Latest / Morning Medical with Dr. Chow / Multicancer Tests, Presbyopia Eye Drops, Workforce Trends, and Dementia Risk in Kids

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Multicancer Tests, Presbyopia Eye Drops, Workforce Trends, and Dementia Risk in Kids · Morning Medical with Dr. Chow

0:00
Welcome to Morning Medical with Dr.
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Chow, where we bring you the latest updates in medical and health news from around the globe.
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I'm your host, Dr.
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Chi-Ming Chow.
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As a family physician, general internist, and cardiologist, I'm here to help you navigate the
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ever-evolving world of medicine.
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Today, we'll be diving into a range of topics, starting with an intriguing review on
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multicancer detection tests.
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A recent systematic review has cast doubt on the readiness of multicancer detection tests
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for widespread use.
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Despite the promise of these tests in identifying various cancers early, the review
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found that the current evidence is insufficient to support their effectiveness in improving
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cancer detection, mortality rates, or quality of life.
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The review, led by Dr.
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Leila C.
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Kahwati and colleagues from RTI International, examined over 20 studies involving more than
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100,000 participants.
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They analyzed the accuracy of 19 different multicancer detection tests, but the results
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were mixed.
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The accuracy of these tests, measured by sensitivity and specificity, varied greatly.
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Sensitivity ranged from as low as 9.5 percent to as high as 99.8 percent, while specificity
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ranged from 65.7 percent to a perfect 100 percent.
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However, the area under the curve, a measure of the test's overall ability to discriminate
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between those with and without cancer, also showed significant variability, ranging from
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0.52 to 1.0.
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This inconsistency highlights the challenges in relying on these tests for cancer screening in
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asymptomatic individuals.
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Dr.
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David S.
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Weinberg from the Fox Chase Cancer Center noted in an accompanying editorial that while some
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multicancer detection tests are commercially available with a physician's order, the
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supportive clinical utility data for these tests is lacking.
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The review underscores the need for more robust evidence before these tests can be embraced
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widely.
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Dr.
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Weinberg emphasized that important clinical decision-making requires strong and convincing
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evidence, which at present, these tests do not provide.
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The review also pointed out the limitations of the current studies, such as the lack of
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completed controlled studies evaluating the direct benefits of screening with these tests.
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Only one study reported on the potential harms, and its data was limited.
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This lack of comprehensive data should give pause to both clinicians and patients
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considering the use of multicancer detection tests.
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However, there is optimism that the science behind these tests will continue to improve.
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Dr.
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Kahwati and her team suggested areas for future research, including empirical studies on
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surrogate outcomes for cancer-specific mortality, benefits and harms in various
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populations, and the cost-effectiveness of these tests.
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They also highlighted the importance of effectively communicating the benefits and
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risks of multicancer detection tests to both clinicians and patients, as there is often a
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tendency to overestimate the benefits and underestimate the risks of screening.
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While the potential of multicancer detection tests is certainly exciting, this review
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suggests that we should proceed with caution.
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As the science progresses, we hope to see more concrete evidence that could pave the way for
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these tests to become a staple in cancer screening protocols.
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Until then, it's crucial to rely on established methods and remain informed about the latest
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developments in this area.
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Next up, let's talk about an exciting development for those who rely on reading
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glasses.
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A recent large retrospective review has shown that a combination of pilocarpine and
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diclofenac eye drops can significantly improve vision for patients with presbyopia,
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potentially allowing them to ditch their reading glasses.
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Presbyopia, as many of you know, is the age-related loss of near vision that typically
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affects people in their 40s and beyond.
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This study, which was presented at the European Society of Cataract and Refractive Surgeons
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Congress in Copenhagen, involved a substantial number of patients—766 in total.
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The findings revealed that from 69% to 99% of patients experienced a two to three-line
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improvement in their vision according to the Jaeger criteria.
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This improvement persisted for a median duration of 434 days and, in many cases, lasted
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up to two years.
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The eye drops combined pilocarpine, a well-known agent that facilitates pupillary
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constriction and contraction of ciliary muscles, with the nonsteroidal
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anti-inflammatory drug diclofenac.
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The combination aims to enhance vision while reducing inflammation and discomfort.
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The study highlighted that the eye drops have a favorable safety profile, with temporary dim
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vision after application being the most common adverse event.
