AHA: Fish Oil Plus Statin Reduces Coronary Events - CME Teaching Brief - MedPage Today
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 17, 2005
Also covered by: Forbes, MSNBC, Washington Post
MedPage Today Action Points
* Be aware that this study discusses use of a high dose fish oil supplement that is not available in the United States.
* This study was published as an abstract and presented at a conference either as an oral or poster presentation. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
Review
DALLAS, Nov. 17 - Fish oil supplements in high doses combined with statin therapy deliver a one-two punch that reduces major coronary events, particularly for those with established coronary artery disease.
In a Japanese study, patients with a history of coronary disease who took 1,800 mg/day of highly purified eicosapentaenoic acid (EPA) together with statin therapy-either Pravachol (pravastatin) or Zocor (simvastatin)-had a 19% reduction in risk of major coronary events (P=0.048).
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 17, 2005
MedPage Today Action Points
* NT-proBNP concentrations are useful in confirming a diagnosis of acute heart failure in patients presenting to emergency rooms with dyspnea.
* Understand that NT-proBNP concentrations greater than 5,180 pg/mL may indicate patients at significantly increased risk of death who require more aggressive monitoring and treatment.
* Recognize that an age-independent cutoff of 300 pg/mL had a 98% negative predictive value to exclude acute heart failure.
Review
BOSTON, Nov. 17 - An international study has confirmed the usefulness of a blood test for amino-terminal pro-brain natriuretic peptide (NT-proBNP) in diagnosing suspected acute heart failure in emergency room patients with dyspnea.
The study also found that NT-proBNP concentrations can predict short-term mortality risk, reported James L. Januzzi, M.D., of the Massachusetts General Hospital here and colleagues. Patients with marked elevations of this marker had more than a fivefold increased risk of death within 76 days, compared with patients whose levels were lower.
Decision-Making Tool Reduces Inappropriate Antibiotics - CME Teaching Brief - MedPage Today
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 10, 2005
MedPage Today Action Points
* Be aware that about half of antibiotic prescriptions are written for viral respiratory infections for which antibiotics are not indicated.
* Inform patients who request antibiotics for viral infections that not only will the drugs not help, but such unnecessary antibiotic use contributes to the serious public health threat posed by antibiotic resistant bacteria.
Review
SALT LAKE CITY, Nov. 11 - A community intervention aimed at reducing inappropriate antibiotic prescriptions -- plus a handheld digital assistant for doctors -- had a significant success, investigators here reported. But the antibiotic reduction was not necessarily enough to matter.
The intervention consisted of a series of meetings with community leaders, news releases in the print media, distribution of patient-education materials at pharmacies and doctors' offices, and a mailing to parents with children younger than six.
They all added up to an 11% reduction in inappropriate antibiotic use when the doctors were helped by the digital device.
Nevertheless, said Matthew H. Samore, M.D., of the University of Utah here and colleagues, it's unclear whether the 11% reduction would be enough to have any impact on the spread of antibiotic resistant bacteria.
The study included 407,460 inhabitants and 334 primary care clinicians in three sets of six rural communities in Utah and Idaho, the authors reported in the Nov. 9 issue of the Journal of the American Medical Association.
CDC Report Shows Syphilis Cases On the Rise - CME Teaching Brief - MedPage Today
By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 09, 2005
Also covered by: Forbes, NY Times, USA Today
MedPage Today Action Points
* Inform patients that syphilis is on the rise, and infections appear to be particularly higher in urban areas among men who have sex with men, according to a CDC report.
* Advise patients who are sexually active about the importance of being screened for STDs.
* Discuss with patients the importance of using protection during sex, including oral sex, to prevent the transmission of sexually transmitted diseases.
Review
ATLANTA, Nov. 8 - Syphilis cases rose 8% in America last year, an increase largely attributed to more infections among men who have sex with men, researchers reported here.
It was the fourth consecutive annual increase, coming only five years after syphilis rates hit an all-time low, the CDC reported in Sexually Transmitted Disease Surveillance 2004, the agency's yearly snapshot of incidence trends in syphilis, gonorrhea, and chlamydia.
