Thrombin Test Detects Low Risk of Recurrent Blood Clots - CME Teaching Brief� - MedPage Today
Review
VIENNA, Austria, July 26 -- Patients with a first venous thromboembolism but a thrombin generation of less than 400 nM had a 60% lower risk of a recurrent leg or lung clot, according to a study here.
Measurement of thrombin generation can help determine which patients with venous thromboembolism (VTE) are at low risk for recurrence and can therefore avoid extensive testing and the bleeding risks of anticoagulant treatment, researchers wrote in the July 26 issue of the Journal of the American Medical Association.
Obesity an Increasing Obstacle in Imaging Studies - CME Teaching Brief� - MedPage Today
Review
BOSTON, July 25 -- The increase of obesity in the U.S. doubled the number of poor quality radiology reports, labeled "limited by body habitus," over 15 years, researchers here reported.
In a retrospective analysis of 5,253,014 dictated radiology reports at Massachusetts General Hospital from 1989 through 2003, the number of habitus-limited reports increased steadily from 0.10% in 1989, to 0.14% by 1995, and 0.19% by 2003, according to a report in the August issue of Radiology.
A Systematic Evidence Review
Anne Nedrow, MD; Jill Miller, MD; Miranda Walker, BA; Peggy Nygren, MA; Laurie Hoyt Huffman, MS; Heidi D. Nelson, MD, MPH
Arch Intern Med. 2006;166:1453-1465.
Background Nearly half of adults in the United States use complementary and alternative therapies each year for a variety of reasons. These therapies are increasingly popular among women seeking alternatives to treatment with estrogen for managing menopausal symptoms. The objective of this review was to assess the effectiveness of complementary and alternative therapies in the management of menopausal symptoms.
A Little Exercise Helps Breast Cancer Survivors - CME Teaching Brief� - MedPage Today
Review
HOUSTON, July 21 -- Breast cancer survivors can improve their quality of life by incorporating short bouts of exercise into their daily lives, according to researchers here.
The benefits of brisk walking or climbing stairs include improved physical functioning and decreased pain, reported Karen Basen-Engquist, Ph.D., at the M.D. Anderson Cancer Center here, and colleagues, online in the journal Patient Education and Counseling.
The small pilot study also found that the exercise program significantly improved measures of general health after six months.
Erectile Dysfunction May Be Earliest Warning of Heart Disease - CME Teaching Brief� - MedPage Today
Review
MILAN, July 19 -- Erectile dysfunction may be masking latent ischemic heart disease, according to researchers here.
In a study of almost 300 men with coronary artery disease, erectile dysfunction was seen to appear two to three years before coronary symptoms, reported Piero Montorsi, M.D., and colleagues, of the University of Milan online in the European Heart Journal.
Ultra-Low-Dose Estrogen Patch Found Safe in Later Menopause - CME Teaching Brief� - MedPage Today
SAN FRANCISCO, July 17 -- Unopposed transdermal estradiol at an ultra-low dose over two years did not affect cognitive function or health-related quality of life in post-menopausal women, researchers here reported.
Their randomized, placebo-controlled, double-blind trial of 417 post-menopausal women, ages 60 to 80, at nine U.S. clinical centers, contrasted with two nationwide randomized trials (the Women's Health Initiative Memory Study and the Heart and Estrogen/Progestin Replacement Study).
The earlier studies showed that opposed and unopposed estrogen at the standard dose of 0.625 mg/d worsened cognitive function and increased the risk of heart attack and stroke.
But the new study showed no such cognitive worsening with a weekly transdermal patch that delivered estradiol at 0.014 mg/d to 209 women compared with 208 placebo controls, Kristine Yaffe, M.D., of the University of California San Francisco and the VA Medical Center here, and colleagues, reported in the July issue of the Archives of Neurology.
Women still get lower-quality heart attack care than men, despite hospital improvement efforts
Prevention and Control of Influenza
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54[No. RR-8]:1--44). The 2006 recommendations include new and updated information. Principal changes include 1) recommending vaccination of children aged 24--59 months and their household contacts and out-of-home caregivers against influenza; 2) highlighting the importance of administering 2 doses of influenza vaccine for children aged 6 months--<9 years who were previously unvaccinated; 3) advising health-care providers, those planning organized campaigns, and state and local public health agencies to a) develop plans for expanding outreach and infrastructure to vaccinate more persons than the previous year and b) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is delayed and/or reduced; 4) reminding providers that they should routinely offer influenza vaccine to patients throughout the influenza season; 5) recommending that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until evidence of susceptibility to these antiviral medications has been re-established among circulating influenza A viruses; and 6) using the 2006--07 trivalent influenza vaccine virus strains: A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus. A link to this report and other information can be accessed at http://www.cdc.gov/flu.
Studies indicate medication can be an effective therapy for smoking cessation
The drug varenicline shows effectiveness in helping smokers quit and abstain from smoking when compared to placebo and the smoking cessation medication bupropion, according to three studies in the July 5 issue of JAMA.
Although nearly 41 percent of smokers try to quit smoking each year, relapse is common, and only about 10 percent achieve and maintain abstinence. The negative effects of nicotine withdrawal account, in part, for low success rates, according to background information in the article. Approved pharmacotherapies to treat nicotine dependence (e.g., nicotine replacement therapy and bupropion) have had important, but moderate efficacy, with reported rates of quitting generally twice those of placebo. Additional and more effective therapies are needed.
David Gonzales, Ph.D., of Oregon Health & Science University, Portland, and colleagues with the Varenicline Phase 3 Study Group evaluated the efficacy of varenicline compared with placebo and sustained-release (SR) bupropion in generally healthy adult smokers. Varenicline is a non-nicotine drug that is thought to be beneficial for smoking cessation by stimulating the release of the chemical dopamine in the brain to reduce craving and withdrawal while simultaneously blocking the reinforcing effects of smoked nicotine. Most other smoking cessation pharmacotherapies are nicotine replacement products.