reasons most commonly cited by health care providers for not disclosing an Alzheimer’s diagnosis is fear of causing the patient emotional distress. However, according to the new report, “studies that have explored this issue have found that few patients become depressed or have other long-term emotional problems because of the [Alzheimer’s] diagnosis.” The benefits of promptly and clearly explaining a diagnosis of Alzheimer’s have been established in several studies. Benefits include better access to quality medical care and support services, and the opportunity for people with Alzheimer’s to participate in decisions about their care, including providing informed consent for current and future treatment plans. Knowing the diagnosis early enables the person with Alzheimer’s to get the maximum benefit from available treatments, and may also increase chances of participating in clinical drug trials that help advance research.

Alzheimer’s Disease Facts and Figures Report 2015

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Antidepressants Can Improve Cardiovascular Outcomes

ACCA study being presented at the American College of Cardiology meeting this coming weekend reports that patients with moderate to severe depression who took antidepressants alone had a lower risk of death, coronary artery disease and stroke than patients with moderate to severe depression who did not take antidepressant or statin medications. Moderately to severely depressed patients taking only antidepressants also seemed to do better than those taking statins alone or a combination of statins and antidepressants.

Researchers in Salt Lake City analyzed the health records and death rates, coronary artery disease and stroke of more than 26,000 patients treated in the statewide network over a three-year period. Patients completed a nine-question depression screening questionnaire to determine their level of depressive symptoms. Based on the questionnaires, researchers identified 5,311 patients as having moderate to severe depression and 21,517 patients as having no to mild depression.

Depression is a known risk factor for cardiovascular disease. This is the first study to assess the relative effects of the simultaneous use of antidepressants and cholesterol-lowering drugs among patients with varying levels of depressive symptoms.
Patients with moderate to severe depression who were taking antidepressants alone had a 53 percent lower risk of dying, developing coronary artery disease or having a stroke during the three-year follow-up period as compared to patients with moderate to severe depression who were not taking antidepressants or statins. Moderately to severely depressed patients taking antidepressants alone appeared to also fare better than those taking statins alone or a combination of statins and antidepressants, although these relationships were not directly analyzed.  According to the lead researcher, Heidi May, PhD., MSPH, “We thought we’d see an additive effect—that taking both medications would lower the risk more than either drug alone—but we found that in the more depressed people, the antidepressant really was what made the biggest difference. Antidepressants were not associated with a reduced cardiovascular risk in people with little or no depression, but in moderately to severely depressed people, antidepressants were shown to significantly improve cardiovascular outcomes.”

Findings from another study scheduled for presentation at ACC also add to the evidence that depression may influence cardiovascular outcomes, prompting authors to call on cardiologists to pay closer attention to depression when managing patients with heart disease.

Source: American College of Cardiology News Release

Studies presented

“The Association of Antidepressant and Statin Use to Future Death and Incident Cardiovascular Disease Varies by Depression Severity,” will be presented on March 15 at 9:30 a.m. PT/12:30 p.m. ET/4:30 p.m. UTC at the American College of Cardiology’s 64th Scientific Session in San Diego.
“Depression and Outcome of Patients with Acute Coronary Syndrome: A 3 Year Follow-up Study,” will be presented on March 14 at 9:30 a.m. PT/12:30 p.m. ET/4:30 p.m. UTC.

Posted in Cardiovascular, Depression | Comments Off

Patient Activation to Improve Health Outcomes

The patient is 50% of the clinical equation, but as medical educators, we haven’t always saved a seat for the patient at the education table. We at CME Outfitters would like to share some of our goals and commitments to make some educational adjustments in 2015 to change that scenario.

Few would deny that patient-centered care is the guiding principle of healthcare. Treating patients with respect, hearing and valuing their concerns, and involving them as decisions about their care is the foundation of the National Quality Strategy Prioirities1 and the “triple aim” of improving care, health, and cost of care.

An involved, aware, and informed patient is more prepared to engage in their care decisions and manage their health costs. An activated patient does more than follow the advice of their health care provider, they proactively engage to have skin in the game.

Judith Hibbard, PhD and colleagues described a model of patient activation—the willingness to take ownership of one’s health and gain the knowledge and skill to use that knowledge to participate in managing chronic illness that involves four stages:

Stage 1: Believing the patient role is important

Stage 2: Having the confidence and knowledge to take action

Stage 3: Using skills to take action to improve health

Stage 4: Staying the course to maintain health, even under stress.2

 The evidence supports the activation model as an influencer in positive patient outcomes. Sacks and colleagues found that higher patient activation predicted better depression outcomes and support of patient activation may be an effective approach to reduce depression severity.3

Health care providers have played an important role in educating and empowering patients and beginning in 2015, there are provisions in the Affordable Care Act to reimburse providers $42/patient per month for engagement of Medicare patients with three or more chronic illnesses outside of the clinic visit for services and education to assess medical and psychosocial needs; assess adherence to medication; and transition patients from the hospital to home or nursing home.