IOM Report Finds Doctors Ill-Equipped for Cancer Survivors - CME Teaching Brief - MedPage Today
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 09, 2005
Also covered by: CNN, NY Times, USA Today, Yahoo! News
MedPage Today Action Points
* Be aware that patients who survive cancer will require disease-specific follow-up care and should be given a long-term care-plan that includes information about how to reduce the risk of recurrence.
* Discuss with patients the various legal, financial and psychological support programs available to cancer survivors.
Review
WASHINGTON, Nov. 9 - The American health care system is poorly equipped to take care of the growing population of cancer survivors, which has tripled over the past 30 years.
So declared a report by the Institute of Medicine (IOM) issued this week. It was the theme of an all-day meeting at the National Academy of Sciences that brought together the American Society of Clinical Oncology and the IOM to thrash out problems surrounding cancer survivorship.
In "From Cancer Patient to Cancer Survivor: Lost in Transition, 2006," the IOM found that American doctors, particularly primary care physicians, have little training in the "benefits to patients of prevention and lifestyle change, and the complexities of integrating survivorship concerns with care for other chronic conditions."
Sleep Disorder Increases Risk of Mortality - CME Teaching Brief - MedPage Today
By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 09, 2005
Also covered by: ABC News, Forbes, MSNBC
MedPage Today Action Points
* Consider sleep apnea in patients who report restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, or depression.
* Inform concerned patients that CPAP, while found in one study to be ineffective at increasing survival in patients with heart failure and central (neurologically-based) sleep apnea, has been reported to improve the quality of sleep for patients with obstructive sleep apnea.
Review
NEW HAVEN, Conn., Nov. 9 - Obstructive sleep apnea increases the risk of death from stroke or other causes, whether the sleeper has hypertension or not, according to research reported today.
Equally disquieting was the news that in patients with both central sleep apnea and heart failure, continuous positive airway pressure (CPAP) improves both sleep and cardiovascular function, but does not improve survival.
Those findings were reported in separate sleep apnea studies published in the Nov. 10 issue of the New England Journal of Medicine.
Daily Aspirin Wards Off Cancer in Barrett's Esophagus - CME Teaching Brief - MedPage Today
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 07, 2005
MedPage Today Action Points
* Advise Barrett's patients that it is too preliminary to recommend NSAIDs as prevention for esophageal cancer.
* Explain to patients who ask about NSAID use that the drugs may increase risk of gastrointestinal bleeding and long-term NSAID use may increase the risk of cardiovascular events.
Review
SEATTLE, Nov. 7 - Patients with Barrett's esophagus who regularly take nonsteroidal anti-inflammatory drugs (NSAIDS) reduce their risk of neoplastic progression by 68% compared with Barrett's patients who never use NSAIDs, according to researchers here.
A prospective study of 350 patients with Barrett's found that the hazard ratio for neoplastic progression to adenocarcinoma was 0.32 (95% CI, 0.14-0.76) but dropped to 0.20 (0.10-0.41) for patients who were NSAID users at baseline and continued during five years of follow-up.
The hazard ratio among former NSAID users was 0.70 (95% CI 0.31-1.58), epidemiologist Thomas Vaughan, M.D., M.P.H., of the Fred Hutchinson Cancer Center here reported online today in Lancet Oncology. NSAID-users also had lower risk of aneuploidy and tetraploidy compared with never- users.
By Amanda Strong
MONTREAL, CANADA -- November 4, 2005 -- When faced with a suspected case of pneumonia, hospital physicians should collect a lower respiratory tract culture, initiate antibiotic therapy immediately at high doses, and stop treatment earlier, researchers recommended in a presentation here at CHEST 2005, the American College of Chest Physicians annual meeting.
In addition, treatment should be tailored to culture results, according to newly released evidence-based guidelines for the management of hospital-acquired pneumonia presented on November 3rd.
