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Shoulder injury a rare potential side effect

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1. Shoulder injury is a rare potential side effect of vaccination

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3023

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A retrospective cohort study found that shoulder injury occurred in less than 1 in 10,000 patients who received an intramuscular vaccine administered into the deltoid muscle between April 2016 and December 2017 (pre-COVID-19 pandemic ). The authors say that given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risk. Although shoulder conditions can be prevented if caused by inappropriate vaccine administration, their study did not determine the cause of vaccine-associated shoulder injuries. The findings are published in Annals of Internal Medicine.

The National Vaccine Injury Compensation Program (VICP) provides financial compensation to those who have experienced serious adverse reactions listed in its Vaccine Injury Chart. In 2017, shoulder vaccine administration injury (SIRVA) was added to the table of vaccine injuries based on compelling evidence of a causal relationship between vaccine injection and deltoid bursitis. . Besides bursitis, other shoulder conditions have been linked to vaccination. The proposed mechanism is that shoulder conditions are caused by immune responses when vaccines are injected into the shoulder joint, instead of the deltoid muscle. However, epidemiological data on shoulder conditions after vaccination are limited.

Researchers from the Kaiser Permanente Southern California Department of Research & Evaluation studied the medical records of more than 3.7 million vaccines given during the study period to estimate the risk of shoulder conditions after the vaccination and to assess possible risk factors. A natural language processing (NLP) algorithm was used to identify potential shoulder conditions in vaccinees with shoulder disorder diagnostic codes and characteristics of vaccinees with and without shoulder condition. shoulder were compared. Among more than 3.7 million vaccines administered, 371 cases of shoulder disease have been identified, with an estimated incidence of 0.99 per 10,000 vaccinated adults. The incidence was even lower for pediatric recipients, with only 4 cases of shoulder disease out of more than 750,000 vaccinations.

The researchers also looked at risk factors for developing shoulder conditions and found that in adults, older age, female gender, increased number of outpatient visits in the 6 months prior to vaccination, Having fewer comorbidities and receiving a pneumococcal conjugate vaccine were associated with an increased risk of shoulder disease. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk of shoulder disease. Simultaneous administration of vaccines was associated with a higher risk of shoulder disease in the elderly.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with the corresponding author, Chengyi Zheng, PhD, MS, please contact Dani K. Dodge Medlin at [email protected]

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2. Eye procedures do not increase heart attack risk

Abstract: https://www.acpjournals.org/doi/10.7326/M20-6618

Editorial: https://www.acpjournals.org/doi/10.7326/M22-0709

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A new case crossover study has found that outpatient ophthalmic procedures do not increase the risk of acute myocardial infarction (AMI). These findings support American Academy of Ophthalmology guidelines, which recommend that specialists refrain from unnecessary preoperative medical testing for average-risk patients scheduled for most types of eye surgery. The study is published in Annals of Internal Medicine.

Invasive surgical procedures and the stress that accompanies them are a transient factor in triggering AMI in vulnerable patients. Previous cohort studies have suggested associations between ophthalmologic procedures and AMI. However, these studies were not specifically designed to investigate the effects of transient exposures.

Researchers from the Norwegian University of Science and Technology in Trondheim and the Karolinska Institutet in Stockholm conducted a case-crossover study of 353,031 patients in Norway and Sweden who had suffered a first incident AMI. Of these patients, 806 had suffered an AMI incident within 36 days of an ophthalmologic procedure. The authors identified an eight-day period immediately after the procedure during which the incidence of AMI would be higher than at other times, indicating that ophthalmological procedures carry a risk of AMI events. However, the authors found that the likelihood of AMI risk did not differ between surgical subtypes, type of anesthesia, invasiveness of procedures, duration of surgery, patient age, or comorbidity. underlying.

An accompanying editorial by BobbieJean Sweitzer, MD, FACP notes that despite growing evidence that eye procedures have a low risk of complications in older patients, medical tests and consultations are becoming more common. Sweitzer says the delay caused by these tests may increase the risk of adverse impacts, including more falls, for older patients. According to the authors, although a low relative risk compared to more invasive ophthalmologic procedures was observed, physicians should still perform careful evaluation before procedures that are expected to require prolonged general anesthesia and/or are procedures highly invasive. .

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with the corresponding author, Abhijit Sen, PhD, please email [email protected] or [email protected]

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3. Summary of VA/DoD Guidelines for Management of Substance Use Disorders Focuses on Key Recommendations, Including the Use of Telehealth

Telehealth complements, not replaces, in-person treatment for substance use disorders

Review: https://www.acpjournals.org/doi/10.7326/M21-3931

Guideline: https://www.acpjournals.org/doi/10.7326/M21-4011

Editorial: https://www.acpjournals.org/doi/10.7326/M22-0150

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In August 2021, U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) leaders approved a joint clinical practice guideline (CPG) for the management of substance use disorders (SOUTH). These updated guidelines include consideration of telehealth for SUD, which has become an important component of treatment during the COVID-19 pandemic. A summary of key recommendations and a related review of published evidence is published in Annals of Internal Medicine.

In 2019, 20.4 million Americans met the SUD criteria, with rates apparently increasing during the COVID-19 pandemic. Effective treatment of these patients can help prevent premature deaths from TUS-related illnesses, accidents, and suicides. The authors summarize the recommendations that have the most clinical impact, including the management of alcohol use disorders, the use of buprenorphine in opioid use disorders, the management of contingencies and the use of technology and telehealth to manage patients remotely.

In response to safety restrictions during the pandemic, clinicians have turned to telehealth services to provide care for patients with SUD. To reflect these changes, the updated VA and US DoD clinical practice guidelines for the management of SUD provide guidance and evidence related to the implementation of telehealth in the treatment of SUD. The 2021 guidelines recommend using technology-based interventions in addition to usual care for alcohol use disorders, and structured telephone care in addition to usual care for SUDs.

Researchers from the Center for Clinical Excellence, ECRI and the University of Pennsylvania reviewed randomized controlled trials (RCTs) of adults diagnosed with SUD to synthesize recent findings on the effectiveness of telehealth for the SOUTH. Telehealth services included videoconferencing therapy, web-based cognitive behavioral therapy (CBT), supportive text messaging, other web-based interventions, and enhanced telephone monitoring (ETM) in the treatment of various SUDs. The authors report that the overall strength of evidence was very low, indicating considerable uncertainty about the use of telehealth as an alternative to in-person care for the treatment of SUD. However, the authors note that the synthesized studies reported fewer participants prematurely discontinuing videoconferencing therapy or web-based CBT, which the authors suggest may suggest better adherence to telehealth interventions than to in-person care. According to the authors, their findings suggest areas for future research into the role of telehealth as an additional means of providing support and access to care among a population that may experience significant barriers to care.

An editorial by Sarah Wakeman, MD, highlights recommendations for treatment and testing for substance and alcohol use disorders made by the VA and DoD that apply to both veterans and public. The author says that amid the growing overdose crisis and rising alcohol-related mortality among young people, the need for standardized approaches to diagnose and manage the full spectrum of substance use unhealthy and SOUTH in general medical settings is urgently needed. Wakeman notes that the guidelines do not mention harm reduction, which she says is a late inclusion for SUD treatment in light of the growing number of overdose deaths in the year 2020-2021.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with synopsis author James Sall, PhD, please email [email protected] To speak to someone at ECRI, please contact Laurie Menyo at [email protected]

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A guide to patient prices for prescription drugs

Robin Feldman, JD; Natalie Feldman, MD; and Enrique Seoane-Vazquez, PhD

Ideas and opinions

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4755

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