Medical News Today
- Functional Technologies Develops Yeast Solution For Acryl... Functional Technologies Corp. (TSX VENTURE:FEB), a world leader in yeast research and development, announced today that it has developed, tested and filed patent applications for yeast technology that reduces the formation of acrylamide, a carcinogen formed when starchy foods are baked, fried or toasted. Recognized globally as a serious food safety issue since 2002, acrylamide has been found in many widely consumed foods, including bread, cookies, crackers, baby food, breakfast cereal, French fries and potato chips...
- Arcadia Biosciences Completes First Commercial Production... Arcadia Biosciences, Inc., an agricultural technology company focused on developing technologies and products that benefit the environment and human health, announced today that it has successfully completed the first commercial production of SONOVA™ 400 High GLA Safflower Oil. Seed produced by the first High GLA Safflower crop, grown during 2009, was processed to produce commercial quantities of SONOVA™ 400 oil, which is now available for distribution as a key ingredient in dietary supplements...
- Kevin P. Black, MD, Elected To American Academy Of Orthop... Orthopaedic surgeon Kevin P. Black, MD, of Hershey, Penn., was elected to the Board of Directors of the American Academy of Orthopaedic Surgeons (AAOS) at the organization's 2010 Annual Meeting in New Orleans. "It's an enormous honor to be elected to the AAOS Board of Directors," said Dr. Black. "I'm looking forward to working with and learning from the other members of the Board and having the opportunity to contribute to our great profession and ultimately the patients for whom we care." Dr...
- AngioScore Announces Favorable Results From The MASCOT Trial AngioScore, Inc., a developer of novel angioplasty catheters for use in the treatment of cardiovascular disease, announced today favorable clinical trial results from the MASCOT Trial, an important study evaluating the AngioSculpt® PTA Scoring Balloon Catheter for the treatment of femoro-popliteal PAD (peripheral artery disease). "PAD is one of the fastest-growing segments of the Endovascular Market, with an estimated two million annual procedures worldwide...
- FDA Allows IND For Bio-Path Holdings' Liposomal Grb-2 Bio-Path Holdings, Inc. (OTCBB: BPTH), a publicly traded biotechnology company with drug development operations in Houston, Texas, announced that the U.S. Food and Drug Administration (FDA) has allowed an IND (Investigational New Drug) for the Company's lead cancer drug candidate liposomal Grb-2 to proceed into clinical trials...
- Patient Advocacy Group Asks FDA To Enhance Its Enforcemen... The National Minority Quality Forum (The Forum) is launching a new public information campaign aimed to help educate consumers, physicians, and policymakers about the risks associated with prescribing and taking unapproved drugs that have not been subjected to the rigorous Food and Drug Administration's (FDA) review and approval process. Unapproved drugs can be dangerous - or even deadly - to patients as a result of the lack of testing, unknown or unregulated ingredients, improper labeling, and as a result of this lack of information, the inability to predict drug to drug interactions...
- Risk Stratification Imperative To Treatment Selection In ... Using risk stratification to assist in treatment selection was just one of the focal points at a recent presentation of the NCCN Clinical Practice Guidelines for Oncology (NCCN Guidelines™) for Acute Myeloid Leukemia (AML) at the NCCN 15th Annual Conference. B. Douglas Smith, MD of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and a member of the NCCN Guidelines Panel for AML, spoke about the challenges in treating AML as well as recent updates to the NCCN Guidelines™. Dr...
- Ligand Announces Approval For Revolade(R) In Europe Ligand Pharmaceuticals Incorporated (NASDAQ:LGND) today announced that GlaxoSmithKline (NYSE: GSK) was granted marketing authorization from the European Commission (EC) for Revolade® (eltrombopag) for the oral treatment of thrombocytopenia (reduced platelet count) in adults with the blood disorder chronic immune (idiopathic) thrombocytopenic purpura (ITP). Eltrombopag is indicated for adult chronic ITP splenectomized patients who have not responded (are refractory) to other treatments, such as corticosteroids and immunoglobulins...
- Frost & Sullivan Lauds Positron Corporation For Cardiac-F... Based on its recent analysis of the cardiac molecular imaging systems market, Frost & Sullivan recognizes Positron Corporation with the 2010 North American Award for New Product Innovation, for its pioneering cardiac positron emission tomography (PET) scanner, Attrius™. The Attrius™ was developed and optimized for molecular imaging of the heart, making it the ideal solution for cardiologists and hospitals looking to add high accuracy, cost effective imaging technology...
- Cancer Care At The End Of Life: When Is Enough, Enough? Despite the advances and groundbreaking research being performed in the area of cancer treatment, sometimes cancer cannot be cured. In this situation, patients and their families are faced with complex emotions and a variety of end of life issues and decisions. ABC News veteran and anchor Sam Donaldson shared his own perspective as a cancer survivor while moderating a roundtable of notable panelists at the NCCN 15th Annual Conference: Clinical Practice Guidelines & Quality Cancer Care™ on March 11, 2010. "I had to figure out who I was going to be on my own." Mr...
Newswise: MedNews
- Vitamin D Levels Have Different Effects on Atherosclerosi... Vitamin D is quickly becoming the "go-to" remedy for treating a wide range of illnesses, from osteoporosis to atherosclerosis. However, new evidence from a Wake Forest University School of Medicine study suggests that supplementing vitamin D in those with low levels may have different effects based on patient race and, in black individuals, the supplement could actually do harm.
- Cardiac Rehabilitation Helps Survival Time in Heart Patie... A team of Mayo Clinic researchers have found that cardiac rehabilitation is associated with significantly reduced mortality rates for patients who have had stents placed to treat blockages in their coronary arteries. The findings, presented today at the annual meeting of the American College of Cardiology in Atlanta, found that patients who had coronary angioplasty (stent placement, also known as percutaneous coronary intervention) and afterwards participated in a cardiac rehabilitation program had a 45 to 47 percent decrease in mortality compared to those who did not participate in a cardiac rehabilitation program.
- Recent Cigarette Marketing Campaign Targeted Teen Girls The 1998 Master Settlement Agreement (MSA) prohibits tobacco industry advertising practices that encourage underage teenagers to smoke, yet new research out of the Moores Cancer Center at the University of California, San Diego has found that a 2007 marketing campaign for Camel brand cigarettes was effective in encouraging young girls to start smoking.
- Mayo Clinic Study on How to Minimize Radiation Risks of A... Body size, gender and the complexity of heart disease significantly influence how much cumulative radiation skin dose that patients receive during percutaneous coronary intervention (PCI) therapy, also known as angioplasty, according to a new Mayo Clinic study. The study was undertaken as a quality control initiative to reduce the potential radiation risks of cancer to patients and PCI operators.
- Mayo Clinic Proceedings Study Finds Link Between Hypoglyc... In a study published in the March issue of Mayo Clinic Proceedings, researchers report that they have found a link between mild to moderate hypoglycemia (low blood sugar) and mortality in critically ill patients.
- Amniotic Fluid Cells More Efficiently Reprogrammed to Plu... In a breakthrough that may help fill a critical need in stem cell research and patient care, researchers at Mount Sinai School of Medicine have demonstrated that skin cells found in human amniotic fluid can be efficiently "reprogrammed" to pluripotency, where they have characteristics similar to human embryonic stem cells that can develop into almost any type of cell in the human body.
- UNC's Dr. John Buse to Receive National Award for Clinica... UNC's John B. Buse, M.D., Ph.D., has been selected to receive a Clinical Excellence award at the Castle Connolly National Physician of the Year Awards ceremony.
- Meditation Techniques Effective for Pain Relief Meditation has analgesic benefits associated with creating a relaxed state of mind and enhancing the ability to moderate reactions to pain, according to new research published in The Journal of Pain, the peer review publication of the American Pain Society.
- Scientists Identify Chemical in Bananas as Potent Inhibit... A potent new inhibitor of HIV, derived from bananas, may open the door to new treatments to prevent sexual transmission of HIV, according to a study by University of Michigan scientists.
- In the Fight Against Life-Threatening Catheter Infections... Hospitals may reduce the risk of life-threatening bloodstream infections in newborns with peripherally inserted central venous catheters by replacing the device every 30 days or so, according to a new Johns Hopkins Children's Center study.
ScienceDaily: Health & Medicine News
- Unlocking the opium poppy's biggest secret: Genes that ma... Researchers have discovered the unique genes that allow the opium poppy to make codeine and morphine, opening the door to alternate methods of producing these effective painkillers either by manufacturing them in a lab or controlling the production of these compounds in the plant.
- Body's anticipation of a meal can be a diabetes risk factor Alterations in our response to the taste or smell of food may be another culprit responsible for Type 2 diabetes, according to scientists who have identified the specific mechanism in human specimens and in mice.
- Minimally invasive sports hernia repair may get athletes ... A new minimally invasive sports hernia repair gets athletes back in the game 3 times faster than the traditional repair, according to a new study. Sports hernias were often difficult to diagnose and prior to this new repair had a lengthy rehabilitation time.
- New insight on how fast nicotine peaks in the brain Nicotine takes much longer than previously thought to reach peak levels in the brains of cigarette smokers, according to new research.
- Pancreatic cancer study reveals mechanism initiating dise... Scientists have discovered how a mutated gene known as Kras is able to hijack mouse cells damaged by acute pancreatitis, putting them on the path to becoming pancreatic cancer cells.
- 'Microtentacles' on tumor cells appear to play role in ho... Researchers have discovered that "microtentacles," or extensions of the plasma membrane of breast cancer cells, appear to play a key role in how cancers spread to distant locations in the body. Targeting these microtentacles, which are linked to a protein called "tau," might prove to be a new way to prevent or slow the growth of these secondary cancers, the scientists say.
- Inner workings of the inflammatory response to Leishmaniasis The secret world of inflammation is slowly being revealed by the application of advanced techniques in microscopy, as shown in a new study. Researchers used 2-photon microscopy to identify how killer T lymphocytes behaved when they enter sites of inflammation caused by the parasite Leishmania donovani, and which infected cells they were able to recognize.
- Free hormonal contraception halved termination rate, Norw... Free hormonal contraception was offered for a year to young women in two Norwegian cities. The result was that the abortion rate in the trial cities was halved.
- Psychopaths' brains wired to seek rewards, no matter the ... The brains of psychopaths appear to be wired to keep seeking a reward at any cost, new research finds. The research uncovers the role of the brain's reward system in psychopathy and opens a new area of study for understanding what drives these individuals.
- New cancer drug screening technique more closely mirrors ... Improving on traditional screening tests for potential anti-cancer drugs, scientists have developed a laboratory technique that more closely simulates the real-world conditions in which tumor cells mingle with the body's normal cells.
Yahoo! News: Health News
- Studies: Intense treatment doesn't help diabetics (AP) AP - Key results from a landmark federal study are in, and the results are disappointing for diabetics: Adding drugs to drive blood pressure and blood-fats lower than current targets did not prevent heart problems, and in some cases caused harmful side effects.
- Hearts may swoon when stocks do, study suggests (AP) AP - Stock market slides may hurt more than your savings. New research suggests they might prompt heart attacks.
- Many WTC responders show early signs of heart woes (... AP - Law enforcement officers who worked near ground zero after the World Trade Center attacks seem to show early signs of heart problems at a higher rate than would be expected for their age, a new study suggests.
- Women on the pill may live longer (AP) AP - Women who took the birth control pill beginning in the late 1960s lived longer than those never on the pill, a new study says.
- Court says thimerosal did not cause autism (AP) AP - The vaccine additive thimerosal is not to blame for autism, a special federal court ruled Friday in a long-running battle by parents convinced there is a connection.
- Experts say even Obama getting too many med tests (AP) AP - Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.
- 2 Drugs Fail to Prevent Diabetes in the Overweight (... HealthDay - SUNDAY, March 14 (HealthDay News) -- Hopes that two available drugs could help prevent diabetes and the problems it causes in overweight people with poor sugar metabolism have been dashed by a major international study.
- As You Age, Better Health Means Better Sex (HealthDay) HealthDay - TUESDAY, March 9 (HealthDay News) -- Better health translates into better sex lives, with healthy people more likely to engage in sex (and good sex at that) and to express an interest in sex, new research finds.
- Clinical Trials Update: March 15, 2010 (HealthDay) HealthDay - (HealthDay News) -- Here are the latest clinical trials, courtesy of ClinicalConnection.com:
- Amnesty International Report on U.S. Maternal Health ... Time.com - In a new report on pregnancy andchildbirth care in the U.S., Amnesty details the maternal health care crisisin this country as part of a systemic violation of women's rights
BBC World Health News
- No quick fix for diabetes risk Exercise and diet are key to prevent diabetes in high-risk people, say researchers who found two drug treatments offer no benefit.
- Gum disease 'link' to early birth Successful treatment for gum disease cuts the risk of pregnant women giving birth early, say US researchers.
- Obese drinkers face 'double hit' Obese women drinking little more than a glass of wine a day have double the risk of liver disease, experts warn.
- New blood pressure approach urged Occasionally high blood pressure may be a greater indicator of stroke risk than consistently high readings, researchers say.
- Women on pill 'may live longer' Women who took the contraceptive pill are less likely to die of cancer and heart disease, a long-term study has found.
- Home 'cervical cancer' test hope At-home screening tests for the virus responsible for most cervical cancers could detect many more cases, say researchers.
- New York agrees 9/11 dust payout New York City agrees to pay up to 657m US Dollars (437m Sterling) to thousands of rescue and clean-up workers at the 9/11 attacks site.
- GPs 'lax' on cholesterol targets Many lives could be saved if GPs followed guidelines for reducing cholesterol in those at high risk of heart disease, a study suggests.
- Vitiligo skin graft 'effective' Skin transplant surgery can be an effective way of treating the skin disease vitiligo, say US researchers.
- Hospital rap over medicine errors Too many patients in England and Wales are not getting their medicines in hospital, a safety watchdog says.
MedPageToday Headlines
- ACC: Old Trumps New in Stent Comparison (CME/CE) ATLANTA (MedPage Today) -- For patients with chronic stable coronary artery disease, the first-generation sirolimus-eluting stent (Cypher) was better than the second-generation zotarolimus-eluting stent (Endeavor) for preventing major adverse cardiac events, a randomized trial showed.
- AAOS: Artificial Turf Injuries Still More Likely in NFL (... NEW ORLEANS (MedPage Today) -- National Football League players were significantly more likely to injure their legs and feet on a popular brand of artificial turf than on grass, researchers found in one of three NFL injury studies reported here.
- AAOS: Sports Account for Half of U.S. Ankle Sprains (CME/CE) NEW ORLEANS (MedPage Today) -- About half of U.S. ankle sprains occur while patients are playing sports, with basketball taking most of the blame, according to the largest study of this common injury to date.
- AAOS: Uncertain Future for Platelet-Rich Plasma (CME/CE) NEW ORLEANS (MedPage Today) -- Clinicians are trying to determine where platelet-rich plasma (PRP) fits into the armamentarium of treatments for orthopedic injuries.
- AAOS: Surgery Doesn't Improve Achilles Tendon Recovery (C... NEW ORLEANS (MedPage Today) -- Surgical and nonsurgical treatment were equally effective for patients with an acute rupture of the Achilles tendon, a randomized trial showed.
- SGO: Drug Combination Slows Recurrent Ovarian Cancer (CME... SAN FRANCISCO (MedPage Today) -- Combination chemotherapy resulted in a longer, progression-free survival (PFS) than did sequential therapy in a randomized clinical trial of patients with recurrent, platinum-sensitive ovarian cancer.
- AAOS: Orthopedic Injuries Common in Deployed Soldiers (CM... NEW ORLEANS (MedPage Today) -- Musculoskeletal injuries exact a heavy toll on U.S. military forces fighting overseas, a longitudinal cohort study showed.
- FDA on the Lookout for Fake Surgical Mesh WASHINGTON (MedPage Today) -- The FDA cautioned healthcare professionals and consumers of counterfeit surgical mesh products marketed as a known brand of the soft tissue support.
- ACC: Degree of Rate Control Questioned in Atrial Fib Tria... ATLANTA (MedPage Today) -- For patients with permanent atrial fibrillation, lenient control of heart rate does not result in worse outcomes than more strict control, a multicenter, randomized trial showed.
- SSRI, Naltrexone, Talk Therapy Keep Depressed Alcoholics ... Combining sertraline (Zoloft) and the opioid antagonist naltrexone is better than either drug alone or placebo in keeping depressed alcoholics sober, researchers said.
Reuters: Health News
- Merck blood thinner appears safe, effective ATLANTA (Reuters) - An experimental blood thinner being developed by Merck & Co from a new class of drugs appeared to be safe and effective in a mid-stage study that compared three doses against widely used warfarin in patients with atrial fibrillation.
- Boston Scientific suspends ICD sales; shares slump CHICAGO (Reuters) - Boston Scientific Corp said it has suspended sales of its implantable heart defibrillators after failing to notify regulators of changes in how it manufactures the devices. It said patient safety was not at risk.
- Donors asked for $4.3 billion for vaccines for poor LONDON (Reuters) - A further $4.3 billion is needed if a global vaccines alliance is to meet its goal of supplying life-saving immunizations to millions of children in poor countries by 2015, the organization said on Monday.
- Screening for rare fatal disease too costly: study NEW YORK (Reuters Health) - Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether genetic tests are worth the cost.
- House Democrat says still short on health votes WASHINGTON (Reuters) - White House officials on Sunday confidently predicted quick final passage of healthcare reform but a top Democratic vote-counter said the party still needs to line up more support in the House of Representatives.
- China drug list seen boosting Western firms' sales LONDON (Reuters) - Chinese plans to broaden the list of medicines eligible for a rebate from July will benefit Western drugmakers such as AstraZeneca and Sanofi-Aventis, according to Morgan Stanley analysts.
- No heart benefit seen with fibrates in diabetics ATLANTA (Reuters) - Adding a triglyceride-lowering drug to cholesterol-fighting statins provided no additional protection from heart attack, stroke and death from heart disease in patients with Type 2 diabetes, according to data from a large study.
- Abbott's heart valve device proves safe, effective ATLANTA (Reuters) - An experimental, minimally invasive technique to repair the most common type of heart valve problem proved to be far safer and nearly as effective as open heart surgery, meeting the primary goals of a pivotal study, researchers said on Sunday.
- Novartis drugs fail to help high-risk patients ATLANTA (Reuters) - The Novartis diabetes drug Starlix failed to reduce progression to the disease or cut down on serious heart problems in patients at high risk for both diabetes and heart disease, according to a large study released on Sunday.
- U.S. court rules again against vaccine-autism claims WASHINGTON (Reuters) - Vaccines that contain a mercury-based preservative called thimerosal cannot cause autism on their own, a special U.S. court ruled on Friday, dealing one more blow to parents seeking to blame vaccines for their children's illness.
Medscape Headlines
- Adherence to Guidelines Varies in Treatment of Pediatric ... Adherence or nonadherence to asthma guidelines did not appear to affect clinical outcomes for many children with asthma. Medscape Medical News
- Safely Switch From Amiodarone to Dronedarone in Two Days,... Most patients, at least, who are in sinus rhythm after cardioversion from atrial fibrillation and for whom a transition from the old drug to the new one is planned can switch in two days. The post hoc analysis points to two signals that waiting longer might be safer, according to researchers. Heartwire
- Boston Scientific Issues Broad ICD, CRT-D Recall, Halts S... Day 2 of the ACC/i2 Summit was abuzz, not with meeting news, but over the ICD/CRT-D recall announced Monday morning. Heartwire
- No Marked Difference in Death Rate Between Norepinephrine... Although there was no significant difference in death rates between patients treated with dopamine and those treated with norepinephrine, dopamine was linked with twice as many adverse events. Medscape Medical News
- Pediatric Lyme Arthritis Twice as Common as Septic Arthri... Pediatric joint effusions are more likely to be due to Lyme arthritis than septic arthritis in the Northeastern United States and other areas where Lyme disease is more prevalent. Medscape Medical News
- NCCN AML Guidelines Updated: Cytogenetic Analysis, Expand... Advances in the molecular characterization of acute myeloid leukemia (AML) are helping with the clinical assessment of risk in patients with the disease. Medscape Medical News
- MRI More Sensitive Than Mammography or Ultrasound in Wome... Magnetic resonance imaging (MRI) used alone is substantially more accurate than mammography in young women at high risk, so should guidelines be revised? Medscape Medical News
- Smaller Blood Tubes Reduce Amount of Blood Drawn for Lab ... Using smaller tubes to collect blood does not affect lab results and reduces the amount of blood drawn in intensive care units and other settings. Medscape Medical News
- "Lenient" as Good as "Strict" Ventricular Rate Control in... The standard heart-rate target of <80 bpm doesn't lead to better clinical outcomes and is harder to achieve than a target of <110 bpm, a prospective randomized trial found. Heartwire
- Statins Added to Standard Psoriasis Therapy May Improve D... Statin users with psoriasis showed a 64% reduction in psoriasis severity, whereas nonusers showed a 45% reduction in severity after the initiation of a new psoriasis medication. Medscape Medical News
AP Health News
- Study: Mini clip is safer than heart-valve surgery
- Studies: Intense treatment doesn't help diabetics ATLANTA (AP) -- Key results from a landmark federal study are in, and the results are disappointing for diabetics: Adding drugs to drive blood pressure and blood-fats lower than current targets did not prevent heart problems, and in some cases caused harmful side effects....
- Hearts may swoon when stocks do, study suggests ATLANTA (AP) -- Stock market slides may hurt more than your savings. New research suggests they might prompt heart attacks....
- Many WTC responders show early signs of heart woes ATLANTA (AP) -- Law enforcement officers who worked near ground zero after the World Trade Center attacks seem to show early signs of heart problems at a higher rate than would be expected for their age, a new study suggests....
- Women on the pill may live longer LONDON (AP) -- Women who took the birth control pill beginning in the late 1960s lived longer than those never on the pill, a new study says....
- Court says thimerosal did not cause autism WASHINGTON (AP) -- The vaccine additive thimerosal is not to blame for autism, a special federal court ruled Friday in a long-running battle by parents convinced there is a connection....
- Experts say even Obama getting too many med tests CHICAGO (AP) -- Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system....
- FDA warning: some patients cannot process Plavix WASHINGTON (AP) -- The Food and Drug Administration is adding its strongest warning to the label for Plavix, cautioning that some patients do not respond to the blockbuster blood thinner....
- People with variable blood pressure at stroke risk LONDON (AP) -- People with occasional spikes in their blood pressure could be at higher risk of having a stroke than those with regularly high blood pressure, new studies said Friday....
- Study suggests too many invasive heart tests given NEW YORK (AP) -- A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests....
NYTimes Health News
- Steps to Stop Heart Attacks in Diabetics Fail, Studies Say Three treatment strategies that doctors had expected would prevent heart attacks among people with Type 2 diabetes have proven to be ineffective or even harmful.
- When Your Partner Is a Sex Addict Sex addiction therapist Mavis Humes Baird responds to one reader traumatized by her boyfriend's betrayal.
- Recipes for Health: Table for One, Please A meal eaten alone can be an almost meditative experience, offering an opportunity to contemplate what you eat and how.
- Millions Spent to Sway Democrats on Health Care Advertising that rivals the ferocity of a presidential campaign is taking aim at about 40 House Democrats.
- The South Bronx, Plagued by Obesity, Tops a Hunger Survey Experts say a key bridge between hunger and obesity is the scarcity of healthful options in low-income areas.A recent survey found that the most severe hunger-related problems in the nation are in the South Bronx, long one of the country’s capitals of obesity.
- Doctors Blame Economy for Drop in Plastic Surgery Cosmetic surgeries are down. Doctors blame the recession. But maybe it’s more than a pocketbook issue.
- City Tries to Shut M2 UltraLounge Over Smoking Ban The first enforcement action of its kind is part of an offensive by the health department against nightclubs it says flouts the rules.
- Yoga Licensing Rebellion in New York on the Verge of Victory Gov. David A. Paterson is expected to approve a bill that would exempt training programs for yoga teachers from state regulation.
- Rays of Hope in Battling an Agonizing Disease Epdermolysis bullosa, a rare genetic disease full of suffering and disfigurement that makes skin as fragile as a butterfly’s wing, is the focus of research along three differing paths.
- Patient Money: Finding the Right Care for the Elderly Advice for making an informed decision about supporting an ailing parent without bankrupting the family.
USAToday Health News
- NIH studying progesterone to treat traumatic brain injuries A small study, now being expanded, shows promise for the female hormone best known for playing a key role in maintaining pregnancy.
- Allergy sufferers journey into the season of symptoms Seasonal allergies won't kill you, but they sure can knock you down. USA TODAY sorts through the latest allergy research.
- Heart health: Doctors devise less invasive valve surgery A new study shows that leaky heart valves can be fixed without major surgery by guiding a clip into place from an incision in ...
- Your Health: Vulnerability to ankle sprains varies with age Men under 30, women over 30 most at risk
- Study: Camel No. 9 cigarette ads appeal to teen girls R.J. Reynolds denies targeting teens, but a study finds that the ads, since pulled, were a hit with girls ages 12 to 16.
- Tricor doesn't lower diabetics' heart risk in large study The drugmaker argues that the patients used in the study did not qualify for treatment with fenofibrate and therefore did not ...
- Women on birth control pill may live longer Women who took the birth control pill beginning in the late 1960s lived longer than those never on the pill, a new study says.
- Court: Thimerosal in vaccine didn't cause autism The vaccine additive thimerosal is not to blame for autism, a special federal court ruled Friday in a long-running battle by ...
- FDA black box warning: Some can't process blood thinner P... The U.S. Food and Drug Administration is adding its strongest warning to the label for Plavix after reports that some patients ...
- Nursing covering more health care As the debate over health care legislation continues in Washington, advocates for nurse practitioners say it is these primary ...
msnbc.com:
- Health care 101: Consumer guide to reform bill It took lawmakers a year to shape President Barack Obama's health care bill. If it finally passes Congress, it'll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies.
- Advanced gene test better at spotting autism U.S. researchers looking for genetic changes linked to autism reported Monday an advanced gene test that searches for deleted or extra DNA in chromosomes worked three times better than standard tests.
- Prenatal screening for rare disease too costly Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether genetic tests are worth the cost.
- NY license exemption backed for yoga, martial arts Instructors teaching New Yorkers how to do downward dogs or karate kicks may soon join the state's dance, music and acting teachers with an exemption from state licensing.
- Israel launches radical way to boost organ supply Israel is launching a potentially trailblazing experiment in organ donation: Sign a donor card, and you and your family move up in line for a transplant if one is needed.
- Dentist pleads guilty to dumping waste in NJ ocean A Pennsylvania dentist has pleaded guilty to dumping medical waste into the ocean, causing numerous beach closures in New Jersey.
- Study: Hearts may swoon when stocks do Stock market slides may hurt more than your savings. New research suggests they might prompt heart attacks.
- Court rules again against vaccine-autism claims Vaccines that contain a mercury-based preservative called thimerosal cannot cause autism on their own, a special U.S. court ruled on Friday, dealing one more blow to parents seeking to blame vaccines for their children's illness.
- Women on the Pill may live longer Women who took the birth control pill beginning in the late 1960s lived longer than those never on the pill, a new study says.
- Literature helping docs connect with patients Doctors, nurses and other health care workers are increasingly tapping their literary sides to better understand their patients.
