Inappropriate Use of Skeletal Muscle Relaxants in Geriatric Patients
Inappropriate Use of Skeletal Muscle Relaxants in Geriatric Patients
SOURCE: U. S. Pharmacist 2020 (Jan 21); 45 (1): 25–29
Caressa Trueman, PharmD, RPh, Shana Castillo, PharmD, RPh
Karen K. O’Brien, BS Pharm, PharmD, RPh, Eric Hoie, PharmD, RPh
Creighton University School of Pharmacy and Health Professions
Omaha, Nebraska
Falls in geriatric patients cost the United States billions of dollars each year and contribute to morbidity and mortality in this population. Polypharmacy can significantly contribute to the fall risk, especially those medications that are on the Beers Criteria list. Skeletal muscle relaxants are on this list, and an increased risk of falls is associated with their use. These medications are inappropriately used as an alternative to conventional pain medications and can be as harmful as opioids in the geriatric population. Education of patients and prescribers is necessary in order to prevent inappropriate muscle-relaxant use and to lessen the risk of falls.
In the United States, an estimated 29 million falls occurred in 46 million people older than age 65 years in 2014, and 7 million of those falls resulted in injuries. [1] In 2015, estimated medical costs related to fatal and nonfatal falls totaled more than $49 billion. [2]
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Treatment of Rheumatoid Arthritis with Marine and Botanical Oils
Treatment of Rheumatoid Arthritis with Marine and Botanical Oils: An 18-month, Randomized, and Double-blind Trial
SOURCE: Evid Based Complement Alternat Med. 2014 (Mar 19)
George W. Reed, Katherine Leung, Ronald G. Rossetti, Susan VanBuskirk, John T. Sharp, and Robert B. Zurier
University of Massachusetts Medical School,
Department of Medicine,
Division of Preventive and Behavioral Medicine,
55 Lake Avenue North, Shaw Building,
Worcester, MA 01655, USA.
OBJECTIVE: To determine whether a combination of borage seed oil rich in gamma linolenic acid (GLA) and fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is superior to either oil alone for treatment of rheumatoid arthritis (RA).
METHODS: Patients were randomized into a double-blind, 18–month trial. Mixed effects models compared trends over time in disease activity measures.
RESULTS: No significant differences were observed in changes in disease activity among the three randomized groups. Each group exhibited significant reductions in disease activity (DAS28) at 9 months (fish: –1.56[–2.16, –0.96], borage: –1.33[–1.83, –0.84], combined: –1.18[–1.83, –0.54]) and in CDAI (fish: –16.95[–19.91, –13.98], borage: –11.20[–14.21, –8.19], and combined: –10.31[–13.61, –7.01]). There were no significant differences in change of RA medications among the three groups. Reduced disease activity in study patients was similar to matched patients from an RA registry, and reduction in disease modifying antirheumatic drugs (DMARD) use was greater (P < 0.03) in study patients.
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Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic to Offer Treatment Under Medicaid
Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic to Offer Treatment Under Medicaid:
A Critical Appraisal of Missouri Inclusion of Chiropractic Under Missouri Medicaid
SOURCE: Journal of Chiropractic Humanities 2019 (Dec 10)
John R. McGowan, PhD, Leonard Suiter, DC, FICC
Department of Accounting,
Richard A. Chaifetz School of Business,
Saint Louis University,
St. Louis, Missouri
OBJECTIVES: The objectives of this study were to critically evaluate the methodology and conclusions of the fiscal notes prepared by the state of Missouri for including doctors of chiropractic (DCs) under Missouri Medicaid and to develop a dynamic scoring model that calculates the savings if DCs were allowed to offer treatment under Missouri Medicaid.
METHODS: We used a secondary analysis to determine the cost-saving assumptions to be incorporated into a dynamic model. We reviewed the literature on efficiency and effectiveness of DC–delivered care regarding the most reliable assumptions concerning cost savings and utilization. The assumptions for percentage savings from DC–provided care and the avoidance of spinal surgeries were then combined in the dynamic scoring model to determine projected cost savings from adding DCs as covered providers under Missouri Medicaid. The actual cost of opioid abuse in Missouri was then determined as a basis to measure cost savings from adding DC care as an alternative therapy for the management of neck and low back pain.
DISCUSSION: The Missouri Health Division initially used the static scoring approach to evaluate proposals to cover DC care under Missouri Medicaid. This approach only considers added costs from a legislative change.
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Approach to Cervicogenic Dizziness: A Comprehensive Review of its Aetiopathology and Management
Approach to Cervicogenic Dizziness: A Comprehensive Review of its Aetiopathology and Management
SOURCE: Eur Arch Otorhinolaryngol. 2018 (Oct)
K. Devaraja
Department of Otorhinolaryngology,
Kasturba Medical College,
Manipal Academy of Higher Education,
Manipal, Udupi, Karnataka, 576104, India.
PURPOSE: Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other.
METHODS: This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers’ understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links.
RESULTS: Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm.
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Cervicogenic Dizziness
Cervicogenic Dizziness
SOURCE: Oxford Medical Case Reports 2019 (Dec 9)
Julie C. Kendall, Simon D. French, Jan Hartvigsen, and Michael F. Azari
New York Chiropractic & Physiotherapy Center,
New York Medical Group
Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24–year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
KEYWORDS: cervical proprioception; cervicogenic dizziness; chiropractic adjustment; neck pain
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Post-Poliomyelitis Syndrome
Post-Poliomyelitis Syndrome
SOURCE: International Medical Case Reports 2019 (Aug 8); 12: 261–264
Eric Chun Pu Chu, Kary Ka Wai Lam
New York Chiropractic and Physiotherapy Center,
New York Medical Group
Most developed countries eliminated paralytic poliomyelitis (polio) in the 1970s to 1980s. It was believed that after recovery from acute paralytic poliomyelitis, the physical condition of survivors would remain stable for the rest of their lives. However, the elimination of polio does not equate the end of medical management of polio. Hundreds of thousands of polio survivors worldwide are still at risk of developing the late effects of the disease. Here, we report a case of post-polio syndrome who attended our clinic for the presence of new weakness and neuromuscular problems six decades after recovery from paralytic polio. It is essential that health professionals be aware of these conditions and have an understanding of the underlying pathophysiology of the symptoms.
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