Concerns Also Expressed About Impact of '08 Budget on Medicare Recipients in Need of Medical Rehabilitation Care CRYSTAL CITY, Va., Feb. 12 /PRNewswire-USNewswire/ -- Researchers presented findings today at the State of the Science Symposium on Post-Acute Rehabilitation in Crystal City demonstrating that the setting for rehabilitative care directly influences the outcome for patients recovering from strokes, joint replacement operations, and other conditions. The findings highlighted the need for evidence-based research to drive public-policy decisions for Medicare recipients in need of post-acute rehabilitation services. Researchers also expressed concern about the impact of the proposed 2008 budget on Medicare beneficiaries who are in need of rehabilitative care to recover from a stroke, joint replacement surgery, hip fracture, and other illnesses. The findings were discussed at a press conference today at the opening of the symposium in Crystal City, Virginia. The symposium opened with remarks from Senator Bob Dole.
ASA: Stroke Symptoms in Women Often Atypical - CME Teaching Brief- MedPage Today
SAN FRANCISCO, Feb. 8 -- Women do not always show textbook examples of stroke symptoms to emergency department physicians, researchers said here.
In a study of more than 1,700 patients with confirmed stroke, women were 33% less likely than men to have any of the five classical warning signs as the chief complaint, said Julia W. Gargano, M.S., of Michigan State University in East Lansing.
Lonely Souls Susceptible to Alzheimer's Disease - CME Teaching Brief - MedPage Today
CHICAGO, Feb. 5 -- Older men and women who are lonely are twice as likely to develop Alzheimer's-type dementia as their peers with good social networks, researchers have found.
The elevated risk for dementia among the lonely was unrelated to medical causes for Alzheimer's disease or other forms of dementia, suggesting that the social isolation may lead to dementia by another route, wrote Robert S. Wilson, Ph.D., and colleagues at Rush University here and the University of Pennsylvania.
Action Points
* Explain to patients who ask that the link between loneliness and increased risk for dementia is unclear, but may be related to behavioral changes brought on by dementia, or by changes in brain function caused by reaction to social isolation.
"The basis of the association of loneliness with Alzheimer's disease and cognitive decline is uncertain," the investigators wrote in the February issue of Archives of General Psychiatry. "One possibility is that loneliness is a consequence of dementia, perhaps as a behavioral reaction to diminished cognition or as a direct result of the pathology contributing to dementia."
First Time May Be Charm for Anti-Epileptic Drugs - CME Teaching Brief� - MedPage Today
GLASGOW, Scotland, Feb. 5 -- About half of adults with newly diagnosed epilepsy will have good control of their seizures with the first medication tried, and a majority of responders will be seizure free at the lowest dose, reported European investigators.
Action Points
* Explain to patients who ask this study indicates that either of two drugs -- controlled-release carbamazepine (Carbatrol) or levetiracetam (Keppra) -- is effective at preventing recurring seizures in adults who are newly diagnosed with epilepsy.
In a double-blind trial comparing Keppra (levetiracetam) with Carbatrol (controlled-release carbamazepine) in such patients, nearly three-fourths of those randomized to either medication were seizure-free on the last evaluated dose for at least six months, reported Martin J. Brodie, M.D., of the Western Infirmary here, and colleagues, in the Feb. 6 issue of Neurology.
Striking Disparities in ER Evaluation of Chest-Pain - CME Teaching Brief - MedPage Today
MILWAUKEE, Feb. 2 -- When patients with chest pain arrive at the emergency department, they may get profiled, before decisions are made on care, by race, female gender, and insurance coverage, found a national study by researchers here.
Action Points
* Explain to interested patients that although this study contributes to the growing literature on disparities in the provision of cardiac care, the study could not determine the clinical outcome of the disparities, or the cause or appropriateness of these differences.
A retrospective study of 7,068 patients, corresponding to more than 32 million such visits annually, found differences in who gets ECGs and x-rays as well as cardiac rhythm and oxygen saturation monitoring using pulse oximetry, said a study published in the February issue of Academic Emergency Medicine.
News - Guidelines to Address Support of Families in the ICU
DES PLAINES, IL -- February 1, 2007 -- Clinical practice guidelines on supporting families whose loved ones are patients in intensive care units (ICU) will be published in the February issue of Critical Care Medicine and available on the Society of Critical Care Medicine's website www.LearnICU.org.
This is the first set of guidelines that defines standards for incorporating families into decision-making and care for ICU patients. "The guidelines attempt to define evidence-based best practices for support of families in the delivery of patient-centered care in the ICU," says Judy E. Davidson, RN, FCCM, chairperson of the American College of Critical Care Medicine task force and the lead author of the guidelines. "It is now known that up to 80% of family members of ICU patients develop anxiety, depression and/or post-traumatic stress response related to their experience."
TAMPA, Fla.--(BUSINESS WIRE)--Jan 31, 2007 - Nanobac Pharmaceuticals Inc. (OTCBB:NNBP) ("Nanobac" or "the Company") announces new evidence that may help solve one of the great puzzles of 21st century medicine was published today in a special section of the Journal of Investigative Medicine. It features leading scientists in the field brought together by The American Federation for Medical Research and the American Physiological Society.
Is chronic disease triggered by an infection? New evidence comes from scientists at NASA, Mayo Clinic, and Nanobac Pharmaceuticals who pioneered investigations into infectious calcifying particles.
A condition known as calcification occurs in most diseases on the leading cause of death list and in illnesses such as kidney, gallbladder and prostate stones. Calcification is also linked to chronic inflammation in atherosclerosis and end-stage renal disease, but it is unclear how this occurs.
The United Nations Food and Agriculture Organisation (FAO) has reported resurgence of the dreaded avian influenza in at least eight countries in Asia and Africa, and has urged all nations to remain vigilant and fully cooperate with international organisations in keeping this menace under check.
In a statement issued simultaneously in Rome and Bangkok, the FAO has said 2007, new flare-ups of the bird flu have been reported this year, from China, Egypt, Indonesia, Japan, Nigeria, South Korea, Thailand and Vietnam.
The FAO has cautioned that cold weather enhances virus survival. Wild bird migration as well as the movement of animals can play a role in its spread. However, it also pointed out that the number of outbreaks in the first few weeks of this year has been significantly lower than the epidemic waves of last year.
Even while observing that the inter-continental flow of the H5N1 bird flu virus by wild birds migrating from Asia to Europe and Africa had not taken place during this autumn/winter season at the same level as it had in 2005, the FAO has stressed that the virus persists in several Asian countries as well as in Egypt and Nigeria. Other countries may also have it but have yet to declare.
With the start of the first epidemic wave in Asia in late 2003 and early 2004, eight countries became infected. During 2004/05, the situation improved in some countries but remained largely unchanged. In 2005/06, the virus spread from East Asia to Siberia, Eastern Europe, the West Asia and Africa, affecting over 40 countries, including India.
MRI Beats CT for Acute Stroke Diagnosis - CME Teaching Brief- MedPage Today
BETHESDA, Md., Jan. 25 -- MRI is better than CT for detecting acute strokes of any kind, and should be the diagnostic imager of choice in the ER, according to NIH researchers.
Comparing the two modalities in patients with suspected acute stroke, the investigators found that the sensitivity of MRI for diagnosing acute strokes was 83%, compared with just 26% for CT performed on the same patients.
Action Points
* Explain to patients who ask that early diagnosis of acute stroke and differentiation between ischemic and hemorrhagic strokes is essential for preventing or reducing subsequently disability. This study suggests that MRI should be the imager of choice when emergency doctors suspect acute stroke.
MRI was also superior to CT at diagnosing acute hemorrhagic stroke and chronic stroke, and was comparable at detecting intracranial hemorrhage, reported Steven Warach, M.D., Ph.D., of the National Institute for Neurological Disorders and Stroke, and colleagues, in the Jan. 27 issue of The Lancet.
TIA-to-Stroke Risk Prediction Easy As A-B-C-D2 - CME Teaching Brief - MedPage Today
SAN FRANCISCO, Jan. 26 -- A new prognostic tool called ABCD2 for predicting the early risk of stroke after transient ischemic attack (TIA) may help physicians determine which patients need emergency care, according to researchers here.
Action Points
* Explain to interested patients that after a TIA most strokes occur within the first days or weeks.
* Point out to patients that risk prediction tools help physicians determine which patients may need hospitalization and emergency care due to their high risk for a stroke after TIA.
The ABCD2 scoring system tended to predict short-term stroke risk better than the two existing longer-term risk prediction scales, reported S. Claiborne Johnston, M.D., of the University of California San Francisco, and colleagues, in the Jan. 27 issue of The Lancet.
CDC - Influenza (Flu) | Flu Vaccine Effectiveness: Q & A for Health Professionals
How is influenza vaccine effectiveness measured?
Vaccine efficacy and effectiveness studies use various endpoints or outcomes, which influence how we interpret the results. These endpoints may include the prevention of medically attended acute respiratory illness (MAARI), prevention of laboratory-confirmed influenza virus illness or hospitalization, prevention of influenza-like illness (ILI, such as illness with fever and cough or sore throat), or influenza-associated hospitalizations or deaths. Studies that use outcomes such as an influenza laboratory-confirmed outcome provide the most specific estimates of the impact of the vaccine in preventing influenza. The more non-specific the outcome being measured (e.g., all pneumonia hospitalizations or influenza-like illness that include many illnesses not caused by the influenza virus), the lower the estimates of vaccine effectiveness. For example, a study by Bridges et al. (JAMA 2000) among healthy adults found that the inactivated influenza was 86% effective against laboratory-confirmed influenza, but only 10% effectiveness against all respiratory illnesses in the same population and year.
Background Rapid influenza testing decreases antibiotic and ancillary test use in febrile children, yet its effect on the care of hospitalized adults is unexplored. We compared the clinical management of patients with influenza whose rapid antigen test result was positive (Ag ) with the management of those whose rapid antigen test result was negative or the test was not performed (Ag0).
Drug-Eluting Stents: What Is the Real Risk? - CME Teaching Brief - MedPage Today
GAITHERSBURG, Md., Jan. 11 -- The issues surrounding the safety of drug-eluting coronary stents remain white hot, with extremes views on the future of the little mesh devices.
The core question is whether drug-eluting stents will emerge, in the end, as a great boon to coronary-disease patients or as an out-of-control lethal insult of major magnitude.
The two approved devices, Cypher (sirolimus-eluting) and Taxus (paclitaxel-eluting), dodged several bullets late last year when an FDA advisory safety panel agreed that the stents are safe when used according to label directions Yet that use represents a minority of the millions of drug-eluting stents implanted in Americans.
New recommendations for the diagnosis of Pulmonary Embolism
Diagnosis of Pulmonary Embolism (PE) is a challenging process. Because PE is only present in about one-third of those in whom it is suspected, the diagnosis must be confirmed or excluded by further testing. In an article in the December issue of The American Journal of Medicine, researchers describe the diagnostic pathways that can be used to achieve an accurate and safe diagnosis of PE.
Based on the results from the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and other studies, these guidelines include both evidence-based recommendations and opinions based on information available at this time.
Antibiotics are no cure for acute bronchitis
Posted on Thursday, November 16, 2006 (EST)
A new study by researchers at the Virginia Commonwealth University School of Medicine has found that antibiotics that are routinely prescribed for acute bronchitis are totally unnecessary.
Washington, Nov 16: A new study by researchers at the Virginia Commonwealth University School of Medicine has found that antibiotics that are routinely prescribed for acute bronchitis are totally unnecessary.
Richard P. Wenzel, M.D., professor and chair in the Department of Internal Medicine at the VCU School of Medicine, and Alpha A. Fowler III, M.D., chair in the Division of Pulmonary Disease and Critical Care Medicine, conducted a critical review of the world literature.
They examined research studies and clinical trials regarding acute bronchitis as they related to individuals, pathology, diagnosis, treatment strategies and any data supporting the potential benefits of anti-bacterial agents.
No Heart Risk for Women Who Favor Protein Over Carbs - CME Teaching Brief - MedPage Today
BOSTON, Nov. 8 -- Women who say no to carbs, but yes to protein as recommended in the South Beach and Zone diets, do not increase their risk of coronary heart disease, according to researchers here.
And women who consume low-carbohydrate diets that emphasize vegetables rather than animals as the source of protein and fat may be rewarded with a moderate reduction in risk of heart disease.
Action Points
* Explain to interested patients that this observational study found no increase in the risk of coronary heart disease for women who followed a low-carb, high-protein diet.
* Explain to interested patients that this report is based on an observational study, the findings of which are not considered as solid as findings from a randomized clinical study.
So it emerged from the Nurses' Health Study, a longitudinal study of 82,802 women who have been followed since 1976.
Women whose diets consisted mainly of vegetable protein and fat were are about 30% less likely to develop coronary heart disease than women who whose diets contained either more carbohydrates or more animal protein and fat (P for trend=0.002), Thomas L. Halton, Sc.D. of the Harvard School of Public Health, and colleagues reported in the Nov. 9 issue of the New England Journal of Medicine
Aricept (donepezil) Wins Indication for Severe Alzheimer's - CME Teaching Brief - MedPage Today
ROCKVILLE, Md., Oct. 13 -- Aricept (donepezil), a cholinesterase inhibitor on the market for mild to moderate Alzheimer's disease, today became the first of its class to win FDA approval for severe disease.
The FDA action made Aricept the only drug approved to treat all stages of Alzheimer's.
The FDA decision was based on efficacy demonstrated in two randomized, placebo-controlled 24-week trials in Sweden and Japan. The trials enrolled more than 500 patients with severe Alzheimer's dementia.
