Shifting interpretations in evidence and guidance in pain and opioids research: A bibliometric analysis of a highly cited case series from 1986

Rationale, aims, and objectives: Portenoy and Foley’s 1986 landmark study “Chronic use of opioid analgesics in non-malignant pain: report of 38 cases” has been reproached for opening the floodgates of opioid prescribing for chronic non-cancer pain and the attendant harms. This influential article has been cited over 500 times in the scientific literature over the last four decades. This study seeks to understand the impact of Portenoy and Foley’s article on subsequent discussions and research about opioids. Methods: We conducted a multi-method bibliometric analysis of all citations of this article from 1986 through 2019 using quantitative relational and qualitative content analysis to determine how uses and interpretations of this case series and associated prescribing guidance have changed over time, in relationship to the evolution of the North American opioid crises. Results: Using time series analysis, we identified three periods with distinct interpretations and uses of the index study. In the first “exploration” period (1986-1996), the index study was well-received by the scientific community and motivated further study of the effects of opioids. In the second “implementation” period (1997-2003, coinciding with the release of OxyContin®), this study was used as evidence to support widespread prescribing of opioid analgesics, even while it was recognized that long-term effects had not yet been evaluated. The third “reassessment” period (2004-2019) focused on how opioid-related harms had been overlooked, and in many cases these harms were directly attributed to this study. Conclusion: These changes in interpretation demonstrate shifting currents of the use and mobilization of evidence regarding pain and opioids, and how these currents both impact and are impacted by clinical practices and major sociohistorical phenomena such as the opioid crisis. Researchers and clinicians must account for these shifting dynamics when developing and interpreting scientific knowledge, including in the form of clinical practice guidelines.

The Dynamic Motor Control Index as a Marker of Age-Related Neuromuscular Impairment

Biomarkers that can identify age-related decline in walking function have potential to promote healthier aging by triggering timely interventions that can mitigate or reverse impairments. Recent evidence suggests that changes in neuromuscular control precede changes in walking function; however, it is unclear which measures are best suited for identifying age-related changes. In this study, non-negative matrix factorization of electromyography data collected during treadmill walking was used to calculate two measures of the complexity of muscle co-activations during walking for 36 adults: (1) the number of muscle synergies and (2) the dynamic motor control index. Study participants were grouped into young (18–35 years old), young-old (65–74 years old), and old–old (75+ years old) subsets. We found that the dynamic motor control index [χ2(2) = 9.41, p = 0.009], and not the number of muscle synergies [χ2(2) = 5.42, p = 0.067], differentiates between age groups [χ2(4) = 10.62, p = 0.031, Nagelkerke R2 = 0.297]. Moreover, an impairment threshold set at a dynamic motor control index of 90 (i.e., one standard deviation below the young adults) was able to differentiate between age groups [χ2(2) = 9.351, p = 0.009]. The dynamic motor control index identifies age-related differences in neuromuscular complexity not measured by the number of muscle synergies and may have clinical utility as a marker of neuromotor impairment.

ASSESSMENT OF FALL RISK AMONG ELDERLY IN HOME ENVIRONMENT IN AL-HASA

Introduction and Aim: Fall it is an accident that unintentionally breaks down a person on the floor, the surface of the earth, or any other low level. The goal of this study was to estimate the prevalence of falls among the elderly and investigate the factors that contribute to this study. Method: The study design was quantitative, descriptive that surveyed for elderly risk of fall and their caregivers, using google form. The study was conducted by a two questionnaire type assessment, 8 questions were used to assess each questionnaire, using fall efficacy scale International with four options (not at all concerned, somewhat concerned, fairly concerned, very concerned), and using Modified Barthel index scale with thee options (No, complete dependence, yes, partially assist, and independence). Result: People who are 65 Years old and above were 140 participated in the study. In Barthel index study about (32.9% - 52.1%) was independence, and about (29.3% - 48.6%) were need partial assist, and about (18.6% - 36.4%) were complete dependence. In fall efficacy scale about (6.4% - 42.9%) were not at all concerned, and about (12.9% - 31.4%) were somewhat concerned, and about (12.9% - 29.3%) were fairly concerned, and about (12.9% - 57.1%) were very concerned. Conclusion: The elderly stage is the most stage or period that the human will have many conditions that enhance to fall.

Cognitive testing in the COVID-19 era: can existing screeners be adapted for telephone use?

Aim: To examine whether two existing cognitive screeners might be adapted for telephone administration by omission of item content requiring visual cues or assessment. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke’s Cognitive Examination (MACE) and Free-Cog were used to derive scores for ‘Tele-MACE’ and ‘Tele-Free-Cog’. Results: As in the index study, both Tele-MACE and Tele-Free-Cog proved sensitive for dementia diagnosis. Tele-MACE had a better balance of sensitivity and specificity than observed with MACE. Tele-MACE was sensitive for mild cognitive impairment diagnosis, whereas Tele-Free-Cog was more specific for mild cognitive impairment. Conclusion: Existing cognitive screeners may be adapted for telephone administration. Such developments may prove necessary in the COVID-19 era as remote rather than face-to-face cognitive assessment increasingly becomes the established norm.

Consumption of flavonoid-rich fruits, flavonoids from fruits, and stroke risk: a prospective cohort study

We sought to examine the prospective associations of specific fruit consumption, in particular flavonoid-rich fruit (FRF) consumption, with the risk of stroke and subtypes of stroke in a Japanese population. A study followed a total of 39,843 men and 47,334 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline since 1995 and 1998 to the end of 2009 and 2012, respectively. Data on total and specific FRF consumption for each participant were obtained using a self-administrated food frequency questionnaire. The hazard ratios (HRs) of stroke in relation to total and specific FRF consumption were estimated through Cox proportional hazards regression models. During a median follow-up of 13.1 years, 4092 incident stroke cases (2557 cerebral infarctions and 1516 hemorrhagic strokes) were documented. After adjustment for age, body mass index, study area, lifestyles, dietary factors, and other risk factors, it was found that total FRF consumption was associated with a significantly lower risk of stroke in women (HR= 0.70; 95% CI, 0.58-0.84), while the association in men was not significant (HR= 0.93; 95% CI, 0.79-1.09). As for specific FRFs, consumptions of citrus fruits, strawberries, and grapes were found associated with a lower stroke risk in women. Higher consumptions of FRFs, in particular citrus fruits, strawberries, and grapes, were associated with a lower risk of developing stroke in Japanese women.

Reference values of alanine transaminase and aspartate transaminase in apparently healthy individuals and their relation with body mass index.

Objectives: The purpose of this study is to determine the reference values of ALT and AST in healthy, young individuals of Lahore and compare them with international reference values and to determine its relation with Body Mass Index. Study Design: Descriptive Cross Sectional Study. Setting: Department of Pathology, Jinnah Hospital Lahore. Period: March 2017 to May 2017. Material & Methods: Blood Samples were drawn from apparently healthy volunteers and medical students coming to Blood Bank of Jinnah Hospital, Lahore for blood donation, and their ALT and AST values were obtained after screening. Data was analyzed using SPSS v.20 and values between 5th and 95th percentile of ALT and AST levels from healthy subjects were taken as reference values. Results: Reference values for ALT came out to be 13.50-52.50 IU/l whereas reference values for AST were 15.75-47.00 IU/L. It was also observed that Body Mass Index had direct correlation with upper normal limit of ALT & AST values. Conclusion: Values of ALT and AST in our study were consistent with the reference values given in the text books.