Medical News Today
- Visit Your Pharmacy This No Smoking Day Helping a man to stop smoking after 43 years and supporting a woman to quit cigarettes following 15 previous relapses are just two examples where a local pharmacy made the difference of a life time. This No Smoking Day on Wednesday 10 March the Royal Pharmaceutical Society of Great Britain (RPSGB) is advising the public to make a trip to their community pharmacy as the first step towards quitting for good. Every year thousands of people across the UK give up smoking on the national day and this year's campaign theme, Break free, we can help, has come from smokers themselves...
- Advocates Seek Increased Federal Funding To Bridge The Ga... On March 16, 2010, an anticipated 1,000 advocates will band together for lupus in person and virtually by phone, email, and through social media networks, to share their personal stories with Members of Congress during the Lupus Foundation of America's, (LFA) Twelfth Annual Advocacy Day. Advocates' personal stories will demonstrate how the gaps in lupus research and understanding have a profound effect on the estimated 1.5 million people in the United States who are living with the disease. It has been more than 50 years since the U.S...
- Los Angeles Times Profiles Antiabortion Pastor Who Travel... The Los Angeles Times on Monday profiled Dave Wilkinson, an evangelical pastor who runs three Ventura County, Calif., pregnancy clinics that try to urge women not to have abortions. Once weekly, Wilkinson and other antiabortion-rights advocates drive to Los Angeles in a donated motor home to offer ultrasounds to pregnant women and urge them not to have abortions through "prayer-filled counseling sessions," according to the Times. Wilkinson said that many of the women promise to carry their fetuses to term...
- Study Shows Need To 'Speak Plainly' When Discussing Sex, ... "A new study suggests that what people mean when they say they've had sex -- or haven't -- depends on whom you ask," St. Petersburg Times columnist Colette Bancroft writes in an opinion piece about new research from the Kinsey Institute for Research in Sex, Gender and Reproduction and the Rural Center for AIDS/STD Prevention. The study, published in the journal Sexual Health, examined how men and women in various age groups classify whether various physical acts constitute "having sex...
- Health Overhaul Policy Tidbits NPR: For those who have forgotten what the Senate's bill would actually do as the debate has turned to politics and procedure, "a short refresher" may come in handy. The legislation's main concepts include the requirement that individuals buy health insurance, a plan that would help eliminate pre-existing condition exclusions and spread risk more widely, and subsidies to help people buy coverage to meet the new requirement (Rovner, 3/9)...
- Senate Test Vote Today On Bill To Extend COBRA Subsidy, D... The Senate is poised to consider a measure today that would include extending subsidies for COBRA benefits and unemployment insurance, prevent the Medicare payment cut for doctors and provide additional funding to state Medicaid programs. The legislation "faces a key test vote in the Senate, its momentum helped by about 60 popular tax breaks for individuals and businesses that expired at the end of last year," The Associated Press reports. "All told, the measure would add $107 billion to the deficit over the coming decade...
- Questioning The Benefits Of Elective Removal Of Ovaries D... Removal of the ovaries (bilateral oophorectomy) while performing a hysterectomy is common practice to prevent the subsequent development of ovarian cancer. This prophylactic procedure is performed in 55 percent of all US women having a hysterectomy, or approximately 300,000 times each year. An article in the March/April issue of the Journal of Minimally Invasive Gynecology suggests that this procedure may do more harm than good.. William H...
- Brain Activity Predicts Emotional Resiliency Following A ... Common wisdom tells us that for a successful relationship partners shouldn't go to bed angry. But new research from a psychologist at Harvard University suggests that brain activity - specifically in the region called the lateral prefrontal cortex - is a far better indicator of how someone will feel in the days following a fight with his or her partner. Individuals who show more neural activity in the lateral prefrontal cortex are less likely to be upset the day after fighting with partners, according to a study in this month's Biological Psychiatry...
- Fashion And IT Consider this T-shirt: It can monitor your heart rate and breathing, analyze your sweat and even cool you off on a hot summer's day. What about a pillow that monitors your brain waves, or a solar-powered dress that can charge your ipod or MP4 player? This is not science fiction - this is cotton in 2010. Now, the laboratory of Juan Hinestroza, assistant professor of Fiber Science and Apparel Design, has developed cotton threads that can conduct electric current as well as a metal wire can, yet remain light and comfortable enough to give a whole new meaning to multi-use garments...