Both trials evaluated Aricept's efficacy with standard measures that assessed cognitive function including memory, language, orientations, and attention as well as overall functioning. The patients randomized to Aricept had better scores than patients in the placebo arms of both studies.
ANA: 24-Hour Patch for Parkinson's Exhibits Staying Power - CME Teaching Brief - MedPage Today
CHICAGO -- Parkinson's patients were able to control symptoms of early-stage disease for at least 85 weeks using a once-daily transdermal patch delivering investigational rotigotine, investigators reported here.
Action Points
* Explain to interested patients that the rotigotine transdermal patch is still investigational therapy.
* This study was presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
The patients were part of an open-label extension trial of the patch, which contains 2 mg to 6 mg of the rotigotine, a dopamine agonist.
Before the extension trial, the patch was compared with placebo in a six-month test of efficacy, reported Ray Watts, M.D., chairman of neurology at the University of Alabama at Birmingham, at the American Neurological Association meeting.
The 137 patients on the active medication showed an immediate reduction in scores on the Unified Parkinson's Disease Rating Scale of about seven points, he said, and after six months that score remained four points below baseline.
Obesity May Mask Prostate Cancer Risk by Lowering PSA Levels - CME Teaching Brief - MedPage Today
Obesity May Mask Prostate Cancer Risk by Lowering PSA Levels
SILVER SPRING, Md., Oct. 5 /PRNewswire/ -- Discovery Health announced today the premiere of its Continuing Medical Education (CME) program on the 2005 Dietary Guidelines, EAT RIGHT, LIVE RIGHT: THE POWER OF SIMPLE STEPS (Premieres: Sunday, October 8, at 10:00 AM ET/PT). Created for use by health care professionals, the program addresses the epidemic of adult and childhood obesity in the United States, resulting in a burden of chronic disease, such as type 2 diabetes, cardiovascular disease, cancer and other diseases. This new Discovery Health CME program brings together a group of experts to discuss the U.S. Department of Health & Human Services and the U.S. Department of Agriculture's 2005 Dietary Guidelines for Americans, which provide scientific-based information to promote health and reduce the risk of chronic disease. The guidelines provide simple yet sensible steps that can lead to improved health among all populations. Learning about dietary guidelines assists in a better understanding of how sound nutrition, coupled with regular physical activity, can prevent disease and help individuals live longer, more active lives.
News - Management of Hypertension in Ischemic Stroke: AAFP 2006
WASHINGTON, DC -- October 4, 2006 -- Available data support the use of diuretics alone and in combination with an angiotensin-converting enzyme inhibitor (ACEI), according to a presentation made here at the American Academy of Family Physicians (AAFP) Annual Scientific Assembly.
News - Updated Guidelines on Diagnosis, Treatment of Lyme Disease
ALEXANDRIA, VA -- October 2, 2006 -- In response to growing concern and confusion about Lyme disease, the Infectious Diseases Society of America (IDSA) has updated its Clinical Practice Guidelines on the disease, in order to provide guidance to physicians and patients based on the latest scientific evidence. The guidelines were originally published in 2000.
The most significant changes in the updated version include:
-- The addition of information on human granulocytic anaplasmosis (HGA) and babesiosis, two diseases transmitted by the same tick that transmits Lyme disease;
-- Recommendations of a single dose of an antibiotic for certain high-risk patients who have been bitten by a tick but do not have symptoms of Lyme disease;
-- Expanded discussion and definition of so-called "chronic" or post-Lyme syndromes.
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.
Review
CORTE MADERA, Calif., Aug. 28 -- If alcoholics quit drinking early enough and stay sober long enough, the recovery of their mental functions will be nearly complete, a study here suggested.
A group of 48 alcoholics who had remained sober for an average of nearly seven years (and some as long as 13 years), performed essentially the same on an extensive battery of neurocognitive tests as a group of healthy controls, George Fein, Ph.D., and colleagues reported in the September issue of Alcoholism: Clinical & Experimental Research.
Review
SAN ANTONIO, Aug. 25 -- For men with newly diagnosed metastatic prostate cancer treated with androgen deprivation therapy (ADT), PSA levels at seven months seem to predict long-term survival or early failure.
Those whose PSAs fell to below 4 ng/dL while undergoing androgen deprivation therapy had about one-third the mortality risk, of men whose levels were higher, said Maha Hussain, M.D., of the University of Michigan in Ann Arbor, reporting for the Southwestern Oncology Group (SWOG).
"This is the first trial in the setting of new D2 [metastatic] prostate cancer to demonstrate unequivocally the survival advantage associated with absolute PSA value in response to androgen deprivation therapy," Dr. Hussain and colleagues wrote in the Aug. 20 issue of the Journal of Clinical Oncology.
MRSA Skin Infections Flooding Emergency Department - CME Teaching Brief� - MedPage Today
Review
SYLMAR, Calif., Aug. 16 -- Methicillin-resistant bacteria are taking emergency room doctors back to the pre-penicillin days, when skin infections were lanced and drained.
Methicillin-resistant Staphylococcus aureus (MRSA) infection has become the most common cause of skin and soft tissue infections seen in metropolitan emergency departments, and half-century-old therapeutic approaches are being revisited to combat it, according to two studies in the Aug. 17 New England Journal of Medicine.
NEJM -- Changing the Paradigm for HIV Testing -- The End of Exceptionalism
The Centers for Disease Control and Prevention (CDC) is poised to issue new recommendations for testing for HIV in adults, adolescents, and pregnant women. Frustrated that more than 25 percent of Americans with HIV infection are unaware of their status and that almost 40 percent of those with newly diagnosed AIDS discover that they are infected less than a year before diagnosis, officials have proposed that HIV screening be routinely offered in all health care settings.
The CDC already recommends routine testing among high-risk groups and in high-prevalence settings. The radical departure is the extension of routine testing to the entire population and the reconceptualization of the requirements for consent. Patients would be told that HIV testing was a routine part of care and given the opportunity to opt out. According to the CDC, specific signed consent would no longer be required, because "general consent for medical care is sufficient to encompass consent for HIV testing."
Vegan Diet Bests ADA Plan at Diabetes Control - CME Teaching Brief� - MedPage Today
Review
WASHINGTON, Aug. 9 -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.
Both a low-fat vegan diet and a diet following American Diabetes Association guidelines improved glycemic control and cardiovascular risk factors in patients with type 2 diabetes, found a 22-week study partially funded by NIH and published in the August issue of Diabetes Care.
High-Dose Statins Following a Stroke Can Prevent a Second - CME Teaching Brief� - MedPage Today
Review
Patients with cardiovascular disease are less likely to have a stroke if they are taking statins.
CHICAGO, Aug. 9 -- Loading up on a statin within six months of a stroke or transient ischemic attack reduced the risk of recurrent stroke or TIA, according to results of a major trial published today.
Lipitor (atorvastatin) at 80 mg/day begun during that period was associated with 2.2% five-year absolute reduction in risk of stroke (P=0.03) and a 16% relative reduction in risk of fatal or nonfatal stroke, found the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial.
Secondary endpoints, with the exception of death, also significantly favored the Lipitor group, reported K. Michael Welch, M.B., Ch.B., of Rosalind Franklin University of Medicine and Science, and colleagues, in the Aug. 10 issue of the New England Journal of Medicine.
Genetic Tests Generally Agree on Breast Cancer Prognosis - CME Teaching Brief� - MedPage Today
Review
CHAPEL HILL, N.C., Aug. 9 -- Geneticists are coming to general agreement that they know the future of a breast tumor when they see it.
Four of the five available genetic tests to predict cancer recurrence or death of individual patients are in concordance even though each uses a gene set largely distinct from the others for expression profiles, said geneticist Charles M. Perou, Ph.D., of the University of North Carolina Lineberger Comprehensive Cancer Center, and colleagues.
When they applied the five tests to tumor samples from 295 patients, the investigators found that four agreed in their predictions of cancer recurrence or death of individual patient, they reported in the Aug. 10 issue of the New England Journal of Medicine.
DES Daughters at Higher Risk of Breast Cancer - CME Teaching Brief� - MedPage Today
Review
BOSTON, Aug. 7 -- Women whose mothers took the synthetic estrogen DES (diethylstilbestrol) have a sharply increased risk of breast cancer once they are 40 or older, according to researchers here.
"This is really unwelcome news because so many women worldwide were prenatally exposed to DES, and these women are just now approaching the age at which breast cancer becomes more common," said Julie Palmer, Sc.D., of the Boston University School of Public Health here.
The so-called DES daughters -- perhaps as many as two million in the U.S. -- were already known to be at higher risk of clear cell carcinoma of the vagina and cervix and their mothers have already been shown to be at higher risk of breast cancer.
But the current study, published in the August issue of the journal Cancer Epidemiology, Biomarkers & Prevention, is the first to show clearly that the DES daughters are at higher risk of breast cancer as they age than are women who weren't exposed to the drug, Dr. Palmer and colleagues said.
Review
A single injection of ketamine can eliminate depression symptoms within 110 minutes.
BETHESDA, Md., Aug. 7 -- Symptoms of depression can be made to disappear in less than two hours with a common anesthetic, not the weeks or months required for onset of relief with traditional antidepressants, according to results of a pilot study.
"We have broken the sound barrier in depression treatment," said Carlos A. Zarate, Jr., M.D., chief of the mood disorders section the National Institute of Mental Health, who reported on the effects of ketamine, a common anesthetic, in the August 8 issue of the Archives of General Psychiatry.
Coumadin Outweighs Hemorrhage Risk in Older Afib Patients - CME Teaching Brief� - MedPage Today
Review
SAN FRANCISCO, Aug. 4 -- Even though anticoagulation for atrial fibrillation may boost the chance of an intracranial bleed slightly in elderly patients, the benefits of the therapy outweigh the risk of a hemorrhage, according to researchers here.
In a retrospective study of more than 13,500 adults with non-valvular atrial fibrillation, hemorrhage rates rose with age, and were actually slightly higher among patients who were not taking Coumadin (warfarin), wrote Margaret C. Fang, M.D., M.P.H., of the University of California San Francisco, and colleagues.
The risk for hemorrhage rose "strikingly" after age 80, the authors reported in the Aug. 10 issue of the Journal of the American Geriatrics Society. But they also found the risks for other adverse events outweigh the risks for hemorrhage in patients on Coumadin.
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.
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.
Diabetes Adds 15 Years to Heart Attack Risk Calculation - CME Teaching Brief - MedPage Today
TORONTO, June 29 — Diabetes is the clinical equivalent of aging 15 years, thrusting men and women with the disease into a high-risk category for cardiovascular disease while still in middle-age.
A 48-year-old diabetic man has a 20% risk of suffering an acute myocardial infarction by age 58, wrote Gillian L. Booth, M.D., and colleagues, of the University of Toronto in the July 1 issue of The Lancet.
WHO | WHO updates aviation guidelines for TB prevention
WHO today issued updated guidelines for the airline industry that will further minimise the risk of tuberculosis (TB) and other infectious diseases being passed from passenger to passenger on board aircraft. The 'Tuberculosis and Air Travel' guidelines stipulate that people with infectious TB must postpone long-distance travel, while those with multidrug-resistant tuberculosis (MDR-TB) must postpone any air travel.
To date, no case of active TB has been identified as a result of exposure on a commercial aircraft. The quality of the air on board commercial aircraft is high and under normal conditions cabin air is cleaner than the air in most buildings.
LISBON, Portugal, June 27 /Xinhua-PRNewswire/ -- The newly released version of the International Consensus Statement on Prevention and Treatment of Venous Thromboembolism (VTE), one of the leading expert consensus document specifically dedicated to the prevention and treatment of VTE, was presented at the 22nd Congress of the International Union of Angiology, Lisbon, Portugal. "These international guidelines provide recommendations guided by the rigorous review of clinical evidence by a large panel of international experts. These evidence-based guidelines provide updated recommendations on appropriate therapies and medical strategies to use with the different categories of patients at risk for VTE" says Pr. Andrew Nicolaides, Emeritus Professor, Imperial College, London, UK, and chairman of the editorial committee of the Guidelines.
Review
DENVER, June 27 — Treatment decisions for localized prostate cancer tend to be driven more by patients' fears and misconceptions rather than by understanding of the evidence, according to accounts of newly diagnosed patients.
A deliberate and thorough decision-making process is uncommon, suggest structured interviews with 20 men (age 54 to 80) diagnosed with localized prostate cancer, said Thomas Denberg, M.D., Ph.D., of the University of Colorado here.
Instead, fearful that the cancer might quickly spread, more than half of the men expressed the desire to have it treated as quickly as possible, even though most knew prostate cancer is slow-growing, Dr. Denberg and colleagues, all internists, reported online in the journal Cancer.
Chest X-Rays Raise Breast Cancer Risk in Susceptible Women - CME Teaching Brief - MedPage Today
Review
PARIS, June 26 — Diagnostic chest x-rays apparently bestow an increased risk of breast-cancer in women with mutations in BRCA susceptibility genes.
Any exposure to radiation from chest x-rays increased the women's risk by about 1.5-fold, reported Nadine Andrieu, Ph.D., and colleagues of the Institut Curie here, and other centers, in an early online release from the July 20 issue of Journal of Clinical Oncology.
LISBON, Portugal, June 26 /PRNewswire/ -- The newly released version of the International Consensus Statement on Prevention and Treatment of Venous Thromboembolism (VTE), one of the leading expert consensus document specifically dedicated to the prevention and treatment of VTE, was presented at the 22nd Congress of the International Union of Angiology, Lisbon, Portugal.
