Triple-Drug Therapy Reduces Stroke Severity - CME Teaching Brief - MedPage Today
BOSTON, April 24 - When ischemic strokes occur, patients who happen to be taking ACE inhibitors, antiplatelet agents, and statins may have reduced the severity.
In a record review of 210 patients who arrived at the hospital within 24 hours of stroke onset, those who had been on the triple therapy had lower National Institutes of Health Stroke Scale scores and smaller lesions on imaging than patients who were on either two of the three agents, antiplatelet therapy alone, or no therapy.
Patients on triple therapy were also more likely to have a shorter length of stay and better functional status on discharge.
Magdy Selim, M.D., Ph.D., and colleagues at Beth Israel Deaconess Medical Center here reported in the April 25 issue of Neurology.
Elderly Cancer Survivors Report Significant Disabilities - CME Teaching Brief - MedPage Today
SALT LAKE CITY, April 19 - Surviving cancer does not mean a return to a full, functional life for many elderly women, researchers here report.
Forty-two percent of elderly women (median age 72) who were five-year survivors of cancers said they were unable to do heavy housework versus 31% of same-age women who never had cancer (OR 1.47; 95% CI 1.27-1.69), Carol Sweeney Ph.D., of the Health Research Center at the University of Utah and colleagues wrote in the April 19 issue of the Journal of the National Cancer Institute.
Cochrane Review Backs Antibiotics for COPD Exacerbations - CME Teaching Brief - MedPage Today
AUCKLAND, New Zealand, April 19 - Exacerbations of chronic obstructive pulmonary disease (COPD) should be treated with antibiotics, according to a systematic review published online today by the Cochrane Collaboration.
The review of 11 trials including 917 patients found that antibiotics reduced the risk of dying from the attack by 77%, decreased the risk of treatment failure by 53%, and decreased the risk of developing purulent sputum by 44%.
There was, however, a small increase in the risk of developing diarrhea with antibiotic therapy, said Felix Ram, M.D., of the Massey University here, and colleagues, online in the Cochrane Library, published by The Cochrane Collaboration, an international organization that evaluates medical research.
Mumps Outbreak Tops 1,000 in Eight States - CME Teaching Brief - MedPage Today
ATLANTA, April 19 - The CDC said today that more than 1,000 cases of mumps have been reported in eight states, but Iowa continues to be the epicenter of the outbreak, with 815 confirmed, probable and suspect cases there.
CDC director Julie Gerberding, M.D., M.P.H., said at a press conference here that this year's mumps outbreak is the largest to hit the U.S. in more than 20 years.
Other states with confirmed cases are Kansas, Illinois, Minnesota, Missouri, Nebraska, Oklahoma, and Wisconsin, she said. Seven additional states, which Dr. Gerberding would not identify, are investigating possible mumps cases, she said.
Dr. Gerberding said the CDC has shipped 25,000 doses of mumps vaccine to the Iowa Department of Public Health, and vaccine maker Merck is donating an additional 25,000 doses to the CDC, a gesture that she characterized as both generous and necessary because the CDC is nearing the end of its fiscal year.
The Iowa agency is scheduled to update its mumps reporting tomorrow, but the 815 cases reported yesterday reflect a jump of 210 cases from the data reported April 13. That increase suggests that the outbreak has not yet peaked.
HBNS: Inhaled Steroids Preferred Over Cromolyn to Treat Asthma
Adults and children with asthma will breathe deeper and have better control over their asthma with inhaled corticosteroids than with the medicine cromolyn, according to a new review of recent studies comparing the two treatments.
Adult asthma patients using inhaled steroids such as the brand names Beclovent, Pulmicort and Flovent had on average three fewer severe asthma flare-ups each year compared to patients using inhaled cromolyn, sold under the brand name Intal.
Patients taking the steroids also scored significantly higher on tests of lung function and used their “rescue� inhalers less often than those taking cromolyn, say James Guevara, M.D., of the University of Pennsylvania School of Medicine and colleagues.
The findings were similar for children, Guevara and colleagues add, saying that their review supports recent consensus in the medical community that favors inhaled corticosteroids as a first-choice treatment for asthma.
“To our knowledge, this is the first systematic review comparing the effects of cromolyn to the gold standard, inhaled steroids,� Guevara said.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
HBNS: Herbals Effective for Low-Back Pain in the Short Term, Studies Find
The herbal preparations devil's claw, white willow bark and cayenne plasters may be as effective as pain medication for short-term low back pain and are better than placebo, a new systematic review of studies has found.