Presenter Richard G. Wunderink, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States, said the new guidelines also include healthcare-associated pneumonia (HCAP), which was previously included in guidelines for community-acquired disease.
By Amanda Strong
MONTREAL, CANADA -- November 4, 2005 -- It's been only a year since the last revision of the evidence-based practice guidelines for the diagnosis and management of pulmonary hypertension, but already much has changed.
"Because treatments have been evolving, we will be updating the treatment algorithm very soon," said Lewis J. Rubin, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, United States.
Dr. Rubin is chair of the international panel of experts who developed the guidelines. He said an update to the medical therapy section of the guidelines is expected to be available mid-2006.
Apple Shape Predicts Heart Attack Risk Better than BMI - CME Teaching Brief - MedPage Today
By Michael Smith, MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 04, 2005
Also covered by: Atlanta Journal-Constitution, Newark Star-Ledger
MedPage Today Action Points
* Advise patients that abdominal obesity is a major cardiovascular risk factor.
* Explain to patients that this study suggests that the key predictor of risk may be how the waist size relates to the hips, a high waist-to-hip ratio appearing to predict an increased risk of heart attack.
* Note also that the study implies that more people will be counted as "at risk" using waist-to-hip ratio criteria than would have been, based on body-mass index.
Review
A pot belly increases the risk of a heart attack.
HAMILTON, Ontario, Nov. 4 - A pot belly increases the risk of a heart attack -- even if the rest of the physique is as skinny as a beanpole.
The person with that build would have a low body mass index (BMI). Based on that, the person would be classified as having a low heart attack risk. But, insist researchers here, it's really the ratio between the distance around that pot belly and the circumference of the hips that tells the tale of risk.
CHEST Cheek Scrapings Can Detect Lung Cancer - CME Teaching Brief - MedPage Today
Review
MONTREAL, Oct. 31 – The quest for a simple diagnostic test of lung cancer is beginning to pay off, researchers said here today.
A scraping of cheek cells contains a “clear signal” of malignancy-associated cellular changes that indicate lung cancer, reported Bojana Turic, M.D., of Perceptronix, Inc., at CHEST 2005, the annual meeting of the American College of Chest Physicians. But the sensitivity and specificity of the test are not good enough for prime time yet.
Her Vancouver-based company, a spin-off from the public-sector British Columbia Cancer Agency, has spent the past two years on prospective clinical trials evaluating changes found in the sputum of 2,400 participants, all at high risk for lung cancer.
ECCO 13 - One voice, one vision needed to overcome cancer in Europe
Patients and healthcare professionals unite with politicians at ECCO 13 to address the inequalities in access to quality cancer care
Monday 31 October, Paris, France – Despite improved technologies and treatments following a decade of exciting progress in cancer research, Europe is failing to meet the expectations of patient and healthcare professionals on the standard of cancer care according to the first patient programme held by Federation of European Cancer Societies at ECCO 13. The event, involving patients, healthcare professionals and politicians, found that many of these advances do not realise their potential due to diverse stakeholder agendas and no clear way to prioritise in the face of limited budgets. Europe now needs to face the situation of potentially having more technologies/treatments to offer than it can afford and subsequently needs to agree who decides where the money is spent.
In a step to address this issue, the Federation of European Cancer Societies is holding a three-day patient programme to debate what improvements need to be made and of these what constitutes a priority and have to ensure that the right decisions are taken. The meeting provided the opportunity for all interested parties to join together to form a common voice, and highlighted key decision making tools that can be used to improve the outlook for patients.
As Professor John Smyth, Director of the University of Edinburgh Cancer Research Centre, UK, stated, "Our first step in addressing the issue of our overstretched healthcare system is listening to the concerns and expectations of healthcare professionals and patients. As politicians are ultimately the people who make the decision about healthcare directives, it is important that they are involved throughout the discussions so as to ensure they can make informed and educated decisions. But when it comes to deciding what priority should be given to improvements in cancer care, the public needs to be encouraged to play their part in order to provide an impartial, unbiased opinion."