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Dr.
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Giovanna Benozzi, from the Center for Advanced Research for Presbyopia in Buenos Aires,
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Argentina, reported that a significant proportion of patients achieved complete
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independence from eyeglasses.
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Their near visual acuity improved to between Jaeger 1 and Jaeger 2.
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Moreover, the uncorrected visual acuity was either improved or remained unchanged.
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Importantly, no serious adverse events were observed during the two-year follow-up period.
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While the study's results are promising, Dr.
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Burkhard Dick, president-elect of the European Society of Cataract and Refractive Surgeons,
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emphasized the need for broader, long-term multicenter studies to confirm these findings.
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He pointed out that while surgery for presbyopia has advanced, not all patients are
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suitable candidates, making these eye drops a potentially viable alternative.
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However, he cautioned about the potential side effects of long-term use of pilocarpine and
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diclofenac, such as reduced night vision and eye strain.
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It's worth noting that pilocarpine has been a staple in the treatment of glaucoma for many
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years, although newer, safer, and more effective agents have since emerged.
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Recently, pilocarpine has been re-evaluated for presbyopia treatment, with the Food and Drug
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Administration approving several pilocarpine-containing ophthalmic solutions
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over the past few years.
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This particular study adds to the growing body of evidence supporting its efficacy for
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presbyopia.
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Dr.
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Benozzi's study analyzed different concentrations of pilocarpine in combination
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with diclofenac across three patient groups.
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The group treated with the 3% concentration had the most significant improvements, with 84%
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achieving at least a three-line improvement in uncorrected near vision.
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Even the group with the mildest presbyopia showed substantial benefits, underscoring that
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higher concentrations might yield better results for those with more severe conditions.
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The study also found that adverse events were generally mild and transient, decreasing
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significantly by the second follow-up visit.
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The most common issue was dim vision immediately after using the drops, reported by
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32% of patients.
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However, these side effects did not lead to treatment discontinuation, suggesting a
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favorable risk-benefit profile for these eye drops.
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This research is a significant step forward in the non-surgical treatment of presbyopia,
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offering hope to those who might not be candidates for surgery.
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As always, we need more comprehensive studies to confirm these findings and establish
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long-term safety and efficacy.
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But for now, it seems that these eye drops could be a game-changer for many people
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struggling with presbyopia.
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In a revealing survey conducted by The Harris Poll and commissioned by Strategic Education,
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it's been reported that a significant portion of the United States healthcare workforce is
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considering making a job change in the next year.
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The survey, which included responses from 1,504 healthcare workers and 304 healthcare
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employers, highlights a concerning trend where 55 percent of healthcare workers expressed
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intentions to seek new employment opportunities, either within their current
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organizations or elsewhere.
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The primary reasons driving this potential exodus are multifaceted.
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Inadequate compensation and benefits topped the list, with 49 percent of respondents citing
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this as a major factor.
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Closely following, burnout or emotional fatigue was noted by 48 percent of healthcare workers
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as a significant issue, reflecting the ongoing challenges posed by high-pressure work
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environments and the lingering effects of the COVID-19 pandemic.
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Additionally, 48 percent of workers pointed to a lack of career advancement, personal
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development, or educational opportunities as key reasons for their dissatisfaction.
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Jennifer Musil, the global president of research at The Harris Poll, described the
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results as painting an "alarming picture" of a workforce at a critical juncture.
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The survey's findings come at a time when the United States is projected to face a shortage
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of nearly 700,000 critical healthcare workers by 2037.
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This anticipated gap includes essential roles such as physicians, registered nurses, and
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licensed practical nurses.
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The survey also shed light on the perceived value healthcare workers feel from their
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employers.
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Only a third of respondents reported feeling very valued or loyal to their employers, with a
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staggering 80 percent feeling taken for granted.
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Additionally, 42 percent felt underappreciated by their managers or supervisors.
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This lack of recognition could be contributing to the high turnover intentions within the
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industry.
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Interestingly, both healthcare workers and employers recognized the importance of
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educational opportunities.
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Over 80 percent of healthcare workers believe that employers should invest in their
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education, and a similar percentage of employers agreed that supporting employees'
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education is crucial.
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However, there appears to be a disconnect in execution, as only 47 percent of employers
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reported using tuition assistance or education benefits as a retention strategy.