MSN Health News
- Aspirin Alone Works Best to Prevent Clots a Year After St...
- Repeated Anesthesia May Hamper Children's Learning Ability
- Driving With Early Alzheimer's May Be Ill-Advised
- Clinical Trials Update: March 15, 2010
- Teen Girls Say Pink Camel in Cigarette Ads Caught Their Eye
- Newer Genetic Test for Autism More Effective
- Combination Treatment May Help Depressed Alcoholics
- More Evidence That Swings in Blood Pressure Raise Stroke ...
- Intense Cholesterol, Blood Pressure Therapies Don't Help ...
- Many WTC Responders Show Signs of Heart Trouble
CBS Health News
- Boston Scientific Halts Defibrillator Sale Finds Error in Device, Also Plans to Retrieve All Inventory of Defibrillators
- Surgery-Free Fix for Leaky Heart Valves Company Seeks US Approval of Tiny Clip They Say Works as Well as Open-Heart Surgery, Without All the Cutting
- Video: Diabetes Treatments Deemed Harmful A major diabetes study has found that common treatments don't reduce heart trouble and some may actually cause harm. Elaine Quijano speaks with Russ Mitchell about this revealing study.
- Video: Final Battle for Health Reform? After a year of work and missed deadlines, the White House says the final battle for health care reform bill is just days away. As Whit Johnson reports, Republicans were quick to cry foul.
- Blood Pressure Drugs No Help for Diabetes Studies: Statins, Fibrates to Lower Fats, Cholesterol and Blood Pressure Do Not Reduce Heart Attack Risk in Diabetics
- Video: Gibbs: Health Care "This Week" White House Press Secretary Robert Gibbs told Bob Schieffer that health care reform will pass the House in one week. Sen. Lamar Alexander (R-Tenn.) said that House Democrats are being asked to "jump off a cliff".
- Video: The End Result on Health Insurance Reform Karen Ignagni, President of AAHP and Rep. Debbie Wasserman-Shultz join Bob Schieffer for a discussion on insurance reform in health care.
- Video: History of the Filibuster Slate Magazine's Timothy Noah explains the two biggest and most talked about issues when it comes to health care. Reconciliation to avoid and "procedural filibuster".
- Happier News for Those Suffering From SAD Doctors Eye New Treatments for Seasonal Affective Disorder, Shedding Light on Winter Depression
- Video: Court Hinders Autism, Vaccine Link There has been another setback for people who believe that vaccines may cause children's autism. As Elaine Quijano reports, will the latest court rulings put an end to this debate?
BBC UK Health News
- Call for children's fitness tests Fitness tests should be introduced for children in secondary schools to help make people more active, the chief medical officer for England says.
- No quick fix for diabetes risk Exercise and diet are key to prevent diabetes in high-risk people, say experts who found two medicines offer no benefit.
- 'Too many' baby hip cases ignored A charity says parents and health professionals need to check babies' hips in order to prevent pain and permanent disability.
- Gum disease 'link' to early birth Successful treatment for gum disease cuts the risk of pregnant women giving birth early, say US researchers.
- Surgeon's patients tell of ordeal Former patients of a hospital consultant struck off after one of his patients died speak of their suffering at his hands.
- Cancer patients 'miss out' on £8m Cancer patients are losing out on benefit payments worth millions of pounds, according to a leading charity.
- Out-of-hours GP care 'inadequate' Too many people in England are receiving poor quality out-of-hours doctors services, the Patients Association says.
- Obese drinkers face 'double hit' Obese women drinking little more than a glass of wine a day have double the risk of liver disease, experts warn.
- Care home neglect highlighted An elderly woman suffered serious neglect at a Teesside care home because of widespread failings, a review finds.
- Breathing 'as good as massage' Massage is no more effective at cutting anxiety than deep breathing and soothing music, say US researchers.
New England Journal of Medicine
- AIDS in America -- Forgotten but Not Gone (No abstract is available for this citation)
- Five Next Steps for a New National Program for Comparativ... (No abstract is available for this citation)
- The FDA and Safe Use of Long-Acting Beta-Agonists in the ... (No abstract is available for this citation)
- Contaminated Heparin Associated with Adverse Clinical Eve... (No abstract is available for this citation)
- Choosing Asthma Step-up Care (No abstract is available for this citation)
- The Israeli Field Hospital in Haiti -- Ethical Dilemmas i... (No abstract is available for this citation)
- Health Care Reform -- Where Do We Go from Here? (No abstract is available for this citation)
- Ministry of Touch -- Reflections on Disaster Work after t... (No abstract is available for this citation)
- The Democrats' Last Ditch -- Reconciliation or Bust (No abstract is available for this citation)
- Step-up Therapy for Children with Uncontrolled Asthma Rec... Background For children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking. Methods We randomly assigned 182 children (6 to ...
NEJM This Week - Audio Summaries
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of March 11, 2010. Featured are articles on tumor-associated macrophages and survival in classic Hodgkin's lymphoma, low diagnostic yield of coronary angiography, oral ivermectin versus malathion lotion for difficult-to-treat head lice, use of the thyroid hormone analogue eprotirome in statin-treated dyslipidemia, and ameliorating amyotrophic lateral sclerosis; a review article on commotio cordis; a case report of a man with peripheral neuropathy and ascites; and Perspective articles on the missing voice of patients in drug-safety reporting, on whether the states can nullify health care reform, and on health care volunteers and disaster response.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of March 4, 2010. Featured are articles on dopamine vs. norepinephrine for shock; ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy; glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults; pneumococcal conjugate vaccine in HIV-infected adults; and the collection of data on patients' race and ethnic group; a review article on the management of varices and variceal hemorrhage in cirrhosis; a Clinical Problem-Solving article on stalking the diagnosis; and Perspective articles on Partners in Health and the Haitian earthquake, on Medicare's opportunity to encourage innovation in health care delivery, and on the FDA's review of a new antidiabetic therapy.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of February 25, 2010. Featured are articles on genetic associations with stuttering, lasofoxifene and osteoporosis, timing of initiation of antiretroviral drugs during tuberculosis therapy, an algorithm for tuberculosis screening and diagnosis in people with HIV, and wrestling with BRCA1; review articles on permethrin and ivermectin for scabies and on Graves' ophthalmopathy; a case report of a man with a lesion on the tongue; and Perspective articles on conflicts of interest in academic medicine, on avoiding side effects in implementing health insurance reform, and on risking big changes with small reforms.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of February 18, 2010. Featured are articles on the willful modulation of brain activity in disorders of consciousness, projected effect of dietary salt reductions on future cardiovascular disease, dose of prophylactic platelet transfusions and prevention of hemorrhage, and newborn-care training and perinatal mortality in developing countries; a review article on the small renal mass; a case report of a man with HIV infection, proteinuria, and edema; and Perspective articles on the debate over regional variation in health care spending and on the earthquake in Haiti.
NEJM - Image of the Week
- Dermoscopy of Phthiriasis A 50-year-old man presented with a 1-month history of mild, generalized pruritus. A total-body examination of the patient's skin revealed small, yellowish-brown flecks in the hair of the upper arm (Panel A), chest, and axilla . . .
- Neuropathic Ulceration A 61-year-old man with a 15-year history of diabetes and resulting foot neuropathy presented with an ulcer of 3 months' duration overlying the first metatarsal head (Panel A). He was unaware of any recent foot . . .
- Abdominal-Wall Abscess An 83-year-old man with hypertension presented with a 3-month history of a painful, progressively enlarging mass in the right subcostal region. He reported no associated constitutional symptoms and no history of abdominal surgery. Local . . .
- Prosthetic-Valve Dehiscence A 33-year-old man with rheumatic heart disease presented with an acute onset of chest pain. Five years earlier, the patient had undergone replacement of the mitral and aortic valves (Medtronic Hall and ATS Medical, respectively). . . .
- Cutaneous Leishmaniasis A 25-year-old man presented to our clinic with a 1-year history of skin lesions on his nose and arm. Physical examination was notable for painless erythematous papules and nodules with overlying scale and crust, some . . .
- Bleeding Esophageal Varices A 52-year-old man with cirrhosis associated with alcohol abuse presented to the emergency department with hematemesis and lightheadedness, which had developed 3 hours earlier, after binge drinking. He had no history of decompensated liver disease . . .
- Cutaneous Larva Migrans A 42-year-old man presented with a 1-week history of intensely pruritic eruption on the dorsum of his right foot. He had gone for a barefoot stroll on the beach a few days before the onset . . .
- Hydropneumothorax A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with repeated thoracentesis of the right . . .
- Postoperative Tracheal Stenosis A 45-year-old woman presented for an assessment of breathlessness. She had been receiving inhaled bronchodilators and corticosteroids for years without improvement. Her medical history was notable for prolonged endotracheal intubation 8 years earlier. Examination revealed . . .
- Necrolytic Migratory Erythema A 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis. Her symptoms had been worsening . . .
JAMA current issue
- This Week in JAMA [This Week in JAMA]
- Effect of Influenza Vaccination of Children on Infection ... Context Children and adolescents appear to play an important role in the transmission of influenza. Selectively vaccinating youngsters against influenza may interrupt virus transmission and protect those not immunized. Objective To assess whether vaccinating children and adolescents with inactivated influenza vaccine could prevent influenza in other community members. Design, Setting, and Participants A cluster randomized trial involving 947 Canadian children and adolescents aged 36 months to 15 years who received study vaccine and 2326 community members who did not receive the study vaccine in 49 Hutterite colonies in Alberta, Saskatchewan, and Manitoba. Follow-up began December 28, 2008, and ended June 23, 2009. Intervention Children were randomly assigned according to community and in a blinded manner to receive standard dosing of either inactivated trivalent influenza vaccine or hepatitis A vaccine, which was used as a control. Main Outcome Measures Confirmed influenza A and B infection using a real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and by measuring serum hemagglutination inhibition titers. Results The mean rate of study vaccine coverage among eligible participants was 83% (range, 53%-100%) for the influenza vaccine colonies and 79% (range, 50%-100%) for the hepatitis A vaccine colonies. Among nonrecipients, 39 of 1271 (3.1%) in the influenza vaccine colonies and 80 of 1055 (7.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR, for a protective effectiveness of 61% (95% confidence interval [CI], 8%-83%; P = .03). Among all study participants (those who were and those who were not vaccinated), 80 of 1773 (4.5%) in the influenza vaccine colonies and 159 of 1500 (10.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR for an overall protective effectiveness of 59% (95% CI, 5%-82%; P = .04). No serious vaccine adverse events were observed. Conclusion Immunizing children and adolescents with inactivated influenza vaccine significantly protected unimmunized residents of rural communities against influenza. Trial Registration clinicaltrials.gov Identifier: NCT00877396
- Characteristics of Published Comparative Effectiveness St... Context Policy makers and physician organizations have recently called for more comparative effectiveness (CE) research, yet little is known about existing CE studies. Objective To describe the characteristics of recently published CE studies evaluating medications. Design, Setting, and Participants Analysis of all randomized trials, observational studies, and meta-analyses involving medications published in the 6 general medicine and internal medicine journals with the highest impact factor between June 1, 2008, and September 30, 2009. Main Outcome Measures The prevalence and characteristics of CE studies (those comparing existing, active treatments) and non-CE studies (those involving novel therapies or those using an inactive control). Results We identified 328 studies evaluating medications, 104 of which were CE studies. Among the CE studies, 45 (43%; 95% confidence interval [CI], 34%-53%) compared different medications, 11 (11%; 95% CI, 5%-18%) compared medications with nonpharmacologic interventions, 32 (31%; 95% CI, 22%-41%) compared different pharmacologic strategies, and 16 (15%; 95% CI, 9%-24%) compared different medication dosing schedules. Twenty (19%; 95% CI, 12%-28%) CE studies focused on safety and 2 (2%; 95% CI, 0%-7%) included cost-effectiveness analyses. Comparative effectiveness studies were less likely than non-CE studies to have been exclusively commercially funded: 13% (95% CI, 8%-22%) vs 45% (95% CI, 38%-52%), respectively (P < .001). In total, 90 (87%; 95% CI, 78%-92%) of the CE studies received noncommercial funding, including 66 that received government funding (63%; 95% CI, 53%-73%). Of 212 randomized trials, 97 (46%; 95% CI, 39%-63%) used an active comparator; the rest used an inactive control. Active-comparator trials were less likely than trials with inactive controls to report positive results: 44% (95% CI, 33%-55%) vs 66% (95% CI, 57%-75%), respectively (P = .002). Conclusions In these high-impact general medicine journals, approximately one-third of studies evaluating medications were CE studies. Of these studies, only a minority compared pharmacologic and nonpharmacologic therapies, few focused on safety or cost, and most were funded by noncommercial funding sources.
- Perioperative Mortality and Long-term Survival Following ... Context More than 6000 healthy US individuals every year undergo nephrectomy for the purposes of live donation; however, safety remains in question because longitudinal outcome studies have occurred at single centers with limited generalizability. Objectives To study national trends in live kidney donor selection and outcome, to estimate short-term operative risk in various strata of live donors, and to compare long-term death rates with a matched cohort of nondonors who are as similar to the donor cohort as possible and as free as possible from contraindications to live donation. Design, Setting, and Participants Live donors were drawn from a mandated national registry of 80 347 live kidney donors in the United States between April 1, 1994, and March 31, 2009. Median (interquartile range) follow-up was 6.3 (3.2-9.8) years. A matched cohort was drawn from 9364 participants of the third National Health and Nutrition Examination Survey (NHANES III) after excluding those with contraindications to kidney donation. Main Outcome Measures Surgical mortality and long-term survival. Results There were 25 deaths within 90 days of live kidney donation during the study period. Surgical mortality from live kidney donation was 3.1 per 10 000 donors (95% confidence interval [CI], 2.0-4.6) and did not change during the last 15 years despite differences in practice and selection. Surgical mortality was higher in men than in women (5.1 vs 1.7 per 10 000 donors; risk ratio [RR], 3.0; 95% CI, 1.3-6.9; P = .007), in black vs white and Hispanic individuals (7.6 vs 2.6 and 2.0 per 10 000 donors; RR, 3.1; 95% CI, 1.3-7.1; P = .01), and in donors with hypertension vs without hypertension (36.7 vs 1.3 per 10 000 donors; RR, 27.4; 95% CI, 5.0-149.5; P < .001). However, long-term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants for all patients and also stratified by age, sex, and race. Conclusion Among a cohort of live kidney donors compared with a healthy matched cohort, the mortality rate was not significantly increased after a median of 6.3 years.
- A 31-Year-Old Woman With a Transformed Low-grade Glioma [... Low-grade gliomas in adults have an incidence of 0.8 to 1.2 per 100 000, and their causes are unknown. Despite their histological classification as low-grade, they cannot be cured by any current treatment mode, and no class I evidence exists to guide initial treatment of these tumors. Median survival ranges between 7.5 years and 10 years, with a 5-year survival probability between 55% and 86%. The prognosis depends on age, World Health Organization (WHO) tumor grade, Karnofsky performance score, cytological type (oligodendroglioma vs astrocytoma), and, potentially, the extent of resection. Oligodendrogliomas with loss of heterozygosity on chromosomes 1p and 19q have a distinctly more favorable prognosis and therapeutic response rate. Low-grade tumors progress to high-grade gliomas with aggressive biological behavior at increasing frequency with advancing age. Ms P is a young woman with a previously treated oligodendroglioma, WHO grade II, with loss of heterozygosity on chromosomes 1p and 19q, which at a third resection had transformed into an oligodendroglioma of WHO grade III. She wants to know her current and future therapeutic options.
- Getting It Right When Things Go Wrong [Commentary]
- Building Comparative Efficacy and Tolerability Into the F...
- The Need for Improved Surveillance of Occupational Diseas...
- Promoting Science Education [Commentary]
- Charting a Path From Comparative Effectiveness Funding to...
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- Effect of revaccination with BCG in early childhood on mo... Objective To determine whether BCG revaccination at 19 months of age reduces overall child mortality. Design Randomised trial, with follow-up to age 5. Setting A health project in Bissau,...
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The Lancet
- [Editorial] The Global Fund: replenishment and redefiniti... On March 8, the Global Fund to Fight AIDS, Tuberculosis and Malaria launched its report, The Global Fund 2010: Innovation and Impact, presenting results so far and outlining challenges and new strategies. Since its inception in 2002, the Fund has grown into an impressive force in the landscape of global health initiatives. By its own estimation, the Fund has supported programmes that have saved around 4·9 million lives. It has allocated US$19·2 billion and disbursed $10 billion to 144 countries.
- [Editorial] The price of foodborne illness in the USA What do spinach, peanut butter, tomatoes, and cookie dough have in common? They have all been the source of major foodborne outbreaks and recalls in the USA over the years, and have led to widespread illness and a sharp drop in public confidence in food safety. According to the US Centers for Disease Control and Prevention (CDC), about 76 million cases of foodborne illness occur yearly in the USA, which accounts for 325 000 admissions and 5000 deaths.
- [Editorial] A 10-year plan to reduce road-traffic accidents In 2004, the UN General Assembly discussed the global burden of road-traffic accidents for the first time, mainly thanks to an effort by Oman to raise the profile of the problem within the UN. Still, few member states, especially low-income and middle-income nations where most deaths on the roads occur, were interested in the issue. Now, 6 years on, the story is very different. Last week, the UN General Assembly unanimously adopted a resolution to make 2011–20 the Decade of Action for Road Safety. 98 countries, including Russia, France, and Brazil, co-sponsored the resolution.
- [Comment] Stroke and blood-pressure variation: new permut... Although high blood pressure is one of the most important treatable risk factors for cardiovascular disease, the mechanisms leading to clinical events are poorly understood. Many believe that clinic blood pressure accounts for most of the risk and for the benefits of antihypertensive drugs. In The Lancet today, Peter Rothwell and co-workers challenge this notion, and present comprehensive data in two Articles (one a cohort study, the other a meta-analysis) and one Review on long-term (visit-to-visit) variability of blood pressure and cardiovascular risk. Moreover, a third Article is published online today on a similar issue in The Lancet Neurology.
- [Comment] CBT for low-back pain in primary care Chronic low-back pain is becoming increasingly common. Freburger and colleagues showed an increase in the prevalence of debilitating chronic low-back pain over 14 years. In 1992, the prevalence was 3·9%, and in 2006, it was 10·2%. The overall prevalence increase was 161%, with an increase of 11·4% per year. Low-back pain is a major concern to all when the rapid increase in health-care expenditures worldwide is taken into consideration.
- [Comment] Diarrhoea: why children are still dying and wha... Just under 9 million children aged under 5 years died in 2008 and nearly 40% of these deaths were due to two diseases: pneumonia and diarrhoea. Diarrhoea remains the second leading cause of death in children younger than 5 years globally. Nearly one in every five child deaths—around 1·5 million a year—is due to diarrhoea, which kills more children than AIDS, malaria, and measles combined.
- [Comment] Medical complicity, torture, and the war on terror Medical complicity in torture is not new. Evidence of medical involvement dates back to the 16th century, and the participation of medical personnel in torture under military and other dictatorships throughout the 20th century is well documented. Should we then be so surprised to learn, as we have done most recently from Physicians for Human Rights, that US military medical personnel have been working closely alongside interrogation teams in the war on terror, devising and monitoring techniques some of which, such as waterboarding, have been condemned by the Attorney General of the USA as torture.
- [Comment] New WHO HIV treatment and prevention guidelines On Nov 30, WHO released rapid advice summaries of revised recommendations on antiretroviral therapy, on antiretrovirals for the prevention of mother-to-child transmission of HIV, and on infant feeding in the context of HIV. WHO followed the GRADE approach to develop and update these recommendations.
- [Comment] Expression of concern—Probiotic prophylaxis i... In December, 2009, the attention of The Lancet was drawn to the publication of a report by three Dutch regulatory authorities (Inspectie voor de Gezondheidszorg [IGZ; Health Care Inspectorate], Centrale Commissie Mensgebonden Onderzoek [CCMO; Central Committee on Research Involving Human Subjects], and Voedsel en Waren Autoriteit [VWA; Food and Consumer Product Safety Authority]) into the design, approval, and conduct of this study. The investigation was prompted by the finding of higher mortality in the trial participants who received the intervention, a mixture of probiotics produced especially for this trial, than in the control group.
- [Comment] Surgery—call for papers In 2009, The Lancet published a special theme issue on surgery to coincide with the American College of Surgeons' (ACS) Clinical Congress. In addition to original research in surgery and Comments, the issue featured a Series of papers proposing a new paradigm for surgical innovation and evaluation—the IDEAL framework. IDEAL (Idea–Development–Exploration–Long-term study) was the result of a 2-year collaboration between the surgeons and methodologists of the Balliol Collaboration and The Lancet. Our goal was to encourage a culture of research at the very heart of surgical practice, and show the journal's ongoing enthusiasm for improving and reporting surgical studies.
Listen to The Lancet
- Listen to The Lancet: 13 March Peter Rothwell discusses a new approach for assessing hypertension and cardiovascular.
- Listen to The Lancet: 6 March Prevention of venous thrombosis after knee-replacement surgery (ADVANCE-2 study).
- Listen to The Lancet: 27 February Ischaemic preconditioning for patients with acute myocardial infarction.
- Listen to The Lancet: 20 February Discussion of childhood obesity, the topic of this week's main Editorial.
- Listen to The Lancet: 13 February An expert view on TB/HIV co-infection from Linda-Gail Bekker.
- Listen to The Lancet: 06 February Discussion of glucose control in type 2 diabetes.
- Listen to The Lancet: 30 January Discussion of herceptin and chemotherapy for early advanced HER2+ breast cancer.
- Listen to The Lancet: 23 January Discussion of the violent conflict and health themed issue.
- Listen to The Lancet: 16 January Discussion of antimicrobial dosing according to bodyweight.
- Listen to The Lancet: 9 January The role of C-reactive protein in vascular and non-vascular diseases.
Archives of Internal Medicine current issue
- First Physical [Editorial]
- About This Journal [About This Journal]
- In This Issue of Archives of Internal Medicine [In This I...
- Patient-Centered Comparative Effectiveness Research: Esse...
- Food Surcharges and Subsidies: Putting Your Money Where Y...
- Changing the Culture of Nursing Homes: The Physician's Ro...
- Triple-Class Virologic Failure in HIV-Infected Patients U... Background Life expectancy of people with human immunodeficiency virus (HIV) is now estimated to approach that of the general population in some successfully treated subgroups. However, to attain these life expectancies, viral suppression must be maintained for decades. Methods We studied the rate of triple-class virologic failure (TCVF) in patients within the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who started antiretroviral therapy (ART) that included a nonnucleoside reverse-transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) from 1998 onwards. We also focused on TCVF in patients who started a PI/r-containing regimen after a first-line NNRTI-containing regimen failed. Results Of 45 937 patients followed up for a median (interquartile range) of 3.0 (1.5-5.0) years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% (95% confidence interval [CI], 3.1%-3.6%) and 8.6% (95% CI, 7.5%-9.8%) of patients, respectively, had developed TCVF. The incidence of TCVF rose during the first 3 to 4 years on ART but plateaued thereafter. There was no significant difference in the risk of TCVF according to whether the initial regimen was NNRTI or PI/r based (P = .11). By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF. Conclusions The rate of virologic failure of the 3 original drug classes is low, but not negligible, and does not appear to diminish over time from starting ART. If this trend continues, many patients are likely to need newer drugs to maintain viral suppression. The rate of TCVF from the start of a PI/r regimen after NNRTI failure provides a comparator for studies of response to second-line regimens in resource-limited settings.
- Food Price and Diet and Health Outcomes: 20 Years of the ... Background Despite surging interest in taxation as a policy to address poor food choice, US research directly examining the association of food prices with individual intake is scarce. Methods This 20-year longitudinal study included 12 123 respondent days from 5115 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Associations between food price, dietary intake, overall energy intake, weight, and homeostatic model assessment insulin resistance (HOMA-IR) scores were assessed using conditional log-log and linear regression models. Results The real price (inflated to 2006 US dollars) of soda and pizza decreased over time; the price of whole milk increased. A 10% increase in the price of soda or pizza was associated with a –7.12% (95% confidence interval [CI], –63.50 to –10.71) or –11.5% (95% CI, –17.50 to –5.50) change in energy from these foods, respectively. A $1.00 increase in soda price was also associated with lower daily energy intake (–124 [95% CI, –198 to –50] kcal), lower weight (–1.05 [95% CI, –1.80 to –0.31] kg), and lower HOMA-IR score (0.42 [95% CI, –0.60 to –0.23]); similar trends were observed for pizza. A $1.00 increase in the price of both soda and pizza was associated with greater changes in total energy intake (–181.49 [95% CI, –247.79 to –115.18] kcal), body weight (–1.65 [95% CI, –2.34 to 0.96] kg), and HOMA-IR (–0.45 [95% CI, –0.59 to –0.31]). Conclusion Policies aimed at altering the price of soda or away-from-home pizza may be effective mechanisms to steer US adults toward a more healthful diet and help reduce long-term weight gain or insulin levels over time.
- Racial and Ethnic Differences in Hospice Use Among Patien... Background Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure. Methods On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of race and ethnicity on hospice entry for patients with heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors. Results In unadjusted analysis, blacks (odds ratio [OR], 0.52) and Hispanics (0.43) used hospice care for heart failure less than whites. Racial and ethnic differences in patients who received hospice care for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted OR for blacks, 0.59; 95% confidence interval, 0.47-0.73; and adjusted OR for Hispanics, 0.49; 95% confidence interval, 0.37-0.66; compared with whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice use. Conclusions In a national sample of Medicare beneficiaries with heart failure, blacks and Hispanics used hospice care for heart failure less than whites after adjustment for individual and market factors. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior is needed.
- Differences in Patient Survival After Acute Myocardial In... Background There are increasing calls for regionalization of acute myocardial infarction (AMI) care in the United States to hospitals with the capacity to perform percutaneous coronary intervention (PCI). Whether regionalization will improve outcomes depends in part on the magnitude of existing differences in outcomes between PCI and non-PCI hospitals within the same health care region. Methods A 100% sample of claims from Medicare fee-for-service beneficiaries 65 years or older hospitalized for AMI between January 1, 2004, and December 31, 2006, was used to calculate hospital-level, 30-day risk-standardized mortality rates (RSMRs). The RSMRs between PCI and local non-PCI hospitals were compared within local health care regions defined by hospital referral regions (HRRs). Results A total of 523 119 AMI patients was admitted to 1382 PCI hospitals, and 194 909 AMI patients were admitted to 2491 non-PCI hospitals in 295 HRRs with at least 1 PCI and 1 non-PCI hospital. Although PCI hospitals had lower RSMRs than non-PCI hospitals (mean, 16.1% vs 16.9%; P < .001), considerable overlap was seen in RSMRs between non-PCI and PCI hospitals within the same HRR. In 80 HRRs, the RSMRs at the best-performing PCI hospital were lower than those at local non-PCI hospitals by 3% or more. Among the remaining HRRs, the RSMRs at the best-performing PCI hospital were lower by 1.5% to 3.0% in 104 HRRs and by greater than 0 to 1.5% in 74 HRRs. In 37 HRRs, the RSMRs at the best-performing PCI hospital were no better or were higher than at local non-PCI hospitals. Conclusions The magnitude of benefit from comprehensively regionalizing AMI care to PCI hospitals appears to vary greatly across HRRs. These findings support a tailored regionalization policy that targets areas with the greatest outcome differences between PCI and local non-PCI hospitals.