- Male Batterers Consistently Overestimate General Rates Of... Men who engaged in domestic violence consistently overestimated how common such behavior is, and the more they overestimated it the more they engaged in abusing their partner in the previous 90 days, according to new research conducted at the University of Washington. Those men overestimated by two to three times the actual rates of seven behaviors ranging from throwing something at a partner to rape, according Clayton Neighbors, lead author of a paper to be published in a spring issue of the journal Violence Against Women...
Newswise: MedNews
- Fewer Platelets Could be Used for Some Cancer and Bone-Ma... Physicians may be able to safely lower the platelet dosage in transfusions for cancer and bone-marrow transplant patients without risking increased bleeding, according to new research involving UT Southwestern Medical Center and 28 other medical institutions.
- Maryland Legislation Introduced to Prohibit Indoor Tannin... New Maryland legislation to protect youth from melanoma, the deadliest form of skin cancer, is based on significant scientific evidence that indoor tanning before the age of 30 is undeniably linked to increased risk of developing the disease. Senator James N. Robey and Delegate William A. Bronrott represent a broad-based coalition of 20 legislators in the Senate and House co-sponsoring cross-filed bills SB 718 and HB 1039 to prohibit minors' use of tanning devices in tanning facilities and prevent any marketing offers of these services to minors.
- UNC Helps Establish the First National Public Health Agen... Leigh Callahan, Ph.D., a member of UNC's Thurston Arthritis Research Center, has been working as part of the 12-member steering committee for the past two years to develop this new initiative. The agenda makes 10 recommendations designed to dramatically reduce the impact of osteoarthritis on Americans.
- Dr. Emile Bacha Joins Pediatric Cardiac Surgery Team at N... A leader in advancing new surgical treatments for congenital heart defects, Dr. Emile Bacha has joined the pediatric cardiac surgery team at NewYork-Presbyterian/Morgan Stanley Children's Hospital. He has been appointed as director of congenital and pediatric cardiac surgery at NewYork-Presbyterian/Morgan Stanley Children's Hospital and professor of surgery at Columbia University College of Physicians and Surgeons.
- Daylight-Saving Time Switch May Leave You Sleepy, Physici... Many Americans will lose an hour of sleep on March 14, the first day of daylight-saving time--making it harder to wake up, causing difficulty in staying alert and increasing the chance of sleepy-driving car crashes. However, this is not the only time when the amount of sleep should be of concern because many aspects of health are related to sleep. Read on for more information.
- NYU Langone Medical Center Orthopaedic Experts Present at... Joseph Zuckerman, MD, Walter A. L. Thompson Professor of Orthopaedic Surgery and chair, department of orthopedic surgery at NYU Langone Medical Center Hospital for Joint Diseases, will present at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), March 9-13 at the Morial Convention Center in New Orleans, and joined by other orthopaedic surgeons from the medical center.
- Allergist Expert Onsite at the FDA Advisory Committee Mee... ACAAI executive medical director will present comments to the FDA Advisory Committee meeting on long acting beta-2 adrenergic agonists (LABA's) on Thursday, 3/11.
- Research Findings Expected to Ease Treatment of Low Neutr... Multicenter trial led by St. Jude Children's Research Hospital investigators may change neutropenia treatment for all childhood cancer patients.
- Breast Cancer Drug Fulvestrant Appears More Effective in ... Women's responsiveness to the second-line breast cancer drug fulvestrant may depend on whether the cancer cells are expressing two key proteins, Indiana University Bloomington scientists report in this month's Cancer Biology & Therapy.
- Osteoporosis Drug Improves Healing After Rotator Cuff Sur... Tears in the shoulder's rotator cuff, a common sports injury, are painful and restricting. New research shows an approved therapy for osteoporosis, Forteo, may speed healing and improve patient outcomes.
ScienceDaily: Health & Medicine News
- Hormone thought to slow aging associated with increased r... Older men with high levels of the hormone IGF-I (insulin-like growth factor 1) are at increased risk of cancer death, independent of age, lifestyle and cancer history, according to a new study.