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"These international guidelines provide recommendations guided by the rigorous review of clinical evidence by a large panel of international experts. These evidence-based guidelines provide updated recommendations on appropriate therapies and medical strategies to use with the different categories of patients at risk for VTE," says Pr. Andrew Nicolaides, Emeritus Professor, Imperial College, London, UK, and chairman of the editorial committee of the Guidelines.
Newswise | Hospital Publishes Rehabilitation Guidelines Book
Newswise — Soon everyone who needs it will be able to benefit from Hospital for Special Surgery’s high rehabilitation standards.
With the publication of Hospital for Special Surgery’s (HSS) comprehensive reference book, Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, therapists around the country will be able to follow step-by-step examples to develop their own postsurgical treatment plans. Incorporating 45 comprehensive guidelines, it is the first textbook of its kind to cover all aspects of evidence-based postsurgical rehabilitation for musculoskeletal disease.
“I believe it is the only textbook to feature 25 years of collective knowledge from a highly ranked musculoskeletal hospital like ours,� said JeMe Cioppa-Mosca, PT, MBA, assistant vice president, Department of Rehabilitation at Hospital for Special Surgery in New York City. “Most other available textbooks focus primarily on one area such as hands or sports. Our textbook is different. It focuses on the entire spectrum of postsurgical rehabilitation as it relates to musculoskeletal disease.�
The overlying organization of the book is based on the major orthopedic services performed at HSS. Sections include Arthroplasty, Hand, Pediatric, Spine and Sports Medicine Rehabilitation.
Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician features easy-to-follow guidelines that enable practitioners and students to look up a procedure and quickly see the recommended rehabilitation strategy. Also, the clear photos and illustrations show how to correctly perform the techniques described in the book, and the phases of treatment are defined in tables that clearly show goals, precautions, treatment strategies and criteria for advancement.
SLEEP: Treatment for Apnea Needs Follow-Up Fine Tuning - CME Teaching Brief - MedPage Today
Review
Carl Stepnowsky, Ph.D.
SALT LAKE CITY, June 22 — Adherence to treatment with continuous positive airway pressure (CPAP) by patients with obstructive sleep apnea may be considerably less than believed.
A retrospective analysis of 528 new users of CPAP machines showed that only 17% were using them as prescribed, said Carl Stepnowsky, Ph.D., of the University of California at San Diego.
Another 63% "are below what we would usually consider to be acceptable, which is four hours a night," he reported here at Sleep 2006, the joint meeting of the Sleep Research Society and the American Academy of Sleep Medicine.
More men than women get best care for heart attack�|�Reuters.com
More men than women get best care for heart attack
Fibromyalgia Symptoms Respond to Acupuncture - CME Teaching Brief - MedPage Today
Review
ROCHESTER, Minn., June 16 — Acupuncture not only offered pain relief for fibromyalgia patients, but it significantly improved fatigue and anxiety symptoms, Mayo Clinic researchers reported.
This prospective, partially blinded, controlled, randomized trial included 50 fibromyalgia patients who had met American College of Rheumatology criteria for the disorder and had tried conservative treatments, including dietary and herbal supplements, David Martin, M.D., Ph.D., and colleagues, here wrote in the June issue of the Mayo Clinic Proceedings.
Family Physicians Skip Lung Function Test in Diagnosing COPD - CME Teaching Brief - MedPage Today
Review
HINES, Ill., June 16 — Family physicians may be diagnosing chronic obstructive pulmonary disease (COPD) overly hastily, evaluating only symptoms and smoking history without the recommended spirometry, according to researchers here.
About two-thirds of patients newly diagnosed with COPD never received spirometry testing, reported Todd A. Lee, PharmD, Ph.D., of the Hines Veterans Affairs hospital here, and colleagues in the June issue of the journal Chest.
FDA Approves Cervical Cancer Vaccine - CME Teaching Brief - MedPage Today
OCKVILLE, Md. June 8 — The FDA today approved Gardasil (quadrivalent human papillomavirus [Types 6, 11, 16, 18] recombinant vaccine) for prevention of cervical cancer and for prevention of cervical, vulvar and vaginal pre-cancers caused by HPV types 16 and 18.
The agency said the vaccine, made by Merck, was approved for immunization of girls and women ages nine to 26. The vaccine was not approved for immunization of boys, however, a blow to the cancer prevention community that had campaigned for approval in both boys and girls.
Biological Clock Tolls for Men Too - CME Teaching Brief - MedPage Today
Review
LIVERMORE, Calif., June 7 — As healthy men age, they become less likely to father a successful pregnancy, according to investigators here. Aging men have an increased risk for having children with musculoskeletal and craniofacial mutations.
Evidence shows that the genetic quality of sperm deteriorates significantly with age, wrote Andrew J. Wyrobek, Ph.D., of the Lawrence Livermore National Laboratories here, and colleagues, in the online edition of the Proceedings of the National Academy of Sciences.
Breathing Exercises May Ease Asthmatics' Inhaler Dependence - CME Teaching Brief - MedPage Today
Review
SYDNEY, Australia, June 5 — Asthmatics can reduce their habitual dependence on inhalers by the use of breathing exercises, according to researchers here.
Breathing exercises reduced inhaler use by more than 80% in a small group of asthmatics, reported Cassandra Slader, Ph.D., of the University of Sydney, and colleagues, online in the journal Thorax.
About DailyMed
DailyMed provides high quality information about marketed drugs. This information includes FDA approved labels (package inserts). This Web site provides health information providers and the public with a standard, comprehensive, up-to-date, look-up and download resource of medication content and labeling as found in medication package inserts.
Other information about prescription drugs may also be available. NLM regularly processes data files uploaded from FDA's system and provides and maintains this Web site for the public to use in accessing the information. Additional information about medicines is available on NLM's MedlinePlus Web site http://www.nlm.nih.gov/medlineplus/medicines.html.
Vioxx Heart Risk Found to Be Early and Persistent - CME Teaching Brief - MedPage Today
MONTREAL, May 3 — Vioxx (rofecoxib) attacks hearts early, not late, and its hazardous effect is sustained for seven days after treatment is stopped, according to researchers here.
The drug is now the centerpiece of hundreds of liability suits against Merck, which voluntarily pulled the Cox-2 inhibitor from the market almost two years ago.
First-time Vioxx users had a 67% increase in the risk of a myocardial infarction during the first six to 13 days of use Linda Lev�que, a doctoral fellow at the Department of Epidemiology and Biostatistics at McGill University, and colleagues, reported in an early online release for the May 23 issue of the Journal of the Canadian Medical Association.
Stents Trump Balloons for Restoring Blood to Ischemic Limbs - CME Teaching Brief - MedPage Today
VIENNA, Austria, May 3 — There may be light at the end of the tunnel for diseased superficial femoral arteries, which have routinely frustrated endovascular interventions.
A self-expanding, nitinol (nickel-titanium) stent demonstrated significant efficacy in patients with severe claudication or chronic limb ischemia, reported Martin Schillinger, M.D., and colleagues of the Medical University of Vienna in the May 4 issue of The New England Journal of Medicine.
At six months the restenosis rate by intention-to-treat analysis was 24% in the stent group versus 43% in a balloon angioplasty group (P=0.05), they wrote.
State firm's fast flu test ready for trials
Mukilteo-based CombiMatrix Corp. said its quick test for H5N1 Avian Flu will get field testing this fall through a Pullman-based laboratory -- and the company is ready to step up production if the product works and the dreaded virus actually arrives on this continent.
Concerns about the virus' spread are centering on this coming autumn, when the annual migration along the Pacific Flyway will bring birds to this continent that may have mingled with others infected in Asia. The flyway includes Alaska, western Canada and West Coast of the United States.
"That problem will need solutions, and we've invested in the development of products that can be a tremendous aid," said Amit Kumar, president and chief executive of CombiMatrix.
HBNS: Antibiotics Help When Chronic Lung Diseases Flare Up
Antibiotic therapy leads to fewer treatment failures and deaths among people suffering from moderate to severe flare-ups in lung diseases such as emphysema and chronic bronchitis, according to a new systematic review.
The analysis compared outcomes among patients who received either antibiotics or a placebo when they experienced acute flare-ups of chronic obstructive pulmonary disease.
“Our study is the first to show clinically measurable beneficial effects of antibiotic therapy in exacerbations of COPD,� said lead author Dr. Felix Ram of New Zealand’s Massey University. “This has been one of the most highly debated topics in respiratory medicine for years.�
However, the various trials focused on a wide range of patients, including those undergoing treatment in doctors’ offices, hospital wards and intensive care units.
“These results should be interpreted with caution due to the differences in patient selection, antibiotic choice, small number of included trials and lack of control for [other] interventions that influence outcome,� say the authors.
COPD includes a group of disorders that result in chronic blockage of air flow. Cardinal symptoms include shortness of breath, coughing and sputum production. For many patients these symptoms worsen noticeably from time to time, and antibiotics are commonly given to provide relief.
Controversy over this practice arises from data suggesting that at least one-third of these acute episodes are not caused by bacteria. Unnecessary use of antibiotics may promote emergence of drug-resistant organisms.
The review appears in the most recent 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.
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.
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.
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.
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.
PURPOSE We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.
METHODS In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction.
RESULTS During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians.
CONCLUSIONS Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world’s best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.
Key Words: Diet, physical activity • smoking cessation • alcohol drinking • obesity • health promotion • practice-based research • communication • delivery of
Doctors Flub Lub-Dub Proficiency Test - CME Teaching Brief - MedPage Today
STANFORD, Calif., March 28 - When it comes to proficiency in a clinical cardiac exam, residents, faculty members, and private practitioners all matched up about equally well with third-year medical students, showed investigators here.
The finding suggests that better cardiac exam training is necessary not only for medical students but for the faculty members who teach them, said Jasminka M. Vukanovic-Criley, M.D., of Stanford and colleagues.
"Cardiac examination skills do not improve after the third year of medical school and may decline after years in practice, which has important implications for medical decision making, patient safety, cost-effective care, and continuing medical education," they reported in the March 27 issue of the Archives of Internal Medicine.
Human Lungs Resist Avian Flu Infection - CME Teaching Brief - MedPage Today
MADISON, Wis., March 22 - People anxiously watching the skies for the arrival of sick migratory birds can relax, just a bit, if research here pans out on where avian flu resides in the human airway.
The research reported in the March 23 issue of Nature shows that the human airway isn't particularly hospitable to the bird flu virus.
Unlike most human influenza strains, which can infect cells high in the airway, the avian flu prefers cells that are mainly found deep in the lungs, according to Yoshihiro Kawaoka, D.V.M., Ph.D., of the University of Wisconsin at Madison.
U.S. Unveils Expanded Bird Flu Surveillance - CME Teaching Brief - MedPage Today
WASHINGTON, March 21 - Warning that migratory birds could bring avian flu to the U.S. this year, government officials have unveiled a five-point plan for early detection.
But they said that even if the highly pathogenic H5N1 strain is detected in birds in America, there is no reason for panic.
"It is critically important for the American people to understand that a detection of this virus in birds does not signal the start of a pandemic among people," Secretary of Agriculture Mike Johanns told reporters.
He added that fear of the flu shouldn't stop people from eating poultry, because proper cooking kills the virus.
Newswise | New Guidelines Reveal the Complexity of Food Allergy Management
Newswise — Allergists representing three organizations developed evidence-based guidelines for food allergy diagnosis and management, which has become more sophisticated and challenging in recent years due to the increase in prevalence of certain food allergies and important scientific developments.
The Joint Task Force guidelines, “Food Allergy: A Practice Parameter,� are published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI). The Joint Task Force on Practice Parameters, representing the ACAAI, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Joint Council of Allergy, Asthma and Immunology (JCAAI), has published 20 practice parameters for the field of allergy-immunology.
“The practice parameter on food allergy represents more than 10 years of research and investigation of literature by members of the Joint Task Force,� said Jean A. Chapman, M.D., Cape Girardeau, Mo., a chief editor. “Designed to improve patient care, the guidelines provide practicing physicians with an evidence-based, broadly accepted approach to the diagnostic evaluation and management of IgE-mediated (allergic) food reactions.�
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.
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.
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."
KRT Wire | 10/27/2005 | Amid signs of panic buying, drug maker halts U.S. sales of Tamiflu
BY JEREMY MANIER
Chicago Tribune
CHICAGO - In a bid to stop panic buying of flu medications based on premature fears about a pandemic, drug maker Roche Holding AG has temporarily halted distribution of Tamiflu in the United States, citing unusually large purchases as an indication some buyers are hoarding the drug.
Most public-health experts have urged consumers not to build private stores of Tamiflu, a prescription drug that can reduce the severity of ordinary flu and may help against the avian flu strain, which some experts fear could spur a pandemic. Unwarranted use of Tamiflu could help flu strains mutate into forms that are resistant to the drug, among other problems.
How effective are flu vaccines?
People are freaked out about the flu. Public-health officials have been fretting about bird flu and the possibility that it could turn into a worldwide pandemic.
There is not much anybody can do about avian flu. No vaccine has been developed, and there is not enough antiviral flu medicine to treat everyone. No one even knows yet whether the bird flu will actually morph into a real danger or if it will just remain a threatening prospect.
In the meantime, public-health pundits are urging high-risk Americans to sign up for their annual flu shots. Last year, shortages of flu vaccine created panic as people waited in long lines, only to have supplies run out.
This year, experts do not expect a shortfall of flu vaccine. But the heavy emphasis on immunization does not fit well with research on the efficacy of flu vaccine, especially for older, sicker people.