Annals of Internal Medicine current issue
- Cardiovascular Screening in College Athletes With and Wit... Background: Although cardiovascular screening is recommended for athletes before participating in sports, the role of 12-lead electrocardiography (ECG) remains uncertain. To date, no prospective data that compare screening with and without ECG have been available. Objective: To compare the performance of preparticipation screening limited to medical history and physical examination with a strategy that integrates these with ECG. Design: Cross-sectional comparison of screening strategies. Setting: University Health Services, Harvard University, Cambridge, Massachusetts. Participants: 510 collegiate athletes who received cardiovascular screening before athletic participation. Measurements: Each participant had routine history and examination–limited screening and ECG. They received transthoracic echocardiography (TTE) to detect or exclude cardiac findings with relevance to sports participation. The performance of screening with history and examination only was compared with that of screening that integrated history, examination, and ECG. Results: Cardiac abnormalities with relevance to sports participation risk were observed on TTE in 11 of 510 participants (prevalence, 2.2%). Screening with history and examination alone detected abnormalities in 5 of these 11 athletes (sensitivity, 45.5% [95% CI, 16.8% to 76.2%]; specificity, 94.4% [CI, 92.0% to 96.2%]). Electrocardiography detected 5 additional participants with cardiac abnormalities (for a total of 10 of 11 participants), thereby improving the overall sensitivity of screening to 90.9% (CI, 58.7% to 99.8%). However, including ECG reduced the specificity of screening to 82.7% (CI, 79.1% to 86.0%) and was associated with a false-positive rate of 16.9% (vs. 5.5% for screening with history and examination only). Limitation: Definitive conclusions regarding the effect of ECG inclusion on sudden death rates cannot be made. Conclusion: Adding ECG to medical history and physical examination improves the overall sensitivity of preparticipation cardiovascular screening in athletes. However, this strategy is associated with an increased rate of false-positive results when current ECG interpretation criteria are used. Primary Funding Source: None.
- Cost-Effectiveness of Preparticipation Screening for Prev... Background: Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness. Objective: To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening. Design: Decision-analysis, cost-effectiveness model. Data Sources: Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. Target Population: Competitive athletes in high school and college aged 14 to 22 years. Time Horizon: Lifetime. Perspective: Societal. Intervention: Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. Outcome Measure: Incremental health care cost per life-year gained. Results of Base-Case Analysis: Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000). Results of Sensitivity Analysis: Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. Limitations: Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. Conclusion: Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. Primary Funding Source: Stanford Cardiovascular Institute and the Breetwor Foundation.
- Association of Leg-Length Inequality With Knee Osteoarthr... Background: Leg-length inequality is common in the general population and may accelerate development of knee osteoarthritis. Objective: To determine whether leg-length inequality is associated with prevalent, incident, and progressive knee osteoarthritis. Design: Prospective observational cohort study. Setting: Population samples from Birmingham, Alabama, and Iowa City, Iowa. Patients: 3026 participants aged 50 to 79 years with or at high risk for knee osteoarthritis. Measurements: The exposure was leg-length inequality, measured by full-limb radiography. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or greater, and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee. Results: Compared with leg-length inequality less than 1 cm, leg-length inequality of 1 cm or more was associated with prevalent radiographic (53% vs. 36%; odds ratio [OR], 1.9 [95% CI, 1.5 to 2.4]) and symptomatic (30% vs. 17%; OR, 2.0 [CI, 1.6 to 2.6]) osteoarthritis in the shorter leg, incident symptomatic osteoarthritis in the shorter leg (15% vs. 9%; OR, 1.7 [CI, 1.2 to 2.4]) and the longer leg (13% vs. 9%; OR, 1.5 [CI, 1.0 to 2.1]), and increased odds of progressive osteoarthritis in the shorter leg (29% vs. 24%; OR, 1.3 [CI, 1.0 to 1.7]). Limitations: Duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiography, are subject to measurement error, which could result in misclassification. Conclusion: Radiographic leg-length inequality was associated with prevalent, incident symptomatic, and progressive knee osteoarthritis. Leg-length inequality is a potentially modifiable risk factor for knee osteoarthritis. Primary Funding Source: National Institute on Aging.
- Brief Communication: Management of Implantable Cardiovert... Background: Communication about the deactivation of implantable cardioverter-defibrillators (ICDs) in patients near the end of life is rare. Objective: To determine whether hospices are admitting patients with ICDs, whether such patients are receiving shocks, and how hospices manage ICDs. Design: Cross-sectional survey. Setting: Randomly selected hospice facilities. Participants: 900 hospices, 414 of which responded fully. Measurements: Frequency of admission of patients with ICDs, frequency with which patients received shocks, existence of ICD deactivation policies, and frequency of deactivation. Results: 97% of hospices admitted patients with ICDs, and 58% reported that in the past year, a patient had been shocked. Only 10% of hospices had a policy that addressed deactivation. On average, 42% (95% CI, 37% to 48%) of patients with ICDs had the shocking function deactivated. Limitation: The study relied on the knowledge of hospice administrators. Conclusion: Hospices are admitting patients with ICDs, and patients are being shocked at the end of life. Ensuring that hospices have policies in place to address deactivation may improve the care for patients with these devices. The authors provide a sample deactivation policy. Primary Funding Source: National Institute of Aging and National Institute of Nursing Research.
- Narrative Review: Thrombocytosis, Polycythemia Vera, and ... The myeloproliferative disorders polycythemia vera, essential thrombocytosis, and primary myelofibrosis are clonal disorders arising in a pluripotent hematopoietic stem cell, causing an unregulated increase in the number of erythrocytes, leukocytes, or platelets, alone or in combination; eventual marrow dominance by the progeny of the involved stem cell; and a tendency to arterial or venous thrombosis, marrow fibrosis, splenomegaly, or transformation to acute leukemia, albeit at widely varying frequencies. The discovery of an activating mutation (V617F) in the gene for JAK2 (Janus kinase 2), a tyrosine kinase utilized by hematopoietic cell receptors for erythropoietin, thrombopoietin, and granulocyte colony-stimulating factor, provided an explanation for the shared clinical features of these 3 disorders. Constitutive JAK2 activation provides a growth and survival advantage to the hematopoietic cells of the affected clone. Because signaling by the mutated kinase utilizes normal pathways, the result is overproduction of morphologically normal blood cells, an often indolent course, and (in essential thrombocytosis) usually a normal life span. Because the erythropoietin, thrombopoietin, and granulocyte colony-stimulating factor receptors are all constitutively activated, polycythemia vera is the potential ultimate clinical phenotype of the JAK2 V617F mutation and, as a corollary, is the most common of the 3 disorders. The number of cells expressing the JAK2 V617F mutation (the allele burden) seems to correlate with the clinical phenotype. Preliminary results of clinical trials with agents that inhibit the mutated kinase indicate a reduction in splenomegaly and alleviation of night sweats, fatigue, and pruritus.
- Systematic Review: Vitamin D and Cardiometabolic Outcomes Background: Vitamin D may modify risk for cardiometabolic outcomes (type 2 diabetes, hypertension, or cardiovascular disease). Purpose: To examine the association between vitamin D status, including the effect of vitamin D supplementation, and cardiometabolic outcomes in generally healthy adults. Data Sources: English-language studies in MEDLINE (inception to 4 November 2009) and the Cochrane Central Register of Controlled Trials (fourth quarter of 2009). Study Selection: 11 reviewers screened citations to identify longitudinal cohort studies that reported associations between vitamin D status and cardiometabolic outcomes, including randomized trials of vitamin D supplementation. Data Extraction: 5 independent reviewers extracted data about study conduct, participant characteristics, outcomes, and quality. Differences were resolved by consensus. Data Synthesis: 13 observational studies (14 cohorts) and 18 trials were eligible. Three of 6 analyses (from 4 different cohorts) reported a lower incident diabetes risk in the highest versus the lowest vitamin D status groups. Eight trials found no effect of vitamin D supplementation on glycemia or incident diabetes. In meta-analysis of 3 cohorts, lower 25-hydroxyvitamin D concentration was associated with incident hypertension (relative risk, 1.8 [95% CI, 1.3 to 2.4]). In meta-analyses of 10 trials, supplementation nonsignificantly reduced systolic blood pressure (weighted mean difference, –1.9 mm Hg [CI, –4.2 to 0.4 mm Hg]) and did not affect diastolic blood pressure (weighted mean difference, –0.1 mm Hg [CI, –0.7 to 0.5 mm Hg]). Lower 25-hydroxyvitamin D concentration was associated with incident cardiovascular disease in 5 of 7 analyses (6 cohorts). Four trials found no effect of supplementation on cardiovascular outcomes. Limitations: Studies included primarily white participants. Observational studies were heterogeneous. Several trials reported post hoc analyses. Conclusion: The association between vitamin D status and cardiometabolic outcomes is uncertain. Trials showed no clinically significant effect of vitamin D supplementation at the dosages given. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Disease, the National Institutes of Health Office of Dietary Supplements, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, and Public Health Agency of Canada.
- Systematic Review: Vitamin D and Calcium Supplementation ... Background: Vitamin D and calcium may affect the cardiovascular system independently and interactively. Purpose: To assess whether vitamin D and calcium supplements reduce the risk for cardiovascular events in adults. Data Sources: Studies published in English from 1966 to July 2009 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Study Selection: Two investigators independently selected 17 prospective studies and randomized trials that examined vitamin D supplementation, calcium supplementation, or both and subsequent cardiovascular events. Data Extraction: Three investigators extracted and checked data about study designs, participants, exposures or interventions, outcomes, and data quality. Data Synthesis: Five prospective studies of patients receiving dialysis and 1 study involving a general population showed consistent reductions in cardiovascular disease (CVD) mortality among adults who received vitamin D supplements. Four prospective studies of initially healthy persons found no differences in incidence of CVD between calcium supplement recipients and nonrecipients. Results of secondary analyses in 8 randomized trials showed a slight but statistically nonsignificant reduction in CVD risk (pooled relative risk, 0.90 [95% CI, 0.77 to 1.05]) with vitamin D supplementation at moderate to high doses (approximately 1000 IU/d) but not with calcium supplementation (pooled relative risk, 1.14 [CI, 0.92 to 1.41]), or a combination of vitamin D and calcium supplementation (pooled relative risk, 1.04 [CI, 0.92 to 1.18]) compared with placebo. Limitations: Only articles published in English that reported cardiovascular event outcomes were included. The small number of studies, the lack of trials designed specifically to assess primary effects on cardiovascular outcomes, and important between-study heterogeneity preclude definitive conclusions. Conclusion: Evidence from limited data suggests that vitamin D supplements at moderate to high doses may reduce CVD risk, whereas calcium supplements seem to have minimal cardiovascular effects. Further research is needed to elucidate the role of these supplements in CVD prevention. Primary Funding Source: The American Heart Association and the National Heart, Lung, and Blood Institute.
- National Electrocardiography Screening for Competitive At... Two articles in this issue offer much-needed data on presport screening with ECG. In a study of 510 college student–athletes, Baggish and colleagues report that screening with ECG enhanced sensitivity and negative predictive accuracy (compared with history and physical examination alone) for detection of cardiovascular abnormalities but had a high rate of false-positive results. In a detailed economic analysis, Wheeler and coworkers present a construct supporting the cost-efficacy of ECG in screening athletes for CVD. However, the feasibility of routine ECG screening in the United States remains uncertain.
- Vitamin D Supplementation in the Age of Lost Innocence Two systematic reviews in this issue summarize the role of vitamin D in CVD and provide insight into the type of evidence that is needed to fully understand the effects of vitamin D. Pittas and colleagues reviewed the prospective observational studies on the association between vitamin D status and incident cardiometabolic outcomes. Wang and colleagues identified consistent inverse associations between vitamin D supplementation and CVD mortality in 6 prospective cohorts.
- In Transition Somehow, it's fitting. She's the first cancer patient whom I worked up from scratch. She's also my last patient as a medical student. She presented like a textbook, which is what all students secretly hope for. But I'm hoping that she doesn't go like the textbooks say.
Annals of Internal Medicine Podcast
- Athlete screening Screening young athletes for heart disease; interview with Barry Maron, MD, of the Minneapolis Heart Institute Foundation; plus a summary of all articles in the issue.
- Cigars Cigar and pipe smoking and lung function; interview with Stanton Glantz, PhD, of the University of California San Francisco; plus a summary of all the articles in the issue.
- CRPS Treatment of complex regional pain syndrome; interview with Dr. Robert J. Schwartzman of Drexel University College of Medicine in Philadelphia; plus a summary of all the articles in the issue.
- Opioids Opioids and overdose; interview with A. Thomas McLellan, PhD, Deputy Director of the White House Office of National Drug Control Policy; plus a summary of all the articles in the issue.
- Vaccine update 2010 adult immunization guidelines; interview with Gregory Poland, MD, of the Mayo Clinic; "Why Geriatrics?" by Louise Aronson, MD, MFA, of the University of California San Francisco; plus a summary of all the articles in the issue.
- [PDF] Immunization schedule [PDF] Recommended Adult Immunization Schedule, 2010
- Cardiology topics Emerging antiplatelet therapies; interview with Eric Bates, MD, of the University of Michigan; advance in perioperative medicine; interview with Vineet Chopra, MD, of the University of Michigan; "Three Degrees of Separation" by Howard Beckman, MD; plus a summary of all the articles in the issue.
- Sore throat Pharyngitis in adolescents and young adults; interview with Robert M. Centor, MD, of the University of Alabama at Birmingham; plus a summary of all the articles in the issue.
- Breast cancer Preventive screening and treatments for breast cancer; interview with Karla Kerlikowske, MD, of the University of California San Francisco; plus a summary of all the articles in the issue.
- [PDF] USPSTF statement [PDF] Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement
Evidence-Based Medicine current issue
- Purpose and procedure
- New look Evidence-Based Medicine
- Simple physical interventions such as hand washing and we...
- Combined educational and contraceptive interventions redu...
- Feedback to internal medicine ward physicians from multid...
- No difference between short-course and long-course antibi...
- High efficacy of HPV 16/18 AS04-adjuvanted vaccine shown ...
- Use of inhaled budesonide for 1 year does not increase ri...
- "Hospital at home" care shows similar mortality and subse...
- Healthcare assistant case management may reduce depressio...
Cleveland Clinic Journal of Medicine current issue
- Vaccination: An option not to be ignored Outbreaks of measles are seemingly on the rise, mainly because of lower vaccination rates, which are in part due to the unfounded fear that the vaccine causes autism.
- Treating silent reflux disease does not improve poorly co... A recent multicenter trial indicated that empirically prescribing a proton pump inhibitor does not help control asthma symptoms and that current guidelines need to be reevaluated.
- Diffuse alveolar hemorrhage (APRIL 2008)
- Renal stone interventions (OCTOBER 2009)
- Stenting for atherosclerotic renal artery stenosis: One p... The three randomized trials of stenting vs medical therapy published so far are so seriously flawed that it is impossible to make treatment decisions based on their results.
- Stenting atherosclerotic renal arteries: Time to be less ... It is time to strongly reconsider the current aggressive approach to revascularization of stenotic renal arteries and to take a more coordinated, critical approach.
- Interpreting The JUPITER Trial: Statins can prevent VTE, ... The incidence of venous thromboembolism in people taking rosuvastatin (Crestor) 20 mg/day was about half that in people taking placebo. This was a relatively healthy population, and the incidence in both groups was low.
- When and how to evaluate mildly elevated liver enzymes in... Not all asymptomatic people with a mildly elevated liver enzyme value need an extensive evaluation, which can be costly, anxiety-provoking, and risky.
- Palpable purpura A healthy 47-year-old woman presents with a 3-day history of widespread asymptomatic lesions in the extremities, fever, arthralgias, and mild abdominal pain. What is the diagnosis?
- Measles: Not just a childhood rash Outbreaks continue to be reported in communities with a high number of unvaccinated people. Most cases are linked to international travel.
QJM - current issue
- Elements: In this month's issue
- Autoantibodies in rheumatoid arthritis: rheumatoid factor... Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease, characterized by chronic, erosive polyarthritis and by the presence of various autoantibodies in serum and synovial fluid. Since rheumatoid factor (RF) was first described, a number of other autoantibodies have been discovered in RA patients. The autoantigens recognized by these autoantibodies include cartilage components, chaperones, enzymes, nuclear proteins and citrullinated proteins. However, the clinical significances and pathogenic roles of these antibodies are largely unknown except for RF and anticitrullinated protein antibodies (ACPAs), whose clinical usefulness has been acknowledged due to their acceptable sensitivities and specificities, and prognostic values. This review presents and discusses the current state of the art regarding RF and ACPA in RA.
- Barriers to targeted HIV testing on an acute admissions u... Background: One-quarter of people living with human immunodeficiency virus (HIV) in the UK are unaware of their infection, leading to late presentation with consequent increased morbidity and mortality, as well as ongoing transmission of infection. Recent UK guidelines advise HIV testing of patients with ‘indicator diseases’ in secondary care. There are limited seroprevalence data to support this recommendation, and acute medical settings present operational difficulties that may limit its feasibility. Methods: We conducted an audit of HIV testing rates over a 3-month period in an inner London acute admissions unit. Results: Lower respiratory tract infection and fever were the most frequent indicator diseases. A total of 14% were known to be HIV positive on admission, indicating a high prevalence of HIV infection among patients presenting with indicator diseases. Of the remaining 56 patients, 29% were tested for HIV infection, with one new positive diagnosis. Conclusions: Longer hospital admission and infectious disease consult were associated with testing. Introduction of an HIV testing protocol based on the UK recommendations had no impact on testing rates. Given the high prevalence of HIV infection in these acute hospital settings, more intensive strategies are needed to facilitate testing.
- Primary biliary cirrhosis is associated with falls and si... Background: Osteoporosis and autonomic dysfunction are prevalent in the autoimmune liver disease primary biliary cirrhosis (PBC). Postural hypotension is one consequence of autonomic dysfunction and is a recognized risk factor for falls, which, alongside osteoporosis could lead to significant injury and fractures. Aim: To determine the prevalence and sequelae of falls in PBC and to identify modifiable risk factors. Design: Cross-sectional, geographical, population census of PBC and two control groups: primary sclerosing cholangitis and a community dwelling population. Multidisciplinary falls assessment of a representative group of PBC. Methods: Symptom assessment tools, completed by the three cohorts, determined the prevalence of falls, injuries and associated symptoms. Multidisciplinary assessments, adhering to NICE guidelines, identified modifiable fall associations. Results: Significantly more of the PBC population had fallen (72% P < 0.001) than both control groups. Fifty-five percent had fallen in the last year (P < 0.001), and 22% more than once in the last year (P < 0.01). Seventy percent of PBC fallers were injured, 27% fractured a bone and 19% were admitted to hospital, all significantly more common than controls. Postural dizziness was significantly worse in fallers (P < 0.001), as were balance (P < 0.001) and lower limb strength (P = 0.002). Lower limb strength was independently associated with number of falls in previous year (β = 0.184, P < 0.001). Conclusion: Falls and resultant injury are prevalent in PBC and more common than previously recognized. Addressing postural dizziness, poor balance and lower limb weakness using a multidisciplinary approach has the potential to reduce falls, morbidity and mortality and as a result improve quality of life.
- Chronic obstructive pulmonary disease hospitalization rat... Background: Chronic Obstructive Pulmonary Disease (COPD) causes a huge economic burden and >80% of COPD cases are attributable to smoking. Massachusetts introduced a comprehensive Tobacco Control Program (MTCP) in January 1993. A trend analysis of COPD hospitalization rates might indirectly reflect the potential impact of such comprehensive tobacco control programs. Methods: Age-adjusted COPD hospitalization rates/100 000 was abstracted from the Massachusetts Community Health Information Profile Database between 1989 and 2005. Joinpoint Regression Analyses program was employed to estimate annual percent changes (APC) in COPD rates by age, sex and race. Results: In 1989, 265/100 000 age-adjusted COPD hospitalization rates were reported that increased to 423/100 000 in 1993, and then declined to 329/100 000 in 2005. A significant annual decline of 5.6 percentage points was observed in overall COPD rates from 1993 onwards. A similar temporal pattern, with an age-gradient and a slower annual decline in female COPD rates relative to male COPD rates, was observed. COPD rates in both Blacks and Whites were similar to the general overall pattern. Such consistent annual declines in COPD hospitalization rates from 1993 onwards in Massachusetts also closely correspond to the introduction of the MTCP in January 1993. Conclusion: The findings indirectly suggest that smoking cessation should remain the cornerstone strategy for the prevention and control of COPD burden. However, additional studies across different population settings are essential for a definitive conclusion with regard to the immediate impact of a comprehensive tobacco control program on COPD hospitalization rates showing possible gender susceptibility.
- The value of serial plasma nuclear and mitochondrial DNA ... Background: Increased levels of plasma nuclear and mitochondrial DNA have been reported in critically ill patients. We tested the hypothesis that plasma nuclear and mitochondrial DNA are substantially increased in acute bacterial meningitis and decrease after antimicrobial therapy, and that plasma nuclear and mitochondrial DNA levels can predict treatment outcomes. Methods: We examined serial plasma nuclear and mitochondrial DNA levels in 22 adult community-acquired bacterial meningitis (ACABM) patients. The plasma nuclear and mitochondrial DNA levels were also evaluated in 11 aseptic meningitis patients and 22 volunteer subjects during the study period. Results: All of the both bacterial and aseptic meningitis groups had a higher plasma DNA levels on admission as compared with those of volunteer groups. Levels of plasma nuclear and mitochondrial DNA in ACABM cases were significantly increased initially and substantially decreased thereafter. Both plasma nuclear DNA and plasma mitochondrial DNA levels at presentation are significantly negative correlate with modified Barthel Index (average) (r = –0.639, P = 0.004 and r = –0.551, P = 0.018) at 3 months after discharge (average), respectively, in this study. Both higher plasma nuclear (cutoff value of >169 ng/ml) and mitochondrial DNA levels (cutoff value of >58.9 ng/ml) at presentation were associated with poor outcome in ACABM patients. Conclusions: Based on our results, the higher plasma DNA levels were associated with a poorer outcome. Therefore, we look forward to more prospective multicenter investigations specifically to confirm the predictive value of plasma DNA levels in outcome prediction.
- Intra-abdominal fibrosis in a recent cohort of patients w... Background: Fibrosis is a hallmark of neuroendocrine tumours (NETs) arising in the jejunum and ileum and may manifest in the mesentery and elsewhere. It is clinically important and once-established, there are few effective therapies. Aim: To examine the frequency, radiological manifestations and clinical significance of intra-abdominal fibrosis in a patient cohort using modern cross-sectional imaging. Current prevalence is compared to historical series and correlation with cardiac fibrosis evaluated. Design: Cross-sectional, retrospective survey of a cohort of patients with mid-gut NETs from a single centre. Methods: Review of clinical features, biochemistry and imaging of patients with sporadic mid-gut NET and available imaging between 2002 and 2008. Results: Thirty-one patients were included: 26 (83.9%) had liver metastases and 11 (35.4%) had small-bowel wall thickening; 17 patients (55%) had mesenteric involvement, with a mass, which contained coarse calcification in seven patients and fine calcification in a further two. There was soft-tissue stranding in 13 patients (plus in a further patient with no mass) and ‘indrawing’ of tissues in 11 patients. Two patients had a ‘misty’ mesentery and two had early retroperitoneal fibrosis. Mesenteric involvement was unrelated to gender and urinary 5HIAA excretion. Conclusions: Intra-abdominal fibrosis can be detected radiologically in around half of patients with mid-gut NET using contemporary cross-sectional imaging. Although not statistically significant, small-bowel obstruction was seen more frequently in the group with fibrosis. There was no relationship with cardiac fibrosis. Prospective studies are needed to evaluate predictors of fibrosis onset and clinical course and determine optimal methods of prevention and treatment.
- The swinging thyroid in hepatitis C infection and interfe...
- One confused patient, many confused physicians: a case of...
- Grave's disease and acquired hyposplenism
The American Journal of Medicine
- We Can Reduce US Health Care Costs The primary reason that the US needs health care reform is that we pay more for health care than any other country in the world; yet our health outcomes are below that of other western nations. Our health outcomes are suboptimal because millions of Americans have limited access to ongoing primary and preventive care because they can't afford our health insurance.
- Reexamining the Physician Scholar–Professional Organiza... Physician faculty at most medical schools are expected to establish a “national reputation,” often in part through scholarly contributions to national nonprofit professional organizations. Yet, those who generate most of their income through clinical work and teaching (ie, clinician scholars, clinician educators) find it increasingly difficult to volunteer their time and effort to these organizations compared with their historical colleagues. Those receiving salaries, fixed or based on billings/collections or work relative value units, have increasingly limited discretionary time off-site, and protected time on-site, for such endeavors. Travel issues (connecting, delayed and canceled flights, fewer travel options) add further to the cost of committee and meeting work. Employer-provided travel funding is a fraction of its former level, having totally disappeared at many institutions, whereas support from healthcare-associated industry has been banned or severely limited by some employers as an apparent conflict of interest, leaving the physician scholars to provide their own out-of-pocket travel support for many such activities. Colleagues have less uncommitted time to provide coverage of clinical duties during off-site meetings. Simultaneously, the physician contributor's responsibilities per activity have mushroomed by the need to address a host of regulatory and quality requirements (securing copyright releases, adhering to standardized formatting, preparing educational goals and hand-outs, composing assessment questions, validating statistics, and reviewing and rewriting test questions).
- Thank You, Thank You, Thank You The machinery that makes The American Journal of Medicine (AJM) function is powered by many different individuals performing a variety of tasks. Without its long list of employees and volunteers, the Journal could not function. I am writing this editorial to thank the individuals who have made AJM what it is today, and what it will become in the future. The order in which these expressions of appreciation appear in this essay should not be construed as any indication of the importance of the individual or the group named. They are all equally important in the success of the Journal. To use a sports analogy, a baseball team needs a second baseman just as much as it needs a center fielder.
- Atrial Fibrillation in Heart Failure: A Comprehensive Review Abstract: Chronic heart failure and atrial fibrillation are 2 major disorders that are closely linked. Their coexistence is associated with adverse prognosis. Both share several common predisposing conditions, but their interaction involves complex ultrastructural, electrophysiologic, and neurohormonal processes that go beyond mere sharing of mutual risk factors. Rate control approach remains the standard therapy for atrial fibrillation in heart failure because current strategies at rhythm control have so far failed to positively impact mortality and morbidity. This is largely because of the shortcomings of current pharmacologic anti-arrhythmic agents. Surgical and catheter-based therapies are promising, but long-term data are lacking. The role of non-anti-arrhythmic therapeutic agents also is being explored. Further progress toward improved understanding the complex relationship between atrial fibrillation and heart failure should improve management strategies.