- Papaya extract thwarts growth of cancer cells in lab tests Papaya extract seems to have a toxic effect on cancer cells in culture, suggesting a potential treatment. Scientists documented for the first time that papaya leaf extract boosts the production of key signaling molecules called Th1-type cytokines. This regulation of the immune system, in addition to papaya's direct anti-tumor effect on various cancers, suggests possible therapeutic strategies that use the immune system to fight cancers.
- Obese 3-year-olds show early warning signs for future hea... A new study finds that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.
- Low oxygen levels in body linked to cancer-aiding protein A professor of biochemistry who was researching protein kinase C gamma in the lens of the human eye found her work taking a fascinating turn when she discovered a correlation between the protein Coonexin46 and hypoxia -- a deficiency of oxygen which kills normal tissue cells. The researcher believes the findings will lead to serious advancements in treating retinoblastoma, a cancer that forms in the tissue of the retina.
- Transplant drug preserves kidneys, avoids toxicity, studi... The experimental drug belatacept can prevent graft rejection in kidney transplant recipients while better preserving kidney function when compared with standard immunosuppressive drugs, data from two international phase III clinical trials show.
- Life is shorter for men, but sexually active life expecta... At age 55, men can expect another 15 years of sexual activity, but women that age should expect less than 11 years, according to a new study. Men in good or excellent health at 55 can add 5 to 7 years to that number. Equally healthy women gain slightly less, 3 to 6 years.
- New study questions benefits of elective removal of ovari... Removal of the ovaries (bilateral oophorectomy) while performing a hysterectomy is common practice to prevent the subsequent development of ovarian cancer. This prophylactic procedure is performed in 55% of all U.S. women having a hysterectomy, or approximately 300,000 times each year. A new article suggests that this procedure may do more harm than good.
- Chemical competition: Research identifies new mechanism r... A research team has discovered that protein competition over an important enzyme provides a mechanism to integrate different signals that direct early embryonic development. The work suggests that these signals are combined long before they interact with the organism's DNA, as was previously believed, and also may inform new therapeutic strategies to fight cancer.
- Hemoglobin A1c outperforms fasting glucose for risk predi... Measurements of hemoglobin A1c (HbA1c) more accurately identify persons at risk for clinical outcomes than the commonly used measurement of fasting glucose, according to a new study. HbA1c levels accurately predict future diabetes, and they better predict stroke, heart disease and all-cause mortality as well.
- Reovirus may be a novel approach to prostate cancer treat... Researchers in Canada have detected a novel oncolytic viral therapy against prostate cancer with use of a virus called the reovirus, according to a new study.
Yahoo! News: Health News
- Hoped-for drop in childbirth deaths not happening (AP) AP - Eleven days after her son Benjamin's birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot.
- Researchers: AIDS virus can hide in bone marrow (AP) AP - The virus that causes AIDS can hide in the bone marrow, avoiding drugs and later awakening to cause illness, according to new research that could point the way toward better treatments for the disease.
- Brazil's Silva quits smoking after 50 years (AP) AP - Brazil's president said Tuesday that he kicked the smoking habit he had for 50 years after a recent health scare sent his blood pressure soaring.
- WHO: over 85M African kids get polio vaccination (AP) AP - The World Health Organization says more than 85 million children under 5 in west and central Africa will be vaccinated against polio.
- Gene test claims to show what diet works best (AP) AP - Diet not working? Blame your genes. That's the pitch behind a new test that claims to show whether people will do better on a low-fat or a low-carb weight loss plan.
- Texas lottery officials move ahead with bidding (AP) AP - Bidding on a new lucrative Texas lottery contract should move forward because there's no evidence that state consultant Gartner Inc. and the lottery's current operator GTECH Corp. improperly shared information about the process, a lottery official said Tuesday.
- Health Tip: What's Behind Childhood Obesity (HealthD... HealthDay - (HealthDay News) -- Obesity is a major problem in the United States, and children are no exception. Today's kids are spending more hours watching TV, sitting at the computer or playing video games, and less time being active.