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This suggests that while there's recognition of the issue, the implementation of effective
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solutions remains lacking.
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The survey also highlighted the growing importance of artificial intelligence skills
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within the healthcare field.
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Fifty-six percent of healthcare workers identified AI skills as increasingly critical
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to their profession, pointing to the potential role of technology in mitigating some of the
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industry's challenges, such as burnout.
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As the healthcare industry continues to evolve, these findings underscore the urgent need for
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systemic changes to retain and support the dedicated professionals at its core.
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Addressing issues of compensation, burnout, career advancement, and educational
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opportunities could be crucial steps in ensuring the sustainability of the healthcare
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workforce in the coming years.
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In a recent study, researchers have uncovered crucial insights into the risks associated with
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hormone therapy for hot flashes, particularly in older women.
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This secondary analysis of two significant randomized clinical trials has revealed that
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women starting hormone therapy at age 70 or older face a doubled to tripled risk of
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developing atherosclerotic cardiovascular disease.
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This risk is particularly concerning for postmenopausal women experiencing vasomotor
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symptoms such as hot flashes and night sweats.
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The analysis, led by Dr.
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Jacques Rossouw from the National Heart, Lung, and Blood Institute, focused on the effects of
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oral hormone therapies on cardiovascular health.
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The findings, published in JAMA Internal Medicine, suggest that while hormone therapy
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can effectively reduce vasomotor symptoms in postmenopausal women in their 50s without
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increasing cardiovascular risk, the same cannot be said for older women.
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In fact, the study recommends exercising caution when considering hormone therapy for
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women aged 60 to 69, and advises against initiating therapy in women aged 70 and older.
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The study utilized data from the Women's Health Initiative trials, which have long been pivotal
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in understanding the health implications of hormone therapy.
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These trials initially tested conjugated equine estrogens, with or without medroxyprogesterone
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acetate, against a placebo in women with and without a uterus, respectively.
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The trials, which spanned from 1993 to 2012, were halted early due to increased risks of
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stroke and other adverse outcomes associated with hormone therapy.
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Despite the limitations of the study, such as the use of older hormone therapy formulations
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and doses not typically used today, the updated analysis provides valuable evidence.
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It underscores that hormone therapy for treating vasomotor symptoms does not increase
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cardiovascular risk in women in their 50s but significantly raises the risk in those in their
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70s.
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This insight is particularly important as it guides current clinical practices and informs
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patients about the potential risks involved.
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Dr.
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Deborah Grady, from the University of California San Francisco, and her colleagues
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emphasized the importance of these findings in an editorial note.
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They highlighted that while hormone therapy remains a viable option for younger women,
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newer nonhormonal therapies approved by the Food and Drug Administration, such as
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fezolinetant, offer alternatives for treating vasomotor symptoms without the associated
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cardiovascular risks.
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However, these alternatives also come with their own side effects, prompting some experts
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to caution against the over-medicalization of menopause.
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The researchers noted that the prevalence of vasomotor symptoms was higher in younger women
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at the study's onset, with moderate or severe symptoms affecting about 25% of women in their
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50s compared to less than 10% in their 70s.
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The analysis determined the risk of atherosclerotic cardiovascular disease based on
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serious cardiovascular events such as nonfatal heart attacks and strokes.
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Interestingly, the efficacy of hormone therapy in alleviating vasomotor symptoms appeared to
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decrease with age, particularly with the combination of conjugated equine estrogens and
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medroxyprogesterone acetate.
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The authors of the study speculated that this might be due to increased adiposity in older
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women, which could blunt the expected rise in blood estrogen levels.
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While the study provides significant insights, it also acknowledges its limitations, including
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the post hoc nature of the analysis and the small sample sizes in subgroup stratifications.
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These factors contribute to broader confidence intervals and suggest that the findings should
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be interpreted with caution.
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A fascinating new study has uncovered a potential link between childhood loneliness and
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an increased risk of dementia later in life.
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This large longitudinal study, led by Dr.
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Xiuhua Guo and colleagues from Capital Medical University in Beijing, China, suggests that
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loneliness experienced during childhood can lead to faster cognitive decline and a
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heightened risk of developing dementia, even if individuals do not experience loneliness as
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adults.