The review comprised 10 randomized controlled trials involving nearly 1,600 adults who had acute, sub-acute or chronic low back pain.
Led by Dr. Joel J. Gagnier of the Provincial Medical Centre in Windsor, Canada, the review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The authors looked at randomized controlled trials of the three herbals that involved nearly 1,600 adults with acute, sub-acute or chronic low back pain. The studies pitted devil's claw (Harpago procumbens), white willow bark (Salix alba) and cayenne (Capsicum frutescens) against sham pills and against Vioxx, the painkiller since removed from the market amid concerns over its long-term safety.
“The results of these 10 trials suggest that specific herbal medicines may be effective for short-term (four to six weeks) improvement in pain and functional status for individuals with acute episodes of chronic non-specific low-back pain,� the authors concluded. "These herbal medicines could be considered as treatment options for acute episodes of chronic low back pain," they said.
New Cardiac Resuscitation Protocol Improves Survival - CME Teaching Brief - MedPage Today
TUSCON, Ariz., April 13 - When performed by EMS personnel, a new approach to cardiopulmonary resuscitation (CPR) substantially improves the survival rate for most patients with out-of-hospital cardiac arrest, according to researchers.
The new approach, dubbed cardiocerebral resuscitation (CCR), emphasizes fast, forceful chest compressions to get blood moving through the body over airway management, said Michael J. Kellum, M.D., of the University of Arizona College of Medicine here.
Compared with standard CPR, the new approach nearly tripled survival rates during a one-year study, Dr. Kellum and colleagues reported online in the American Journal of Medicine.
FDA Approves Monthly Injection for Alcohol Dependence - CME Teaching Brief - MedPage Today
AMBRIDGE, Mass., April 13 - The FDA has approved a monthly injectable formulation of Vivitrol (naltrexone for extended-release) for treatment of alcohol-dependent patients, the drug marketers, Alkermes and Cephalon, announced today.
The drug, intended for use by outpatients who are not actively drinking, should be used in combination with psychosocial support, the announcement said.
The companies said they will market the drug in 380 mg IM doses and expect the product to be available by June.
"Vivitrol is the first once-a-month medication for alcohol dependence that ensures patients get the benefit of medication over the entire month," said Richard Rosenthal, M.D., chairman, of psychiatry at St. Luke's-Roosevelt Hospital Center in New York, in the companies' statement.
Vivitrol binds opioid receptors in the brain and preclinical data suggest that binding results in blockade of neurotransmitters that promote alcohol dependence. That blockade is thought to be the mechanism by which Vivitrol reduces alcohol consumption in treated patients.
ScienceDaily: First Clinical Guidelines Issued For Treatment Of 'Swimmer's Ear'
First Clinical Guidelines Issued For Treatment Of 'Swimmer's Ear'
Antibiotic Eases Symptoms in Acute Asthma Attacks - CME Teaching Brief - MedPage Today
LONDON, April 12 - The antibiotic Ketek (telithromycin) improved recovery from an acute asthma attack by three days, reduced symptoms, and improved hospital-based lung function measurements, researchers here reported.
Ketek is a ketolide, a new class of antibiotics structurally related to the macrolides. It has a bactericidal effect against the atypical pathogens Chlamydophila pneumoniae and Mycoplasma pneumoniae, and for that reason the researchers decided to study its potential role in acute asthma attacks, according to a report in the April 13 New England Journal of Medicine.
Abstract-- OBJECTIVE: To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression? METHODS: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence. Results and CONCLUSIONS: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.
AAN: New Parkinson's Disease Treatment Guidelines Issued - CME Teaching Brief - MedPage Today
Review
SAN DIEGO, April 7 - New guidelines for the treatment of Parkinson's disease, issued by the American Academy of Neurology, are more proscriptive than prescriptive.
"We did not describe in what order useful drugs for the treatment of Parkinson's disease should be used," said William Weiner, M.D., of the University of Maryland School of Medicine in Baltimore. "That still remains part of the art of medicine."
Yet the guidelines, released simultaneously in Neurology and at the AAN meeting here, were quite explicit about agents of neuroprotection -- drugs that can prevent or turn back the disease: There are none, the guidelines said.
Review
PHILADELPHIA, April 9 - When it comes to adverse events associated with Coumadin (warfarin) therapy, beware of herbs and many supplements beginning with the letter G, according to a University of Washington investigator.