The Cochrane Library newsletter, 2005, Issue 4
People with asthma who perform regular exercise have an increased ability to take up oxygen and increase their ventilation leading to improved cardiopulmonary fitness. Physical training involved 20 to 30 minutes of aerobic exercise, taken at least 2 to 3 times a week. "Therefore, there is no reason why people with asthma should not participate in regular physical activity," says lead Cochrane Review Author Dr Felix Ram. There is no evidence to suggest that regular exercise worsens asthmatic symptoms.
Because exercise can worsen symptoms, people with asthma have often been prevented from playing sports or attempting to keep fit. But physical training programmes have been designed that enable these people to improve physical fitness, muscle coordination and confidence.
Working on this Review, the authors drew together the results of 13 studies that involved 455 participants. While the studies varied in the features they were setting out to measure, the researchers concluded that exercise can increase the total amount of oxygen a person can take in by up to 20%. It can also increase the amount of air a person can transfer in and out of their lungs each minute by up to 6L/min. Improvements in fitness were seen by a 6.27 watt increase in work capacity and an average increase in maximum heart rate of more than 3 beats per minute. All these changes are clinically important and will improve patient well-being.
One note of caution: "It is imperative to give asthmatic subjects guidance on how to prevent or treat exercise-induced asthma before encouraging them to start training," says Ram.
Review title: Ram FSF et al. Physical training for asthma. The Cochrane Database of Systematic Reviews 2005, Issue 4.
Shorter colds, milder flu may follow from newly revealed immune mechanism
Enlisted to help fight viral infections, immune cells called macrophages consume virus-infected cells to stop the spread of the disease in the body. Now researchers at Washington University School of Medicine in St. Louis have uncovered how macrophages keep from succumbing to the infection themselves. Boosting this mechanism may be a way to speed recovery from respiratory infections.
The researchers found that a specific protein produced in the course of respiratory viral infections can serve to protect macrophages from an untimely death. Their report will appear in an upcoming issue of Nature Medicine and is available at the journal's website.
Click on the link above to read more...
By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
October 20, 2005
Review
SILVER SPRING, Md., Oct. 20 - Antibacterial soaps don't reduce the risk of illness any better than plain old soap, proclaimed an FDA advisory committee today in a unanimous vote.
Indeed, said Alastair J.J. Wood, M.D., of Vanderbilt, chairman of the FDA's Nonprescription Drugs Advisory Committee, the members of the panel were unconvinced by testimony during the day that antibacterial soaps and disposable wipes are any more effective than regular soap and water in preventing infections in the home.
Read more...medpage Today
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
October 20, 2005
Review
LOS ANGELES, Oct. 20 - Elderly patients with dementia who take so-called atypical anti-psychotic drugs have an increased risk of death, according to a meta-analysis of clinical trials.
The increased risk of about 50% compared with placebo was not found for any individual drug and could not have been detected by any of the individual trials included in the analysis, according to a report published in the Oct. 19 issue of the Journal of the American Medical Association.
"It is only when all trials are combined that a statistically significant effect is found," said Lon S. Schneider, M.D., and colleagues at the University of Southern California, Los Angeles.
Read more at...medpage Today
No Evidence for Routine Use of Pulmonary Artery Catheter in CHF - CME Teaching Brief - MedPage Today
Review
BOSTON, Oct. 4 - Pulmonary artery catheterization does more harm than good when used in patients who are hospitalized for severe congestive heart failure, researchers here reported.
Medical therapy by itself effectively reduced volume overload, but the addition of pulmonary artery catheterization significantly increased in-hospital adverse events -- 47 versus 25 (P=0.04), according to findings reported in the Oct. 5 Journal of the American Medical Association.
Click on the link above to learn more...
Trip J. Meine, MD; Manesh R. Patel, MD; Venita DePuy, MStat; Lesley H. Curtis, PhD; Sunil V. Rao, MD; Bernard J. Gersh, MB, ChB, DPhil; Kevin A. Schulman, MD; and James G. Jollis, MD
4 October 2005 | Volume 143 Issue 7 | Pages 481-485
Background: Previous studies suggest that patients hospitalized with acute myocardial infarction (MI) in December have poor outcomes, and some studies have hypothesized that the cause may be the infrequent use of evidence-based therapies during the December holiday season.
Objective: To compare the care and outcomes of patients with acute MI hospitalized in December and patients hospitalized during other months.
Design: Retrospective analysis of data from the Cooperative Cardiovascular Project.
Setting: Nonfederal, acute care hospitals in the United States.
Patients: 127 959 Medicare beneficiaries hospitalized between January 1994 and February 1996 with confirmed acute MI.
Measurements: Use of aspirin, ß-blockers, and reperfusion therapy (thrombolytic therapy or percutaneous coronary intervention), and 30-day mortality.
Results: When the authors controlled for patient, hospital, and physician characteristics, the use of evidence-based therapies was not significantly lower but 30-day mortality was higher (21.7% vs. 20.1%; adjusted odds ratio, 1.07 [95% CI, 1.02 to 1.12]) among patients hospitalized in December.
Limitations: This was a nonrandomized, observational study. Unmeasured characteristics may have contributed to outcome differences.
Conclusions: Thirty-day mortality rates were higher for Medicare patients hospitalized with acute MI in December than in other months, although the use of evidence-based therapies was not significantly lower.
Avian Flu Virus Showing Resistance to Tamiflu - CME Teaching Brief - MedPage Today
Review
HONG KONG, Sept. 30-Scientists here are reporting that a strain of the H5N1 avian flu virus is showing resistance to Tamiflu (oseltamivir), the antiviral many health organizations and governments are stockpiling to protect against a potential pandemic.
Tamiflu is proving less effective against the H5N1 strain that surfaced in northern Vietnam earlier this year, Hong Kong scientists reported. The greatest number of human deaths from avian flu have occurred in Vietnam since the start of the outbreak in 2003.
Click on the link above to read more...
QUALITY IN RESIDENCY EDUCATION -- Tenzer 3 (5): 469 -- Annals of Family Medicine
From the Association of Family Medicine Residency Directors
In discussing the concept of quality, I am reminded of the old Zenith advertisement, "quality goes in before the name goes on."1 Quality must be a requisite to be called a family doctor.
Concepts and standards of quality continue to evolve. Advances in technology, rising health care costs, increasing health disparities, and shifting population demographics will shape the future concept of health care quality. The Future of Family Medicine (FFM) project offers a template for acquiring the skills and resources needed to thrive in an ever-changing environment. The AFMRD has reformatted its strategic plan to reflect the FFM recommendations.2–4
This year’s AFMRD presidential theme is "Forging the Future of Family Medicine Through Quality and Innovation." Innovation will be a key driver and marker of health care quality in the future. Compared with health care outcomes in countries with fewer health care dollars, our expensive, high-technology health care results in poorer outcomes, and racial and socioeconomic health care disparities are increasing. Clearly, now is the time for innovation.2,4
Click on the link above to read more...
Some people deride them as “sugar water,” others as “liquid candy.” Never favorites with dietitians or parents, sodas are receiving more and more nutritional heat these days – and the drumbeat to run them out of schools is growing louder.
Click on the link above to read more...
SUNDAY, Oct. 2 (HealthDay News) -- Alcohol-based hand sanitizers, found in drug and grocery stores everywhere, do a good job of preventing gastrointestinal infections from spreading within the home, according to a new study.
As reported in the current issue of Pediatrics, the five-month study involved 292 Boston-area families, each of whom had at least one child in day care and were therefore at high risk for common respiratory and gastrointestinal infections.
Click on the link above to read more...
They've Got the Whole World in Their Hands: PDAs in Medicine - CME Teaching Brief - MedPage Today
Review
BERLIN, Sept. 29-You say you want a revolution? Look no further than the halls of your local teaching hospital. There you'll see a new generation of physicians who have eschewed volumes of bulky medical manuals, drug guides and charts for shirt-pocket libraries, a.k.a personal digital assistants (PDAs).
Click on the link above to read more...
Cancer experts now back Seattle doctor's findings
Some natural supplements interfere with chemo
By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER
Some of the nation's top cancer researchers have rediscovered what a Seattle naturopathic physician, Dr. Dan Labriola, reported more than half a decade ago -- that it can be dangerous to combine some cancer therapies and certain natural supplements.
Scientists at the prestigious Memorial Sloan-Kettering Cancer Center in New York City reported this week in the journal of the American Cancer Society that the use of anti-oxidant supplements such as vitamins C and E could significantly undermine the effectiveness of common chemotherapeutic agents.
Click on the link above to read more...
Guidant Recalls 170,000 Pacemakers - CME Teaching Brief - MedPage Today
INDIANAPOLIS, Sept. 23-Guidant said it is recalling 170,000 of its Insignia and Nexus pacemakers. It was Guidant's fifth recall of pacemakers or implantable cardioverter-defibrillators (ICDs) since June.
In a statement issued Thursday, the company urged patients with Insignia or Nexus pacemakers to consult with their doctors. The company did not suggest across-the-board explants of the devices.
Click on the link above to read more...
Study: second-generation antidepressants
Because clinical depression is so disabling and affects more than 16 percent of adults in the United States at some time in their lives, researchers have worked hard to develop more effective treatments. But how much better are the newer pharmaceuticals?
Many second-generation antidepressants, despite differences in drug classification and cost, offer patients essentially the same benefits with little variation in risks, University of North Carolina at Chapel Hill researchers have found.
Such antidepressants include selective serotonin reuptake inhibitors (SSRIs) and other drugs that affect the activity of neurotransmitters in a selective way.
In a paper published online today (Sept. 19) and to be published in the October issue of the journal Annals of Internal Medicine, Dr. Richard A. Hansen and colleagues examined the effects of 10 commonly prescribed second-generation antidepressants. Those drugs included familiar brand-name drugs such as Prozac, Zoloft, Click on the linkEffexor, Wellbutrin and Paxil.
Click on the link above for to read more....
Digital mammograms found better for younger women
Digital mammograms work at least as well as standard film technology at detecting early-stage breast cancer, and the newer method offers clear advantages to younger women and those whose breast scans are hard to read.
A major study released Friday gave new impetus to a digital revolution already under way in breast cancer screening. But experts insisted there's nothing wrong with an old-fashioned mammogram, either.
"Nobody has to run out and demand digital," said Dr. R. James Brenner, chief of breast imaging at UCSF and the current president of the Society of Breast Imaging, the nation's largest such organization.
Digital mammograms work at least as well as standard film technology at detecting early-stage breast cancer, and the newer method offers clear advantages to younger women and those whose breast scans are hard to read.
A major study released Friday gave new impetus to a digital revolution already under way in breast cancer screening. But experts insisted there's nothing wrong with an old-fashioned mammogram, either.
"Nobody has to run out and demand digital," said Dr. R. James Brenner, chief of breast imaging at UCSF and the current president of the Society of Breast Imaging, the nation's largest such organization.
Hartford Hospital
Hartford, CT-Birth by Cesarean Section may occur for a variety of reasons, including a large baby, placenta previa, prior Cesarean Section or a breech presentation. The process of childbirth remains an amazing miracle when accomplished through this surgical procedure. Watch Hartford Hospital physicians bring a new life into the world in this live webcast September 23 rd at...
To read more click on the link above.
American Thoracic Society Journal news tips for September 2005 (second issue)
PORTLAND, Oregon - Some people call it "the dark time," the period between when a person is diagnosed with Parkinson's disease and when treatment with medication begins. Julie Carter, R.N., knows it all too well. The associate professor of neurology in the Oregon Health & Science University School of Medicine hosts workshops to help newly diagnosed Parkinson's patients and their families cope with the prospect of fighting a chronic, degenerative, incurable neurological disease the rest of their lives.
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myDNA.com - News: Review of radiosurgery to treat brain tumors
The American Society for Therapeutic Radiology and Oncology gathered a panel of experts to compile and analyze existing studies on the use of radiosurgery, a specialized type of external beam radiation therapy that pinpoints high doses of radiation to treat brain tumors. The panel has developed evidence-based reviews that consolidate the information available and identify questions to be answered in future research. The two new reviews are published in the September 1, 2005 issue of the International Journal of Radiation, Oncology, Biology and Physics, the official journal of ASTRO.
lick on the link above to read more...
WASHINGTON, Sept. 7 /PRNewswire/ -- West Nile Virus continues to infect Americans across the country and case counts have risen significantly in
recent weeks.
So far this year public health officials have reported 732 West Nile infections, which are caused by mosquito bites. Most cases have been
diagnosed within the past month. Illinois officials reported 46 new WNV cases last week, raising their total this year to 89. Nearly all are in the Chicago area, primarily Cook County (46). California, which for the second straight
year has the most WNV cases (268 so far this year, 779 in 2004), is seeing a slow decline after a peak in August.
West Nile Virus activity peaks in August and September, according to the U.S. Centers for Disease Control and Prevention, and floodwaters and rain from Hurricane Katrina has heightened concern in many states. The CDC last year
reported of 2,749 human cases of WNV, with 900 the serious "neuroinvasive disease" and 88 deaths.
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Intertrigo is inflammation of skinfolds caused by skin-on-skin friction. It is a common skin condition affecting opposing cutaneous or mucocutaneous surfaces. Intertrigo may present as diaper rash in children. The condition appears in natural and obesity-created body folds. The friction in these folds can lead to a variety of complications such as secondary bacterial or fungal infections. The usual approach to managing intertrigo is to minimize moisture and friction with absorptive powders such as cornstarch or with barrier creams. Patients should wear light, nonconstricting, and absorbent clothing and avoid wool and synthetic fibers. Physicians should educate patients about precautions with regard to heat, humidity, and outside activities. Physical exercise usually is desirable, but patients should shower afterward and dry intertriginous areas thoroughly. Wearing open-toed shoes can be beneficial for toe web intertrigo. Secondary bacterial and fungal infections should be treated with antiseptics, antibiotics, or antifungals, depending on the pathogens. (Am Fam Physician 2005;72:833-8, 840. Copyright© 2005 American Academy of Family Physicians.)
