LEXINGTON, Ky. Sept. 25 -- Diabetes is a strong predictor of acute organ failure and early death for obese or non-obese patients alike, eclipsing even obesity without diabetes, according to researchers here.
In the absence of diabetes, a patient's body mass index (BMI) did not foretell organ failure or in-hospital death, according to a large prospective cohort study of 15,408 middle-aged adults, reported in the Sept 25 issue of Critical Care.
Heartburn Remedy May Help Treat Heart Failure - CME Teaching Brief� - MedPage Today
SUITA CITY, Japan, Sept. 25 -- Heart failure patients who added 30 mg of Pepcid (famotidine) to standard therapy significantly improved NYHA functional class and reduced plasma B-type natriuretic peptide levels compared with patients given 150 mg of teprenone.
In a prospective open-label study, the 25 patients assigned to Pepcid for 24 weeks also had significant improvement in blood pressure, left ventricular end diastolic volume, and left ventricular end systolic volume compared with patients in the teprenone group, wrote Masfumi Kitakaze, M.D., Ph.D., and colleagues form National Cardiovascular Center.
The results of the prospective study appeared to confirm results of a retrospective study, and both findings were published together in a single paper in the Oct. 3 issue of the Journal of the American College of Cardiology.
Diabetes Control Requires Options Based on Data
Last weekend the European Association for the Study of Diabetes convened in Copenhagen for their 42nd annual meeting. As reported in Zee News, Dr. Targ Elgzyri from Lund University, Malmo, Sweden presented data that found "people who develop type 2 diabetes when they're younger than 50 years of age are more likely to experience a worsening of their disease than those diagnosed at an older age."
He said the study was conducted because "we found, as previously shown, a progressive rise in HbA1c over time in newly diagnosed patients with type 2 diabetes despite different modes of therapy."
Evidence-based medicine search engine now free
A search engine aimed at health professionals looking for clinical research literature to support patient care will become free-to-access this month.
The Turning Research Into Practice (TRIP) database has been running since 1997, but money spent on improving the search facility, led to it converting to a subscription-only basis, three years ago.
Directors John Bassey and Dr Chris Price now feel that with the service has been improved as planned and can now go back to being a free service, supported through advertising and paid for links into the database.
Review
FRESNO, Calif., Sept 5 -- Pumping up the statin dose may decrease the risk for cardiovascular events in patients with coronary disease and metabolic syndrome.
In a post-hoc analysis of the Treating to New Targets study, which compared high-dose Lipitor (atorvastatin) with a moderate-dose of the same drug in patients with stable coronary heart disease, high-dose Lipitor provided incremental protective benefits in patients with the metabolic syndrome.
So reported Prakash Deedwania, M.D., of the University of California San Francisco and the VA Central California Healthcare System here, in the Sept. 5 online edition of The Lancet for the Treating to New Targets Investigators.
Leah Ranney, PhD, MA; Cathy Melvin, PhD, MPH; Linda Lux, MPA; Erin McClain, MA, MPH; and Kathleen N. Lohr, PhD
5 December 2006 | Volume 145 Issue 11
Background: While smoking cessation interventions have been shown to work, questions remain about how to increase their efficacy.
Purpose: To examine strategies for effective tobacco treatment in adults and special populations.
Data Sources: MEDLINE, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane Library, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts (1 January 1980 to 10 June 2005).
Study Selection: Systematic reviews; randomized, controlled trials; and observational studies.
Data Extraction: Two reviewers independently abstracted data on study design, population, sample size, treatment, outcomes, and quality.
Data Synthesis: Findings from systematic reviews were summarized and compared with findings from original research published beyond date ranges included in the reviews. Strength of evidence was used to assess the body of evidence. Our review included studies evaluating the efficacy of cessation strategies, such as self-help, counseling, single pharmaceutical agents, combined pharmacotherapies, and pharmacotherapies combined with psychological counseling. Research findings consistent with previous reviews show that self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve rates of success with quit attempts. Two studies of self-help materials reported discrepancies across effects. Five studies provided mixed results for counseling interventions. Fourteen studies provided sufficient evidence of the efficacy of single pharmacotherapy, combined pharmacotherapy, and psychological interventions either with or without pharmacotherapy.
Few studies focused on ways to reach or treat special populations. Three studies with hospitalized patients agreed with findings of a previous review showing no strong evidence that clinical diagnosis affected the likelihood of quitting. New evidence was insufficient to address the effectiveness of interventions for persons with coexisting psychiatric conditions and substance abuse problems.
Limitations: Previous systematic reviews variably cover the range of issues we addressed. More recent studies do not fill all gaps, especially those for persons with coexisting disease.
Conclusions: Although self-help strategies alone marginally affect quit rates, individual and combined pharmacotherapies and counseling either alone or in combination can significantly increase cessation. Using effective smoking treatments is strongly encouraged for all populations, especially those with high and heavy rates of smoking, such as psychiatric and substance abuse populations.
Newswise | New Report Suggests Will Power Alone Not Effective in Helping Smokers Quit
Newswise — People who wish to stop smoking can significantly increase their chances of success by using medications such as bupropion, nicotine patch, gum, or an inhaler, according to a new report by researchers at the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
The report, published in the September issue of Annals of Internal Medicine, found that self-help smoking cessation strategies alone are often ineffective.
This article reviews how data on the benefits and hazards of antidepressants have been analysed, and how conclusions drawn from these analyses conflict with the data. Randomised trials of antidepressants have for two decades consistently shown evidence of an increased risk of suicidal acts on active treatment compared with placebo, but an inappropriate application of significance testing has led to this evidence being dismissed. During the same period a minority of antidepressant trials have produced data indicative of benefits that have reached statistical significance at a 95% level. In this case significance testing appears to have led to an unrealistic impression of the likely benefits of treatment in practice. Current approaches to evidence-based medicine risk perpetuating misunderstandings of this type. Against a background of current developments in healthcare delivery, clinicians might need to reconsider how they handle and present clinical trial data.
Deep Brain Stimulation Improves Parkinson's Symptoms - CME Teaching Brief� - MedPage Today
Review
KIEL, Germany, Aug. 30 -- Deep-brain stimulation for Parkinson's disease outperformed medical management in a randomized trial of the electrodes.
The surgical technique, in which an electrode is implanted in the subthalamus, led to sharp increases in quality of life and decreases in severity of symptoms, according to G�nther Deuschl, M.D., Ph.D., of Christian Albrechts University here.
On the other hand, serious adverse events were greater in the surgical arm, Dr. Deuschl and colleagues reported in the Aug. 31 issue of the New England Journal of Medicine.
Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention (see Table 1). MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes MNT. The previous position statement with accompanying technical review was published in 2002 (1) and modified slightly in 2004 (2). This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available based on the American Diabetes Association evidence-grading system. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT.
NEJM -- Primary Care -- Will It Survive?
The American College of Physicians recently warned that "primary care, the backbone of the nation's health care system, is at grave risk of collapse."1 And indeed, primary care is facing a confluence of factors that could spell disaster. Patients are increasingly dissatisfied with their care and with the difficulty of gaining timely access to a primary care physician; many primary care physicians, in turn, are unhappy with their jobs, as they face a seemingly insurmountable task; the quality of care is uneven; reimbursement is inadequate; and fewer and fewer U.S. medical students are choosing to enter the field.