Douglas S. Paauw, M.D., spelled them out for a standing-room-only crowd at the American College of Physicians meeting here. They are garlic, ginger, and gingko biloba, and ginseng.
"Garlic, ginger, and gingko biloba all increase the anticoagulation of warfarin [Coumadin], while ginseng can decrease it," he said.
Adverse events associated with Coumadin therapy continue to be a leading cause of hospitalizations for drug-related adverse events, and many times the problem can be traced to those herbs and supplements, he said. Dr. Paauw ran through those and other hazards during a session titled, "Ten Common Prescribing Errors: Drug Interactions and Side Effects."
The American College of Physicians supports the need for reform throughout the continuum of training in internal medicine. Today's internists must have the necessary knowledge, skills, and attitudes to meet the challenges of an expanding body of medical knowledge and a rapidly evolving system of health care delivery. Suggested priorities for undergraduate medical education include redesigning curricular experiences to afford students earlier and more exposure to career opportunities in internal medicine, improving ambulatory education, exposing students to outstanding faculty role models in internal medicine, and incorporating educational experiences during the fourth year that optimize its value and relevance to the student's future career plans in internal medicine. Internal medicine residency training should remain a 3-year experience, with a component of core education common to all trainees and a component of customized training in the third year targeted toward the resident's career goals. Residency programs should be designed around educational rather than institutional service needs. The ambulatory component of training requires substantial reform in its structure, sites, content, and timing. Team-based models should be used both for patient care and for flexibility in design of residency training. Better faculty models must be developed that build on the concept of a "core faculty," improve the rewards for teaching faculty, and provide appropriate faculty development focusing on a necessary set of educator competencies.
Sleep Disorders are Widespread in U.S.
Wakeful nights may force your blood pressure to shoot sky high, as per the study conducted by the Researchers at Columbia University in New York. As per the study, if you’re middle age and sleep five or fewer hours a night, you may be increasing your risk of higher blood pressure and increasing heart rate.
Wakeful nights may force your blood pressure to shoot sky high, as per the study conducted by the Researchers at Columbia University in New York. As per the study, if you’re middle age and sleep five or fewer hours a night, you may be increasing your risk of higher blood pressure and increasing heart rate. The data for the study was collected from the first National Health and Nutrition Examination Study of 4,810 people ages 32 to 86 who did not have high blood pressure at baseline. The study was conducted after monitoring the subjects for a 10 year period. It was conducted by a team of researchers led by James E. Gangwisch, PhD, post-doctoral fellow in the psychiatric epidemiology training (PET) program at Columbia University’s Mailman School.
The study resulted out with the higher risk of hypertension for those who slept less than six hours a night. It revealed that 24 percent of people ages 32 to 59 who slept for five or fewer hours a night developed hypertension after controlling for factors such as obesity, diabetes, physical activity, salt and alcohol consumption, smoking, depression, age, education, gender, and ethnicity as compared to 12 percent of those who got seven or eight hours of sleep.
SIR: Ablation of Chest Wall Tumors Eases Intractable Pain - CME Teaching Brief - MedPage Today
TORONTO, April 4 -Minimally invasive ablation of chest wall tumors, alone or combined with radiation, can dramatically reduce pain in terminally ill cancer patients, investigators reported here.
The procedure may even improve survival, said Damian Dupuy, M.D., of Brown Medical School in Providence, R.I., at the Society of Interventional Radiology meeting.
"The key finding of this study is that image-guided ablation therapy can significantly improve patient symptoms caused by chest wall cancer," Dr. Dupuy told reporters.
AACR: Celebrex Dramatically Reduces Adenoma Recurrence - CME Teaching Brief - MedPage Today
WASHINGTON, April 3- The selective Cox-2 inhibitor Celebrex (celecoxib) is effective in reducing recurrence of benign or precancerous adenomas in patients at a high risk of sporadic colorectal cancer, according to two large chemoprevention trials.
One investigator, Nadir Arbor, M.D., of Tel Aviv Sourasky Medical Center, called it "proof of principle that chemoprevention is feasible" in sporadic colon cancer.
Dr. Arbor presented results today of the international Prevention of Sporadic Adematous Polyps (PreSAP) trial at the American Association for Cancer Research meeting. Monica Bertagnolli, M.D., of the Dana-Farber Cancer Institute and Harvard Medical School presented results of the Adenoma Prevention with Celebrex (APC) trial.