Read more...American Family Physician
8/24/2005 12:35:00 PM
To: National Desk, Health Reporter
Contact: Agency for Healthcare Research and Quality, Office of Public Affairs, 301-427-1241 or 301-427-1855, Web: http://www.ahrq.gov
WASHINGTON, Aug. 24 /U.S. Newswire/ -- Daily consumption of soy protein found in tofu and other soybean products may result in a small reduction in low-density lipoprotein (LDL, known as bad cholesterol) and triglyceride levels, according to a new evidence review supported by HHS' Agency for Healthcare Research and Quality. In addition, isoflavones found in soy may reduce the frequency of hot flashes in post-menopausal women. However, the available studies on the health impacts of soy were limited in number, of poor quality, or their duration was too short to lead to definite conclusions.
Read more...U.S. Newswire
By CHERYL WITTENAUER, Associated Press Writer
ST. LOUIS -- Scientists who set out to explore changes in the brain as Alzheimer's disease progresses got a surprise: a possible link between daydreaming and the degenerative brain disease that robs memory, language and thought.
A new Washington University study shows the part of the brain used to daydream is the same where Alzheimer's disease develops -- in some people -- later in life. It suggests the normal brain activity of daydreaming fuels the sequence of events leading to Alzheimer's.
"The implication, albeit a speculative one, is that those activity patterns in young adults are the foothold onto which Alzheimer's disease forms," said lead researcher Randy Buckner, associate professor of psychology. He said they may lead to a life-long cascade that ends in Alzheimer's disease in some people.
"It suggests a new hypothesis and opens an avenue in exploration," Buckner said. "By no means is it definitive."
The study appears in this week's The Journal of Neuroscience.
Read more...latimes.com
Medicine is always trying to improve, and sometimes that means discarding some fond procedures and medical devices that are no longer acceptable to today's evidence-based practice. So, inspired by a list of discarded technology at C|Net, we'd like to start the nostalgia over medical devices and procedures we miss (or, in most cases, never got to use):
Read more...medGadget
Family-based treatments are effective for substance abuse and conduct disorders in children and adolescents, according to a new, ten-year research review released this week. The treatment also helps reduce the behavior problems associated with attention deficit hyperactivity disorder (ADHD) and shows promise in treating depression and anxiety.
"There are some myths about family therapy, and one of them is that it's not effective," said Allan Josephson, M.D., chief executive officer of the Bingham Child Guidance Center in Louisville and co-author of the study. "However, the empirical support for its success has been growing. This paper documents that counseling and working with families is not only an intuitively good idea--there's scientific evidence for its effectiveness in specific conditions."
Dr. Josephson spoke today in New York City at the American Medical Association and National PTA media briefing, Back to School: Child and Adolescent Health. The study will be published in the September issue of the Journal of the American Academy of Child & Adolescent Psychiatry.
Read more...News-Medical.Net
By ANDREW DAMSTEDT
WASHINGTON, Aug. 5 (UPI) -- Simplified guidelines authored by a University of Cincinnati physician could help physicians treat and prevent heart attacks in patients.
Dr. Brian Gibler, chairman of UC's Department of Emergency Medicine, said the guidelines were a streamlined version of the American College of Cardiology and American Heart Association's guidelines.
Read more...Science Daily
July/August 2005 Annals of Family Medicine tip sheet
Posted on Eureka Alert
In recent years, American hospitals have made significant improvements on standardized, evidence-based measures of clinical performance for several medical conditions, including heart attacks, heart failure, and pneumonia. But an editorial, published in the July 21 issue of the New England Journal of Medicine, says it's not clear how much effect these improvements in patient care have had on public health, especially in reducing morbidity and mortality. The editorial, authored by Patrick S. Romano, professor of general medicine at UC Davis School of Medicine and Medical Center, is published along with two new quality-of-care studies.
Read more...I-Newswire.com
UCLA investigators found large gaps and marked variation in U.S. hospitals' heart failure treatment based on adherence to four standard quality measures. The study points to the need for hospitals to establish education programs and systems to improve quality of care for this patient population.
(I-Newswire) - Published in the July 11 issue of the Archives of Internal Medicine, researchers compared four standard measures for heart failure treatment used by the Joint Commission of Accreditation of Healthcare Organizations, the national agency that accredits hospitals.
“We found that the quality of care for heart failure treatment really depends to a very large extent on which hospital patients are admitted to. This is one of the first studies to take a scientific look at the variation in performance measures in hospitals across the country,” said Dr. Gregg C. Fonarow, lead study author, The Eliot Corday Chair in Cardiovascular Medicine and Science, professor of cardiology, David Geffen School of Medicine at UCLA.
Read more...I-Newswire.com
Becoming a frequent question as cost-conscious hospitals turn to in-house specialists who reduce stays and standardize treatment. But 'handing off' patients can be risky.
By Kelly Kleiman. Kelly Kleiman is a regular contributor to the Magazine
Published July 24, 2005
She went to the hospital in an ambulance. We didn't realize at the time that her internist no longer visited patients in the hospital. She was having a lot of pain and was inappropriately medicated, which I attribute to the fact that it was not her regular physician treating her. The whole experience was just hideous. Not having any medical professional who'd ever dealt with her before made it worse."
-Laura Stempel, daughter of a patient at Evanston Northwestern Hospital (not affiliated with Northwestern Memorial Hospital).
Read more...Chicago Tribune
Friday, 22 July 2005, 11:34 am
Press Release: College for Emergency Medicine
Poisoning: are current treatments best?
Friday 22 July 2005
Over the years, poisoning has been variously treated by attempting to bring the poison back up, rushing it through the body, or binding it in the gut so that it doesn't spread to other body parts.
And relatively recently, treatments such as syrup of ipecac, orogastric tubes, and activated charcoal have been largely discarded.
Activated charcoal is still used, however, for potentially serious poisoning if the patient is treated within an hour of ingestion.
At the Winter Symposium of the Australasian College for Emergency Medicine being held at the Millennium Hotel in Queenstown NZ, Professor Mike Ardagh, Professor of Emergency Medicine at Christchurch School of Medicine and Health Sciences, will canvass whether the current treatment of poisoning is in fact the best.
Read more...SCOOP Independent News
Standard therapies for such ailments as pneumonia, heart attacks often ignored.
By Elizabeth Weise / USA TODAY
Health update
Chemical levels dropping
Americans have lower levels of lead, secondhand-smoke byproducts and other potentially dangerous substances in their bodies than a decade ago, the Centers for Disease Control and Prevention said Thursday. It tested for 148 environmental chemicals, including pesticides and disinfectants.
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Years and even decades after doctors agreed on life-saving standard therapies for heart attacks, pneumonia and congestive heart failure, disturbingly large numbers of patients aren't receiving them, according to two papers in Thursday's New England Journal of Medicine.
Reviewing data from the Centers for Medicare and Medicaid Services on 10 indicators for quality of care at 3,558 hospitals in the first half of 2004, researchers at Harvard School of Public Health found that simple, universally accepted treatments were not provided for:
• 11 percent of heart attack patients.
• 19 percent of those with congestive heart failure.
• 29 percent of pneumonia sufferers.
Read more...The Detroit News: Healthcare
By Elizabeth Weise, USA TODAY
Years and even decades after doctors agreed on lifesaving standard therapies for heart attacks, pneumonia and congestive heart failure, disturbingly large numbers of patients aren't receiving them, according to two papers in today's New England Journal of Medicine.
Reviewing data from the Centers for Medicare and Medicaid Services on 10 indicators for quality of care at 3,558 hospitals in the first half of 2004, researchers at Harvard School of Public Health found that simple, universally accepted treatments were not provided for:
•11% of heart attack patients.
•19% of patients with congestive heart failure.
•29% of pneumonia patients.
Treatment can be as simple as giving a heart attack patient an aspirin, something only 92% of hospitals do for all appropriate patients, says Ashish Jha of the Harvard School of Public Health and lead author of one of the papers.
But despite authoritative, universal agreement that those measures should happen quickly and be given to all patients, a surprising number didn't receive them.
Read more...USA Today
By Dr. Jeff Hersh / Daily News Correspondent
Tuesday, July 19, 2005
Q: I just read an article about Lorenzo's oil in the newspaper that said a new medical study showed it works. Years ago when that film "Lorenzo's Oil," starring Susan Sarandon, came out, medical studies at the time showed that is was not helpful at all. Is it common that medical studies contradict themselves?
A: I will not discuss the specifics about the recent Lorenzo's oil article. I think it showed some benefit from Lorenzo's oil in preventing symptoms in patients with adrenoleukodystrophy (ALD), a progressive degenerative disorder, before they become symptomatic rather than in treating patients who were already sick). Rather, I will discuss the very important point you raise, that of the reliability of medical studies. There are still many weaknesses in the medical literature, and I will discuss the good, the bad and the ugly of the medical literature in today's column.
Read more... Posted by gruwell at 7:02 AM | TrackBack
2005-06-23
Annals of Internal Medicine
Educators have recognized the need to apply evidence-based approaches to medical training. To do so, medical educators must have access to reliable evidence on the impact of educational interventions. This paper describes 5 methodologic challenges to performing systematic reviews of educational interventions for health care professionals: finding reports of medical education interventions, assessing quality of study designs, assessing the scope of interventions, assessing the evaluation of interventions, and synthesizing the results of educational interventions. We offer suggestions for addressing these challenges and make recommendations for reporting, reviewing, and appraising interventions in medical education.
Read more...Black Enterprise
By LEE BOWMAN
Scripps Howard News Service
June 27, 2005
- Professional guidelines don't endorse them, but a new survey of family doctors shows that most still see value in adults getting an annual checkup even if the patients have no specific symptoms.
The survey, published Monday in the Archives of Internal Medicine, showed that 65 percent of respondents believe an annual physical examination is necessary, and 88 percent said they do them for at least some patients.
The study, done in 2002, was based on responses of a random sample of 763 primary-care doctors in and around Boston, Denver and San Diego. Dr. Allan Prochazka and colleagues at the University of Colorado Health Sciences Center and the Denver Veterans Affairs Medical Center led the research.
Read more...Scripps Howard News Service
CHICAGO – Although the quality of outpatient care in the United States has improved over the last decade, greater use of evidence-based medicine is needed, however, and quality of care is not significantly associated with the patient's racial or ethnic background, according to a study in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The recently released National Healthcare Quality Report (NHQR) identified a variety of areas where health care has markedly improved across time and is now reaching or surpassing national performance goals, as well as many more areas where the quality of health care delivery is suboptimal, according to background information in the article. Its companion document, the National Healthcare Disparities Report, demonstrated that racial, ethnic, and socioeconomic disparities in health care are national problems. However, the authors suggest, limited use has been made of readily available national survey data to measure quality of care and racial disparities in outpatient settings.
Jun Ma, M.D., Ph.D., and Randall S. Stafford, M.D., Ph.D., of Stanford University School of Medicine, Stanford, Calif., used data from the two national surveys of outpatient care to assess overall performance and racial/ethnic disparities in private physician offices and hospital outpatient departments in 1992 and 2002. The researchers examined 23 outpatient quality indicators, including appropriate antibiotic use, treatment of depression, avoiding unnecessary screening and avoiding inappropriate medications in the elderly. Quality indicator performance was defined as the percentage of applicable visits receiving appropriate care.
Read more...Eureka Alert
By Suzanne LeighTue Jun 21, 7:09 AM ET
It was my sixth attempt to reach my doctor by phone, with a simple query about a prescription. "The doctor is with a patient right now," intoned the receptionist - again.
I took a deep breath. "Would it be possible to reach him by e-mail?"
There was a pause. "The doctor doesn't have an e-mail address."
No e-mail address? My doctor practices in the shadow of Silicon Valley.
"He'll try to call between patients," she said.
And so I waited, held hostage by the phone, like most patients who need to make contact with their doctors but don't require a face-to-face consultation.
In a 2002 survey by Harris Interactive, 90% of adults with Internet access indicated they want to communicate with their physicians via e-mail. But a survey last year by Manhattan Research, a marketing information and services firm, found that less than 20% of physicians communicate via e-mail.
The top reason doctors give for withholding their e-mail address is the fear that it will lead to "too much access" and they will be barraged with messages about "trivial matters," according to a Journal of Family Practice article in 2001.
In other words, patients can't be trusted not to abuse our doctors' time. But if doctors finally moved into the high-tech age, they'd soon discover that many of their concerns about e-mail are misplaced.
Last month, the journal Pediatrics confirmed what disgruntled patients have known for a long time: E-mail can save the doctor's time, too. Researchers evaluated e-mails sent between two pediatricians and 54 parents of patients over six weeks. They found that of the 81 e-mails generated by parents, 70 required just one e-mail response. Most focused mostly on medical questions. And far from being deluged, the physicians said they spent an average 30 minutes a day responding to e-mails. Parents, as a result, reported fewer phone calls and appointments.
Read more USA Today
Many of the medications widely used to manage chronic insomnia have not yet been rigorously evaluated for long-term use, according to an independent scientific panel convened this week by the National Institutes of Health. This is a critical consideration because for many patients, insomnia can persist for decades. The panel also stressed that many chronic insomnia sufferers could benefit from currently underused behavioral and cognitive therapies.
