By Kris B. Mamula
Pittsburgh Business Times
Updated: 8:00 p.m. ET May 15, 2005
He's a slender, unshaven pizza maker who helped load ceramic tile into his brother's car yesterday afternoon. Now, his back is killing him.
advertisement
The man gingerly leans forward in a hospital bed as Dr. Ted Delbridge works his fingers down the man's spine, feeling for anything out of place. The patient, who is 38 years old, lies back in the emergency department exam room. Dr. Delbridge asks him to lift each leg. The man complies slowly, wincing.
The pizza man is one of 49,000 people who will seek medical care this year in the emergency room at UPMC-Presbyterian Hospital in Oakland. In deciding how to treat patients, doctors like the 42-year-old Dr. Delbridge are mostly guided by experience and what they learned in medical school.
But that's quickly changing.
Read more...MSNBC
Matthew Herper, 05.10.05, 6:00 AM ET
In November, a tiny company called NitroMed unveiled results showing that its drug combo, BiDil, reduced deaths due to heart failure by half.
The results were astounding, but there was a catch. The drug was only tested on African-Americans and had previously failed to show a benefit in a broader population. An editorial in The New England Journal of Medicine by M. Gregg Bloche, a Georgetown University medical ethicist, warned of the need to manage the downside of "race-based therapeutics"--and predicted that it was only a matter of time before race was linked to the effects of other drugs.
Only six months later, Bloche seems prescient. A flood of studies has emerged showing racial differences in how patients suffer from disease--or benefit from drugs--in ailments ranging from osteoporosis to cancer. And several more have looked at the effects of drugs on particular racial groups. Many of the doctors conducting the studies are African-American.
Read more...Forbes.com
By Colin Nelson, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
May 06, 2005
Review
TORONTO, May 6-Acupuncture appears to confer modest, short-term pain relief with little risk in patients who suffer from chronic low back pain, according to a systematic review and meta-analysis of the medical literature by the Cochrane Collaboration.
Read more...Medpage
DURHAM, N.C. -- While patients hospitalized for a heart attack have long been treated with morphine to relieve chest pain, an analysis by researchers from the Duke Clinical Research Institute has shown that these patients have almost a 50 percent higher risk of dying.
The researchers call for a randomized clinical trial to confirm their analysis. Meanwhile, they advise cardiologists to begin treatment with sufficient doses of nitroglycerin to relieve pain before resorting to morphine.
In their analysis of the clinical data and outcomes of more than 57,000 high-risk heart attack patients -- 29.8 percent of whom received morphine within the first 24 hours of hospitalization -- the researchers found that those who received morphine had a 6.8 percent death rate, compared to 3.8 percent for those receiving nitroglycerin. The increase in mortality persisted even after adjustment for the patients' baseline clinical risk.
The results of the Duke were published as a fast-track article in the American Heart Journal.
"The results of this analysis raise serious concerns about the safety of the routine use of morphine in this group of heart patients," said Duke cardiologist Trip Meine, M.D., the study's lead author. "Since randomized clinical trials evaluating the safety or effectiveness of morphine for these patients have not been conducted, official guidelines for its use are based solely on expert conjecture. Given the adverse outcomes associated with morphine use found in our analysis, a randomized clinical trial is in order."
Read more...Eureka Alert
Heart failure patients who are treated in accordance with established European guidelines do better than patients who are not, yet many doctors are still not adhering to the guidelines, according to pioneering research published today (Tuesday 3 May) in Europe’s leading cardiology journal, the European Heart Journal.
In the first large European study to look at the effect of prescribing practices on outcome in heart failure outpatients outside of a clinical trial[1], Professor Michel Komajda and colleagues investigated the way that 1,410 patients with mild to moderate heart failure were treated by 150 randomly selected cardiologists or cardiology departments in six European countries (France, Germany, Italy, The Netherlands, Spain and the UK). They measured how closely the patients’ treatment adhered to the guidelines issued by the European Society of Cardiology (ESC) for the use of the five most commonly used cardiac drugs: ACE-inhibitors[2], beta-blockers, spironolactone[3], diuretics and cardiac glycosides.
Prof Komajda, professor of cardiology at the Pitie-Salpetriere Hospital, Paris, France, and a specialist in heart failure, said: "We found that where doctors had treated their patients in accordance with the ESC guidelines, fewer patients had to be referred to the hospital due to deterioration of their heart failure or for cardiovascular symptoms, and there was a longer time before patients had to be readmitted to hospital because of their symptoms.
Read more...innovations report
A computerized tool to help emergency room physicians determine whether a patient is having a heart attack may not work as well among some racial and ethnic groups, according to research of almost 12,000 patients at nine medical centers.
"It's notorious that women and elderly patients have markedly different heart attack symptoms from the younger male patient," said Chadwick D. Miller, M.D., from Wake Forest University School of Medicine. "This study shows us that race and ethnicity also play a role in symptoms."
Results from the research, conducted at Wake Forest and eight other medical centers, are reported in the May issue of Academic Emergency Medicine. The researchers studied a computerized risk stratification tool, called the Acute Coronary Ischemia-Time Insensitive Predictive Instrument (ACI-TIPI), which is designed to predict whether a patient is having a heart attack. Although ACI-TIPI itself is not widely used clinically, its elements form the basis of many other risk assessment tools.
Read more...Medical News Today
Bernadette Tansey, Chronicle Staff Writer
Sunday, May 1, 2005
Chances are that you -- or people you know -- have left the doctor's office at some point with a drug prescription that didn't jibe with the use approved by the Food and Drug Administration.
Although many patients are unaware of it, physicians often prescribe drugs for a disease, or at a dose, or for a patient type that's different from what the FDA has sanctioned.
But exactly what information are doctors basing these treatments on?
Although off-label prescribing is a legal and common practice, the evidence supporting these treatments can vary widely in quality.
Read more...San Francisco Chronicle