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The research, published in JAMA Network Open, is touted as possibly the first of its kind to
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assess the connection between childhood loneliness and cognition in later life.
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The study analyzed data from 13,592 participants involved in the China Health and
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Retirement Longitudinal Study between 2011 and 2018.
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Participants who reported feeling lonely as children, defined by frequent feelings of
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loneliness and a lack of close friendships before the age of 17, were found to have a
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faster rate of cognitive decline and an increased risk of dementia compared to those
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who did not report such experiences.
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Interestingly, the study found that adult loneliness only explained a small part of the
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association between childhood loneliness and cognitive decline, mediating 8.5% of the
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cognitive decline association and 17.2% of the dementia risk association.
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However, it did not significantly alter these relationships, indicating that childhood
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loneliness might serve as an independent risk factor for later-life cognitive issues.
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Dr.
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Guo and her team highlighted that loneliness is a subjective experience resulting from a gap
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between desired and actual social connections.
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Although the mechanisms linking loneliness to cognitive decline are not fully understood,
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it's hypothesized that loneliness could trigger stress responses that negatively impact brain
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structure and function.
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This study emphasizes the importance of recognizing loneliness as a phenomenon that can
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begin in childhood, with global prevalence rates of childhood loneliness reaching 13.2%.
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The findings underscore the need for early interventions to address childhood loneliness,
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given its potential long-term implications for cognitive health.
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While loneliness is often studied in the context of late-life or middle-age, this
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research shows that the roots of cognitive decline and dementia risks may stretch back to
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childhood experiences.
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The study did have some limitations, as the researchers acknowledged.
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The assessment of childhood loneliness relied on retrospective self-reported survey
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questions, which may not fully capture the complex nature of loneliness.
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Additionally, the study was conducted within a Chinese population, which might limit the
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applicability of its findings to other sociocultural or genetic backgrounds.
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Despite these limitations, this study provides valuable insights into how early life
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experiences can shape cognitive health in later years.
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It calls for further research into understanding how childhood loneliness might be
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mitigated to prevent its potential long-term effects on dementia risk.
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Today, we're diving into a common yet often overlooked issue that can be both uncomfortable
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and concerning: the inability to urinate.
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This problem can arise suddenly and, if treated early, many urination issues can improve before
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they escalate into emergencies.
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Dr.
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Jamin Brahmbhatt, a urologist and robotic surgeon with Orlando Health, shares his
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personal experience with this issue.
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After undergoing kidney stone surgery, Dr.
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Brahmbhatt found himself unable to urinate despite feeling a full bladder.
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This situation, though temporary for him, highlighted how even a urologist could feel
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panicked and helpless when faced with urinary retention.
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Urinary retention occurs when your bladder is full but cannot empty.
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Alternatively, you might feel the urge to urinate even when your bladder is empty.
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This can be due to a variety of reasons, such as blockages, weak bladder muscles, or poor
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nerve signals interfering with the normal process of urination.
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In men, particularly those over 50, an enlarged prostate is a common culprit, leading to
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blocked urine flow.
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Research shows that by age 70, about 1 in 10 men will have experienced acute urinary
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retention within five years, a number that rises to nearly 1 in 3 by their 80s.
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In women, nerve issues or conditions like a cystocele can alter urine flow, though acute
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retention is much less common in women.
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Sometimes, everyday issues like constipation can contribute to urinary problems by altering
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the bladder neck's angle, essentially kinking the outlet.
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Medications, such as decongestants, antihistamines, and some antidepressants, can
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also slow or stop urine flow.
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Other causes might include urinary stones, strictures, blood clots, or infections.
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It's important to recognize the warning signs of urinary retention.
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A weak or stop-and-start stream might be bothersome but isn't immediately dangerous.
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However, if you cannot urinate at all, your bladder feels painfully full, and relaxation or
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bowel movements do not help, this could be an emergency situation requiring immediate medical
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attention.
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Urologists use various tools to diagnose urinary retention.
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They may measure how much urine remains in the bladder after attempting to void, test for
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infections, or evaluate kidney function.
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Using a uroflow machine, they can assess the strength and pattern of your urine stream, and
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if necessary, perform a cystoscopy to look for blockages.
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Dr.
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Brahmbhatt emphasizes the importance of early detection and treatment.