- Primary Care of the Transplant Patient Abstract: A total of 153,245 patients are living with a solid organ transplant in the US. In addition, patients are experiencing high 5-year survival rates after transplantation. Thus, primary care physicians will be caring for transplanted patients. The aim of this review is to update primary care physicians on chronic diseases, screening for malignancy, immunizations, and contraception in the transplant patient. Several studies on the treatment of hypertension and hyperlipidemia demonstrate that most agents used to treat the general population also can be used to treat transplant recipients. Little information exists on the medical management of diabetes in the transplant population, but experts in the area believe that the treatment of diabetes should be similar. Transplant recipients are at increased risk for all malignancies. Aggressive screening should be employed for all cancers with a proven screening benefit. Killed immunizations are safe for the transplant population, but live virus vaccines should be avoided. Women of childbearing age should be counseled about the impact of immunosuppressants on the efficacy and side effects of contraception.
- Diabetic Retinopathy: An Update on Treatment Abstract: Diabetic retinopathy is a progressive disease that results from vascular injury due to chronic hyperglycemia. It is the leading cause of blindness in working-age adults in the US and is usually asymptomatic until late stages. Treatment with laser photocoagulation is effective at preventing severe vision loss; thus, diabetic patients should be referred for regular screening by an ophthalmologist. New inhibitors of vascular endothelial growth factor may provide targeted nonsurgical treatment to improve vision in diabetic retinopathy.
- The Improving Continuous Cardiac Care (IC3) Program and O... For decades, the American College of Cardiology (ACC) and the American Heart Association (AHA) have distilled clinical evidence into guidelines and, recently, guidelines into performance measures. Yet, there remains a significant gap between the potential for high quality health care and the quality of health care that is actually delivered to patients. Although some programs, such as the ACC's National Cardiovascular Data Registries and the AHA's Get with the Guidelines, have demonstrated improvements in the quality of inpatient care, the quality and opportunity for improvement in the outpatient setting are largely unknown. The importance of quantifying and improving care in the outpatient setting is becoming increasingly important, with the recent emphasis on reporting of postdischarge mortality and readmission rates as a reflection of inpatient hospital care. Thus, there is a compelling need to systematically measure the quality of care, as quantified by established performance measures, in the outpatient setting.
- Exotic Origin, Familiar Culprit Certain diseases are great mimickers in medicine, presenting with diverse clinical manifestations that masquerade as other entities. We present a case, which illustrates the importance of considering these diseases in the differential diagnosis of patients who present with non-specific signs and symptoms.
- A Post-cure Complication Long-term drug therapy for hepatitis C virus (HCV) infection would prove to have persistent effects—both desirable and undesirable. A 29-year-old woman with chronic hepatitis C, genotype 4, was to embark on a treatment regimen of oral ribavirin, 1000 mg, once daily and subcutaneous injections of pegylated interferon alfa-2b, 80 μg, once a week. At her initial physical examination, she had a body mass index of 26 (25-29 indicates overweight). Laboratory results showed that her alanine transaminase level, at 88 IU/mL, was well above the normal reference value (<31 IU/mL). Her albumin level and prothrombin time were within the normal range. She had no other relevant medical or family history.
- Computer Calls for Cardiology Consult STAT! Although the electronic readouts provided by electrocardiographic systems often include an interpretation of the electrocardiogram (ECG), the clinician must not rely on this interpretation alone. In the following case, the “assistance” provided by the computer's interpretation of a routine ECG proved quite misleading.
European Journal of Internal Medicine
- Editorial Board
- Contents
- HCV carriers with normal alanine aminotransferase levels:... Abstract: Approximately 30% of patients with chronic HCV infection show persistently normal ALT levels. Although formerly referred to as ‘healthy’ or ‘asymptomatic’ HCV carriers, and thus historically excluded from antiviral treatment, it has now become clear that the majority of these patients have some degree of histological liver damage that may be significant in up to 20% of patients and might progress toward a more severe degree of liver fibrosis. A significant proportion of patients (≥20%) experience periods of increased serum ALT (flare) associated with enhanced disease progression. However, controversies still exist in clinical practice regarding the definition of ‘persistent’ ALT normality, the virological and histological features of these subjects, the need for liver biopsy, the role of non invasive tools for the assessment of liver fibrosis (transient hepatic elastography, fibroscan), and the natural history and optimal management of chronic hepatitis C with normal ALT. The advent of new therapeutic options (pegylated interferons plus ribavirin) has shifted treatment targets toward eradication of underlying infection, with therapy decision based on age, severity of disease and likelihood of response rather than on aminotransferase levels. This review does approach the main unresolved issues on this topic in the form of a dialog between a hepatologist and a patient with HCV infection but normal alanine aminotransferase levels, trying to give evidence-based answers to the more frequently asked questions from patients and their physicians.
- The coagulopathy of chronic liver disease: Is there a cau... Abstract: Variceal hemorrhage is a major cause of death in patients with cirrhosis. Much still could be performed in clinical practice to reduce the risk for bleeding in cirrhotic patients and accurate predictive rules should be provided for early recognition of high-risk patients. Liver cirrhosis patients present a complex hemostatic dysfunction with prolongation of bleeding time, chronic coagulation activation, and secondary hyperfibrinolysis. Therefore, liver failure determines an acquired coagulopathy that has been considered to be one potential underlying mechanism of bleeding. Endotoxemia may play a pivotal role in activating clotting system in portal and systemic circulation and it could represent a common mechanism accounting for portal vein thrombosis, systemic hyperfibrinolysis and eventually gastrointestinal bleeding. Nevertheless, clinical trials should also be planned to investigate the causal relationship between acquired coagulopathy and bleeding in patients with chronic liver disease.
- The coagulopathy of chronic liver disease: Is there a cau... The integrity of the vascular system in normal conditions is secured by highly integrated cellular and humoral processes that include primary hemostasis (platelet–vessel wall interaction), coagulation (thrombin generation and fibrinogen-to-fibrin conversion) and fibrinolysis (fibrin-clot dissolution). Impairment in anyone of these processes may result in bleeding or thrombosis. Chronic liver diseases are associated with thrombocytopenia and/or thrombocytopathy, decreased synthesis of most coagulation factors and hyper-fibrinolysis. Because of the above characteristics chronic liver disease has been identified until recently as the prototype of the acquired hemostasis abnormalities and the causal relationship between abnormal hemostasis tests and the risk of bleeding has become a paradigm. In this Debate I shall attempt to demonstrate how data from the most recent literature challenge this dogma. This reassessment may have important practical implications for treatment and prophylaxis of patients with chronic liver disease.
- Vaccination, squalene and anti-squalene antibodies: Facts... Abstract: Squalene, a hydrocarbon obtained for commercial purposes primarily from shark liver oil and other botanic sources, is increasingly used as an immunologic adjuvant in several vaccines, including seasonal and the novel influenza A (H1N1) 2009 pandemic flu vaccines. Nearly a decade ago, squalene was supposed to be the experimental anthrax vaccine ingredient that caused the onset of Persian Gulf War syndrome in many veterans, since antibodies to squalene were detected in the blood of most patients affected by this syndrome. This evidence has raised a widespread concern about the safety of squalene containing adjuvants (especially MF59) of influenza vaccines. Nevertheless, further clinical evidence clearly suggested that squalene is poorly immunogenic, that low titres of antibodies to squalene can be also detected in sera from healthy individuals, and that neither the presence of anti-squalene antibodies nor their titre is significantly increased by immunization with vaccines containing squalene (or MF59) as an adjuvant. This review summarizes the current scientific evidence about the relationship between squalene, anti-squalene antibodies and vaccination.
- Genome-wide association studies in atherothrombosis Abstract: Atherothrombotic diseases are complex diseases, arising from the interaction between several genetic and environmental factors. Until recently, the genetic basis of complex diseases in general, and of atherothrombosis in particular, were poorly characterized. Progress in DNA analysis techniques and the increasing level of characterization of the variability of the human genome has recently allowed to study comprehensively the association between genetic variants and diseases. To date, more than 400 genome-wide association studies have been conducted, allowing to identify more than 430 genomic regions at which common genetic variants influence the predisposition to complex diseases of great epidemiological relevance. This review article summarizes the progress achieved in the genetic basis of atherothrombotic diseases such as myocardial infarction and ischemic stroke. The advances achieved so far now await for clinical applications.
- The prothrombotic potential of platelet factor 4 Abstract: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder initiated by heparin administration. It is caused by the formation of pathogenic antibodies to complexes of platelet factor-4 (PF4) and heparin on platelet surfaces that cause platelet activation, aggregation and thrombosis. There has been intense research on this intriguing, drug-related thrombocytopenia explaining several characteristic aspects of this condition. However, prothrombotic potential of the key player, PF4 has not been investigated in many studies although it has been shown to be critical in monocyte chemotaxis, monocyte–platelet interaction, and megakaryocyte suppression, all of which can contribute to the pathophysiology of HIT. This article explains the important role of PF4 released during platelet activation with the administration of heparin in the pathogenesis of thrombocytopenia and thrombosis in HIT.
- Cocaine and beta-blockers: The paradigm Abstract: Cocaine is one of the most commonly used substances of abuse. The use of beta-blockers in cocaine induced acute coronary syndrome has long been a matter of debate. While it is widely believed that beta-blockers are contraindicated in cocaine toxicity, there appears to be some recognizable role for certain beta-blockers in ameliorating the cardiovascular as well as central nervous system effects of cocaine. This article explores the role of beta-blockers in the management of cocaine toxicity.
- Relationship between anaemia and cognitive functions in e... Abstract: Background: The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people.Methods: This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folstein's Mini-Mental State Examination (MMSE).Results: The mean age of the anaemic group and the nonanaemic group were 76.0±11.7 and 72.5±15.2years, respectively. The average haemoglobin level among the anaemic population was 10.4g/dL compared with 13.6g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8±4.3 vs 9.3±3.7) and cognition (MMSE) (17.9±6.4 vs 21.7±6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring.Conclusion: In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.
Canadian Medical Association Journal current issue
- Achieving control of asthma in preschoolers [Review]
- Acquired reactive perforating collagenosis [Practice]
- Second neoplasm: 31-year latency after childhood leukemia...
- Hemoptysis caused by erosion of thoracic aortic aneurysm ...
- Infestation of the eyelashes with Phthirus pubis [Practice]
- CIHR pledges to tackle primary health care [News]
- Value of medical practice guidelines questioned [News]
- Physicians pressed to play nice [News]
- Electronic health records: an asset or a whole lot of hyp...
- Dengue fever on the rise at tourist getaways [News]
ACP Internist: Current Contents
- Rethinking the value of the annual exam Patients expect it and internists won't let it go. But does the evidence support the need for the periodic health exam? Data say routine lab tests are of little or no use, but experts weigh in on the value of regularly seeing patients for preventive screening.
- Expert explains thyroid diagnosis, treatment and common r... The estimate that 25 million people have thyroid problems would double if the normal range for thyroid-stimulating hormone was adjusted, as some medical societies suggest. In this Web-only feature, Victor Bernet, FACP, the author of MKSAP 15's chapter on disorders of the thyroid gland, offers his insights into management.
- Influenza featured at infectious disease meeting A digest of information on seasonal and H1N1 influenza, mandatory vaccines for health care workers, and new rapid diagnostic tests for the flu from the Infectious Diseases Society of America's meeting.
- Clinicians crucial to avoiding coding errors Beware believing that coding isn't an important part of an internist's job. What gets overlooked could cost a significant amount if errors go unchecked, especially in the era of Recovery Audit Contractors.
- Get time on your side: expert tips to eliminate waiting Resolve to solve the waiting-room back-ups. Find out where the practice falls behind and implement solutions, including time studies, prior preparation and using medical assistants to their highest level of practice.
- Ketorolac, Liposyn recalled for particulate contamination A summary of approvals, recalls, warnings and alerts digested by ACP Internist from the Food and Drug Administration's alerts.
- What to do when one expects everything to fit, but it doe... James Hennessey, FACP, reports on a young woman's elevated testosterone level, and how he made a diagnosis even though the lab results and imaging conflicted. Our diagnostic experts consider confirmation bias and how this internist sidestepped being misled.
- A better Board of Regents for a better health care system ACP's Board of Regents will reorganize to meet the future needs of the organization.
- Political perils of cost control complicate health care r... Even if health reform passes, the problem of rising costs will not go away. And politicians cannot confront the fundamental issue that Americans can't have all the health care they want.
- Beyond the annual physical It's a new year, and promises to be an exciting one in health care. But concepts such as bundled payments, comparative effectiveness and the patient-centered medical home seem certain to remain center stage.
ACP Internist
- QD: News Every Day--Health reform vote by the weekend A vote on health care reform could come this weekend, with the House members considering whether to pass the Senate's version and then a bill of budget changes. House members are leery of the upper chamber's following through. The Majority Whip is trying to ensure there will be enough votes for passage. Abortion, immigration and costs remain key sticking points. Both sides are applying pressure to those on the fence, and Republicans are trying to make sure Democrats pay a price for victory. (Wall Street Journal, Washington Post, Fox News, Los Angeles Times)The impact from this weekend's vote will play out over the next decade. Primary care doctors will see a 10% payment boost from Medicare for their office, nursing home and other outpatient visits. Medicare also plans to pilot accountable care organizations that reward primary care doctors for managing multiple chronic illnesses. Doctors and hospitals would band together for payments, similar to a "Mayo Clinic model." (AP) [Editor's note: This post originally stated the legislation applies to rural and inner city physicians. It applies to all physicians for the three conditions stated above.]
- Medical News of the Obvious At first, the results of this study seemed totally unobvious. Researchers found that people didn't lie any more often when online dating than they did in person, reported HealthDay. Really? This finding immediately led me to wonder how many daters are wearing platform shoes and compression garments on their in-person dates.But then it turns out the methodology was to ask people whether they lied. Mightn't the liars be likely to lie to the surveyors, too?Regardless of whether you believe them, most of the findings were pretty entertainingly obvious: older people lied more about their age, more "extroverted" people (ahem) lied more about their past romantic experiences. And interestingly, men lied more about "how nice and polite they are," according to a study author. Can you picture that? "I told her I open doors for women, and really I never do. Heh heh."So what's the big conclusion we can draw from all this research? Hold on to your hats. "Online daters, speed-daters, and the like seem to be just like the rest of us in most ways," said the study's author. Does that mean that the people you see on the computer are also people in real life? This is going to require further investigation.
- QD: News Every Day--Considering health care reform, and t... Democratic legislators want at least a week to consider elements of health care reform, as they parse out language over abortion, federal subsidies and regulating insurers. (Los Angeles Times, AP)The Byzantine rules of passing legislation have left House representatives in the position of having to trust their colleagues in the Senate to follow through on their promise to fully reconcile health care reform goals, not just use reconciliation to pass it. Yet, they don't fully do so. (The Hill)Literature in medicineBook clubs in the workplace are common, and now, they're extending into the hospital. Literature in medicine programs are growing, and medical staff say a background in the humanities helps them deal with the messiness and uncertainty of practicing medicine in real life. (AP)
- QD: News Every Day--Federal action leads to states' reaction Congressional leaders and the White House will introduce health care legislation's latest incarnation to the entire Congress today. Immigration reform and abortion remain sticking points for some Democrats. (AP, The Hill, New York Magazine)Meanwhile, Virginia's legislature passed a bill that would exempt that state from federal health care reform. It's the first state to reach this point, and legislators recognize their action as symbolic. But 34 other states are lining up to fight state recognition of federal law, setting up a Constitutional debate, albeit a short-lived one. (New York Times, WTVR of Richmond, Va., University of Missouri-Kansas City School of Law, New England Journal of Medicine)
- QD: News Every Day--The end is in sight (until later) The Senate voted today to delay until September 30 Medicare's 21% reimbursement cut. The legislation also extends federal financial assistance for state Medicaid programs for six months and COBRA and unemployment insurance benefits through all of 2010. (Modern Physician)For the broader issue of health care reform, Democrats are trying to build a majority for the final push, while Republicans hope to capitalize on the divisions as well as create procedural roadblocks to the reconciliation process that might be used to pass it. (Christian Science Monitor, Washington Post, New York Times)
- Coffee and the Heart - Researchers are Getting Paid Way T... This post by Westby Fisher, MD, originally appeared at Better Health.This week, coffee seems to be good for the heart: "People who are moderate coffee drinkers can be reassured that they are not doing harm because of their coffee drinking," said Arthur Klatsky, the study's lead investigator and a cardiologist at Kaiser's Division of Research.These "surprising" data were presented at the American Heart Association meeting on March 5th. But a quick Google search on Dr. Klatsky's earlier studies using the same questionnaire database shows the problems with using questionnaire data to make such sweeping conclusions. Take, for instance, these findings from 1973: Coffee drinking is not an established risk factor for myocardial infarction.And yet a bit later, in 1990, there's a flip flop: Because of conflicting evidence about the relation of coffee use to coronary artery disease, the authors conducted a new cohort study of hospitalizations among 101,774 white persons and black persons admitted to Kaiser Permanente hospitals in northern California in 1978-1986. In analyses controlled for eight covariates, use of coffee was associated with higher risk of myocardial infarction (P=0.0002). (By the way, British researchers failed to find a similar correlation in instant coffee drinkers.)So what, really, do these data from the Kaiser questionnaire data regarding heavy coffee consumption and the heart say?What they say is:1) Questionnaire data crunched to suggest correlations are insufficient to mean causation, irrespective of how the media parses it. 2) Questionnaire data are subject to significant sampling and reporting biases. 3) Rehashing the same old questionnaires using the same samples with newer data can dramatically alter prior findings. 4) Researchers are getting paid way too much to keep rehashing the same data for large health systems. 5) On the lighter side, college undergrads and medical students should note that they could use these types of questionnaire data to justify significant caffeine consumption along with alcohol to protect themselves from developing cirrhosis. Sigh. This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
- What if Other Parts of Life Were Like Healthcare? Health care is bizarre. Anyone who spends significant time in its ranks will attest to the many quirky and downright ludicrous things that go on all the time. But I am not sure people realize just how strange our system is. Perhaps it would be interesting to see what it would be like if other parts of our lives were like health care.1. Get up in the morningThe first thing that happens in your day is that your alarm fails to go off. Although you have major things happening, nobody ever has explained to you exactly what you are supposed to do and when. You watch the morning TV show and it seems that some experts say you should go to school while others say you should avoid school at all cost. You call a friend who says that she knows someone who went to school and it destroyed their liver. Another friend goes to school every day and is just fine.Confused, you turn to the Internet and go to a Web site that explains that you should base your schedule on the pattern of tea leaves in a cup. This site claims that your normal schedule is actually fraught with secret appointments that will, unbeknown to you, make you have cancer. It states that those people in power are making you go through this dangerous schedule so they can make money off of you. They don't care for you like the people who made this web page (and for $400 you can have six months of magic tea leaves).Finally, you decide that you are going to go with the majority opinion and go to school.2. SchoolYou go to your bus stop and wait. You keep waiting. You know that the bus was supposed to come at 8 a.m., but after an hour you begin to wonder if you missed it. Calling the bus service, you find out that the bus got caught up doing some extra routes. There is a shortage of buses, and so the ones that remain have to do twice as many routes as is feasible. After a two-hour wait, the bus finally arrives to take you to school.The first teacher comes into the classroom and looks very distracted. She teaches general studies and is staring at a curriculum that contains a huge amount of subjects. As she is doing her lessons, she furiously takes notes on her own teaching so that she can submit documentation to the school board and prove that she taught you. This is the only way she gets paid.In total, she teaches for about 15 minutes and documents her teaching for 45 minutes. You want to ask questions, but the bell rings and you have to move on to your next class before any can be answered.The next teacher only teaches a small specialized subject. This teacher is paid four times more than the first teacher. Instead of teaching and answering questions, however, he is constantly making you take tests. Apparently, the school system pays a huge amount for making you take tests, but very little for teaching lessons that would make you do well on those tests in the first place.School is finally over, but you don't feel like you got much out of it (except for taking a lot of tests and getting more confused). You decide that a trip to the store would perhaps make you feel better.3. The groceryUpon entering the grocery store, you notice something odd. There are very few different brands of items stocked on the shelves. Your choice is limited to only the brands that have struck the best deal with the grocery chain. These brands have to send the grocery store a large "rebate" check because they are carried exclusively in this store.When you go to the meat counter and ask for some steak, the butcher asks you if you have first tried the ground beef. You may not purchase steak unless you have first tried and disliked the ground beef. The ground beef, of course, is actually ground turkey, but the butcher says that these two are basically interchangeable and so the substitution is permitted.The grocer can't post prices because all customers have different negotiated prices. Posting prices, in fact, would be considered collusion since other grocers could find out exactly what this grocer is charging. Some congressman in California decided that grocers are all crooks and should not be allowed to share what they charge for things.You go to the cash register to pay. The total is $380, but the cashier informs you that your negotiated price is only $150. A poor person behind you has not had the chance to negotiate a price and so must pay full price for everything.There are a few people in the store who don't have to pay anything. They have had the price negotiated for them by the government, and so will come to the store very often. They sometimes come for real food, but are often coming for candy and cigarettes--all paid for by the government.This experience leaves you more tired and confused, and so you decide to go home.4. HomeComing home, you notice that your house is under construction. There is a new wing being built that contains all sorts of the newest and fanciest gadgets, such as flat-screen TVs, the fastest computers, and wonderful new kitchen appliances. Going into the house, you notice that there is no running water or heat. Apparently, there are all sorts of grants and low-interest loans to pay for the fancy gadgets, and so contractors find it much more profitable to do that instead of fixing water or heating.Your mother is in the kitchen trying to make dinner, but instead of cooking she is staring into a cookbook and at the ingredients you brought from the grocery store. You assume she can make do with what you brought, but she just sighs helplessly. Despite the fact that your mother is incredible at improvising meals, she is required to follow a cookbook that doesn't fit the ingredients that are available. This makes dinner taste pretty bad. Your mother, obviously angry about this, gives you a weak smile and tells you to finish what is on your plate.After dinner, you settle down to watch some television. As you are finally starting to relax, a knock on the front door breaks your peace. At the front door stands a police officer. "You are only authorized to be in the house for two hours today, so I am going to have to ask you to leave."You try to explain that two hours is not enough to get the rest you need, but the officer threatens a stiff fine and forces you to leave. Before you can get your necessary things, you are forced to leave without an explanation of how you are supposed to survive on the streets.If it doesn't make sense in real life, how can it make sense in medical practice?Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
- QD: News Every Day--Reform rhetoric heats up All eyes are on the bully pulpit as President Barack Obama begins stumping for health care reform. His talking points include rising insurance rates, legislators who fear election repercussions, and those who would politicize the process. (New York Times, Los Angeles Times, USA Today)But the Republicans plan to capitalize on the later two points. If it passes, they'll use it during their own stump speeches during the fall Congressional campaigns. They'll focus on the short-term pain--have people's health care costs fallen by election time--and not the long-term gain. (MSNBC, Politico)
- Is Chronic Fatigue Syndrome Caused By Retroviruses? This post by Harriet Hall, MD, originally appeared at Better Health.When I first heard that a retrovirus had been identified as a possible cause of chronic fatigue syndrome, I withheld judgment and awaited further developments. When I heard that two subsequent studies had failed to replicate the findings of the first, I assumed that the first had been a false alarm and would be disregarded. Not so.It's a classic case of wishful thinking outweighing good judgment. One unconfirmed report of an association between the XMRV virus and chronic fatigue syndrome (CFS) resulted in a rush to test for the virus, speculation about possible implications, and even suggestions for treatment. And the subsequent negative studies did little or nothing to reverse the trend. XMRV is Xenotropic murine leukemia virus-related virus. In the past, there were reports that this retrovirus was associated with prostate cancer, but then other reports found no link. In 2009 a study was published in Science, Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome by Lombardi et al., reporting an association with CFS:We identified DNA from a human gammaretrovirus, xenotropic murine leukemia virus-related virus (XMRV), in 68 of 101 patients (67%) as compared to 8 of 218 (3.7%) healthy controls.Later, the researchers reported that up to 95% of CFS patients test positive with antibody testing. The study did not prove a causal relationship. The authors suggest that the retrovirus may reactivate other viruses, such as herpes viruses (the opposite is also possible). There could be many different viruses behind CFS/ME. And it could be that XMRV is an incidental finding secondary to the immune dysfunction in CFS/ME. Two subsequent studies in the UK, here and here, also looked for the virus in CFS patients but both failed to find it.CFS is still a controversial diagnosis. Some observers have implicated psychological factors and somatization. Sufferers are on the defensive, wanting to validate CFS as a real physical entity. The finding of a virus was just what they were hoping for. They want to believe in it, and their emotions have clouded their judgment.A battle has erupted between retrovirus believers and non-believers, each side attacking the other's research and accusing them of bias. Some of the criticisms are based on virological laboratory procedural details that I am not competent to judge. Some of the other criticisms are about things I can understand.The Science study came out of the The Whittemore-Peterson Institute. This institute was founded by a couple (the Whittemores) whose daughter had CFS and who was treated by Dr. Peterson with an experimental antiviral drug. They are clearly biased towards finding a viral etiology. The researchers in the UK were similarly accused of bias towards finding a psychological etiology. Accusations of bias may be credible but don't necessarily mean that the bias contaminated the results. Another criticism is less credible: the UK studies used a different set of criteria for diagnosing CFS. Even if you think that some of the UK subjects didn't qualify as having CFS, if even a few of them had CFS and the virus was really associated with it, the virus should have shown up in at least a few subjects. Critics have tried to rationalize away the negative findings in the UK by suggesting that the virus occurs regionally and is absent in the UK; but then if the virus were the cause of CFS, there wouldn't be any CFS in the UK.So far we have one study for and two against the association of XMRV with CFS. More studies are underway that should settle the debate. If the virus is there, it will be found by other labs and a consensus will eventually develop as to whether there is an association. If an association is confirmed, there will still need to be further research to determine what the association means and whether there is a causal relationship. The logical response is to stay tuned, not to leap prematurely into testing and treatment.Tests are already commercially available. One is offered by VIP Diagnostics, a company owned by the Whittemore family. It costs $450 and uses the same methods as were reported in the Science article. The website discloses that the tests have not been approved by FDA for diagnostic purposes and that medical expertise is required for test interpretation. The lab pays a royalty to the Whittemore-Peterson Institute for each test it performs.In his Nov. 3, 2009 Lyndonville Times newsletter, Dr. David Bell offered this cogent advice: "I am reluctant to suggest to anyone that they spend big bucks for a commercial test now. We do not know if a particular test is accurate, and even if it is accurate we do not know what it means, and even if we did know what it meant we would not know what to do with it."That pretty much says it all. Nevertheless, patients are flocking to be tested. If they test positive, they can feel vindicated. If they test negative, they can rationalize that they may actually be positive but have a viral load too small to be picked up on the test at the moment; they might even rationalize that they are better off than if the test had shown a larger viral load. Win/win.Antiretroviral treatments are already being proposed by some doctors. Most proposals are based on the drugs used for HIV/AIDS, on the assumption that antiretroviral AIDS drugs would be equally effective for the XMRV retrovirus. But that might well be a false assumption, and these are powerful drugs with worrisome side effects, not the sort of thing that you would want to try "just in case."Other concerns have been raised by the CFS community. Is XMRV sexually transmitted like HIV/AIDS? If you have chronic fatigue syndrome or another XMRV-related condition, should you take special precautions with your sexual partners, even if you're in a committed relationship? Should you opt for not breastfeeding your children? Should you not even have children?I can understand the desperation of these patients. I can understand their need to believe anything that would validate their suffering. I can understand their motivation to try anything that might bring them relief. But I don't want to see people wasting money on useless tests, I don't want to see mothers unnecessarily worrying about whether it is safe to breastfeed their children, and I don't want to see people suffering side effects from drugs they don't need. A cautious wait-and-see approach is dictated by common sense and by an understanding of how often initial scientific research findings turn out not to be true. Like remarriage after divorce, the overblown enthusiasm for the XMRV/CFS connection is a triumph of hope over experience.This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
- QD: News Every Day--Health care reform's "endgame" All the talk is of the endgame to health care reform. You'll find the word used repeatedly as the fourth column discusses the timeframe, strategy and roadmap how to finish the legislation. ACP Internist points out that even if passed, future legislators can continue the game year after year. It's the sport of kings. Medicare pay cutPrimary care doctor William Schreiber, MD, broke down his practice expenses and figures the pending 21% Medicare pay cut would leave him with the equivalent pay of a minimum-wage job. The pay cut has been pushed back until the end of the month. (CNN)
AAFP News Now
- Free Resources Designed to Help Docs Communicate With Par... Parental concerns can make it difficult for family physicians to get their youngest patients immunized. Now, the CDC, in collaboration with the AAFP and the American Academy of Pediatrics, or AAP, has developed new materials to help physicians talk to parents about vaccinating their children.
