Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Acupuncture improves symptoms of chronic prostatitis/chronic pelvic pain syndrome compared to sham treatment
Abstract: https://www.acpjournals.org/doi/10.7326/M21-1814
URL goes live when the embargo lifts
A multicenter randomized trial showed that 20 sessions of acupuncture over 8 weeks resulted in greater improvement in symptoms of moderate to severe chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) compared with sham therapy. Treatment effects endured over 24 weeks follow up. The findings are published in Annals of Internal Medicine.
CP/CPPS manifests discomfort or pain in the pelvic region for at least 3 of the previous 6 months without evidence of infection. Lower urinary tract symptoms, psychological issues, and sexual dysfunction may also be involved. Men with CP/CPPS may have a poor quality of life due to the many neuropsychophysiologic pathophysiology factors associated with the disorder, such as inflammation in the prostate, anxiety and stress, and dyssynergic voiding. Antibiotics, a-blockers, and anti-inflammatories are the mainstays of treatment in clinical practice, but they have limited effectiveness and are associated with adverse events with long-term use. Acupuncture has shown promise as an alternative treatment, but high-quality evidence is scarce.
Researchers from the China Academy of Chinese Medical Sciences randomly assigned 440 male participants (220 in each group) to either 8 weeks of acupuncture or sham therapy to assess the long-term efficacy of acupuncture for improving symptoms of CP/CPPS. The treatment was considered effective if participants achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Ascertainment of sustained efficacy required the between-group difference to be statistically significant at both time points. The researchers found that compared with the sham acupuncture group, larger proportions of participants in the acupuncture group reported marked or moderate improvements in symptoms at all assessment points. No significant difference was found in changes in International Index of Erectile Function 5 score at all assessment time points or in peak and average urinary flow rates at week 8. No serious adverse events were reported in either group.
According to the researchers, these findings show long-term efficacy of acupuncture and provide high-quality evidence for clinical practice and guideline recommendations.
Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Zhishun Liu, MD, PhD, please contact Yuanjie Sun at puzhisun@163.com.
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2. Dexamethasone underused among mechanically ventilated patients hospitalized with COVID-19
Abstract: https://www.acpjournals.org/doi/10.7326/M21-0857
Editorial: https://www.acpjournals.org/doi/10.7326/M21-3221
URL goes live when the embargo lifts
A retrospective cohort study looking at trends in the use of therapeutics for COVID-19 found that dexamethasone may be underused among mechanically ventilated patients in the United States. While use of hydroxychloroquine was abandoned early in the pandemic, the use of remdesivir and dexamethasone varied across health systems. The findings are published in Annals of Internal Medicine.
Traditionally, peer-reviewed, published, randomized clinical trials define the standard-of-care for treatment. During the COVID-19 pandemic, a more rapid response evolved and available drugs were repurposed for treatment based on available data and clinical cases. Despite rapidly accumulating evidence on safety and efficacy, far less is known about how treatments have been used in the United States and how much use of these therapeutics have varied across patients and health systems.
Researchers from Johns Hopkins Bloomberg School of Public Health studied data for 137,870 hospitalized adults in the National COVID Cohort Collaborative (N3C), a retrospective cohort constructed from electronic health record data at 43 health centers, to describe temporal trends in the use of three drugs – hydroxychloroquine, remdesivir, and dexamethasone – over a 13-month period beginning in February 2020. They found that brisk uptake and abandonment of hydroxychloroquine early in the pandemic was offset by increases in use of remdesivir and, to an even greater degree, dexamethasone. Despite release of favorable evidence from the RECOVERY trial in mid-June, approximately one fifth of patients who were mechanically ventilated and potentially eligible for its use, did not receive dexamethasone or any other glucocorticoid. Further, substantial variation in dexamethasone use was observed across sites, despite robust evidence supporting the value of dexamethasone in reducing the likelihood of death among persons with COVID-19 who require mechanical ventilation.
The authors of an accompanying editorial from Weill Cornell Medicine note that the study authors demonstrated how rapidly clinicians navigated a cacophony of data to incorporate appropriate treatments into practice during an infectious disease pandemic. Clinicians adopted a drug with a mortality benefit (dexamethasone), abandoned a drug with no benefit and the potential for harm (hydroxychloroquine), and recognized the nuances of a third drug (remdesivir). They conclude that lessons learned during the pandemic will have lasting implications for clinical practice.
Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with first author Hemalkumar Mehta, PhD, please contact Barbara Benham at bbenham1@jhu.edu.
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Also new in this issue:
Quoting Patients in Clinical Notes: First, Do No Harm
Mary Catherine Beach, MD, MPH; Somnath Saha, MD, MPH
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M21-2449
Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with first author Mary Catherine Beach, MD, MPH, please contact Jamie Smith at jamie.smith@jhu.edu.
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Inpatient Notes: How We Treat Hyperglycemia in the Hospital
Francisco J. Pasquel, MD, MPH; Guillermo E. Umpierrez, MD, CDE
Annals for Hospitalists
Abstract: https://www.acpjournals.org/doi/10.7326/M21-2789
Journal
Annals of Internal Medicine