Read more NIH News
Glenn Howatt, Star Tribune
June 16, 2005
A heart drug developed by Minnesota researchers appears headed for approval by federal regulators as the country's first race-based medicine.
Food and Drug Administration staff members Wednesday recommended that BiDil be approved as a heart medicine for black patients.
Critics say the race designation is a marketing ploy because there's scant scientific evidence that the drug is a better treatment for blacks compared to whites.
The drug was originally developed by Dr. Jay Cohn, a cardiologist at the University of Minnesota. Recent research showing promising results in blacks was led by a colleague, Dr. Anne Taylor, a heart specialist and associate dean of the university medical school.
In that study, BiDil increased survival rates and improved quality of life for 1,050 black patients with heart failure, which is a slow deterioration of the heart. The drug cut the rate of hospitalization by about one-third, according to results released last November.
NitroMed Inc. of Lexington, Mass., is the drug's manufacturer. Its publicly traded stock price has soared on news of the drug's effectiveness. Stock analysts have predicted that if approved, the drug would be successful for the company because blacks have a higher rate of heart failure than whites.
BiDil is a combination of two generic drugs that have been used for decades to treat chest pain and high blood pressure. The drug combo is easier to administer than separate generic pills.
Developed by Cohn 30 years ago, the drug was turned down by the FDA. NitroMed took up the drug after Cohn discovered that it tended to work better in blacks in the studies he had conducted.
But still, no research study has proved that the racial differences affect the drug's performance.
Jonathan Kahn, a law professor at Hamline University in St. Paul, has criticized the effort to repackage BiDil along racial lines.
"BiDil did not begin as an ethnic drug," he wrote in a critique in the Yale Journal of Health Policy, Law and Ethics last year. It only became one because it failed to win wider approval, he said.
Critics contend that FDA approval would reinforce disproved beliefs of significant genetic differences between the races.
If the medicine is approved, doctors would be free to prescribe it regardless of a patient's race. Indeed, drug founder Cohn has used the drug for patients of all races.
An FDA advisory panel will meet today to review the drug and is expected to issue a final recommendation by week.
Glenn Howatt is at howatt@startribune.com.
More than 90 percent of surveyed physicians in Pennsylvania reported defensive medicine practices such as over-ordering of diagnostic tests, unnecessary referrals and avoidance of high-risk patients, according to a study in the June 1 issue of JAMA.
Read more...iNewswire.com
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.
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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
4/18/2005 3:02:00 PM
To: Business and Health Editor
Contact: Carri Cummings, 916-341-0472; 916-502-1131 (cell) or carri@zieglerassociates.net; Susan Herold of Consumers Union, 202-462-6262
SACRAMENTO, Calif., April 18 /U.S. Newswire/ -- Sacramento regional leaders today launched an ambitious effort to get free information on the cost and effectiveness of prescription drugs into the hands of consumers -- especially seniors, low income residents and the uninsured -- to help Californians stretch their health care dollars in an era of spiraling drug prices.
The information is provided by Consumer Union, the nonprofit publisher of Consumers Reports, through its innovative Consumer Reports Best Buy Drugs program. The grant-funded project is a pioneering effort to provide consumers with information in one place on the safety, effectiveness and costs of prescription drugs. Currently, the Consumer Reports Best Buy Drugs evaluations are available only on the Web at http://www.CRBestBuyDrugs.org. But pilot projects in Sacramento and Atlanta will determine how to get printed copies of the materials into the hands of those without Internet access.
Read more...US Newswire
NEW YORK, April 5 /PRNewswire/ -- Cardiovascular disease (CVD) is the leading cause of death among dialysis patients, but the treatment for dialysis patients with CVD is not as effective as it is in the general population, according to new guidelines published by the National Kidney Foundation (NKF) in a supplement to the April 2005 issue of the American Journal of Kidney Diseases. The guidelines, Cardiovascular Disease in Dialysis Patients, warn that CVD is also prevalent in the pediatric dialysis population, dialysis patients are more prone to side-effects of treatment and that more research is needed to help better manage CVD in dialysis patients. More than 300,000 Americans receive dialysis to treat kidney failure.
"This guideline highlights those aspects of CVD care that are different in dialysis patients when compared to the general population," said Alfred K. Cheung, M.D., co-chair of the NKF work group that developed the guideline. "Because of these differences, practitioners cannot solely rely on existing CVD guidelines for the general population to treat CVD in dialysis patients."
Read More...Yahoo News
30 Mar 2005
While the discipline of family medicine has always been predicated on a core assumption that interpersonal continuity of care - the ongoing relationship between an individual doctor and patient - is important, individual studies measuring its impact on health care outcomes and cost have yielded conflicting results.
In a critical review that synthesizes the findings of 41 research studies, researchers found a significant association between interpersonal continuity and improved preventive care and lower rates of hospitalization.
Although even fewer studies addressing the association between continuity and cost exist, a review of 20 studies found an association between interpersonal continuity and lower cost variables.
Interpersonal Continuity of Care and Care Outcomes: A Critical Review
By John W. Saultz, M.D., et al
Read more...Medical News Today
Hand hygiene initiative is designed to help reduce healthcare-associated infections in U.S. hospitals, including 90,000 related deaths and $5 billion in added costs
(Mentor, Ohio) - STERIS Corporation (NYSE:STE) today announced the U.S. launch of Partners in Your CareSM , an evidence-based program shown to increase and sustain hand hygiene compliance and thus reduce healthcare-acquired infections by partnering patients with healthcare workers.
"Think about this the next time you visit a medical facility. Research indicates that more than 60 percent of healthcare workers do not properly wash or sanitize their hands prior to treating a patient," said Robert Mosher, vice president, Applied Infection Control, STERIS Corporation. "Consequently, the spread of infection by worker to patient contact in healthcare settings continues to be a serious problem."
Read more...FeatureXpress
i-Newswire, 2005-03-26 - Researchers with the Department of Veterans Affairs ( VA ) and the University of California at Los Angeles ( UCLA ) found that a diet high in docosahexenoic acid, or DHA--an omega-3 fatty acid found in relatively high concentrations in cold-water fish--dramatically slowed the progression of Alzheimer's disease in mice. Specifically, DHA cut the harmful brain plaques that mark the disease. The results appear in the March 23 online edition of the Journal of Neuroscience.
Senior author Greg M. Cole, Ph.D., a neuroscientist at the Greater Los Angeles VA Healthcare System and UCLA, said that unlike many studies with mice, this one points to the benefits of a therapy that is easily available and already touted for other medical conditions. DHA--either from food sources such as fish and soy, or in fish-oil supplements--is recommended by many cardiologists for heart health, based on scores of previous studies.
Read more...iNewswire.com
By: UPMC News Bureau on Mar 07 2005 08:00:11
PITTSBURGH – "Despite multiple challenges, health care professionals are embracing information technology and are enabled to do their jobs more efficiently with the use of electronic health records," stated G. Daniel Martich, M.D., vice president of eRecord at the University of Pittsburgh Medical Center (UPMC) at a March 4 presentation before the American Medical Association's Physician Consortium for Performance Improvement in Chicago.
The Consortium includes representatives from more than 60 national medical specialty and state medical societies, the Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services and works to develop evidence-based clinical performance measures and clinical outcomes reporting tools to support physicians in quality improvement efforts.
Read more...eMaxHealth
3/9/2005 10:52:00 AM
To: National Desk, Health Reporter
Contact: Susan Herold of Consumers Union, 202-462-6262, Grace Trimble of the Atlanta Regional Commission, 404-463-3192
ATLANTA, March 9 /U.S. Newswire/ -- Atlanta area residents will be the first to participate in a nationwide outreach effort by Consumers Union to put easy-to-understand information about the effectiveness, safety and price of prescription drugs in the hands of seniors, low-income residents and the uninsured to help them navigate the confusing prescription drug marketplace and get the best value for their health-care dollar.
"Our goal is to get unbiased information on prescription drugs into the hands of millions of consumers, and Atlanta is the starting point for that," said Gail Shearer, project director of Consumer Reports Best Buy Drugs. "Only when consumers and doctors have independent information on the effectiveness, safety and price of medicines will we see real change in the prescription drug marketplace. We hope to level the playing field for consumers who are confused by all the advertisements for prescription drugs."
Read more...US Newswire
By Rob Stein
The Washington Post
Published on: 03/07/05
WASHINGTON — Aspirin does not protect women against heart attacks in the same way it does for men, but the venerable painkiller does cut women's chances of suffering a stroke, researchers reported Monday.
A long-awaited 10-year study of nearly 40,000 women, the biggest and best such study to date, provides the first strong evidence of the benefits of taking aspirin regularly for healthy women, a practice that many have already begun based largely on studies of men.
Read more...ajm.com
A Teleconference Series to Accelerate Health Care Improvement
Catherine D. DeAngelis, MD, MPH; Donald M. Berwick, MD, MPP
JAMA. Feb. 23, 2005;293:1004.
Translating the results of published studies into clinical action is a challenge. JAMA readers know, and we acknowledge, that the devil is in the details in taking useful knowledge from page to patient—just as it is in moving basic scientific insights from bench to bedside. This is one of the reasons for the frustrating and recurring finding that important clinical research innovations rarely reach all the patients who potentially could benefit.
Thanks to a grant from The Robert Wood Johnson Foundation, JAMA, in partnership with the Institute for Healthcare Improvement (IHI), is pleased to announce an 18-month test of a new resource called Author in the Room. This program is designed to help our readers explore specific, peer-reviewed articles directly with the articles’ authors so that the reported clinical science can be more effectively and quickly incorporated into clinical practice. This initiative will comprise 12 conference calls, roughly 1 call per month, each call focusing on the practical application of a potentially useful research finding that has recently been published in JAMA.
01 Mar 2005
The American Medical Student Association (AMSA), the nation's largest independent medical student organization, today released survey results showing that a large majority (72.7 percent) of medical students surveyed believe that global HIV/AIDS is the "crisis of our generation." Nearly 90 percent of respondents agree that the US should make its response to the pandemic a higher or top priority.
While medical students ranked global HIV/AIDS as what should be one of healthcare's top three priorities, the survey shows that many medical schools provide insufficient or poorly coordinated education and little or no clinical experience on the topic.
Read more....Medical News Today
February 14, 2005 09:15 AM US Eastern Timezone
MEDecision Puts Payer-Based Patient Record in Doctors' Hands
HIMSS 2005 Annual Conference
WAYNE, Pa.--(BUSINESS WIRE)--Feb. 14, 2005--
Industry-First Electronic Patient Clinical Summary for Doctors Delivers Comprehensive Information from All Providers, Labs, Pharmacies Associated with Patient's Health Plan
MEDecision Inc., the leader in collaborative care management, today announced the general availability of MEDecision's Patient Clinical Summary (PCS). A healthcare industry first, the Patient Clinical Summary takes patient information available from a health plan and electronically delivers it to doctors when and where the patient is being treated. Doctors now have fast, simple access to patient medical histories and critical information that can improve outcomes and save lives.
The Patient Clinical Summary is the industry's first electronic health record generated for treating physicians and created by a health plan or other payer organization. It provides a common patient view that includes a patient's historical and current medical data from doctors, labs, pharmacies and other provider organizations that have been paid for by the patient's health plan. As a result, doctors receive comprehensive, actionable intelligence about the patients they are treating when it is most valuable -- when they are making treatment decisions.
Read more...Businesswire
Florida Congressman C.W. Bill Young Joins National Library of Medicine, American Medical Association Foundation, and Fisher Center for Alzheimer's Research Foundation to Launch Health Information Program for Physicians, their Patients, and Caregivers
DUNEDIN, Fla.--After a doctor sees a patient, he or she often prescribes medications. But what if a doctor also wants to direct a patient to up-to-date, reliable, consumer-friendly information about a health concern? Under a pilot program to be launched in Florida on Feb. 14, physicians from six counties are being encouraged to refer their patients to MedlinePlus, a consumer health site of the National Institutes of Health.
The American Medical Association Foundation (AMAF) and the Fisher Center for Alzheimer's Research Foundation have teamed up with the National Library of Medicine (NLM), an arm of the National Institutes of Health, to encourage Florida physicians to point patients to first-rate online health information in NLM's MedlinePlus database (www.medlineplus.gov), and Fisher Center Foundation's Web site (www.alzinfo.org). The pilot program, called the "Information Rx" project, will be launched in six Florida counties with a demonstration hosted by Rep. C. W. Bill Young (R-FL).
Read more...NLM Press Conference
February 10, 2005 08:00 AM US Eastern Timezone
WASHINGTON--(BUSINESS WIRE)--Feb. 10, 2005--Successful disease management across broad populations depends on adopting a new health care model. At the model's foundation is the delivery of information prescriptions to support personalized health decisions, according to a white paper by the Center for Information Therapy (CIT).
In "Improving Population Care and Disease Management Using Ix Principles," Joshua Seidman, PhD, executive director of the CIT, and Paul Wallace, MD, executive director of the Kaiser Permanente Care Management Institute, detail the new care model to show health care providers and systems how this strategy better supports patients' self-care and decision-making needs.
Read more...Businesswire
February 10, 2005 08:00 AM US Eastern Timezone
WASHINGTON--(BUSINESS WIRE)--Feb. 10, 2005--Successful disease management across broad populations depends on adopting a new health care model. At the model's foundation is the delivery of information prescriptions to support personalized health decisions, according to a white paper by the Center for Information Therapy (CIT).