- AAFP Uses Connect for Reform to Answer Questions on SGR E... The AAFP has posted a question and answer document about the latest congressional action on the sustainable growth rate, or SGR, formula, along with a detailed analysis of the SGR itself, on its Connect for Reform Web site.
- News Briefs: Week of March 8-12 This roundup includes the following news briefs: FDA Approves Name Change for Heartburn Drug; State Supreme Court Strikes Down Medical Malpractice Law; New Mexico Prepares to Enact Insurance Measure; AAFP Looking for Poster Presenters; Solo FP Testifies on Meaningful Use Regulations; Obama Administration Launches Healthy Food Financing Initiative; MedPAC Submits March Report to Congress.
- Changing the Discussion From Physician Burnout to Physici... A new case study by family medicine educators indicates that to create a more positive educational environment for residents and faculty, academic medicine has to change from a focus on the causes of physician burnout to a focus on physician wellness. In addition, educational programs need to create interventions for residents and faculty that encourage them to think about overall physician wellbeing.
- HHS Presents Plan for Health IT Certification HHS recently announced a proposed rule that would establish certification programs to test electronic health record, or EHR, systems. The federal proposal calls for the establishment of a temporary certification program that eventually would be replaced by a permanent program.
- Warnings, Recommendations Fail to Improve Monitoring of U... An important warning about atypical, or second-generation, antipsychotic drugs and a connection to increased risk for diabetes and hyperglycemia didn't make it to primary care physicians, according to a new study in the Archives of General Psychiatry.
- Docs Should Play Role in Increasing Immunization Uptake i... According to a new report from the Trust for America's Health, up to 50,000 U.S. adults die each year from vaccine preventable diseases, and the direct health care burden of vaccine preventable diseases in American adults is $10 billion a year. Physicians, however, can help increase uptake levels for adult vaccinations by making the most of office visits with these patients to get them immunized.
- Academy Leaders Carry Family Physicians' Message to White... In the wake of legislation that reversed a cut in Medicare physician payments through March 31, AAFP leaders once again fanned out in Washington to deliver their message about the value and importance of primary care and family medicine to the White House and congressional leaders. During a series of meetings with administration officials and lawmakers on March 2-3, AAFP President Lori Heim, M.D., of Vass, N.C.; AAFP President-elect Roland Goertz, M.D., M.B.A., of Waco, Texas; AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho; and AAFP EVP Doug Henley, M.D., stressed the importance of family medicine and the patient-centered medical home, or PCMH.
- 'Meaningful Use' Rule Needs Significant Modifications, Sa... The AAFP has responded to the federal government's Dec. 30 release of electronic health record, or EHR, regulations that define the term "meaningful use" with comments detailing how the Academy would make the regulations more helpful -- and more palatable -- to family physicians. Defining meaningful use is important because qualifying for government stimulus funds for the purchase of health information technology, or health IT, depends on how physician practices are meeting the regulations' criteria.
- Senate Acts to Reverse Deep Reductions in Physician Payme... The Senate has passed a one-month extension of the Medicare physician payment rate, thus reversing a 21.2 percent payment reduction that took effect based on the sustainable growth rate, or SGR, formula on March 1. On March 2, the Senate approved a House-passed bill, H.R. 4691, that provides a 30-day extension for several programs, including the Medicare physician payment rate. President Obama signed the measure into law the same day.
Journal of Internal Medicine
- Profound cardiac conduction delay predicts mortality in m... Abstract. Mörner S, Lindqvist P, Mellberg C, Olofsson B-O, Backman C, Henein M, Lundblad D, Forsberg H (Umeå University Hospital, Umeå; Umeå University, Umeå; Sunderby Hospital, Luleå; Sweden). Profound cardiac conduction delay predicts mortality in myotonic dystrophy type 1. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02213.x.Background. Myotonic dystrophy type 1 (DM1) is known to affect mainly the musculoskeletal system. Early mortality is related to respiratory disease and possibly additional cardiovascular complications.Aims. To identify possible cardiovascular disturbances that could predict survival of DM1 patients.Methods. We studied 30 DM1 patients (mean age 41 ± 13.5 years, range 16[ndash]71, 15 women) who were cardiovascularly stable and compared them with 29 controls (mean age 55 ± 7.8 years, range 42[ndash]66, 14 women) using electrocardiography (ECG) and conventional transthoracic echocardiography. The subgroup that survived a follow-up period of 17 years was re-examined using the same protocol.Results. Of the 30 patients, 10 died of a documented respiratory cause and three of acute myocardial incidents. Compared with controls, left ventricular cavity size, corrected to body surface area, was slightly enlarged at end systole (P 90 ms. Of all ECG and echocardiographic measurements, the sum of QRS duration + PR interval was the best predictor of mortality as shown by the area under the receiver operating characteristic curve of 85%, sensitivity of 70% and specificity of 84%.Conclusions. These findings suggest that silent cardiac dysfunction in DM1 patients may cause significant disturbances that over time result in serious complications. Regular follow-up of such patients with detailed electrical and mechanical cardiac assessment may suggest a need for early intervention that may avoid early mortality in some.
- Cystatin C and risk of vascular and nonvascular mortality... Abstract. Emberson JR, Haynes R, Dasgupta T, Mafham M, Landray MJ, Baigent C, Clarke R (University of Oxford, Oxford, UK). Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02214.x.Objective. To assess the relevance of cystatin C, as a marker of mild-to-moderate renal impairment, for vascular and nonvascular mortality in older people.Design. Prospective cohort study.Setting. Re-survey in 1997 to 1998 of survivors in the 1970 Whitehall study of London civil servants.Subjects. Five thousand three hundred and seventy-one men (mean age at resurvey: 77 years) who took part in the resurvey and had plasma cystatin C concentration measured.Main outcome measures. Cause-specific mortality over subsequent 11 years (1997 to 2008).Methods. Cox regression was used to estimate the associations of cystatin C with vascular and nonvascular mortality, before and after adjustment for prior disease and other risk factors (including lifetime blood pressure).Results. During an 11.0-year follow-up period, there were 1171 deaths from vascular causes [26 per 1000 per year (py)] and 1615 deaths from nonvascular causes (36 per 1000 py). Compared with men with cystatin C in the bottom fifth of the distribution, men in the top 10th had about two-fold higher mortality rates from vascular and nonvascular mortality (fully adjusted P both <0.001) even after adjustment for prior disease and all measured confounders, including lifetime blood pressure. The fully adjusted relative risks per 50% higher cystatin C concentrations were 1.66 [95% CI 1.48 to 1.85] for vascular mortality, 1.92 [95% CI 1.66 to 2.22] for ischaemic heart disease mortality and 1.46 [95% CI 1.31 to 1.61] for nonvascular mortality.Conclusions. In older men, plasma concentration of cystatin C, probably as a marker of mild renal disease, is a strong independent predictor of both vascular and nonvascular mortality.
- Haemochromatosis genotype and iron overload: association ... Ellervik C, Tybjærg-Hansen A, Appleyard M, Ibsen H, Nordestgaard BG (Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Herlev; Næstved Hospital, University of Copenhagen, Naestved; Copenhagen University Hospital, University of Copenhagen, Copenhagen East; Bispebjerg Hospital, Copenhagen University Hospital, University of Copenhagen, Bispebjerg; and Holbaek Hospital, Holbaek; Denmark). Haemochromatosis genotype and iron overload: association with hypertension and left ventricular hypertrophy. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02217.x.Objective. We hypothesized that there is an association between haemochromatosis genotype C282Y/C282Y and/or iron overload and risk of hypertension and/or left ventricular hypertrophy (LVH).Methods. We analysed data from a cross-sectional study of the general population including 8992 individuals from the Copenhagen City Heart Study (CCHS), a follow-up study of 36 480 individuals from the Copenhagen General Population Study (CGPS), and a case-only study of 3815 Scandinavians from the Losartan Intervention For End-point Reduction in Hypertension Genetic Substudy (LIFEGEN) with LVH and hypertension.Results. In the CCHS, individuals with C282Y/C282Y versus wild type/wild type had an odds ratio for antihypertensive medication use of 4.8 (1.8[ndash]13; P = 0.003). In the CGPS, the corresponding hazard ratio was 1.7 (1.0[ndash]2.3; P = 0.003). Also, hazard ratios for antihypertensive medication use in the CGPS were 1.6 (1.0[ndash]2.6; P = 0.05) for transferrin saturation [ge]80% vs. <50%, and 2.3 (1.3[ndash]4.2; P = 0.005) for C282Y/C282Y + transferrin saturation [ge]80% vs. wild type/wild type + transferrin saturation <50%. These results were most pronounced in men above 55 years of age. We did not find any association between C282Y/C282Y or iron overload and LVH or hypertension (measured as blood pressure at a single occasion or continuous blood pressure), or LVH with hypertension in the CCHS or with severity of LVH in LIFEGEN.Conclusions. We found that haemochromatosis genotype C282Y/C282Y and extremely elevated transferrin saturation either separately or combined were associated with increased risk of antihypertensive medication use. Therefore, testing for haemochromatosis genotype C282Y/C282Y and extreme transferrin saturation could be considered in patients with essential hypertension.
- Identifying women with severe angiographic coronary disease Abstract. Kreatsoulas C, Natarajan MK, Khatun R, Velianou JL, Anand SS (McMaster University; CARING Network, McMaster University; Population Health Research Institute, McMaster University and Hamilton Health Sciences; Interventional Cardiology, Hamilton Health Sciences; Eli Lilly Canada[ndash]May Cohen Chair in Women's Health, McMaster University; Michael G. DeGroote-Heart and Stroke Foundation of Ontario Chair in Population Health Research, McMaster University; Population Genomics Program, McMaster University; McMaster University, Hamilton, ON, Canada). Identifying women with severe angiographic coronary disease. J Intern Med 2010; doi: 10.1111/j.1365-2796.2009.02210.x.Objectives. To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD).Design. We analysed 23 771 consecutive patients referred for coronary angiography from 2000 to 2006.Subjects. Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography.Outcome measures. Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis [ge]50%, three-vessel disease with [ge]70% stenosis or two-vessel disease including proximal left anterior descending stenosis of [ge]70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD.Results. Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 ± 10.6 vs. 66.3 ± 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05[ndash]1.05, P < 0.01), male sex (OR = 2.43; CI 2.26[ndash]2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86[ndash]2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39[ndash]1.61, P < 0.01), smoking (OR = 1.10; CI 1.03[ndash]1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34[ndash]1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61[ndash]2.04 vs. men OR = 1.28; CI 1.18[ndash]1.39, P < 0.01).Conclusions. Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men.
- Weight change in later life and risk of death amongst the... Abstract. Bamia C, Halkjær J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel-Chapelon F, Boutron-Ruault M-C, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno-de-Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A (University of Athens, Athens, Greece; Institute of Cancer Epidemiology, Copenhagen, Denmark; Harvard School of Public Health, Boston, MA, USA; Bureau of Epidemiologic Research, Athens, Greece; Hellenic Health Foundation, Athens, Greece; Institute of Preventive Medicine, Copenhagen, Denmark; Institute of Public Health, Aarhus University, Aarhus, Denmark; Center for Cardiovascular Research, Aalborg, Denmark; Institut Gustave-Roussy, Paris, France; German Cancer Research Centre, Heidelberg, Germany; Institute of Epidemiology, Potsdam, Germany; German Institute of Human Nutrition Potsdam-Rehbruecke, Potsdam, Germany; University Medical Center Utrecht, Utrecht, the Netherlands; Public Health and Primary Care, London, UK; National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Public Health Department of Gipuzkoa & Ciberesp, San Sebastian, Spain; Health Institute of Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Health and Healthcare services council, Asturias, Spain; Murcia Regional Health Council, Murcia, Spain; Catalan Institute of Oncology, Barcelona, Spain; International Agency for Research on Cancer, Lyon, France; Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy; and Nutritional Research, Umea, Sweden). Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study. J Intern Med 2010; 000: 000[ndash]000.Objective. Later life weight change and mortality amongst elders.Design. Nested case[ndash]control study.Setting. Six countries from the European Investigation into Cancer and nutrition [ndash] Elderly, Network on Ageing and Health.Subjects. A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34 239 participants, [ge] 60 years at enrolment (1992[ndash]2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time.Outcome measures. Mortality in relation to weight change was examined using conditional logistic regression.Results. Weight loss >1 kg year[minus]1 was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41[ndash]1.92) compared to minimal weight change (±1 kg year[minus]1). Weight gain >1 kg year[minus]1 was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98[ndash]1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17[ndash]2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (<1 year) to death (OR = 3.10; 95% CI: 2.03[ndash]4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07[ndash]2.33). Similar patterns were observed regarding death from circulatory diseases and cancer.Conclusions. In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.
- Energy regulation and neuroendocrine–immune contro... Abstract.Straub RH, Cutolo M, Buttgereit F, Pongratz G (University Hospital Regensburg, Regensburg, Germany; University of Genova, Genova, Italy; and Charité University Medicine Berlin, Berlin, Germany). Energy regulation and neuroendocrine[ndash]immune control in chronic inflammatory diseases (Review). J Intern Med 2010; doi:10.1111/j.1365-2796.2010.02218.x Energy regulation (EnR) is most important for homoeostatic regulation of physiological processes. Neuroendocrine pathways are involved in EnR. We can separate factors that provide energy-rich fuels to stores [parasympathetic nervous system (PSNS), insulin, insulin-like growth factor-1, oestrogens, androgens and osteocalcin] and those that provide energy-rich substrates to consumers [sympathetic nervous system (SNS), hypothalamic[ndash]pituitary[ndash]adrenal axis, thyroid hormones, glucagon and growth hormone]. In chronic inflammatory diseases (CIDs), balanced energy-rich fuel allocation to stores and consumers, normally aligned with circadian rhythms, is largely disturbed due to the vast fuel consumption of an activated immune system (up to 2000 kJ day[minus]1). Proinflammatory cytokines such as tumour necrosis factor or interleukins 1[beta] and 6, circulating activated immune cells and sensory nerve fibres signal immune activation to the rest of the body. This signal is an appeal for energy-rich fuels as regulators are switched on to supply energy-rich fuels ('energy appeal reaction'). During evolution, adequate EnR evolved to cope with nonlife-threatening diseases, not with CIDs (huge negative selection pressure and reduced reproduction). Thus, EnR is inadequate in CIDs leading to many abnormalities, including sickness behaviour, anorexia, hypovitaminosis D, cachexia, cachectic obesity, insulin resistance, hyperinsulinaemia, dyslipidaemia, fat deposits near inflamed tissue, hypoandrogenaemia, mild hypercortisolaemia, activation of the SNS (hypertension), CID-related anaemia and osteopenia. Many of these conditions can contribute to the metabolic syndrome. These signs and symptoms become comprehensible in the context of an exaggerated call for energy-rich fuels by the immune system. We propose that the presented pathophysiological framework may lead to new therapeutical approaches and to a better understanding of CID sequence.
- Effect of gender on prognosis in patients with myocardial... Abstract. Venskutonyte L, Malmberg K, Norhammar A, Wedel H, Rydén L (Karolinska Institute, Stockholm; and Nordic School of Public Health, Göteborg; Sweden). Effect of gender on prognosis in patients with myocardial infarction and type 2 diabetes. J Intern Med 2010; 00: 000[ndash]000.Background. Diabetes is associated with a markedly increased cardiovascular risk, but the role of gender on the combined effects of diabetes and myocardial infarction has been less well explored.Methods. The Diabetes Mellitus and Insulin Glucose Infusion in Acute Myocardial Infarction 2 (DIGAMI2) trial recruited 837 men and 416 women with type 2 diabetes hospitalized due to myocardial infarction and followed for a median of 2.1 years. The effects of gender on diabetes-specific risk factors and conventional cardiovascular risk predictors of unfavourable outcome were analysed using a Cox proportional hazards model.Results. Women were older, more frequently had hypertension and previous heart failure than men, and were more often treated with diuretics. More men were smokers. Treatment during hospitalization, at discharge and during follow-up, did not differ significantly, apart from the more frequent use of diuretics in women. Total mortality did not differ between genders, but the combined cardiovascular end-point of death, re-infarction or stroke was more common in women (38.9% vs. 32.1%). This difference disappeared after age adjustment. Age and previous heart failure were independent risk predictors in both genders, whereas diabetes complications were an additional risk factor in women only. Blood glucose level at randomization and updated glucose concentration during follow-up were independent predictors of poor outcome in men but not in women.Conclusions. Age and not gender itself explained the increased cardiovascular event rate seen in women compared with men. A heavier risk factor burden was seen amongst women. Improved risk factor control instituted before the development of a myocardial infarction should be attempted as a possible means of improving the outcome.
- Relation between renal function, presentation, use of the... Abstract. Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, Wallentin L, Jernberg T, for SWEDEHEART. (Karolinska Institute, Karolinska University Hospital, Stockholm; Karolinska Institute, Danderyd Hospital, Danderyd; Ryhov County Hospital, Jönköping; University Hospital, Uppsala and University Hospital, Linköping; Sweden) Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02204.x.Objective. To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction (MI).Design. Observational study.Setting. Nationwide coronary care unit registry between 2003[ndash]2006 in Sweden.Subjects. Consecutive MI patients with available creatinine (n = 57 477).Results. Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups.Conclusion. Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.
- Worse blood pressure control in patients with cerebrovasc... Abstract. Mechtouff L, Touzé E, Steg PG, Ohman EM, Goto S, Hirsch AT, Röther J, Aichner FT, Weimar C, Bhatt DL, Alberts MJ, Mas J-L, on behalf of the REACH Registry Investigators (Paris-Descartes University; Université Paris 7; Paris, France, Duke University, Durham NC, USA, Tokai University, Isehara, Japan, University of Minnesota, Minneapolis, MN, USA, Academic Teaching Hospital Hannover Medical School, Minden, Germany, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria, University of Duisburg-Essen, Essen, Germany, VA Boston Healthcare System, and Brigham and Women's Hospital, Boston, MA; and Northwestern University Medical School, Chicago, IL; USA). Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease. J Intern Med 2009; 00: 00[ndash]00 doi: 10.1111/j.1365-2796.2009.02198.x.Objectives. Poor blood pressure (BP) control is common amongst patients with symptomatic atherothrombotic disease. It is unclear whether BP control and management differ across atherothrombotic disease subtypes.Methods. We analysed the baseline data of 44 984 patients with documented coronary artery disease (CAD) only (n = 30 414), cerebrovascular disease (CVD) only (n = 11 359) and peripheral arterial disease (PAD) only (n = 3211) from the international REduction of Atherothrombosis for Continued Health Registry and investigated the impact of atherothrombotic disease subtype on BP control and use of antihypertensive drugs.Results. The proportion of patients with BP controlled (<140/90 mmHg) was higher in CAD (58.1%) than in CVD (44.8%) or PAD (38.9%) patients (P < 0.001). Amongst patients with treated hypertension, CAD patients were more likely to have BP controlled than were CVD patients [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.59[ndash]1.75] or PAD (OR = 2.30; 95% CI = 2.10[ndash]2.52). These differences were smaller in women than in men and decreased with age. Amongst treated patients, CAD patients were more likely to receive [ge]3-drug combination therapies than were CVD (OR = 1.73; 95% CI = 1.64[ndash]1.83) or PAD (OR = 1.64; 95% CI = 1.49[ndash]1.80) patients. Adjustment for age, gender, waist obesity, diabetes, education level and world region did not alter the results.Conclusions. Coronary artery disease patients are more likely than CVD or PAD patients to have BP controlled and to receive antihypertensive drugs, particularly combination therapies. Promotion of more effective BP control through combination antihypertensive therapies could improve secondary prevention and therefore prevent complications in CVD and PAD patients.
- Risk factors for end-stage renal disease in a community-b... Abstract. Kastarinen M, Juutilainen A, Kastarinen H, Salomaa V, Karhapää P, Tuomilehto J, Grönhagen-Riska C, Jousilahti P, Finne P. (Kuopio University Hospital, Kuopio; National Institute for Health and Welfare, Helsinki; University of Helsinki, Helsinki; South Ostrobotnia Central Hospital, Seinäjoki; Finnish Registry for Kidney Diseases, Helsinki; Helsinki University Central Hospital, Helsinki; and University of Tampere, Tampere; Finland). Risk factors for end-stage renal disease in a community-based population: 26-year follow-up of 25 821 men and women in eastern Finland. J Intern Med 2010; 00: 00[ndash]00.Background and objective. There are very few European cohort studies assessing the risk factors of end-stage renal disease (ESRD) in a community-based population. This study investigated the predictors of ESRD in Finland.Design. Prospective cohort study.Setting. Eastern Finland.Subjects. A random sample of 25 821 men and women aged 25[ndash]64 years from the national population register participating in three independent cross-sectional population surveys in 1972, 1977 and 1982. Only the subjects without diagnosis of ESRD or chronic kidney disease based on the national register data were included in the study.Main outcome measure. Initiation of renal replacement therapy (dialysis or kidney transplantation) identified from the Finnish Registry for Kidney Diseases through December 31, 2006.Results. A total of 94 cases with ESRD were identified during a mean follow-up period of 26.5 years. In a multivariate proportional subdistribution hazard regression analysis, taking into account death as a competing risk event, diabetes (hazard ratio [HR] 4.76, 95% confidence interval [CI] 2.32[ndash]9.79), hypertension (HR 2.21, 95% CI 1.19[ndash]4.12), obesity defined as body mass index [ge]30 kg m[minus]2 (HR 2.02, 95 %CI 1.10[ndash]3.71) and male gender (HR 1.68, 95% CI 1.19[ndash]4.12) were independent risk factors for ESRD.Conclusion. The findings of the present study confirm that modifiable risk factors play a major role in the development of ESRD in the North-European population. People with diabetes, hypertension or obesity should be considered as the target groups when planning preventive measures to control the future epidemic of ESRD.