- 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 10, 2010 (HealthDay) HealthDay - (HealthDay News) -- Here are the latest clinical trials, courtesy of ClinicalConnection.com:
- Jump in Kids' Sports Injuries Due to Overuse (Health... HealthDay - WEDNESDAY, March 10 (HealthDay News) -- Orthopedic surgeons warn that sports injuries in children are rising dramatically, creating a "silent epidemic."
BBC World Health News
- 'No proof' IVF aided by acupuncture There is no evidence acupuncture or Chinese herbal medicine boost the chance of IVF success, fertility experts warn.
- India help for Sri Lanka amputees An Indian charity sends a team to Sri Lanka to provide 1,000 amputees in the war-ravaged north with artificial limbs.
- 'Problem kids' risk future pain Children with behavioural problems are twice as likely to suffer chronic pain as adults than others, say researchers.
- US school soda deal 'cuts sugar' The US soft drinks industry says it has dramatically cut full-calorie beverages available in schools as part of a drive to tackle obesity.
- Action urged on pregnancy deaths Pregnant women in developing countries face the same risk of death as women in the UK did 100 years ago, say campaigners.
- Obama continues healthcare attack US President Barack Obama attacks insurers for raising rates as he continues his push for healthcare reform.
- UK gives SA millions of condoms The UK donates £1m ($1.5m) to South Africa to buy 42m condoms, as the nation builds up to the football World Cup.
- Surgery on Mubarak 'successful' Egyptian President Hosni Mubarak undergoes successful surgery at a German clinic for an inflamed gall bladder, state media say.
- Africa in bid to wipe out polio A campaign is launched to eradicate polio in west and central Africa, targeting 85 million children.
- 'London bomb stress' recognised Psychologists say they have treated hundreds of survivors of the 2005 London bombings for post-traumatic stress disorder.
MedPageToday Headlines
- AAOS: Bone Graft Substitute Used Mostly Off-Label (CME/CE) NEW ORLEANS (MedPage Today) -- The vast majority of spinal procedures using bone morphogenetic protein (BMP) involve off-label uses, researchers found.
- FDA Okays Botox Use in Elbow, Wrist Muscle Spasms WASHINGTON (MedPage Today) -- The FDA has approved a new indication for botulinum toxin type A (Botox) as a flexor muscle spasm treatment for the elbow, wrist, and fingers in adult patients.
- AAD: Signal Inhibitor Active in Basal Cell Carcinoma (CME... MIAMI BEACH (MedPage Today) -- More than half of patients with locally advanced or metastatic basal cell carcinoma responded to an investigational signal transduction inhibitor, data from a phase I clinical trial showed.
- Anti-TNF Therapy Improves Life with Psoriatic Arthritis (... Treatment with anti-tumor necrosis factor (TNF) agents can significantly improve physical disability and quality of life for patients with psoriatic arthritis, data from an observational study showed
- AAD: HIFU Shows Promise for Body Sculpting (CME/CE) MIAMI BEACH (MedPage Today) -- High-intensity focused ultrasound (HIFU) showed potential as a noninvasive way to remove excess subcutaneous fat, according to results of a small, preliminary clinical study.
- Labor Groups Protest Insurance Companies WASHINGTON (MedPage Today) -- Supporters of healthcare reform rallied against health insurers Tuesday, further casting the industry as the villain in the often theatrical healthcare reform debate.
- Kids' Flu Shots Stop Community Transmission (CME/CE, with... Vaccinating healthy kids effectively protects the entire community against flu, a prospective randomized trial affirmed.
- Americans Have Sex into Their 60s and Beyond (CME/CE, wit... Thirty-somethings can expect to enjoy at least another 30 years of sex, researchers have found.
- Medicare to Drug Plan Operator: You're Fired Medicare has terminated its contract with Fox Insurance Co., a prescription drug plan operator handling 123,000 beneficiaries in 21 states, because the government said it was improperly denying claims.
- FDA Panels to Advise on LABA Study Designs The FDA is seeking advice this week from two of its advisory committees on how manufacturers of a major group of asthma drugs should study their potential risks.
Reuters: Health News
- Canadian vaccination study proves 'herd immunity' CHICAGO (Reuters) - Inoculating children against flu protects more people of all ages in the larger community, probably because young people tend to spread viruses through physical play, Canadian researchers said on Tuesday.