In "Improving Population Care and Disease Management Using Ix Principles," Joshua Seidman, PhD, executive director of the CIT, and Paul Wallace, MD, executive director of the Kaiser Permanente Care Management Institute, detail the new care model to show health care providers and systems how this strategy better supports patients' self-care and decision-making needs.
Read more...Businesswire
Thursday February 10, 8:34 am ET
- Improved Patient Outcomes and Reduced Costs Highlight Crucial Link Between Electronic Medical Data and Clinical Practice Guidelines -
NEW YORK, Feb. 10 /PRNewswire/ -- A new clinical study published today in this month's American Journal of Managed Care demonstrated that a technology- driven clinical decision support system applying evidence-based clinical guidelines to patient's electronic medical data helps flag potentially serious clinical errors or deviations from accepted best practices, while making a significant improvement on the cost and quality of medical care.
Read more...Yahoo Finance
New centre breaks ground in Canada
Mario Toneguzzi
Calgary Herald
Monday, February 07, 2005
Calgary is poised to become the national leader in research and training in the field of complementary and alternative medicine.
The city will be the site of Canada's first post-secondary institute dedicated to advancing complementary and alternative health, as well as the first place where information about scientifically proven alternative health options will be offered by the Calgary Health Region on its 24-hour phoneline.
The two initiatives will be announced at a news conference today at Mount Royal College, the Herald has learned.
Read More...Calgary Herald
Monday February 7, 2:00 pm ET
WASHINGTON, Feb. 7 /PRNewswire/ -- A new URAC study shows that medical management organizations support the idea of improving health care quality, but few have adopted specific initiatives related to the goals of the Institute of Medicine's (IOM) 2001 report, "Crossing the Quality Chasm."(Logo: http://www.newscom.com/cgi-bin/prnh/20030501/URACLOGO )
The URAC study, "Translating the Quality Chasm Aims Into Medical Management Practice: An Examination of Support for and Implementation of the IOM's Six Aims," sought to discover how medical management organizations have responded to the 2001 report's challenge for health care organizations to pursue six major aims: that health care should be safe, effective, patient centered, timely, efficient and equitable. Results of the study, funded by the Robert Wood Johnson Foundation, are published on the URAC website, http://www.urac.org.
Read more...Yahoo Finance
By Tim Christie
The Register-Guard
Doctors, for the most part, know what they're doing, or in the alternative, act like they know what they're doing.
No one wants to be seen by a fumbling, hesitant doctor, after all. They're the experts in the white lab coats with 10 years of medical training and the M.D. after their names.
So when the doctor walks into the exam room, we expect a thorough examination, an authoritative diagnosis, reassuring answers and a deftly scribbled prescription.
But doctors have been keeping a secret from their patients: Sometimes they don't know what they're doing. Sometimes they recommend a treatment not because there's a rock-solid foundation of medical evidence behind it, but because they think it works based on their experience and what they hear from other doctors.
"Unfortunately, for a good percentage of what we do in medicine, there isn't good evidence," said Dr. Lorne Bigley, a family physician at River Road Medical Group. "There isn't literature to support a lot of things we do."
That's why a growing number of doctors, nurses and researchers are changing the way they think about and practice medicine by seeking out drugs and treatments that are proven to work through randomized controlled trials.
Read More...The Register Guard
Twila Brase, the president of the Citizens' Council on Health Care in Minnesota, has issued a powerful review of the Evidence-Based Medicine (EBM) movement. Her paper, "How Technocrats are Taking Over the Practice of Medicine - A Wake-up Call to the American People," is a landmark analysis of the attempt to bureaucratize medical practice, which has been happening largely under the radar screen of most Americans. In 25 pages, with 226 footnotes, she explains how the underlying assumptions and practical applications of EBM will turn physicians into pawns of the payers at the expense of their patients. EBM assumes, for instance, that variation in medical procedures is inherently bad and should be rooted out so that all physicians do the exact same thing. It ignores that variation in patients may require variation in practice. It assumes that there is one best way to do medicine - and that we know what that one best way is. It ignores that medical knowledge is exploding and what seemed to be right last week may be wrong next week.
One of the most powerful arguments in the paper discusses the validity of practice guidelines, and notes, "In 2000, a group of researchers determined that more than 75 percent of the guidelines developed between 1990 and 1996 needed updating." Ms. Brase says that "they discovered that half of the guidelines were outdated in 5.8 years." Yet the development of guidelines is slow, cumbersome and expensive, taking as long as two years and costing as much as $100,000 - unless the government does it, in which case it costs $800,000.
The guidelines themselves are based on "research" that may be biased, incomplete or self-interested. Certainly we have seen numerous examples of research not getting published because it contradicts the claims of the sponsors of the research. Even the decision of what research to fund is often made for political, not medical, reasons.
Research is often contradictory. Hormone Replacement Therapy was found to lower the risk of heart disease in the Nurses Health Study, while the Women's Health Initiative study found that it increased heart attacks by 40%. But neither study can tell a clinician how to treat one particular woman with one particular genetic profile and one particular set of risk factors and co-morbidities. Population-wide information may be interesting, but it is no substitute for individual diagnosis and treatment. Relying on averages never works when dealing with individuals. In fact that may be the biggest problem with EBM - it is trying to standardize medicine at the very time when we should be customizing medicine so that each patient gets precisely the treatment that is best for his or her particular needs.
Still, research and guidelines for all their flaws can be very valuable in growing the knowledge base. The danger is not the research, but how the bureaucrats want to use the research. They want to control physicians who comply and punish those who do not through the use of financial incentives, malpractice exemptions, and even hospital privileges and licensure, all tied to compliance with EBM guidelines.
This is the polar opposite of consumer empowerment and choice. EBM advocates want only to empower themselves, and we all owe Twila Brase a hearty congratulations for bringing this to the attention of the American people.
WASHINGTON -- Advances in science and engineering increasingly require the collaboration of scholars from various fields. This shift is driven by the urgent need to address complex problems that cut across traditional disciplines, and the capacity of new technologies to both transform existing disciplines and generate new ones. At the same time, however, interdisciplinary research is impeded at many institutions by policies on hiring, promotion, tenure, and resource allocation that favor traditional disciplines, says a new report from the National Academies.
"This report identifies steps that individuals and institutions can take to more effectively conduct, facilitate, and evaluate interdisciplinary research programs and projects," said Nancy Andreasen, co-chair of the committee that wrote the report, Andrew H. Woods Chair of Psychiatry, University of Iowa, Iowa City, and director, The MIND Institute, Albuquerque, N.M.
Where's the Beef? The Promise and the Reality of Clinical Documentation.
Author: Davidson SJ
From: Academic emergency medicine
Date: 2004
Volume: 11
Issue: 11
ISSN: 1069-6563
Pages: 1127-1134
See One, Do One, Teach One: Advanced Technology in Medical Education.
Author: Vozenilek J
From: Academic emergency medicine
Date: 2004
Volume: 11
Issue: 11
ISSN: 1069-6563
Pages: 1149-1154
Supporting Clinical Practice at the Bedside Using Wireless Technology.
Author: Bullard MJ
From: Academic emergency medicine
Date: 2004
Volume: 11
Issue: 11
ISSN: 1069-6563
Pages: 1186-1192
Results of a recent study have shown multiple barriers to evidence-based practice, a method of patient care that can improve outcomes by 28%, previous data supports. A key barrier is lack of nurses' knowledge of and belief in EBP suggesting that introducing interventions in health care settings can positively influence use of EBP. Additionally, having an EBP mentor was shown as a potential factor to increase the use of EBP. This demonstrates the importance for healthcare systems to create mentoring positions in their organizations.
Article from EurekaAlert
PLoS Medicine
We are pleased to present the inaugural issue of PLoS Medicine, an international open-access medical journal from the Public Library of Science.
Please read our editorial "Prescription for a Healthy Journal" and message from the PLoS founders "A Medical Journal for the Internet Age".
PLoS Medicine: Table of Contents
Recent decisions on PET scans and defibrillators point to a new trend toward faster coverage, but with provisos for doctors.
By David Glendinning, AMNews staff. Oct. 25, 2004.
--------------------------------------------------------------------------------
Washington -- Physicians who want Medicare to start paying for new uses of cutting-edge medical technology much more quickly than it has in the past could be finally getting their wish. But doctors had better be prepared to do some extra work for it.
Federal officials recently proposed expanding Medicare coverage of implantable cardioverter defibrillators (ICDs), which have been approved for more than a year for use in a limited number of patients with coronary disease. The Centers for Medicare & Medicaid Services anticipates that the list of qualified recipients will jump by one-third, to nearly a half-million as a result.
Article from amednews.com
Posted: Sep 29, 2004 - 10:38:19 PDT
By Joel Gallob Of The News-Times
Some 20-plus local residents joined this week in an exercise in identifying the problems of medical care delivery in today's Oregon. They confronted issues ranging from the old and familiar - how to provide health care to all - to the very newest - how to ensure good health in a culture where self-induced diseases are the chief threat.
Dr. Rick Wopat, a family physician with Samaritan Health Systems in Lebanon, led the forum at Samaritan Pacific Communities Hospital Monday night. The forum, one of ten around Oregon, was organized by the Oregon Health Policy Commission, a body formed by the legislature to research health care problems and make recommendations to the governor and legislature.
The possible solutions discussed, in Newport and elsewhere, Dr. Wopat said, will help form the recommendations the commission will make. "Some will be short term recommendations, some will be intermediate-term, and some will be long term," he said. "Not everything we come up with will lead to legislation next session." But some of it, he said, will.
The exercise focused on four areas: improving access to health care, controlling costs, increasing the health care quality, and improving health generally.
Article from News Times
Linking Benefits to Medical Treatments with Demonstrated Effectiveness Called an Important Step Towards Promoting Quality and Efficiency in Health Care
WASHINGTON, DC -- (MARKET WIRE) -- 09/27/2004 -- The National Business Group on Health announced today that it has formed the National Committee on Evidence-Based Benefit Design. Committee members will recommend ways employers can use health benefit design to promote greater use of evidence-based treatments and procedures, thereby improving the value of their health care investment and enhancing employees' health and quality of life.
"So much of the medical care delivered today is neither recommended nor based on scientific evidence," explains Helen Darling, President of the National Business Group on Health. "It's time for that to change. We have an opportunity to promote evidence-based medicine and in turn, value and effectiveness in health care. We can modify coverage policy and financial incentives to reward excellent care."
Article from: market Wire
September 27, 2004 08:00 AM US Eastern Timezone
Information Therapy Conference
PARK CITY, Utah--(BUSINESS WIRE)--Sept. 27, 2004--The future of health care will be built around informed patients encouraged by their doctors to share in treatment decisions and to actively participate in their own care. That is the take-home message on the opening day at the third annual Information Therapy Conference in Park City, Utah. Information therapy (Ix) is the prescription of specific, evidence-based medical information to patients, caregivers, or consumers at just the right time to help them make a specific health decision or behavior change.
Nearly 200 conference attendees, who range from physicians to health plan executives, are hearing from speakers about the benefits of the informed patient and how leading organizations gain value by offering Ix(R) services. Each perspective points out how information prescriptions for patients are making a difference. Hospitals, clinics, and health plans all provide better service and care when consumers make better health decisions.
Article from: Business Wire
Sep. 27, 2004. 01:00 AM
Doctors need to have unbiased data on effectiveness of new drugs, says medical ethicist Arthur Schafer
North Americans consume a lot of pills: pills for high blood pressure, low libido, high cholesterol, acid reflux, arthritic pain, and depression.
We take prodigious quantities of pills because our doctors have been persuaded and have, in turn, persuaded us, that these pills work.
Doctors get their information about what works and what doesn't from a variety of sources, including what they were taught 20 years ago at medical school and what they were told last night by a paid consultant of some drug company after a fancy-free dinner.
Article from: Toronto Star
More physicians are finding that board recertification has evolved into a continuous certification process.
By Damon Adams, AMNews staff. Sept. 27, 2004.
Family physician Tony Golden, MD, has been through board recertification three times. He isn't sure he can stomach a fourth one.
"I've seriously questioned doing it again," said Dr. Golden, who practices in Idaho Falls, Idaho.
Board-certified family physicians go through recertification every seven years, but Dr. Golden and other doctors are facing a new era in recertification. In 2000, medical specialty boards agreed to transition their recertification programs into maintenance-of-certification processes, which focus on continuous lifelong learning.
Article from amednews.com
JAMA articles in the 9/1/04 issue.
Complete citations:
Carney, Patricia A., Nierenberg, David W., Pipas, Catherine F., Brooks, W. Blair, Stukel, Therese A., Keller, Adam M. Educational Epidemiology: Applying Population-Based Design and Analytic Approaches to Study Medical Education JAMA 2004 292: 1044-1050
Brennan, Troyen A., Horwitz, Ralph I., Duffy, F. Daniel, Cassel, Christine K., Goode, Leslie D., Lipner, Rebecca S. The Role of Physician Specialty Board Certification Status in the Quality Movement JAMA 2004 292: 1038-1043
U of M students, faculty, and staff can access the articles by using this link!
A *NEW* website with information and links on the topic of Understanding Medical Research.
8/23/2004 3:00:00 PM
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To: National Desk
Contact: Kim Becker of the American Medical Student Association, 703-620-6600 ext. 207; prel@www.amsa.org
RESTON, Va., Aug. 23 /U.S. Newswire/ -- The American Medical Student Association (AMSA), the nation's largest, independent medical student organization, with nearly 50,000 members, today announces a national campaign, The Amnesty Campaign, which will collect pharmaceutical marketing paraphernalia, including pens, post-it notes, mugs, calendars and more from medical students across the country. The campaign is the first in a number of events leading up to National PharmFree Day, which will be recognized on December 8, 2004.