Journal of General Internal Medicine
- Variation in Estimates of Limited Health Literacy by Asse... Abstract Objectives This paper compares estimates of poor health literacy using two widely used assessment tools and assesses the effect of non-response on these estimates. Study Design and Setting A total of 4,868 veterans receiving care at four VA medical facilities between 2004 and 2005 were stratified by age and facility and randomly selected for recruitment. Interviewers collected demographic information and conducted assessments of health literacy (both REALM and S-TOFHLA) from 1,796 participants. Prevalence estimates for each assessment were computed. Non-respondents received a brief proxy questionnaire with demographic and self-report literacy questions to assess non-response bias. Available administrative data for non-participants were also used to assess non-response bias. Results Among the 1,796 patients assessed using the S-TOFHLA, 8% had inadequate and 7% had marginal skills. For the REALM, 4% were categorized with 6th grade skills and 17% with 7–8th grade skills. Adjusting for non-response bias increased the S-TOFHLA prevalence estimates for inadequate and marginal skills to 9.3% and 11.8%, respectively, and the REALM estimates for ≤6th and 7–8th grade skills to 5.4% and 33.8%, respectively. Conclusions Estimates of poor health literacy varied by the assessment used, especially after adjusting for non-response bias. Researchers and clinicians should consider the possible limitations of each assessment when considering the most suitable tool for their purposes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1304-2Authors Joan M. Griffin, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USAMelissa R. Partin, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USASiamak Noorbaloochi, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USAJoseph P. Grill, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USASomnath Saha, Portland VA Medical Center Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders Portland OR USAAnnamay Snyder, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USASean Nugent, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USAAlisha Baines Simon, Minneapolis VA Medical Center Center for Chronic Disease Outcomes Research (152/3E-109), One Veterans Drive Minneapolis MN 55417 USAIan Gralnek, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, GI Outcomes Unit Department of Gastroenterology Rambam Health Care Campus Haifa IsraelDawn Provenzale, Durham VA Medical Center Center for Health Services Research in Primary Care Durham NC USAMichelle van Ryn, University of Minnesota School of Medicine Department of Family Medicine and Community Health Minneapolis MN USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Improvement Happens: an Interview with Christine Sinsky, MD Improvement Happens: an Interview with Christine Sinsky, MD Content Type Journal ArticleCategory Innovations and ImprovementDOI 10.1007/s11606-010-1281-5Authors Richard L. Kravitz, University of California, Davis Division of General Internal Medicine 4150 V. Street, Suite 2400 PSSB Sacramento CA 95817 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Room with a View Room with a View Content Type Journal ArticleCategory Healing ArtsDOI 10.1007/s11606-010-1308-yAuthors Adam Possner, Johns Hopkins Bayview Medical Center Department of Internal Medicine 4940 Eastern Avenue Baltimore MD 21224 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- From the Patient’s Perspective: The Impact of Training ... Abstract BACKGROUND It is uncertain whether training improves physicians’ obesity counseling. OBJECTIVE To assess the impact of an obesity counseling curriculum for residents. DESIGN A non-randomized, wait-list/control design. PARTICIPANTS Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1–8 months post-intervention) 163 of the residents’ obese patients were interviewed after their medical visits. INTERVENTION A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients. MAIN MEASURES Patient-report of physicians’ use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics. KEY RESULTS A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std β = 0.18; R 2 change = 2.9%, P < 0.05). CONCLUSIONS Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1299-8Authors Melanie Jay, New York University School of Medicine Division of General Internal Medicine VA New York Harbor, 423 E 23rd Street New York NY 10010 USASheira Schlair, Albert Einstein College of Medicine Division of General Internal Medicine, Montefiore Medical Center Bronx NY 10467 USARob Caldwell, New York University School of Medicine Division of General Internal Medicine VA New York Harbor, 423 E 23rd Street New York NY 10010 USAAdina Kalet, New York University School of Medicine Division of General Internal Medicine VA New York Harbor, 423 E 23rd Street New York NY 10010 USAScott Sherman, New York University School of Medicine Division of General Internal Medicine VA New York Harbor, 423 E 23rd Street New York NY 10010 USAColleen Gillespie, New York University School of Medicine Division of General Internal Medicine VA New York Harbor, 423 E 23rd Street New York NY 10010 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Entering and Exiting the Medicare Part D Coverage Gap: Ro... Abstract BACKGROUND Some Medicare Part D enrollees whose drug expenditures exceed a threshold enter a coverage gap with full cost-sharing, increasing their risk for reduced adherence and adverse outcomes. OBJECTIVE To examine comorbidities and demographic characteristics associated with gap entry and exit. DESIGN We linked 2005–2006 pharmacy, outpatient, and inpatient claims to enrollment and Census data. We used logistic regression to estimate associations of 2006 gap entry and exit with 2005 medical comorbidities, demographics, and Census block characteristics. We expressed all results as predicted percentages. PATIENTS 287,713 patients without gap coverage, continuously enrolled in a Medicare Advantage Part D (MAPD) plan serving eight states. Patients who received a low-income subsidy, could not be geocoded, or had no 2006 drug fills were excluded. RESULTS Of enrollees, 15.9% entered the gap, 2.6% within the first 180 days; among gap enterers, only 6.7% exited again. Gap entry was significantly associated with female gender and all comorbidities, particularly dementia (39.5% gap entry rate) and diabetes (28.0%). Among dementia patients entering the gap, anti-dementia drugs (donepezil, memantine, rivastigmine, and galantamine) and atypical antipsychotic medications (risperidone, quetiapine, and olanzapine) together accounted for 40% of pre-gap expenditures. Among diabetic patients, rosiglitazone accounted for 7.2% of pre-gap expenditures. Having dementia was associated with twice the risk of gap exit. CONCLUSIONS Certain chronically ill MAPD enrollees are at high risk of gap entry and exposure to unsubsidized medication costs. Clinically vulnerable populations should be counseled on how to best manage costs through drug substitution or discontinuation of specific, non-essential medications. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1300-6Authors Susan L. Ettner, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USANeil Steers, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USAO. Kenrik Duru, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USANorman Turk, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USAElaine Quiter, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USAJulie Schmittdiel, Kaiser Permanente Medical Care Program, Northern California Division of Research Oakland CA USACarol M. Mangione, David Geffen School of Medicine at UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine 911 Broxton Plaza Los Angeles CA 90024 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- A Conductor Confronts Cacophony Abstract Content Type Journal ArticleCategory Healing ArtsDOI 10.1007/s11606-010-1280-6Authors Jonathan Chalett, Mary Bridge Children’s Hospital Department of Emergency Medicine Tacoma WA 98415 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Medical Decision Making: What Do We Trust? Medical Decision Making: What Do We Trust? Content Type Journal ArticleCategory EditorialDOI 10.1007/s11606-010-1293-1Authors David A. Cook, Mayo Clinic Division of General Internal Medicine and Office of Education Research, College of Medicine Rochester MN USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Teaching Health Policy to Residents Teaching Health Policy to Residents Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s11606-010-1267-3Authors Celine Goetz, University of Chicago Pritzker School of Medicine Chicago United StatesVineet M. Arora, University of Chicago Pritzker School of Medicine Chicago United StatesValerie G. Press, University of Chicago Pritzker School of Medicine Chicago United States Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Effect of Incarceration History on Outcomes of Primary Ca... Abstract Background Behaviors associated with opioid dependence often involve criminal activity, which can lead to incarceration. The impact of a history of incarceration on outcomes in primary care office-based buprenorphine/naloxone is not known. Objective The purpose of this study is to determine whether having a history of incarceration affects response to primary care office-based buprenorphine/naloxone treatment. Design In this post hoc secondary analysis of a randomized clinical trial, we compared demographic, clinical characteristics, and treatment outcomes among 166 participants receiving primary care office-based buprenorphine/naloxone treatment stratifying on history of incarceration. Main Results Participants with a history of incarceration have similar treatment outcomes with primary care office-based buprenorphine/naloxone than those without a history of incarceration (consecutive weeks of opioid-negative urine samples, 6.2 vs. 5.9, p = 0.43; treatment retention, 38% vs. 46%, p = 0.28). Conclusions Prior history of incarceration does not appear to impact primary care office-based treatment of opioid dependence with buprenorphine/naloxone. Community health care providers can be reassured that initiating buprenorphine/naloxone in opioid dependent individuals with a history of incarceration will have similar outcomes as those without this history. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1306-0Authors Emily A. Wang, Yale University School of Medicine Department of Internal Medicine New Haven CT USABrent A. Moore, Yale University School of Medicine Department of Psychiatry New Haven CT USALynn E. Sullivan, Yale University School of Medicine Department of Internal Medicine New Haven CT USADavid A. Fiellin, Yale University School of Medicine Department of Internal Medicine New Haven CT USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Supporting Patient Autonomy: The Importance of Clinician-... Abstract Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients’ independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals’ autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients’ treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients’ autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy. Content Type Journal ArticleCategory PerspectivesDOI 10.1007/s11606-010-1292-2Authors Vikki A. Entwistle, Universities of Dundee and St Andrews Social Dimensions of Health Institute 11 Airlie Place Dundee DD1 4HJ Scotland UKStacy M. Carter, University of Sydney Centre for Values, Ethics and the Law in Medicine Sydney AustraliaAlan Cribb, Kings College London Centre for Public Policy Research London UKKirsten McCaffery, University of Sydney Sydney School of Public Health Sydney Australia Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
Latest articles from Medical Marketing and Media
- Covidien, Biovail to beef up sales forces While many sales jobs at large pharmaceutical companies continue to be shed amidst reorganizations, mergers and consolidations, Covidien and Biovail are bucking the trend and hiring new personnel.
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WHO news
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- WHO releases new malaria guidelines for treatment and pro... 9 March 2010 -- WHO is releasing new guidelines for the treatment of malaria, and the first ever guidance on procuring safe and efficient anti-malarial medicines.
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- Africa united in fight against polio outbreak 4 March 2010 -- Over 85 million children under five years old will be immunized against polio in 19 countries across West and Central Africa in an example of cross-border cooperation aimed at stopping a year-long polio epidemic.
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- The UN tackles road safety 3 March 2010 -- Governments around the world proclaim 2011-2020 the decade of action for road safety. WHO welcomes the UN General Assembly seeks to halt the increase of world wide traffic accidents through a decade of action.
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- Governments celebrate five years of anti-tobacco convention 26 February 2010 -- The fifth anniversary of the entry into force of the WHO Framework Convention on Tobacco Control was held today in the Geneva headquarters of the World Health Organization.
- Global forum addresses solutions to prevent premature deaths 24 February 2010 -- The first Global Forum of the Noncommunicable Disease Network (NCDnet) marks the first time WHO has convened key stakeholder groups to address the large-scale and increasing global health and development burden posed by noncommunicable diseases (NCDs).
- WHO hails new Gates Foundation support for decade of vacc... 29 January 2010 -- WHO welcomes the Bill & Melinda Gates Foundation pledge of US$ 10 billion over the next ten years to accelerate global vaccine efforts.
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WebMD Health
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CNN.com - Health
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MedlinePlus Health News
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WSJ.com: Health Blog
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National Institutes of Health (NIH) News Releases
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AOL News Collection:health collection
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WashingtonPost Health News
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- Book review: Susan Okie reviews "We've Got Issues: Child... Instead of an epidemic of over-treatment, Warner describes an epidemic of under-treatment of children with mental illness.
- A patient's death prompts a doctor to assess 'Do Not Res... The emergency department is always noisy, but sudden screams from a staffer still get attention. The triage nurse is yelling, "Not breathing, had vitals at triage and just croaked," as she runs toward us pushing a wheelchair. In it, a pale, thin man is slumped over and looking gray. I'm the atten...
- Despite what you may have heard, there's no boom in deaf... When I was growing up, one of my mother's favorite admonitions -- along with "If you keep making that face, it's going to freeze that way" and "Don't sit too close to the television or you're going to need glasses" -- was the classic "Turn that music down, or you'll go deaf."
- Eat, Drink and Be Healthy: Letters about Me Minus 10 Two things I've learned since launching my Me Minus 10 campaign to lose 10 pounds before I turn 50 in December: Many people want to lose 10 pounds -- and many would like to have cartoon images made of themselves! I've received tons of great feedback; here are some of your letters.
- Harry Smith colonoscopy to air on `Early Show' "The Early Show" co-anchor Harry Smith is scheduled to have a colonoscopy Wednesday, with live reports planned as he undergoes the procedure at a New York hospital.
- Obama pitches health plan in spirited appearance GLENSIDE, Pa. -- Stirring memories of his campaign for the White House, President Barack Obama made a spirited, shirt-sleeved appeal for passage of long-stalled health care changes Monday as Democratic congressional leaders worked behind the scenes on legislation they hope can quickly gain passage.
- Big in Japan? Fat chance for nation's young women, obses... TOKYO -- As women in the United States and across the industrialized world get fatter, most Japanese women are getting skinnier.
American Medical News
- Medicare pay patches persist as medicine demands long-ter... The latest plan would delay the pay cut until Oct. 1. Some physicians say they are getting tired of repeatedly being taken to the brink.
- Physicians seek gains in state liability reforms Doctors aren't waiting for federal relief, but are working with legislators to defend caps on noneconomic damages and secure other state-level tort reforms.
- Medicare pay formula needs repair, Sebelius says Rep. Michael Burgess, MD, and Surgeon General Regina Benjamin, MD, also spoke at the annual AMA conference. Topics included health reform, obesity and violence prevention.
- Legal immigrants sue when left out of Mass. health plan Health reform expanded coverage, but lawmakers had to scale it back to balance the 2009 budget. A lawsuit claims that was unconstitutional.
- Stricter training urged for imaging, radiation Radiologists urge accreditation standards that would link Medicare pay to a practitioner's training.
- EMR certification proposal outlines path to "meaningful use" Concerns about safety issues from health IT malfunctions could result in more federal oversight.
- Astrodocs: For these physicians, space is their workplace Since 1973, 23 U.S. physicians have launched into space. They have taken part in spacewalks, treated fellow crew members and conducted medical research.
- Child vaccine rates hinge on educating parents Many parents consider vaccines beneficial, but about one in five believes some vaccines cause autism, a new study says.
- End-of-life care discussions are in patients' best interests Ethics Forum - A column that answers questions on ethical issues in medical practice
- Misguided ID theft rules confuse practices with banks Physicians, already tracking identity theft under HIPAA, should not also be subject to regulations designed for banks.
FOXNews.com
- 30 Foods You Should Never Be Without Unexpected guests are a regular part of life, so here's a list of foods you should always keep on hand
- Ohio Woman Says Doctor Used Wrong Breast Implants An Ohio woman claims in a lawsuit that a Pennsylvania plastic surgeon used the wrong kind of breast implants on her, then kept her knocked out longer than necessary and continued with the botched operation on the advice of her fiance.
- Doctor Teaches Do-It-Yourself Euthanasia Workshop The man Australians call "Dr. Death" came to Britain to teach a workshop on "do-it-yourself euthanasia," Sky News reported Monday.
- Testosterone May Make Women Nicer Women given testosterone act nicer by making fairer offers during a bargaining game than those given a placebo, the researchers say.
- Sex? Read My Lips A new lipstick has gone on sale that shows when women are in the mood for sex.
- Study: Mini Clip Is Safer Than Heart-Valve Surgery Many Americans with leaky heart valves soon might be able to get them fixed without open-heart surgery. A study showed that a tiny clip implanted through an artery was safer than and nearly as effective as surgery.
- U.S. Court Rules Again Against Vaccine-Autism Claims Vaccines that contain a mercury-based preservative called thimerosal cannot cause autism on their own, a special U.S. court ruled on Friday, dealing one more blow to parents seeking to blame vaccines for their children's illness.
- WTC Responders Show Early Signs of Heart Problems Law enforcement officers who worked near ground zero after the World Trade Center attacks seem to show early signs of heart problems at a higher rate than would be expected for their age, a new study suggests.
- Meningitis Outbreak Closes School After 2 Die in Oklahoma two Oologah-Talala elementary school students have died of a disease related to meningitis. The disease has sickened four others.
- What Women Want From Men Women appreciate a little chivalry now and then - so here's how to score points with your lady
CBC | Health News
- Heart valve clip safer than surgery: study A tiny clip implanted through an artery was safer and nearly as effective as open-heart surgery for leaky mitral valves, a U.S. study suggests.
- Senior drivers need more options: MDs A senior's licence to drive shouldn't trump public safety, say doctors advocating better transportation programs for an aging population.
- Opium poppy secrets unlocked Researchers at the University of Calgary say they have discovered the unique genes that allow the opium poppy to make compounds used to produce codeine and morphine.
- Mouthguards may boost athletes' performance A New Brunswick dentist says his research indicates mouthguards can improve the performance of athletes, and take away their aches and pains.
- Listeria-contaminated meat prompts lawsuit The latest meat recall due to concerns over listeria contamination has prompted a proposed class action.
- Williams back on job after heart surgery Newfoundland and Labrador Premier Danny Williams returned to work on Monday, six weeks after triggering a firestorm over medicare.
- 75% of family doctors abused by patients: study Three-quarters of Canadian family doctors say they suffered at least one incident of major abuse at the hands of a patient, according to a new study.
- Blood pressure spikes could boost stroke risk People with occasional spikes in their blood pressure could be at higher risk of having a stroke than those with regularly high blood pressure, according to new studies released Friday.
- Cord-blood banks oversell value: Marketplace Health claims used by private cord-blood banks to persuade parents to save their baby's umbilical cord blood can overstate the benefits, according to an investigation by CBC-TV's Marketplace.
- Insurance urged for beach-bound teens Teenagers going abroad for some fun in the sun this March break would be wise to pick up travel medical insurance, says an Ottawa mother whose own son suffered a terrible accident while on vacation that cost him one of his legs.
The Globe and Mail - Health News
- Lightening blindness's burden With only a handful of doctors trained in low-vision rehabilitation, many Canadians go without advanced visuals aids that could lessen the burden of their disability
- Look out 'cause this stuff is TOXIC! Beware the rubber duck: According to a new book, our bodies are soaking in harmful chemicals that leach out of household items
- Plan for a good death - talk about your wishes We're not very good at dying
- Didgeridoo inspires sleep apnea workout Playing the Australian aboriginal wind instrument seems to help those affected
- Fishing: the cause of more drowning deaths While we revel in water's delights, we too rarely consider its dangers
- A DASH of prevention can protect your heart The diet, known for its ability to lower high blood pressure, may also cut in half your risk of heart failure
- Cheese puffs, with added vitamin D Canada inches closer to a decision on whether to allow companies to add vitamins and minerals to packaged or processed food
- Six steps urged to reverse RN shortfall Canada could have a shortfall of 60,000 registered nurses by the year 2022
- Pharma freebies sway med students Even trivial handouts influence the brand of drugs favoured by students, says new research paper
- Thousands of Canadians sign up for cancer study 31,000 volunteers have already been enlisted to participate in the Canadian Partnership Against Cancer's decades-long investigation
msnbc.com: Health
- FDA working to replace misleading food labels The aisles of American supermarkets can be bewildering places these days. What food claims are the conscientious eater to trust and what foods should they pick to put on their table?
- Health care 101: Consumer guide to reform bill It took lawmakers a year to shape President Barack Obama's health care bill. If it finally passes Congress, it'll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies.
- Advanced gene test better at spotting autism U.S. researchers looking for genetic changes linked to autism reported Monday an advanced gene test that searches for deleted or extra DNA in chromosomes worked three times better than standard tests.
- Doctors may separate Pakistani conjoined twins A Pakistani neurosurgeon says doctors are studying a pair of twin girls who were recently born connected at the head to determine whether they can separate them.
- Q&A: How Obama’s Medicare tax plan works President Barack Obama, to help pay for his health care overhaul package, is proposing that high-income Americans pay Medicare taxes on the money they make on their investments. Here are some basic questions and answers about this little-discussed provision that could affect millions of people.
- Prenatal screening for rare disease too costly Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether genetic tests are worth the cost.
- Health bill can pass without direct vote? House Democrats could pass the Senate health insurance reform bill without actually voting on it. Msnbc.com fact-checks this claim — and more.
- Newsweek: Michelle Obama on how to feed our kids well Let’s be honest, our kids didn’t do this to themselves. Our kids don’t decide what’s served in the school cafeteria or whether there’s time for gym class or recess. We, the adults, do.
- Health care bill heads for make-or-break week The House's chief Democratic headcounter said Sunday he hadn't rounded up enough votes to pass President Barack Obama's health care overhaul heading into a make-or-break week.
- Intense treatment hopes for diabetics dashed Key results from a landmark federal study are in, and the results are disappointing for diabetics: Adding drugs to drive blood pressure and blood-fats lower than current targets did not prevent heart problems, and in some cases caused harmful side effects.
WSJ.com: Health
- Search for Diabetes Therapy Falls Short New strategies to prevent and treat diabetes and heart disease failed to improve care in two major studies, frustrating researchers' efforts to find more-effective approaches to the world's burgeoning diabetes epidemic.
- FDA Scrutinizes Third-Party Reviews Medical-equipment makers can pay companies to do the reviews, but the agency is weighing whether to end the outsourcing program.
- Abbott Heart Device Gains An Abbott Laboratories device designed to improve a leaky heart valve without major surgery met its safety and effectiveness goals in a key study released Sunday.
- Pressure Rises at Roche Roche's recent drug-trial failures are raising pressure on the Swiss company as it seeks to become a powerhouse after its takeover of biotech firm Genentech.
- Awash in Fake Drugs, Nigerians Fight Back A new technology is helping companies and consumers detect fake pharmaceuticals in Nigeria.
- FDA Panel Backs Device For Epilepsy An FDA panel narrowly backed the use of Medtronic's "deep-brain stimulation" device in certain epilepsy patients.
- Surgical-Device Firms Walk Fine Line Heart surgery devices often used to treat a common type of faulty heartbeat haven't been approved by the government for that use. Yet these products are used almost exclusively to treat that condition.
- Heart Test May Be Overused A widely used test to detect blockages in the heart's arteries often turns up little or no evidence of disease, a study found, suggesting that patients are frequently exposed unnecessarily to the risks and costs of the examination.
- FDA Will Review Fosamax, Boniva for Safety The review, of a class of drugs known as bisphosphonates that are commonly prescribed to treat osteoporosis and designed to build bone mass, will try to determine if they increase the risk of femur fractures.
- Abbott to Buy Facet Biotech Abbott Labs will bulk up its product pipeline with a $722 million deal for Facet Biotech, which had rebuffed overtures from development partner Biogen Idec.
PLoS Medicine: New Articles
- New Approaches to Preventing, Diagnosing, and Treating Ne... Karen Edmond and Anita Zaidi highlight new approaches that could reduce the burden of neonatal sepsis worldwide.
- Providing Alcohol-Related Screening and Brief Interventio... Duncan Clark and Howard Moss identify obstacles to alcohol-related screening and treatment for adolescents and propose policy solutions.
- Human Resource and Funding Constraints for Essential Surg... In the second of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues describe the range of providers of surgical care and anesthesia and estimate the related costs.
- Essential Surgery at the District Hospital: A Retrospecti... In the first of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues find low levels of surgical care provision suggesting unmet need for surgical services.
- Where Will the Next Generation of Stroke Treatments Come ... David Howells and G. A. Donnan discuss the next generation of stroke treatments and say that novel therapeutic targets may emerge from the stimulation of neuroplasticity and unraveling the genetic code of stroke heterogeneity.
- Unravelling the Genetics of Ischaemic Stroke Hugh Markus discusses genetic factors in stroke risk, and emphasizes the importance of large sample studies and rigorous replication of results in genetic stroke research.
- Drivers of Inequality in Millennium Development Goal Prog... David Stuckler and colleagues examine the impact of the HIV and noncommunicable disease epidemics on low-income countries' progress toward the Millennium Development Goals for health.
- PLoS Medicine Issue Image | Vol. 7(2) February 2010 A new policy on tobacco papers. In this month's Editorial, the PLoS Medicine editors announce that they will no longer consider papers for which support in whole or in part for the study or the researchers comes from a tobacco company. As a medical journal, this policy is important for two reasons, say the editors: First, tobacco is indisputably bad for health. And second, the editors remain concerned about the tobacco industry's long-standing and well-documented attempts to distort the science of and deflect attention away from the harmful effects of smoking.Image Credit: myuibe at flickr.com
- Packages of Care for Attention-Deficit Hyperactivity Diso... In the sixth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Alan Flisher and colleagues discuss the treatment of attention-deficit hyperactivity disorder.
- Event Rates, Hospital Utilization, and Costs Associated w... Philip Clarke and colleagues examined patient-level data for over 11,000 participants with type 2 diabetes from 20 countries and find that major complications of diabetes significantly increased hospital use and costs across settings.
Forbes.com: Health News
- What You Need To Know About Fish Oil Americans spend billions on foods and supplements containing omega-3 fatty acids. Not all of it is money well spent.
- Saving Big Bucks On Prescription Drugs Many Americans pay far more than they have to for medicines. Here's how you can save money.
- The World's Healthiest Diets Stealing a few eating tips from abroad may keep you healthy into a ripe old age.
- A First: Diagnosis By DNA In a big leap for medicine, gene sequencing helps doctors treat a sick infant.
- A First: Diagnosis By DNA In a big leap for medicine, gene sequencing helps doctors treat a sick infant.
- When City Hall Tells You What To Eat Fed up with high obesity rates, states and cities are trying to force people to eat better. Will it work?
- Ten Questions About High Cholesterol The biggest heart risk factor still mystifies top scientists. Here's what you need to know.
- Ten Misleading Drug Ads The FDA is finally cracking down on drug companies for ads that underplay serious risks.
- The Least Deadly Hospitals Some regional hospitals do a better job preventing fatal complications than famous academic medical centers.
- America's Least Deadly Hospitals Some regional hospitals do a better job preventing fatal complications than famous academic medical centers.
The Differential: Medscape Med Students Blogs
- The Differential Has Moved! New location: http://blogs.medscape.com/thedifferential Be sure to bookmark the new address!
- Practice Makes Perfect Jeff Wonoprabowo -- Earlier this quarter I had a pretty busy afternoon. And for a while it was stressful, too. It all started when a 51-year-old man came into the hospital complaining about shortness of breath. On the way in...
- What Is the Best Age to Start Med School? Anna Burkhead -- The average age of my first-year medical school class was 24.5. The oldest member of the class was 41, and the mythical youngster was but a raw 19 years old. The most common age was probably 22...
- Illegal or Inappropriate? Thomas Robey -- “How old are you?” “Are you married?” “Do you have kids?” Have you ever been asked any of these questions? Have you ever been asked by a potential employer? Would your response depend on the inquisitor? If...
- Starting All Over Again Ben Bryner -- I'm finally on the home stretch for interviews. Only a few more left. As I've mentioned, the thing I like most about interviews is the chance to talk to the leaders in surgery, meet residents, and imagine...
- Catching Winter Bugs Lucia Li -- “If we had no winter, spring would not be so pleasant.” Winter brings many things. Like Christmas, frost, and an excuse for hot chocolate. Mostly, though, it brings norovirus. In as little as one day, the hospital...
- How I Got Into Medicine Ben Bryner -- I’m still interviewing for residency, just trying to take it one trip at a time. Traveling and finding my way around new cities and unfamiliar hospital buildings is always a little stressful, and I won’t miss that...
- To Be, Or Not To Be (In Class) Jeff Wonoprabowo -- As a first year student I attended the majority of lectures. There were, after a while, a few professors whose lecture style I preferred not to listen to. And there were a couple of days when I...
- What Do I Want To Be When I Grow Up? Kendra Campbell -- I’ve recently been thinking a lot about what I would have done with my life had I not gone to medical school. So, I was inspired by Colin's post to make a short list of what I...
- Resolutions of a Fourth-Year Med Student Anna Burkhead -- It’s finally 2009! This is the year that fourth-year medical students across the USA (and final year students all over the world) have been anticipating and dreading for untold amounts of time. It’s the year we get...