Where to begin? That’s where we come in. CME Outfitters is committed to devoting time in each of our activities to help you better activate your patients—provide the tools to increase knowledge, skills, and confidence—to take an active role to improve outcomes, reduce readmissions, and reduce overall health care costs of chronic illnesses. We’ve started the process by using real patient scenarios and vignettes to demonstrate our educational objectives. Look to our revised Clinical Compass newsletter for new opportunities to place the patient at the center of your education and translate the education to patient activation and healthy behaviors in your practice.


1 National Quality Strategy Overview. Accessed 5/6/14.

2 Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Serv Res. 2004;39(4 Pt 1): 1005-1026.

3Sacks RM, Greene J, Hibbard JH, Overton V. How will do patient activation scores predict depression outcomes one year later? J Affect Disord, 2014;169:1-6.

logo_cmeo_176Find CME Activities, We have plenty for you to choose from!

Posted in Patient-centered interview, Uncategorized | Comments Off

Mobile App for Assessment of Traumatic Brain Injury FDA Approved

danasmallA new app called the Defense Automated Neurobehavioral Assessment (DANA), runs on multiple mobile platforms and was recently granted U.S. Food and Drug Administration (FDA) approval. The app will soon be available to help clinicians diagnose traumatic brain injury in as little as five minutes in almost any setting, including a combat environment.

According to the U.S. Army Medical Research and Materiel Command (USAMRMC), DANA operates much like a video game. Service members will undergo a baseline series of on-screen exercises during which both their speed and accuracy are recorded. Those who may have had a serious head injury will then participate in a series of both cognitive efficiency tests and self-administered questionnaires. Afterward, a clinician will review the results, comparing them with the results of the baseline exercises. The combination of the app’s cognitive and psychological components allows for insight into the prevalence of symptoms related to both traumatic brain injury and posttraumatic stress disorder.

Additional Info

Lathan C Mil Med. 2013 PubMed Article website

Posted in Digital medicine, Games, PTSD, Research, Traumatic Brain Injury | Tagged | Comments Off

Assessment of Global Internet Addiction

cybercoverAccording to a meta-analysis of 31 nations across seven world regions, the global prevalence of internet addiction is estimated at 6 percent. The prevalence of Internet addiction varies among regions around the world, as shown by data from more than 89,000 individuals in 31 countries analyzed for a study published in Cyberpsychology, Behavior, and Social Networking this month.

The authors from the University of Hong Kong describe that “societies worldwide are facing new challenges that the convenience and excitement gained through Internet use can result in individuals hooked on online activities to gratify needs. An extreme form of this phenomenon is known as Internet addiction (IA), an impulse control problem characterized by an inability to inhibit Internet use that exerts an adverse impact on major life domains (e.g., interpersonal relations, physical health).”

Although IA is not in DSM-5 it has been associated with disorders related to substance and behavioral addiction and “is often comorbid with mental disorders, such as attention deficit hyperactivity disorder and depression.” The IA prevalence rate was more than threefold higher than that of pathological gambling another impulse control disorder. The researchers also noted that there were considerable differences in the prevalence figures across world regions. The authors reported that the countries that demonstrated a perception of less life satisfaction in general, greater overall pollution (primarily air pollution), greater traffic commute time consumption, and lower national income. They conclude that “taken together, these results provided tentative support for the quality of (real) life hypothesis, which proposed an inverse link between IA prevalence and quality of (real) life.”

Internet Addiction Prevalence and Quality of (Real) Life: A Meta-Analysis of 31 Nations Across Seven World Regions

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Many Dementia Patients Never Screened

NeuroA study by researchers from the University of Michigan found that despite clear signs that their memory and cognitive abilities have diminished, more than half of seniors with these symptoms have not seen a doctor about them. The study, published in Neurology, documents a clear lack of clinical testing for seniors with signs of cognitive problems.

Individuals with severe symptoms of dementia and those who were married were more likely to have had their memory and thinking ability evaluated by a primary care doctor, neurologist or psychiatrist. The study included people with mild cognitive impairment through severe dementia, from all causes.

The study recommends early evaluation of seniors. according to the lead author, Vikas Kotagal, MD, MS,”the results of this study have implications in both primary care and specialty care settings. Recognizing cognitive impairment in older individuals is important, and physicians should explore reasons why dementia has occurred and communicate these findings clearly with patients and family members so that they can take this information with them when they leave the office.”