National PharmFree Day will serve as a day of action where medical students, residents and physicians alike to speak out against the pharmaceutical industry's biased marketing practices.
AMSA developed the PharmFree Campaign in collaboration with No Free Lunch and Dr. Bob Goodman two years ago to educate and train medical students to professionally and ethically interact with the pharmaceutical industry. AMSA is the only medical organization to ban all pharmaceutical advertising in its publications and events.
Article from US Newswire
Recruitment of minorities into health care professions and improving patient-physician communications are among the goals aimed at reducing such barriers.
By Andis Robeznieks, AMNews staff. Aug. 23/30, 2004.
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Working independently on some projects and collaboratively on others, organized medicine is putting its full force behind eliminating health care disparities among racial and ethnic minorities in the United States.
At both the leadership and grassroots levels, programs and studies are being undertaken to publicize the issue of disparities while seeking the best way to reduce and eventually eliminate them.
Articel from amednews.com
Posted By: News-Medical in Medical Procedure News
Published: Tuesday, 17-Aug-2004
The American Society of Clinical Oncology has developed a set of recommendations to address whether patients who have had successful surgery for Stage II colon cancer should be offered adjuvant chemotherapy in routine clinical practice.
The guideline, published in the August 15 issue of the Journal of Clinical Oncology, states that the routine use of adjuvant chemotherapy for medically fit, average-risk patients with Stage II colon cancer is not recommended. Clinical trials have not established with certainty a significant degree of clinical benefit for adjuvant chemotherapy in patients with Stage II colon cancer, although most trials show a small benefit from adjuvant chemotherapy.
Specifically, patients who receive adjuvant chemotherapy have about a 4% to 5% greater chance of survival five years after surgery, compared with patients who had surgery alone. The exact benefit is not known with certainty because not enough Stage II patients have been included in clinical trials involving this group of patients only.
Article from News-Medical.Net
Wed Aug 11, 2004 04:59 PM ET
NEW YORK (Reuters Health) - Treating children for traumatic stress appears to be more effective than routine care or no treatment, according to results of a new study.
"Despite the expenditure of large sums of public monies to ameliorate the consequences of childhood trauma, little is known about the efficacy of treatment for traumatized children and their families," say Drs. Claude M. Chemtob and Tisha L. Taylor of Mount Sinai School of Medicine, in New York.
From Reuters
By Mayo Clinic staff
For years, women have lagged behind men when it comes to prevention and treatment of cardiovascular disease. But the gender gap has been widening. The number of men dying of cardiovascular disease has decreased while women's death rates have remained the same or even increased for some heart conditions.
An essay in the respected journal Circulation attributed the disparity in part to the "bikini approach" to medicine — a focus on women's disorders of the breast and reproductive system. Even women themselves have brushed off the dangers of heart disease.
Article from MayoClinic.com
Government funding of Med School R&D in Great Britain
DEPARTMENT OF HEALTH News Release (2004/0298) issued by the Government News Network on 4 August 2004
A new boost for research in medical schools was announced today by Health Minister, Lord Warner. The new funding is part of the government’s drive to strengthen research and innovation, and make sure that the NHS gets the benefit of the latest scientific developments.
Article from News.scotsman.com
Otolaryngologist Dr. David Roberson has first-hand experience with medical errors. He remembers one near-miss in a patient about to receive a cochlear implant -- and says it typifies the kinds of mistakes he and his colleagues have turned up in a national survey. ''I looked at the CT scan carefully to determine if the cochlea would accept the implant,'' recalls Roberson, from the Department of Otolaryngology and Communication Disorders at Children's Hospital Boston. ''I asked a colleague to look at it also, and he commented that the auditory nerves looked small. I then ordered an MRI which showed the patient had no auditory nerves on either side. I came close to performing surgery and putting a major device in a child's head when there was no possibility of benefit, since she had no auditory nerve. I didn't look carefully enough at the entire scan.''
Link through ScienceBlog
02 Aug 2004
Celiac disease is considerably under-diagnosed, according to an independent consensus panel convened last month by the National Institutes of Health (NIH). The panel, charged with assessing all of the available scientific evidence on celiac disease, announced recommendations for the appropriate diagnosis and management of this disease, which was previously believed to be rare. Celiac disease may affect 3 million Americans. The disease is present in 0.5 to 1% of the U.S. population, ten times higher than previous estimates.
Columbus Children's Reserach Institute Physician Participates in Panel, Which Recommends Six Key Strategies for Disease Management
From Medical News Today
Medical News - Keywords: CANCER, CHEMOTHERAPY, ASSAYS
A new technology assessment from ASCO states that the use of chemotherapy sensitivity and resistance assays (CSRAs) to select chemotherapeutic agents for cancer patients should not be undertaken outside of the clinical trial setting.
Article from newswise
More than 600 million people surf the Internet, and an estimated 36% to 55% of them use it to gather medical information, according to an article published in the April 14 issue of the Annals of Oncology.
Authors of this article, based at the Peninsula Medical School at the Universities of Exeter & Plymouth, Institute of Health & Social Care in Exeter, the United Kingdom, set out to evaluate the quality of information on complementary and alternative medicine (CAM) available on the Internet and identify the most frequently discussed treatments.
Article from CancerWise
Robin J. Moody
Employers providing health benefits often feel powerless in the face of rising health care costs, and simply shift the costs to workers. But panelists at the Oregon Health Forum breakfast Thursday shared other approaches they are using to curb costs while getting better quality care for their money.
TOC Management Services, an association of wood products and manufacturing employers representing thousands of employees, uses a four-pronged strategy to approach health benefits.
It is tweaking plan designs, working to improve communication with members, beefing up disease management programs and aiming to help members be more savvy health care consumers.
For disease management and education, TOC has targeted diabetes, prenatal care, back pain and heart burn, which cost TOC employers $1 million in a recent year. Diabetes patients costs the company four times more than the average covered member, noted TOC Employee Benefits Manager Jim Walton.
Washington, DC – Partnership for Prevention, a nonprofit organization devoted to helping Americans prevent disease and injury, welcomes new proposed rules from the Department of Health and Human Services to expand coverage for preventive services under Medicare as "a step in the right direction." The proposed rules were also well received by the American College of Preventive Medicine, the professional society of physicians who specialize in preventive medicine.
Under proposed rules announced Tuesday, in 2005 Medicare will begin covering initial comprehensive physical examinations for new Medicare beneficiaries and will expand coverage for cardiovascular and diabetes screening. Previous legislation expanded Medicare coverage for a number of cancer screening tests, immunizations, and other preventive services proven to save lives and improve the health of seniors.
Annals of Family Medicine is a peer-reviewed research journal that
provides a cross-disciplinary forum for new, evidence-based information...
Annals of Family Medicine: Article Tipsheet
Link: http://www.eurekalert.org/pub_releases/2004-07/aofm-j2a072204.php
6/30/2004 9:40:00 AM
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To: National Desk
Contact: Jack Pope, 202-261-4556 or jpope@acponline.org, Jacquelyn Blaser, 202-261-4572, or jblaser@acponline.org, both of the American College of Physicians
WASHINGTON, June 30 /U.S. Newswire/ -- The new Medicare Chronic Care Improvement (CCI) pilot program must include at least one demonstration site, which focuses on "patient-centered, physician- guided" care, said the American College of Physicians (ACP) in a June 23 letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan, MD.
Congress created the pilot program in recognition of the current fragmented care provided chronically ill Medicare patients under fee-for-service. Under Section 721 of the Medicare Modernization ACT (MMA) the CMS administrator must establish CCI pilot programs in ten different sites. The results of these test programs will be evaluated and ultimately become a permanent part of Medicare.
Press Release: http://releases.usnewswire.com/GetRelease.asp?id=109-06302004
By Laura Landro
Wall Street Journal
The current push to require drug companies to disclose their unpublished clinical trials could unleash a flood of new information for doctors and patients. But in the meantime, there is already a growing effort by medical publishers, scientific groups and government agencies aimed at helping people find and interpret the results of clinical trials online.
Existing registries are run by the National Institutes of Health and a host of private organizations. Web sites such as MedlinePlus.gov offer direct links to most published medical studies, which in some cases are free or else can be purchased directly from the journal. And more help is under development, such as an upcoming guide from the National Library of Medicine on understanding reports.
Article: http://www.fortwayne.com/mld/journalgazette/living/9031119.htm
Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration.
This article is available in full text at both the U of M and UPR libraries. U of M students, staff and faculty can access it through the MNCAT catalog. UPR students, staff and faculty can access through the ProQuest Medical Library at: http://rcm- library.rcm.upr.edu/ProQuestaccess.htm
LAURA LANDRO, The Wall Street Journal
Thursday, June 17, 2004
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(06-17) 06:07 PDT (AP) --
The current push to require drug companies to disclose their unpublished clinical trials could unleash a flood of new information for doctors and patients. But in the meantime, there is already a growing effort by medical publishers, scientific groups and government agencies aimed at helping people find and interpret clinical-trials results online.
Currently existing registries are run by the National Institutes of Health and a host of private organizations. Web sites like MedlinePlus.gov offer direct links to most published medical studies, which in some cases are free or else can be purchased directly from the journal. And more help is under development, such as an upcoming guide from the National Library of Medicine on understanding reports.
By Amanda Gardner
HealthDay Reporter
TUESDAY, June 15 (HealthDayNews) -- Three of the nation's leading health organizations have joined forces to release the first unified set of recommendations on how to avert the nation's deadliest diseases.
The guidelines are aimed at preventing cancer, diabetes, heart disease, and stroke, and experts said that if they're followed carefully, people can lower their risk of getting these diseases by two-thirds.
The recommendations, announced Tuesday by the American Heart Association, the American Cancer Society, and the American Diabetes Association, are intended to make life simpler and healthier for all Americans. Lifestyle changes that lower the risk for one disease, for instance, could cut the risk for them all, they said.
Article: http://www.forbes.com/lifestyle/health/feeds/hscout/2004/06/15/hscout519548.html
The power of the prescription pad is harnessed to the Internet with the hope that educated patients can be powerful players in their own care.
By Susan J. Landers, AMNews staff. May 24/31, 2004.
Washington -- Officially directing patients to a reputable Web site to research a disease or condition is an idea whose time has come, according to physicians who have participated in pilot projects for Prescriptions for Information.
The program, a joint effort of the National Library of Medicine and the American College of Physicians Foundation, encourages physicians to write prescriptions for a trustworthy, commercial-free Web site packed full of free information -- the NLM's MedlinePlus.
Article: http://www.ama-assn.org/amednews/2004/05/24/hlsb0524.htm
This article is a great review of what to expect from an Internal Medicine RRC site visit in light of the new Outcomes Project requirements.
Download file
Would you like up to date conference coverage, the latest articles in your specialties, and a listing of CME activities...then you might want to take a look at MedScape. Registration is free and info is delevered to your desktop. For mor info see below:
"Medscape offers specialists, primary care physicians, and other health professionals the Web's most robust and integrated medical information and education tools. After a simple, one time, free registration, Medscape automatically delivers to you the specialty site that best fits your profile. You can also change your Medscape home page to any of our specialty and profession sites. Some of Medscape's key features include:
* Physician Optimized MEDLINE
* Over 250 on-line CME activities
* Conference Coverage - thought leaders summarize key data and resentations from major medical meetings.
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* Daily professional medical news in your specialty.
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Hello All!
First I want to say what a pleasure it was to meet all of you and share some of the projects and resources that the Bio-Medical Library uses to support Evidence Based Medicine/Practice Based Learning. I hope that you will find these tools useful in the future. The hospitality from the UPR Medical School was EXCELLENT and in particular I would like to thank Drs. Drs. Marquez and Gomez for making our trip and workshop run so smoothly!
Now, I must apologize if you were receiving email updates from another Web Blog page. I added incorrect scripting. All is fixed now and be sure to check out grant funding opportunities I have added below!
Please feel free to ntify me with any news you might want to add to the page.
Cindy Gruwell
Release: April 11, 2004
Evidence-based Medicine: Ten Hard Facts
Evidence-based medicine is the judicious application of scientific knowledge by clinicians in tandem with patient preferences and values. It is not cookbook medicine; it is an ongoing process of integrating evidence with the clinician’s training and expertise for the care of patients and patient populations. In evidence-based practice, clinicians act as coaches and share decision-making with patients.
The practice of evidence-based medicine is the centerpiece for healthcare transformation. Its consistent application results in improved care, reduced inappropriate variability in practice patterns and improved efficiency. It is the basis for new incentives rewarding clinician and patient adherence by payers, the premise upon which medical malpractice reform is achieved, and the foundation for consumer-directed care. Ten key facts about evidence-based medicine are relevant...
Document: http://ebm.vanderbilt.edu/releases/vcebm_04apr11_10facts.pdf
Australian doctors do not have a basic understanding of terminology regularly used in evidence based medicine, according to a new study.
The survey, published in this week's British Medical Journal, surveyed 50 general practitioners based in Sydney.
"What this is saying is few GPs (and possibly all doctors) understand the terms of the trials they might be looking at," said Professor Paul Glasziou, one of the paper's authors, who works in evidence-based practice at the School of Population Health at the University of Queensland. ..
Article: http://www.abc.net.au/science/news/stories/s537546.htm
Hello!
Welcome to the new University of Minnesota/University of Puerto Rico: Practice Based Learning Collaborative.
We hope this is the beginning of a long and fruitful relationship. Please be on the lookout for news, announcements, and additional projects in the future.