Clinical Cases and Images: CasesBlog
- Monoclonal antibodies against C. difficile toxins reduce ... New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.A randomized, double-blind, placebo-controlled study included 2 neutralizing, fully human monoclonal antibodies against C. difficile toxins A (CDA1) and B (CDB1). The antibodies were administered together as a single infusion, each at a dose of 10 mg per kilogram of body weight, in patients with symptomatic C. difficile infection who were receiving either metronidazole or vancomycin.Among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C. difficile infection was lower among patients treated with monoclonal antibodies (7% vs. 25%).However, the mean duration of the initial hospitalization for inpatients did not differ significantly between the antibody and placebo groups (9.5 and 9.4 days, respectively).The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection.References:Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. Israel Lowy. NEJM Volume 362:197-205 January 21, 2010 Number 3.Image source: Micrograph of a colonic pseudomembrane in Clostridium difficile colitis, a type of pseudomembranous colitis. H&E stain. Wikipedia, Nephron, Creative Commons Attribution-Share Alike 3.0 Unported license. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Emphysema and Airflow Obstruction Associated with Impaire... Very severe chronic obstructive pulmonary disease (COPD) causes cor pulmonale - elevated pulmonary vascular resistance and secondary reductions in left ventricular filling, stroke volume, and cardiac output.The authors of this NEJM study hypothesized that emphysema, as detected on computed tomography (CT), and airflow obstruction are inversely related to left ventricular end-diastolic volume, stroke volume, and cardiac output among persons without very severe lung disease.Of the study participants, 13% were current smokers, 38% were former smokers, and 49% had never smoked.A 10% increase in emphysema on CT was related to decrease in left ventricular end-diastolic volume, stroke volume, and cardiac output.Percent emphysema and airflow obstruction were not associated with the left ventricular ejection fraction (LVEF).Mind map of Chronic Obstructive Pulmonary Disease (COPD) (click to enlarge the image).References:Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling. R. Graham Barr et al. NEJM Volume 362:217-227 January 21, 2010 Number 3.Image source: Enlarged view of lung tissue showing the difference between healthy lung and COPD, Wikipedia, public domain. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- 5.7% of teenagers have participated in "choking game" From the NYTimes:During "choking game" adolescents try to achieve a high by briefly depriving the brain of oxygen through strangulation. The "game" is extremely dangerous and could lead to brain damage, long-term neurological disability and death.According to the recent survey of more than 10,642 eighth graders in Oregon, 36.2 percent reported having heard of the choking game, 30.4 said they had heard of someone participating in it and 5.7 percent said they had participated themselves.Many adults are unaware of the many names the game goes by — including “Knock Out,” “Space Monkey,” “Flatlining” or “The Fainting Game” — and the warning signs:- bloodshot eyes- marks on the neck that may look like hickies- frequent severe headaches- disorientation after spending time alone- ropes, scarves and belts discarded on the floor or tied to bedroom furniture and doorknobsReferences:Choking Game No Mystery to Children, Oregon Study Finds. NYTimes, 2010.Image source: The vulnerable carotid artery, (large, red tube), and the vagus nerve running parallel on its left. Wikipedia, public domain. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- "Cutting Salt as Good as Quitting Smoking" Cutting U.S. salt intake by just half a teaspoon (3 grams) a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. A 3-gm per day reduction in salt (1,200 mg of sodium) will result in 6% fewer new cases of heart disease and 3% fewer deaths.The average U.S. man gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.Alarmed by high death rates from strokes, Portugal plans to decrease salt in bread, blamed for high blood pressure. Portugal has one of the highest mortality rates from strokes in Europe - double that in Spain and 3 times that in France. Strokes account for 20% of deaths in Portugal, reduction of salt intake by 1 gram per day would save 2,650 lives per year. http://is.gd/ndNv The daily salt intake in Portugal is a staggering 12.3 grams (ranging from 5.2 to 24.8 gm) http://is.gd/ndQqReferences:Cutting Salt as Good as Quitting Smoking. WebMD, 2010.Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Single and unhappily married men are at 64% higher risk o... Men who were single in the 1960s were 64% more likely to suffer a fatal stroke over the next three decades than their married counterparts.The risk of fatal stroke was also 64% higher in men who reported dissatisfaction with their marriages than in men who rated their marriages as successful.That figure is comparable to the risk of fatal stroke faced by men with diabetes.References:Single Men Have Higher Risk of Stroke. WebMD.Image source: CT scan slice of the brain showing a right-hemispheric ischemic stroke (left side of image). Wikipedia, GNU Free Documentation License. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Let kids be kids: unstructured play time may be more impo... From Half Full: Science for Raising Happy Kids:Let Kids Just Play: unstructured play time is actually more important than homework.Children have lost 8 hours per week of free, unstructured, and spontaneous play over the last 2 decades due to homework.Decrease in unstructured play time is in part responsible for slowing kids’ cognitive and emotional development. Today’s 5-year-olds had the self-regulation capability of a 3-year-old in the 1940s; the critical factor seems to have been not discipline, but play.Pretend play is particularly beneficial, so make sure kids have ample time for it.Image source: Child playing with bubbles. Wikipedia, Steve Ford Elliott, Creative Commons Attribution 2.0 License. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- How to Exercise WHILE Blogging or Doing Other Computer Work The exercises below have been adapted from a ProBlogger post. Most of the names have been modeled after popular social media services such as Twitter, RSS, Blogger, etc.1. Cyber Squats. Set your chair aside for a few minutes and instead move to a semi-squat position with thighs parallel to the floor. Hold for 1 minute.2. RSS Raises. As you’re sitting at your desk, straighten your knees and lift your legs out in front of you.3. Ten Minute "Move it!" Break. Alternate jogging in place with jumping jacks – do a minute of each and repeat 5 times.4. Twitter Tummy Tone. Tighten your abdominal muscles for 30 seconds and then release.5. Social Squeezes. Tighten your gluteal muscles for 30 seconds and then release.6. Ten Minute "Move it!" Break. Grab a step stool and climb up and down.7. Inbox Incline. While you’re sitting with your feet on the floor, raise your heels so you are on the balls of your feet and lower them.8. Ten Minute "Move it!" Break. Do walking lunges around the house. You can add some weights and do bicep curls at the same time.9. Blogger Breather. Close your eyes and focus on your breath. Count to 10 as you slowly inhale through your nose, thinking positive thoughts. Exhale through your mouth, again counting to 10. Release all the tension and stress out of your body.10. Sign Off Stretches. Shoulder shrugs – with your head at your chest, shrug your shoulders up and down. Neck Rolls – relax your shoulders and let your head roll forward. Slowly rotate your head in a circle. Repeat five times.How to stay healthy while traveling: This is a mnemonic for exercises that can be done with just body weight: PLSSP ushupsS itupsL ungesS quatsExercises that can be done with just body weight: PLSS.Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people. According to the authors, this provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:"Health Promotion" video: Benefits of exercise.References:10 Ways to get Fit WHILE Blogging. ProBlogger, 2009.How to stay healthy while traveling Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- CNN video: Life with Hepatitis C 18-year-old London teenager talks about life with the "silent killer" Hepatitis C and shares the dramatic story of how she came to be infected.References:Life with Hepatitis C for London's teenage 'It Girl'. CNN. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Distracted Walking: Using a Cell Phone and Walking Is Risky From the NYTimes:"Distracted driving has gained much attention lately because of the inflated crash risk posed by drivers using cellphones to talk and text.But phones aren't just distracting drivers; they make pedestrians inattentive too.Distracted walking combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.Examples include a 16-year-old boy who walked into a telephone pole while texting and suffered a concussion; a 28-year-old man who tripped and fractured a finger on the hand gripping his cellphone; and a 68-year-old man who fell off the porch while talking on a cellphone, spraining a thumb and an ankle and causing dizziness."References:Forget Gum. Walking and Using Phone Is Risky. NYTimes.Image source: OpenClipArt.org, public domain. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- How to overcome the fear of blogging or writing in public You will get some ideas from the following conversation on Twitter:@dreamingspires: I realised that a previous problem in my blog was that I was writing for people more qualified than me - instead of health professionals just starting out.@DrVes: One of the best approaches to educational blogging is to write for yourself as you learn or write for beginners - which is basically the same thing.@dreamingspires: good advice - as an(ex)publisher suddenly having to write myself as opposed to hiding behind someone else doing it is... a learning process.@DrVes: Did Twitter help?@dreamingspires: Twitter helped in the sense of connecting me into a community, I didn't 'micro-blog' though.@DrVes: Twitter makes you more comfortable to write in public - you don't have to "micro-blog"... :)@dreamingspires: This IS true and my experience - it reduced my stage fright!@DrVes: Also, you may have micro-blogged on Twitter or somewhere else without even knowing it... I set up my blog posts to publish automatically in the future -- it may help with your "stage fright".@dreamingspires: To be honest I am unsure what micro-blogging is -- specific tweets on a topic like you do, or a mini conversation? Yes, I also now autopublish via Twitter feed, and now using Stumble too. OK - microblog is an 'opinion'/link/statement.@DrVes: Anything you post on Twitter is micro-blog as long it's not only replies... A comment on a comment is not a blog. I think you qualify as a fully-fledged blogger and microblogger now... :)@dreamingspires: You mean I've MADE IT?! Newbie happiness.@DrVes: It's official: You've made it. You're a blogger now. Expect you share of nasty comments and spam... :) Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
Medgadget
- Visual Part of Brain Regularly Predicts What It's Suppose... German scientists from Max Planck Institute for Brain Research and Brain Imaging Center Frankfurt have shown that the primary visual cortex of our brains has a much easier time recognizing expected objects than ones it didn't predict to be seeing. The study involved human subjects that were shown a pattern of dots that was regularly interrupted by white boxes. A functional magnetic resonance machine was used to monitor brain activity inside the visual cortex. The surprising finding was that when white boxes appeared out of their usual pattern, the visual cortex would go into overdrive to identify the unanticipated object. The scientists involved in the study believe that this implies that the visual cortex is performing a great deal of predicting on a regular basis, and that our vision system is far from being a passive mechanism that simply describes what it is seeing. Image: The sight of bars apparently moving from bottom left to top right (dotted line) evokes activity in the primary visual cortex (V1). Right: in the upper part of the image, the test stimulus (a white-framed bar) is presented in such a manner that it is integrated into the motion of the white bars. In contrast, the brain does not predict the appearance of the test stimulus in the lower part of the image. This test stimulus is presented with a certain time delay, so that the motion direction appears to be interrupted. Image detail bottom left: the activity in V1 is significantly higher for the unexpected test stimulus (brown graph) than for the expected test stimulus (blue graph). Press release: The scientific brain ... Abstract in The Journal of Neuroscience: Stimulus Predictability Reduces Responses in Primary Visual Cortex...
- Discovering Quantum Processes in Living Organisms Researchers from Max Planck Institute for Quantum Optics in Garching, Germany and the Institute of Photonic Sciences in Barcelona, Spain are looking for the presence of quantum mechanical processes within viruses and maybe other biological systems. Toward that end, they have proposed an experimental setup that would attempt to create and detect quantum superposition states within viruses billions of atoms large. In order to test for superposition states, the experiment involves finely tuning lasers to capture larger objects such as viruses in an ‘optical cavity’ (a very tiny space), another laser to slow the object down (and put it into what quantum mechanics call a ‘ground state’) and then adding a photon (the basic element of light) in a specific quantum state to the laser to provoke it into a superposition. The researchers say, "We hope that this system, apart from providing new quantum technology, will allow us to test quantum mechanics at larger scales, by preparing macroscopic superpositions of objects at the nano and micro scale. This could then enable us to use more complex microorganisms, and thus test the quantum superposition principle with living organisms by performing quantum optics experiments with them." Press release: Can we detect quantum behaviour in viruses? Full article in New Journal of Physics: Toward quantum superposition of living organisms...
- Physical Forces Shown as Central in Cancer Related Protei... A team of researchers from Berkeley University and Lawrence Berkeley National Laboratory has discovered that the EphA2/ephrin-A1 signaling complex, known as a participant in a number of human cancers, can be influenced through the careful application of physical force. This is quite phenomenal considering that until now only chemical reactions were known to influence signaling systems. From a Berkeley Lab press release: Observations have indicated that mammalian cells are sensitive to the physical aspects of their environment, such as the texture or geometry of the surrounding tissue. However, evidence that physical forces impact freely-moving signaling molecules (as opposed to focal adhesion molecules) in the membranes of cells has been lacking because the cell membrane is an environment that has always been difficult to characterize and manipulate. Groves and his research group have found a way to overcome this obstacle with the development of unique synthetic membranes constructed out of lipids and assembled onto a substrate of solid silica that enables them to directly control cellular signaling activities. In this latest study, Groves and his colleagues worked with mammary epithelial cells from a library of 26 model human breast cancer cell lines that have been well-characterized by co-author Gray and his research groups at Berkeley Lab and UC San Francisco. To test the sensitivity of the EphA2/ephrin-A1 signaling complex to mechanical forces, Groves and his group patterned their silica substrates with chromium metal lines that were 10 nanometers in height and 100 nanometers wide. These metal lines acted as diffusion barriers that impeded the lateral mobility of the EphA2/ephrin-A1 complexes in the synthetic membrane. The movement and spatial organization of the complexes were subsequently tracked through a combination of Total Internal Reflection Fluorescence (TIRF), reflection interference and epifluorescence imaging techniques. “Without the barriers, the clusters of EphA2/ephrin-A1 signaling complexes were transported to the center of the cell–supported membrane junction, but with the barriers in place, there was an accumulation of clusters at the barrier boundaries,” Groves says. “This resulted in a spatial reorganization that altered the cell’s biochemical behavior.” Quantitative analysis of these changes to the spatial organization of the EphA2/ephrin-A1 signaling complexes across the library of breast cancer cell lines revealed a strong correlation with the potential for metastasis. Since the patterned metal lines in the silica substrate are analogous to the stiffness, texture and other elastic and mechanical properties of tissue, as well as to internal structures within the...
- Biodegradable Material Featuring Embedded Silicon-on-Silk Scientists from University of Illinois at Urbana-Champaign and Tufts University have developed an approach of integrating single crystalline silicon electronics, made out of nanomembranes, into silk that is both biocompatible and absorbable by the body. This can lead to the introduction of monitors and therapeutic devices into spaces where traditional electronics cannot function safely. The small size of the thin silicon circuits avoids adverse biological reactions while the silk conforms to tissue and dissolves harmlessly over time, factors that make the technology ideal for safely integrating biomedical devices into the human body. Monitors are not the only potential integrative application. The technology could be used to create electrodes for brain-machine interfaces such as prostheses. The researchers report that the paper outlines strategies for “integrating single crystalline silicon electronics, where the silicon is in the form of nanomembranes, onto water soluble and biocompatible silk substrates,” they add. “Electrical, bending, water dissolution, and animal toxicity studies suggest that this approach might provide many opportunities for future biomedical devices and clinical applications.” The challenge for these types of devices is achieving biocompatibility due to the complexity of the body’s responses to many organic and inorganic materials. By avoiding the use of rigid silicon electronics or packaging materials that may not be biocompatible, silicon-on-silk electronics open up development of entirely new types of biomedical applications. The researchers conclude that silk is preferable to other biodegradable polymers such as polyglycolic acid or collagen, because of “its robust mechanical properties, the ability to tailor the dissolution, and/or biodegradation rates from hours to years, the formation of noninflammatory amino acid degradation products, and the option to prepare the materials at ambient conditions to preserve sensitive electronic functions. “This approach has the advantage that it does not require the development of an entire set of biogradable electronic materials, but still yields an overall system that dissipates bulk material features at a rate suitable for the application.” Full story: Is silk the secret to better biomonitors? Abstract in Applied Physics Letters: Silicon electronics on silk as a path to bioresorbable, implantable devices...
- Handheld Laser Scanner Identifies Nature of Breast Masses In a recent article in journal Radiology, researchers from UC Irvine and University of Illinois, Urbana-Champaign describe a method of using a laser to differentiate between benign and malignant tumors within breast tissue. The handheld scanner device in the study is based on frequency domain photon migration and watches the scattering and absorption of laser light as it moves through tissue. The technology, already proving itself effective in clinical trials, may bring a radiation-free modality to your breast cancer oncologist's office. From a UC Irvine press release: Unlike mammograms, the scanner provides detailed metabolic information by measuring hemoglobin, fat and water content, as well as tumor oxygen consumption and tissue density. In the study, researchers found that potentially dangerous malignant tumors and benign tumors have different metabolic fingerprints. Separately, the UCI laser breast scanner is proving beneficial in evaluating the effectiveness of chemotherapy by supplying detailed data on changes in breast tumor metabolism during treatments. This information, which can be accessed quickly at bedside, lets oncologists tailor chemotherapy based on how a patient responds. Press release: Beyond mammography: Handheld laser scanner improves detection and treatment of breast cancer ... Abstract in Radiology: Characterization of Metabolic Differences between Benign and Malignant Tumors: High-Spectral-Resolution Diffuse Optical Spectroscopy (hat tip: The Engineer)...
- SJM's New Engage and Engage TR Catheter Introducers St. Jude Medical has announced receipt of FDA and European regulatory approvals for the Engage and Engage TR line of introducers for cardiac catheterization procedures. The firm believes the new products' design will facilitate safer arterial access and subsequent closure following the procedure. St. Jude Medical designed the Engage Family of Introducers with features intended to minimize trauma to the artery and set the stage for closure using Angio-Seal(TM) or other closure devices. The Engage Family of Introducers was designed to create a smooth and reliable means of accessing vasculature for a wide variety of patients and procedures. The Engage Introducer is used for femoral access, in which physicians access the patient's heart through the femoral vein or artery located near the groin; this portfolio includes 22 model configurations of varying sizes to accommodate a wide variety of procedures. The Engage TR Introducer portfolio includes 18 model configurations and expands the company's product offering to include introducers used to facilitate transradial (TR) procedures, in which physicians access the patient's heart through the radial artery in the arm. Though uncommon, some risks reported by physicians during interventional and diagnostic procedures include bleeding, vessel trauma, vasospasm (a condition that causes the vessel to constrict), or formation of blood clots within the introducer. The Engage Family of Introducers incorporates new features that were designed to offer physicians more control and minimize these risks both during access and throughout the procedure. Press release: New Introducer Product Line from St. Jude Medical Offers Reliable Access and Facilitates Arterial Closure ......
- Duraspan Biomimetic Coated Hemodialysis Catheter r4 Vascular out of Maple Grove, Minnesota has released a new catheter for patients on long-term hemodialysis. The Duraspan catheter aims to prevent thrombus accumulation thanks to its biomimetic coating that discourages clot formation. A novel coating on the catheter surface mimics the glycocalyx layer found on natural endothelial tissue surfaces in vessel walls. Laboratory tests of the Duraspan™ catheter have demonstrated an 87% reduction in platelet adhesion and thrombus accumulation compared to uncoated catheters. R4 is committed to improving dialysis patient catheter outcomes according to r4 Vascular's President, Don Geer, "physicians have long thought that if one was able to make the catheter less recognizable as a foreign object in the body it could revolutionize catheter-based hemodialysis. Developing the catheter, r4 Vascular engineers utilized stealth coating technologies, approaching the thrombus problem by camouflaging the catheter in a biomimetic coating." The catheter is available in either a 3.5cm tip stagger or a 7cm tip stagger version, providing reduced recirculation. Press release: New Dialysis Catheter Reduces Thrombus Accumulation... (.pdf) Product page: Duraspan™ Coated Dialysis Catheter ... Duraspan Coated Dialysis Catheter product brochure......
- Study Suggests a More Personalized Approach to Tattoo Rem... Dr Ramona Bates of Suture for a Living points us to a recent study in Archives of Dermatology that looked into correlating which laser wavelengths were best for removing different tattoo inks. The team of Spanish researchers blasted 21 tattoo inks with laser light ranging from 300 to 800 nm, and discovered that there's a benefit to matching the color of the laser to the specific ink that is being removed. Here's from the study abstract: Results Reflection spectroscopy facilitated selection of the most adequate laser wavelengths for tattoo removal. Red, orange, and rose inks were successfully lightened at 532 nm with 0.6 J/cm2; brown at 1064 nm with 0.3 J/cm2; yellow and green at 448 nm with 2.6 J/cm2; and blue at 600 nm with 0.9 J/cm2. Similar colors in in vitro and in vivo tattoos responded with the same efficiency to the laser variables. Conclusions High efficiency is reached in the removal of in vivo tattoos by using an irradiation wavelength at which the percentage of reflection from the pigment is minimal. Under this condition, laser pulses can be used with a low fluence, minimizing adverse effects and clinical time. More from Dr Bates: Optimal Laser Variables Required To Remove Tattoos Abstract in Archives of Dermatology: In Vitro and In Vivo Laser Treatments of Tattoos Image credit: Divine Harvester......
- fMRI Now Used as Rudimentary Memory Reading Device At University College London, scientists are using an fMRI machine to identify the memories that people are bringing up. By first playing three different videos to human subjects and then asking them to recall them in turn while inside an fMRI, the researchers were able to use a computer algorithm to identify which video was being recalled. Professor Eleanor Maguire led this Wellcome Trust-funded study, an extension of work published last year which showed how spatial memories – in that case, where a volunteer was standing in a virtual reality room – are recorded in regular patterns of activity in the hippocampus, the area of the brain responsible for learning and memory. “In our previous experiment, we were looking at basic memories, at someone’s location in an environment,” said Professor Maguire. “What is more interesting is to look at ‘episodic’ memories – the complex, everyday memories that include much more information on where we are, what we are doing and how we feel.” Although a whole network of brain areas support memory, the researchers focused their study on the medial temporal lobe, an area deep within the brain believed to be most heavily involved in episodic memory. It includes the hippocampus – an area which Professor Maguire and colleagues have studied extensively in the past. They found that the key areas involved in recording the memories were the hippocampus and its immediate neighbours. However, the computer algorithm performed best when analysing activity in the hippocampus itself, suggesting that this is the most important region for recording episodic memories. In particular, three areas of the hippocampus – the rear right and the front left and front right areas – seemed to be involved consistently across all participants. The rear right area had been implicated in the earlier study, further enforcing the idea that this is where spatial information is recorded. However, it is still not clear what role the front two regions play. Here are the three videos study participants were asked to memorize: Full story: Traces of the past: computer algorithm 'reads' memories ... Abstract in Current Biology: Decoding Individual Episodic Memory Traces in the Human Hippocampus... Image: Siemens Magnetom Verio 3T open bore MRI...
- Newly Discovered Signaling Pathways That Regulate Artery ... Scientists at Yale University believe they have discovered the signaling mechanism at work during artery formation, which may end up being used to control the growth of replacement arteries for people with coronary stenoses, etc. Until now, scientists have focused on growth factors as tools to control vessel formation, but the new research provides a direct signaling mechanism that's already proving to be more effective. Coronary arteries can become blocked with plaque, leading to a decrease in the supply of blood and oxygen to the heart. Over time this blockage can lead to debilitating chest pain or heart attack. Severe blockages in multiple major vessels may require coronary artery bypass graft surgery, a major invasive surgery. “Successfully growing new arteries could provide a biological option for patients facing bypass surgery,” said lead author of the study, Michael Simons, M.D., chief of the Section of Cardiology at Yale School of Medicine. In the past, researchers used growth factors—proteins that stimulate the growth of cells—in an attempt to grow new arteries, but this method was unsuccessful. Simons and his team studied mice and zebrafish to see if they could simulate arterial formation by switching on and off two signaling pathways: ERK1/2 and PI3K. “We found that there is cross-talk between the two signaling pathways. One half of the signaling pathway inhibits the other. When we disable the inhibitor mechanism, we are able to grow arteries,” said Simons. “Instead of using growth factors, we stopped the inhibitor mechanism by using a drug that targets a particular enzyme called PI3-kinase inhibitor.” “Because we’ve located this inhibitory pathway, this opens the possibility of developing a new class of medication to grow new arteries,” Simons added. “The next step is to test this finding in a human clinical trial.” Full story from Yale: New Method to Grow Arteries Could Lead to "Biological Bypass" for Heart Disease ... Full article in The Journal of Clinical Investigation: ERK1/2-Akt1 crosstalk regulates arteriogenesis in mice and zebrafish...
The Health Care Blog
- Aneesh Chopra on txting in Haiti By Matthew Holt Here's a quick video I took at the end of Aneesh Chopra's (the Federal CTO) talk at HIMSS. It’s a remarkable story of the role of SMS, tools and crowdsourcing in aiding in a disaster zone. A...
- In ONC I Trust ... By JOHN HALAMKA It's my nature to question authority. Whether it's religion, politics, or even my local administrative leadership, authority figures must earn my trust. Earning that trust is not easy. As folks who work closest with me know, I...
- Unstable Public Opinion By MERRILL GOOZNER Joseph White, a professor of politics at Case Western Reserve University, made this interesting observation in his weekend column in The Fiscal Times: "On most issues, there is no such thing as a stable "public opinion." People...
- Crowd Sourcing Comes Through Again By PAUL LEVY I have written before about the incredible power of crowd sourcing, using the reach and scope of social networking on the Internet to solve a complex problem. Here's a play-by-play about a difficult question. It demonstrates how...
- It's Not About Meaningful Use ... By JOHN MOORE With the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version. Now it...
- Program Director Healthcare IT Since its inception, the New England Healthcare Institute has been committed to the identification, assessment and promotion of valuable health care technologies with the potential to improve the quality of care while reducing cost. The Fast Assessment and Adoption of...
- MedApps on TV By Matthew Holt Kent Dicks from MedApps does a very nice job on Fox Business News. Kent explains what his company’s cell(phone)-based transmission solution does, why it’s not a privacy threat, who else is in the market, and what the...
- Epocrates--reference present and EMR future By Matthew Holt I met with Bob Quinn the CTO and Geoff Rutledge, the CMO, of Epocrates at HIMSS last week. The company has a big footprint in mobile (and web) reference content for physicians. The big news is that...
- Verb-alizing By BOB WACHTER One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old...
- RememberItNow! and Prezi By Matthew Holt RememberItNow! is a feisty little start-up that's aiming at the medication reminder/management space. I like the feature set and the approach, and I hope the Pam Swigley the engaging CEO gets some traction. It’s launching officially on...
KevinMD.com
- PSA for prostate cancer screening is likely to continue Originally published in MedPage Today by Crystal Phend The ASCO Genitourinary Cancers Symposium met recently, just after the American Cancer Society updated its prostate cancer screening guidelines to emphasize shared decision making and Congress heard testimony over use of prostate specific antigen (PSA) in prostate cancer screening. Now urology is no stranger to debate. Controversy continues on [...]
- USA Today op-ed: How patient satisfaction influences medi... My latest USA Today op-ed was published this morning: Patient satisfaction surveys have drawbacks. I discuss how patient satisfaction scores affect physician salaries, which may, in turn, influence medical decision making. Of course, patient satisfaction is important and should be measured — but it’s a mistake to use them in part to determine physician compensation. [...]
- Nursing needs to confront a culture of bullying Who knew nursing could be so abusive? Nurse Theresa Brown, in a blog post from the New York Times’ Well, reveals the ugly side of nursing. It’s known within hospital walls that “nurses eat their young.” Indeed, as Brown writes, “the expression is standard lore among nurses, and it means bullying, harassment, whatever you want to [...]
- A patient live blogs his hospital stay, looking for a cure Here’s a novel, and incredible, use of social media in health care. A 40-year old man was admitted several days ago with a fever of unknown origin. His significant other, Laura, is live blogging his hospital stay — hoping to solicit other medical opinions on the case, as there is no clear reason on what [...]
- Top health blog posts, February 2010 Here are the top posts from the past month, based on the number of times they were viewed. 1. How fame has corrupted Dr. Mehmet Oz 2. Why did Canadian premier Danny Williams come to the United States for heart surgery? 3. Does your cardiologist deserve his salary? 4. When doctors can’t figure out what’s wrong with a patient 5. [...]
- PSA screening for prostate cancer debated in Congress Originally posted in MedPage Today by Emily P. Walker, MedPage Today Washington Correspondent A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group’s chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer. Otis Brawley, MD, an oncologist and chief medical officer for [...]
- Why doctors should blog with their real name by Martin Young, MBChB, FCS(SA) Blogging is a great way to get things into an open forum for discussion. But I still have nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names. As a new blogger, I often look at those replies to my postings that are anonymous and think, [...]
- Placebo Television #19: President Obama makes an offer yo... Doug Farrago, creator of the Placebo Journal, presents his latest episode of Placebo Television. Placebo Television gives another take on President Obama’s address to the AMA Medscape op-ed on how to help today’s tense, frustrated doctors Does television make toddlers more aggressive?
- Poetry that your patient can appreciate by Danielle Ofri, MD, PhD When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value [...]
- 7 ways inmates can receive quality medical care from doctors by Jeffrey Knuppel, MD Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk? 1. Treat the patient with respect. Not submissive [...]