Source: Neurology

Posted in Cognition, Dementia, Diagnosis, Early intervention, Geriatrics, Memory | Comments Off

CME Is An Effective Learning Hub For Physicians

Why CME Providers Are Celebrating This Week: Decades Worth of CME Studies Found That CME Is Undeniably An Effective Learning Hub For Physicians
By: Haley Hoffman and Beth Brillinger, CCMEP

Last week, the Accreditation Council for Continuing Medical Education (ACCME) published data that has CME providers everywhere throwing their hats up in the air and proclaiming…FINALLY!  The ACCME published two reports, authored by Ronald M. Cervero, PhD, Professor and Associate Vice President for Instruction at the University of Georgia, that address, one: the effectiveness of CME, and two: the relationship between commercial support and perceived bias in CME activities. Dr. Cervero and colleagues compiled hundreds of individual CME studies over several decades and found that overall, research shows that physicians actually perceive very low levels of commercial bias in CME activities (3-5%), and furthermore, they report the same level of bias for activities that were not commercially supported. And as far as the overall effectiveness of CME programs, his research shows that CME has a positive impact on physician performance and patient health outcomes.

From his findings, Dr. Cerveo concluded many things about the effectiveness of CME, one being that CME “leads to greater improvement in physician performance and patient health if is more interactive, uses more methods, involves multiple exposures, is longer, and is focused on outcomes that are considered important by physicians.” Information like this reminds CME providers of the unique opportunity we have to raise the bar when it comes to quality improvements in health care. Formats are just as important as content, and it is critical that we continue to broaden our educational visions in order to really connect to the learner, and make a difference in clinical care.

On the issue of commercial bias, research findings suggest that there is no evidence that supports or refutes the belief that commercial support creates bias in CME activities. Check out this snippet from the article published by Policy and Medicine last week that gives you a glimpse of Dr. Cervero’s conclusions on the issue of commercial support affecting physician practice:

If you were looking at the negative effects of commercial support, you would expect to see more prescriptions for the pharmaceutical company that was supporting that education. That would be the worst outcome, that the physician was not making an independent clinical judgment about how to treat this patient and was unduly influenced by the CME activity because of how it was funded. I mean that would be, to me that would be the trail of action, and there hasn’t been anything that could document that.

– Ronald M. Cervero, PhD

At CME Outfitters, we already know the importance and value of delivering evidence-based and balanced education to clinicians. For every activity CME Outfitters delivers we evaluate, identify, and resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data and research, and a multidisciplinary peer review process. As a CME provider we know how critical our education is to our audiences, but this new research helps prove to skeptics everywhere that providing continuing medical education programs to clinicians is imperative, as it truly does make a difference in clinical practice and patient care. And to top it all off: these findings can help the healthcare community keep worries at bay about perceived commercial bias having an impact on physician performance. Please click on the links below to review the in-depth research reports published by the ACCME.

Effectiveness of Continuing Medical Education: Updated Synthesis of Systematic Reviews

Is There A Relationship Between Commercial Support and Bias in Continuing Medical Education Activities? An Updated Literature Review

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Development and Regulation of Abuse-Deterrent Opioid Medications – FDA Public Meeting

fdaThe FDA is hosting a public meeting on October 30 and 31, 2014 to discuss the development, assessment, and regulation of abuse-deterrent formulations of opioid medications. The meeting will focus on scientific and technical issues related to the development and in vitro assessment of these products, as well as FDA’s approach towards assessing the benefits and risks of all opioid medications, including those with abuse-deterrent properties.

This year the FDA has approved three opioid analgesics with an abuse-deterrent label. In April, FDA approved Evzio (naloxone hydrochloride injection) for the emergency treatment of known or suspected opioid overdose. Naloxone is a medication that rapidly reverses the effects of opioid overdose. Evzio is the first auto-injector designed to deliver a dose of naloxone outside of a healthcare setting.

On July 23, FDA approved Targiniq ER, an extended-release pain reliever that contains a combination of oxycodone and naloxone. Targiniq ER is the second extended-release/long-acting (ER/LA) opioid analgesic with FDA-approved labeling describing the product’s abuse-deterrent properties.

This month the FDA approved new labeling for Embeda (morphine sulfate and naltrexone hydrochloride), an extended-release (ER) opioid analgesic to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. The new labeling includes a claim indicating that Embeda has properties that are expected to reduce oral and intranasal abuse when the product is crushed.

Links to FDA meeting materials and webcast information can be found at

Posted in Drugs, FDA, Opioids, Substance abuse | Comments Off