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Subtle changes like a weaker stream or frequent nighttime bathroom trips should not be
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dismissed as mere signs of aging.
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Reviewing medications with your doctor, staying hydrated, and addressing constipation can
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prevent minor issues from becoming emergencies.
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Finally, Dr.
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Brahmbhatt shares his story to underscore the importance of not ignoring symptoms.
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Whether it's a simple medication change or a medical procedure, early intervention can make
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a significant difference.
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So, if you're experiencing any of these issues, don't hesitate to talk to your doctor.
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In healthcare, much like in customer service, the close of an experience can have a profound
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impact on how it's perceived.
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Imagine having a flawless surgery, only to find yourself frustrated and anxious due to a
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chaotic discharge process.
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This crucial moment, often overlooked, is known as "the goodbye." It's the final touchpoint of
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care where patient satisfaction, loyalty, and even reimbursement can be significantly
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influenced.
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Patient satisfaction is becoming a defining endpoint in healthcare, driven by several
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factors.
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The rise of artificial intelligence tools and digital reviews has made patient experiences
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more visible.
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There's also been an expansion of consumer choices, especially in urgent care and
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outpatient settings.
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Additionally, with cost sharing, patients are more sensitive to price and demand greater
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value.
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Payer contracts are now linking a larger portion of reimbursement to satisfaction
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metrics.
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For instance, the Centers for Medicare & Medicaid Services ties up to 25% of value-based
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purchasing to patient satisfaction, and many states are aligning Medicaid payments to
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patient-centered outcomes.
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In today's consumer-driven market, satisfaction isn't just a "nice to have"—it's essential for
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survival.
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Despite this, satisfaction is often dismissed as a "soft" metric, difficult to control and
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quantify.
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Yet, studies clearly show that good patient satisfaction is associated with better
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compliance, stronger outcomes, increased loyalty, and more frequent referrals.
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The goodbye problem highlights how healthcare providers are evaluated on the entire patient
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experience, even those parts outside their direct control.
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A successful medical procedure can be overshadowed by a poor transportation handoff
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or a confusing discharge process.
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The goodbye, or "be well," is a critical moment where satisfaction is most vulnerable.
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In business, this is akin to "closing the sale." In medicine, it represents a significant
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opportunity to shape outcomes, loyalty, and revenue.
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So, how can we improve the goodbye?
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Research and frontline experience suggest four key rules.
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First, the goodbye should come from a clinician.
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Patients are more satisfied when their last interaction is with a nurse or provider, not
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just administrative staff.
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Provider communication, including listening, explaining, and showing empathy, is a strong
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predictor of satisfaction.
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Second, make the goodbye clinical and personal.
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Address medical, emotional, and informational needs.
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Patients appreciate clarity on next steps, potential side effects, and reassurance.
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A simple question like, "Do you have any questions about your discharge instructions or
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follow-up plan?" can signal respect and partnership.
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Third, put it in writing.
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A discharge packet isn't enough.
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Patients forget up to 80% of what they hear.
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Providing a written, personalized summary that covers care received, medication changes,
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follow-up appointments, warning signs, and lifestyle recommendations can dramatically
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improve understanding and adherence.
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Artificial intelligence and audiovisual tools can aid in streamlining this process and
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managing follow-up.
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Finally, say thank you.
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Patients have a choice, and expressing gratitude for trusting us with their care can
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turn a transaction into a relationship.
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Acknowledging the patient's effort in their health journey strengthens loyalty and
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encourages return visits.
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Data suggests that a simple thank-you can significantly boost customer loyalty.
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The stakes are high.
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While patient-centered health remains the primary goal, the care experience and
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perception are becoming dominant currencies in healthcare.
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Clinicians may not control every aspect of the patient journey, but they can influence how it
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ends.
27:25
A strong close can address care gaps and transform a clinical encounter into long-term
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trust.
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Remember, healthcare is judged not just by what happens in the operating room or at the
27:38
bedside, but also by what happens in those last five minutes before the patient leaves.
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So, close strong and offer a warm, genuine send-off, because in healthcare, as in life,
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the goodbye often defines the experience.
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That's all for today's episode of Morning Medical with Dr.
27:55
Chow.
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Thank you for joining us as we navigated through these important topics.
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I hope you found the insights valuable and empowering.
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Until next time, take care and be well.