Canadian Medicine
- What really causes autism? The vaccine theory is dead. What’s left?In January, after many years of inaction, British medical regulatory officials finally found Dr. Andrew Wakefield guilty of unethical behaviour in carrying out research that, he claimed, showed a connection between the measles-mumps-rubella (MMR) vaccine and autism. Soon after, The Lancet issued a full retraction of Dr. Wakefield’s 1998 paper, turning the page on an ugly chapter in the journal’s recent history that saw most of the coauthors disavow the autism/vaccine theory. That theory, already shown to be unsupported by the evidence in large studies, truly no longer holds water. So what actually causes autism?We asked Jeanette Holden, PhD (left), program director of the Autism Spectrum Disorders - Canadian-American Research Consortium (ASD-CARC), to describe the latest science on autism’s etiology. Dr. Holden, who studied genetics with David Suzuki, is also a professor of psychiatry and physiology at Queen’s University and sits on the board of Autism Society Canada.INTERVIEWPE We know it’s not vaccines, so what are the current ideas about what causes autism?JH It’s quite clear there are two components to all complex disorders -- diabetes, asthma, and so on. Autism is no different. Both genetics and the environment play a role. We know genetics is critical because when you look at a number of patients you often see something very similar to autism, or at least that has some of the components of it. We call that the broader phenotype . That is, there may be some of the social problems and some of that rigidity, almost that one-track mind, the ability to concentrate on something. We see that often in families. Hyperactivity is common in families with autism. Quite often there’s depression in the family. When you start to see a clustering of underlying similar conditions, you really do have to think that genes are somehow involved here. There have been a lot of discoveries in the last few years of specific chromosome changes that happen. It’s not the same change in everybody, but a lot of different changes: small deletions and duplications, or copy-number variants. So there is definitely this genetic component, but we don’t know about factors within the environment -- chemicals or something in our diet -- that might also be contributing to this, and that is going to take a long time to sort out.Click here to read the rest of this article on the Parkhurst Exchange website.Photo: ASD-CARC Get Canadian Medicine news by email or in an RSS reader
- Practice Management: Add travel medicine to your practice Travel can be rewarding in more ways than oneTravel medicine is not formally recognized as a specialty in Canada. Travel medicine consultations aren’t included on provincial lists of reimbursed services. Does that mean travel medicine doesn’t deserve your attention? Far from it.Because travel medicine consults are uninsured, you can charge patients directly and name your price. Administering all the various vaccines can bring in a fair-sized chunk of additional revenue, too.Because it’s not a specialty, says Dr. Jay Keystone, a longtime travel medicine expert and professor at the University Toronto, “any practitioner can call him or herself a travel medicine practitioner without any training or certification whatsoever.” (There’s one exception: your clinic must get a special Health Canada licence to give the yellow fever vaccine.) So there are no major bureaucratic hurdles to jump over to get into travel medicine.And — best of all — according to GP/FP travel medicine practitioners, travel medicine can be an enjoyable and satisfying aspect of your practice.Click here to read the rest of this article on the Parkhurst Exchange website.Image: Shutterstock Get Canadian Medicine news by email or in an RSS reader
- IN THE NEWS: Ottawa takes another stab at Insite Insite ruling appealed, againThe federal government has -- for the second time -- elected to appeal a British Columbia court's ruling that the supervised injection Insite does not fall under federal jurisdiction because it is a health facility. [CBC News] The news of Ottawa's intention to re-appeal sparked protests in Vancouver during the Olympics. [Globe and Mail] Read our previous coverage of the BC Court of Appeal's January decision that found against Ottawa. [Canadian Medicine]Isotope shortfall to worsenA radioisotope shortfall appears imminent, with western Canada likely to suffer to brunt of the damage, as a European reactor gets set to shut off for repairs and the Chalk River plant, in Ontario, remains closed for repairs. [Globe and Mail]Layton has cancerNDP leader and federal MP Jack Layton has prostate cancer. His wife, Olivia Chow, who is also an NDP MP from Toronto, overcame thyroid cancer, and Mr Layton's father suffered from prostate cancer as well. [Toronto Star]New Brunswick's troubled trauma systemAfter years of work, New Brunswick finally explained how it would reorganize its much-criticized trauma-care system. Unfortunately, problems persist: there has been some confusion about patient transfers recently because the province's planned 1-800 number still has not been set up. Until the number is ready to go live in April, Dr Marcil Martin, the head of the trauma system, has given out his cell phone number to doctors across New Brunswick so that he can personally coordinate transfers -- an arrangement that unsurprisingly hasn't proven entirely successful. [Saint John Telegraph-Journal] "I can't understand it because to set up an 800 number, it shouldn't take four years. A company, for instance, would set up an 800 number in two hours time, right?" said Donald Thomas, the man whose botched transfer after a car accident in 2005 served as the impetus for the province's reforms. [CBC News]EMR funding frozenCanada Health Infoway president Richard Alvarez expressed frustration that EMR expansion is being delayed by the federal government's failure to hand over $500 million in funding while program reviews are conducted. [Canadian Medical Association Journal]Winnipeg NPs start for-profit clinicThe Manitoba Ministry of Health acquiesced to the establishment of a private, for-profit clinic in Winnipeg staffed by nurse practitioners with prescribing authority. [Canadian Press]C diff still plagues QuebecMontreal's Maisonneuve-Rosemont Hospital has been fighting a C diff outbreak for the past year, Radio-Canada has learned, and several patients there have died. Recent signs, though, point to a decrease in the infection rate there. [CBC News]Canada to test MS surgery ideaA Canadian trial will test an exciting and controversial Italian theory advanced recently that explains multiple sclerosis as a vascular disorder that can be cured with angioplasty. [Globe and Mail]More pathology errors discoveredAnother pathology investigation has been launched in Ontario after Windsor surgeon Barbara Heartwell performed mastectomies on two patients who didn't have breast cancer. [CBC News] [Canadian Press] In response, the Toronto Star asks whether pathologists are overworked -- a question the very asking of which should make anyone with knowledge of the system laugh, given how utterly obvious it is that the answer is a resounding yes. [Toronto Star] The current run of pathology problems began several years ago. You can read my take on the matter from 2008 in the National Review of Medicine for some background. [NRM]H1N1 vaccine goes mainstreamThe H1N1 flu vaccine could be added to the regular vaccine this year. [Associated Press] Hopefully this will help persuade the detractors that the H1N1 flu vaccine is nothing out of the ordinary.NOSM's economic assistThe Northern Ontario Medical School provided a welcome boost to the local economy, a study found. [Sudbury Star]No online gambling: QC MDsQuebec public-health MDs announced their opposition to the provincial government's plans to create a Loto-Québec gambling website. [Montreal Gazette]DSM-V revisions suggestedProposed DSM-V revisions have been published online and are now available for public comment. [DSM5.org]Tut mystery solvedIt wasn't murder. King Tut was killed by malaria and avascular bone necrosis. [Journal of the American Medical Association abstract] [New York Times] Get Canadian Medicine news by email or in an RSS reader
- A rather unusual public-health initiative "Adventures in Sex City" is an interactive sex-education game produced by the Middlesex-London Health Unit, in Ontario, and it honestly has to be seen to be believed:You can read other media's takes on the game -- and compare their censoring of the image -- in stories from the London Free Press, the Globe and Mail and the National Post.Regardless of what you think of the public-health department's explicit approach, it's hard to deny that any game that asks you to choose to play as Wonder Vag, Willy the Kid, Power Pap or Captain Condom is bound to grab teens' attention. Get Canadian Medicine news by email or in an RSS reader
- Pharmacist prescribing prompts legal concerns Do you need to adjust your practice to limit liability risk?Physicians used to be the only people prescribing drugs to patients. Those days are long gone.Over the last four years or so, in almost every province, limited prescribing and renewal authorities have been granted to other health workers, including pharmacists, nurse practitioners and even naturopaths.The latest province to follow the trend is Ontario. Despite the Ontario Medical Association’s objections, work is now underway to permit pharmacists to extend, adapt and adjust prescriptions. New draft regulations will govern prescribing by nurses and naturopaths as well. British Columbia, P.E.I. and New Brunswick already have similar legislation, while Alberta pharmacists can become certified to initiate certain prescriptions. Nearly every other province is working on some variation of these ideas.The decision to extend prescribing authority to non-doctors is a logical response to the growing queues of orphan patients, and to doctors’ clamouring about suffocating workloads. But the trend towards expanding prescribing authority introduces new liability issues for physicians.Click here to read the rest of this article on the Parkhurst Exchange website.Photo: Shutterstock Get Canadian Medicine news by email or in an RSS reader
- The future of statin therapy Use in normal-cholesterol patients is on the horizon — will over-the-counter be next?The most frequently prescribed drug class in Canada may soon become much, much more popular.AstraZeneca has filed an application with Health Canada to add a new indication for its drug rosuvastatin (Crestor). The application, filed late last year and still under review, asks that rosuvastatin be licensed for use in older patients with normal cholesterol levels but elevated high-sensitivity C-reactive protein (CRP). If approved, the new indication could potentially result in millions of Canadian patients being put on preventive statin therapy.Whether or not AstraZeneca’s new application is approved, however, recent research makes it all but certain that statins are well on their way to far wider use in the years to come.Click here to read the rest of this article on the Parkhurst Exchange website.Photo: Shutterstock Get Canadian Medicine news by email or in an RSS reader
- WHO growth charts replace US charts as gold standard The way we keep track of kids' height and weight is changing.The Canadian Paediatic Society and the College of Family Physicians of Canada have signed on to a new policy statement (PDF) endorsing the WHO's revised growth charts rather than the American CDC growth charts that have long been in use in this country. The new policy is also published in the February issue of the journal Paediatrics & Child Health.On the Canadian Paediatric Society's website you can find more information, including a health professional's guide to using the WHO growth charts, a fact sheet for parents, and (soon) copies of the WHO charts specifically designed for Canadian doctors.What was wrong with the CDC growth charts? Basically, they were outdated: their data were based on the assumption that most babies are fed formula, which may have been true 40 years ago but is not today. In a May 2009 column in Parkhurst Exchange magazine, Dr Richard Haber, an associate professor of pediatrics at McGill University and the Director of the Pediatric Consultation Centre at the Montreal Children’s Hospital, explained the CDC charts' problems:"The revised [CDC] charts don’t necessarily represent optimal growth in infancy as the population data sets represent periods when most babies were bottle-fed; since 1970, only about 50% of infants were breastfed and of these merely 30% for greater than three months. What’s important to remember is that exclusively breastfed babies will plot higher for their weight in the first 6 months and lower for weight in the 6-12 month period. So they may appear to ‘fall off’ their curve. One other disadvantage is that the CDC curves represent cross-sectional data sets based on chronological age and not pubertal stage, and therefore don’t take into account the pubertal growth spurt."Visit the PE website to read the rest of Dr Haber's May 2009 column, "The importance of growth charts," and its June 2009 follow-up on spotting red flags in growth data, "How to use growth charts effectively."Image: World Health Organization Get Canadian Medicine news by email or in an RSS reader
- IN THE NEWS: Newfoundland premier in US for surgery Danny Williams in US for heart surgeryDanny Williams, the multimillionaire Newfoundland and Labrador premier, has gone to the United States to have heart surgery. According to his staff, the operation he needs is not available in Newfoundland. What is that operation, however, and is it available elsewhere in Canada? Those are questions the premier's office has yet to answer. [Canadian Press]Mr Williams's decision to head south for healthcare, like former MP Belinda Stronach's before him, has ignited controversy on both sides of the border about the pros and cons of the Canadian and American health systems.In an editorial, the Montreal Gazette complained that private care should not only be available to the wealthy and lamented the fact that the Supreme Court of Canada's 2005 Chaoulli decision, which overturned elements of Quebec's ban on private health insurance, has not opened up a private-care market in the province. "Two tiers are acceptable to our elites, apparently, provided there's no third-tier option in between, for ordinary people." [Montreal Gazette]The Globe and Mail, meanwhile, dug up a few surgeons -- including Conservative Senator Wilbert Keon, a famous heart surgeon -- to testify that it's unlikely Mr Williams (pictured above, with his pal Arnold Schwarzenegger) really couldn't have had some operation performed in Canada. Dr Keon said there was "no question" Mr Williams could have received treatment in Canada. "He's going to have to admit that when he recovers and has to face you guys [journalists]." Dr Keon also speculated that Mr Williams simply wanted the luxurious rooms and amenities offered at private American clinics. [Globe and Mail]On the other hand, nobody knows what the operation is still.That hasn't stopped people like Dr Keon and throngs of free-market political activists in the United States from jumping to conclusions. "[W]ith his own health on the line, he prefers to put his trust in the "second-rate, profit-driven health-care behemoth" south of the St. Lawrence, rather than try a hospital in Canada," crowed one editorial entitled "Oh (no) Canada." [New York Post]QC docs denied pay for volunteer workA group of Quebec orthopedic surgeons volunteering in Haiti learned that their request to be paid government salaries while they're working overseas has been turned down. Health Minister Dr Yves Bolduc said he was worried that paying them would set a precedent that the government was not prepared to commit to. [CBC News] [Montreal Gazette]New U of T med school campus to openA new campus of the University of Toronto's medical faculty, called the Mississauga Academy of Medicine, is set to open next year. The first class will include 54 students. [Government of Ontario news release]Autism/vaccine doctor labeled "unethical"Dr Andrew Wakefield, the British researcher who conceived of the theory linking the measles-mumps-rubella (MMR) vaccine to autism, was censured for unethical and unprofessional research practices by the UK's General Medical Council. [General Medical Council report (PDF)]Shortly after, The Lancet issued a full retraction of the paper Dr Wakefield published in 1998, "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children," which set off the anti-vaccine movement that still persists the autism community and beyond. [The Lancet (subscription required)]Chronic diseases on the riseIn a new report, the Ontario Medical Association said that the number of patients with diabetes in the province increased by more than 50% between 1995 and 2005, and the prevalence of hypertension rose by nearly 100%. The numbers prompted OMA President Dr Suzanne Strasberg to scold Ontarians: "Ontario's doctors will continue to diagnose, treat and manage chronic disease however; patients also have a responsibility to help themselves by making small and simple choices that can have a significant impact on their health." [OMA news release]Shingles vaccine recommended for Canadians older than 60Canadians 60 or older should be given Zostavax, a recently approved shingles vaccine, recommended the Public Health Agency of Canada's National Advisory Committee on Immunization. The committee noted that it's unclear whether patients who have already had shingles can benefit from the vaccine. Also unclear is whether the vaccine will confer protection for more than just a few years. "The efficacy of protection has not been assessed beyond 4 years and it is not known whether booster doses of vaccine are beneficial." [NACI statement]The Canadian Pain Society urged federal and provincial governments to cover the costs of vaccination for all Canadians over 60. [CPS news release]MORE NEWS FROM ACROSS CANADA AND BEYONDBar codes could help reduce drug dispensing errors, patient safety advocates insisted. [Canadian Patient Safety Institute news release]The Canadian Association of Physicians for the Environment and the Suzuki Foundation joined forces to launch a new blog called Docs Talk. The blog will feature articles written by Canadian doctors about the connections between the environment and human health. The first entry was written by Dr Warren Bell. "It has long been a cherished belief of the doctor that administering medicine to his or her patient is an unmitigated good. We now know that this is a simplistic point of view. Many pharmaceuticals — especially newly synthesized ones — wreak havoc on animals and plants exposed to them after they leave the human body. It is painful for me and my colleagues to learn that our efforts to do good can sometimes do very bad things." [Docs Talk]In many hospitals, women in labour are given only water to drink and ice chips to eat -- no matter how long the labour lasts. A new study published by an international team of researchers, including one Canadian, in the Cochrane Library has determined that the evidence doesn't show any benefit from withholding food and drinks like juice. [Cochrane Library] [Canadian Press]Serotonin deficiency may be behind sudden infant death syndrome (SIDS), new research found. [Journal of the American Medical Association abstract] [Toronto Star]It appears to be more effective to use nicotine patches longer than they're usually indicated for, according to a new study. Six months of use improved the quit rate compared to the standard two months of therapy by a whopping 64%. [Annals of Internal Medicine abstract] [Reuters]Photo: Office of the Premier, Newfoundland and Labrador Get Canadian Medicine news by email or in an RSS reader
- IN THE NEWS: Radioisotope-producing plant shutdown drags on Chalk River nuclear plant to stay closed even longerIs there anyone who is genuinely surprised to learn of further delays in reopening Atomic Energy of Canada Limited's Ottawa-area Chalk River nuclear facility?Chalk River, which accounts for half the world's production of technetium-99 (an important radioisotope used in medical imaging exams), has been shut for repairs since leaks were discovered last summer. The temporary closing is only the latest of several in the past two years, and the series of shutdowns have thrown the nuclear medicine community into panic.The nuclear plant's operator, AECL, announced last week that it wouldn't meet the March deadline it had proposed in late 2009. The new goal is to have everything up and running in April. [AECL news release] [Nuclear Engineering International magazine] [Canwest News Service]The announcement should come as no surprise to readers of Canadian Medicine. No one likes a braggart, of course, but I can't help pointing out that, over a month ago, I predicted the March deadline wouldn't be met. [Canadian Medicine] The only surprise is that vindication came so far in advance of the actual deadline.Surreptitious, unconscious pelvic exams exposedSeventy-two percent of patients expressed disapproval of allowing medical students to practice doing gynecological exams on patients who have been anesthetized for a surgical procedure without obtaining consent, which is commonplace in teaching hospitals. The survey, which brings to light a practice that doctors and students have not spoken about widely in public, was conducted by a team of doctors and researchers from the University of Calgary and published in the January issue of the Journal of Obstetrics and Gynecology of Canada. [JOGC abstract (PDF)]The Globe and Mail's medical columnist André Picard called for an end to the exams being done without consent, calling them unethical. "Patients have a right to say 'No.' They are not merely a collection of body parts to be practised on." wrote Mr Picard. "Patients are due respect and ethical treatment, whether they are awake or anesthetized, and no matter how potentially embarrassing the procedure may be." [Globe and Mail]Quebec MDs request regular pay for Haiti volunteer workQuebec orthopedic surgeons who volunteered to go to Haiti are now formally requesting that the provincial government pay them $704 per day while they're away. "A spokesperson for the Quebec's association of orthopedists said that while doctors are volunteering in Haiti, they still have bills to pay in Quebec," reported CBC News. The Quebec Ministry of Health has not responded to the request yet. [CBC News] [CJAD Radio news]Alberta cuts prices of generic drugsThe Alberta government has negotiated a reduction of around 25% in the prices of generic drugs. [Government of Alberta news release] [CTV News] [CBC News]Ostracizing smokers poses health threats: MDIn his new book "Écrasons la cigarette pas les fumeurs," published last month by Québec Amérique, Quebec psychiatrist Jean-Jacques Bourque says some smokers are harmed by overzealous doctors' urgings to kick cigarettes. Dr Bourque "démontre comment Santé Canada se prête à une propagande de peur en occultant les risques qu'affronte une certaine partie de la population en cessant de fumer." (He shows how Health Canada has undertaken a propaganda campaign of fear without recognizing the risks that a certain portion of the population faces by quitting smoking.) [Québec Amérique]Dr Bourque says he thinks many psychiatrists agree with his views but are contradicted by other specialists. [Le Soleil]"I think we need to show compassion, empathy and understanding towards those who are dealing with such difficulties instead of setting them aside," Dr Yves Lamontagne, the president of the Quebec College of Physicians, told the Montreal Gazette. [Montreal Gazette] Dr Lamontagne, who quit smoking two years ago, wrote an introduction to Dr Bourque's book.Dosage may need adjusting by patient weightA new paper in The Lancet says drug dosages should be tailored to patients' weights. [The Lancet viewpoint (subscription required)]Dr Matthew Falagas, one of the report authors, said of himself (198 pounds) and a female student of his (120 pounds), “If we go with the same diagnosis of pneumonia or bronchitis to a New York hospital today... we will be given the same dose of antibiotics," he told The New York Times. "I should receive almost twice the dose compared with her.”[New York Times]Orbinski gets Order of CanadaDr James Orbinski, a University of Toronto professor of global health and the former Médecins sans frontières international president, was awarded membership in the Order of Canada "for his contributions as a physician who has worked to improve health care access and delivery in developing countries, and as an advocate for those who have been silenced by war, genocide and mass starvation." [Governor General of Canada news release] Also awarded on the same day were film director and producer Ivan Reitman (whose oeuvre includes"Ghostbusters" and "Stripes" as well as "Kindergarten Cop," "Trailer Park Boys: Countdown to Liquor Day" and many others) and hockey star Mario Lemieux. Get Canadian Medicine news by email or in an RSS reader
- How Canadian doctors can volunteer to help in Haiti Reading the terrible stories and seeing the horrific photos from Haiti in the aftermath of the January 12 earthquake has inspired some Canadian doctors to consider donating more than just money: many want to travel to Haiti and put their medical expertise to use. How to go about doing that, however, is not simple. To help you figure it out, we spoke to some aid agencies to learn how Canadian physicians can volunteer to help in Haiti.Médecins sans frontières (Doctors Without Borders): MSF may be the first aid organization that comes to mind but, partly because of its high profile, MSF has a large contingent of experienced physicians who’ve already been sent to Haiti. That doesn’t mean, however, that your offer to volunteer isn’t welcome. In fact, MSF is compiling a database of Canadian medical professionals who are available to help in Haiti.They are looking for French- or Creole-speaking doctors (particularly orthopedic surgeons) with some international experience and a minimum of four weeks available. Shorter deployments aren’t possible. MSF is also looking to reestablish a free obstetrics clinic it ran in Haiti prior to the quake, for which it will need French-speaking ob/gyns.But even if you don’t meet MSF’s criteria for deployment at the moment, you’re encouraged nevertheless to sign on to help out in the future, since MSF anticipates being in Haiti for years and years to come. “You don’t have to be there when Anderson Cooper's there,” Ben Chapman, the organization’s director of human resources in Canada, says. “We will still need people there when the journalists have gone away.” (800) 982-7903; http://www.msf.ca/recruitment/Partners in Health: This Boston-based medical aid organization is one of the most respected aid organizations in Haiti. And just because they’re an American outfit doesn’t mean they won’t take Canadians. They will. Eagerly.In fact, Canadians may be at an advantage securing a spot with PIH compared to Americans, since the organization is currently only accepting French-speaking physicians to travel to Haiti – and preferably Creole-speaking, though that is not required.Their urgent needs at the moment include orthopedic surgeons, but other specialists are in demand, and PIH’s long-term needs will include physicians of all kinds. At the moment, PIH asks that volunteers commit to a minimum of 10 days in Haiti. Volunteers who sign on now likely wouldn’t be deployed until anywhere up to a month from now. (617) 432-5256; http://standwithhaiti.org/haiti/news-entry/update-on-volunteer-request/Médecins du monde: The Canadian branch of this organization has put out an urgent call for physician volunteers to travel to Haiti. They are currently looking for French- or Creole-speaking GPs, emergency physicians and general surgeons to work there for a minimum of two weeks. (514) 281-8998; http://www.medecinsdumonde.ca/site/recrutement.html#gestionnaireurgencehaitiThe UK office has also posted a request for volunteers at http://reliefweb.int/rw/res.nsf/db900sid/OCHA-7ZXG79?OpenDocument&;rc=2&cc=htiCanadian Red Cross: The Canadian Red Cross does not send volunteer physicians to Haiti. If doctors want to work with the Canadian Red Cross there, they must apply to become a medical delegate and, after a week-long training course, could be placed on a emergency-respond rapid deployment team. http://www.redcross.ca/article.asp?id=480&;tid=001For more international volunteer listings, visit ReliefWeb’s Haiti vacancies page at http://reliefweb.int/rw/res.nsf/doc212?OpenForm&;rc=2&cc=htiThis article was originally published by Doctor's Review magazine. Click here to read more from Doctor's Review about medical volunteering.Photo: United Nations Development Programme Get Canadian Medicine news by email or in an RSS reader
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- amednews: Astrodocs: For these physicians, space is their... Astrodocs: For these physicians, space is their workplace Since 1973, 23 U.S. physicians have launched into space. They have taken part in spacewalks, treated fellow crew members and conducted medical research. via amednews: Astrodocs: For these physicians, space is their workplace :: March 15, 2010 … American Medical News. Good article, and I had no idea this many [...] Related posts:Specialist nurses paid higher salaries than family doctors – Mar. 11, 2010 NEW YORK (CNNMoney.com) — Despite the growing shortage of family... Docs Online on Arkansas Medical News Inc. Docs Online on Arkansas Medical News Inc. Features Dr. Bates!... The 2009 Medical Weblog Awards Finalists The 2009 Medical Blog Awards After a careful analysis and... Related posts brought to you by Yet Another Related Posts Plugin.
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- Spring Forward, 2010 My favorite overnight shift of the year! (To be fair, I worked the fall back, and it’s my least favorite…). From a post a few years ago: From a prior post of mine on the subject: “Yes, tonight you either a) lose one hours’ sleep, or, b) get to church in time to shake hands as everyone [...] Related posts:Four Arizona doctors surrender their licenses – Phoenix Business Journal: The Arizona Medical Board accepted proposed consent agreements for surrender... Specialist nurses paid higher salaries than family doctors – Mar. 11, 2010 NEW YORK (CNNMoney.com) — Despite the growing shortage of family... amednews: Astrodocs: For these physicians, space is their workplace :: March 15, 2010 … American Medical News Astrodocs: For these physicians, space is their workplace Since 1973,... Related posts brought to you by Yet Another Related Posts Plugin.
- Best movie trailer so far. Laugh out loud funny. So, that’s how to do a dramatic movie. Here’s how to report the news feature (mild language warning): Both via HotAir. I needed a laugh. Related posts:Social Media use in the ED #127 A colleague who’s not usually late didn’t show up on... Better Health » The Friday Funny: The Homeopath’s ER Better Health [...] Related posts:Social Media use in the ED #127 A colleague who’s not usually late didn’t show up on... Better Health » The Friday Funny: The Homeopath’s ER Better Health » The Friday Funny: The Homeopath’s ER Go... Backpacker Blogs – Hallelujah: Beer Hydrates Better Than Water Backpacker Blogs – Hallelujah: Beer Hydrates Better Than Water Our... Related posts brought to you by Yet Another Related Posts Plugin.
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- Health Care Law Blog: AHLA Connections: Legal Implication... The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care. The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections [...] Related posts:Social Media use in the ED #127 A colleague who’s not usually late didn’t show up on... Dallas-Fort Worth hospitals turn to social networking sites to educate, market services | Top Stories | Star-Telegram.com Dallas-Fort Worth hospitals turn to social networking sites to educate,... Dalrymple: There Is No ‘Right’ to Health Care – WSJ.com Dalrymple: There Is No ‘Right’ to Health Care – WSJ.com... Related posts brought to you by Yet Another Related Posts Plugin.
- I have a confession: I’ve been risking my life Yes, still driving a Prius. I do buy that accelerator pedals can be mechanically jammed by a floor mat (though there’s clips on my car to hold it in place), but this unintended acceleration ‘panic’ is just that. (If for no other reason that there’s now a flurry of cases of this, and none before it [...] Related posts:Better Health » The Friday Funny: The Homeopath’s ER Better Health » The Friday Funny: The Homeopath’s ER Go... Fun with Amazon Tipped by Ace, here’s some hilarity brought to you by... 12 STI’s of Christmas, 2009 My yearly Christmas favorite, reposted: Courtesy of the British National... Related posts brought to you by Yet Another Related Posts Plugin.
- First nonstop around-the-world flight began, ended in For... On the morning of March 2, 1949, Lucky Lady II, an Air Force B-50 Superfortress, touched down at Carswell Air Force Base in Fort Worth, becoming the first airplane to fly nonstop around the world.Lucky Lady II had departed Carswell midday Feb. 26 with a crew of 14 under the command of Capt. James Gallagher. [...] Related posts:Fort Worth soldier’s, um, boxers make him famous | Fort Worth | Star-Telegram.com Fort Worth soldier’s, um, boxers make him famous | Fort... TCU nursing student ’steps up’ during in-flight emergency | Fort Worth | Star-Telegram.com TCU nursing student ’steps up’ during in-flight emergency | Fort... ‘City of Fort Worth’ debuts at Pima From the Star Telegram: The final B-36 Peacemaker off the... Related posts brought to you by Yet Another Related Posts Plugin.
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- No Signs Of Intelligent Life At Boston Scientific Virtually nothing has gone right at Boston Scientific (BSX) since it bought rival Guidant in a biddi
- Haiti experience a lesson for all in disaster resilience In an op-ed for the Miami Herald, Vinod Thomas, Director-General of the World Bank’s Independe
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- Online games for horses These are the games that are on a website. The technology today is so amazing that you can order for
- Medical Tourism - World-class treatment in a secular Award Consumption is the new mantra of the generation of today. People want the price / performance for ea
- IN THE NEWS: Newfoundland premier in US for surgery <!– –> // // Danny Williams in US for heart surgery Danny Williams, the multimilli
- Zolpidem and Uncontrollable Nocturnal Eating Binges <!– –> // // John Cruz Faculty peer reviewed A number of studies have shown that z
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