- More cocaine-overdose deaths seen on hotter days NEW YORK (Reuters Health) - The number of New Yorkers who die of cocaine overdose appears to go up when the temperature surpasses 75 degrees, a new study suggests.
- Health secretary piles pressure on insurers WASHINGTON (Reuters) - U.S. Health Secretary Kathleen Sebelius ratcheted up the pressure on health insurance companies on Wednesday, urging them to forgo short-term profits and stop fighting President Barack Obama's health reform plans.
- U.S. herpes rates remain high: CDC WASHINGTON (Reuters) - About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said on Tuesday.
- Live kidney donors do not die sooner: study CHICAGO (Reuters) - Healthy Americans who donated a kidney were not at higher risk of dying afterward, which may reassure potential donors and help shorten the long waiting list for an organ, U.S. researchers said on Tuesday.
- Medication fears lead to worse side effects NEW YORK (Reuters Health) - It may not be surprising, but a new study offers some proof that patients who are worried about their medications are more likely to have side effects from them.
- Experiment seeks blood test for breast cancer WASHINGTON (Reuters) - An experimental approach that looks for the DNA leaking out from dead and dying cells may provide a route to a blood test for breast cancer, U.S. researchers reported on Tuesday.
- Few U.S. studies compare one drug to another: report WASHINGTON (Reuters) - Comparing medical treatments to find the best and the cheapest may be a pillar of U.S. healthcare reform efforts, but very little such research is being done, according to a report published on Tuesday.
- Circumcision may not cut HIV spread among gay men NEW YORK (Reuters Health) - Although studies in Africa have shown that circumcision can lower the spread of HIV among heterosexuals, it may not do much to prevent infections among gay and bisexual men in Western countries, a new study suggests.
- U.S. says "drugged driving" growing threat VIENNA (Reuters) - Motorists under the influence of drugs are a growing threat on U.S. roads, while the number who drink and drive has fallen thanks to education and law enforcement, a top U.S. drug control official said on Tuesday.
Medscape Headlines
- FDA Approves Botox for Muscle Spasms The FDA has approved a new indication for onabotulinumtoxin A injection for spasticity in the flexor muscles of the elbow, wrist, and fingers for adults. Medscape Medical News
- A 53-year-old Man With Pyogenic Granuloma This relatively common skin growth has been described as "raw hamburger meat." Will you recognize it when you see it? Medscape Dermatology
- A 49-year-old Man With Neck Pain, Vertigo, Headache, and ... Test your knowledge with this imaging case challenge of a 49-year-old man with neck pain, shoulder pain, and severe ataxia. Medscape Neurology & Neurosurgery
- Eating During Labor For many years, women in labor have been allowed only ice chips. But what is the actual risk of allowing food and fluids during labor? Medscape Ob/Gyn & Women's Health
- Which Symptoms Are Red Flags for Anaphylaxis? Anaphylaxis is a medical emergency that must be recognized and managed promptly. Look for the dramatic onset of symptoms. USMLEasy from McGraw-Hill
- American Association of Orthopaedic Surgeons (AAOS) 2010 ... Read clinically focused news coverage of key developments from the meeting. Medscape Orthopaedics & Sports Medicine
- Rituximab for Scleroderma: Does Something Finally Work? Dr. Kevin Deane reports on a recent study in Rheumatology exploring the utility of rituximab in treating scleroderma. Medscape Rheumatology
- Medical Treatment of Uterine Fibroids Is a gonadotropin-releasing hormone agonist or an aromatase inhibitor more effective in reducing fibroid size and symptoms in premenopausal women? Medscape Ob/Gyn & Women's Health
- How Can I Keep From Being Burned Out in Med School? At least half of all medical students are in the same boat as you. Medscape Med Students
- Parents Consider "Hastening Death" in Children With Termi... The first study of its kind found that parents who had lost a child to cancer considered "hastening death" in cases of uncontrollable pain and suffering. Medscape Medical News
AP Health News
- Hoped-for drop in childbirth deaths not happening WASHINGTON (AP) -- Eleven days after her son Benjamin's birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot....
- Court will hear case about vaccine side effects
- Researchers: AIDS virus can hide in bone marrow WASHINGTON (AP) -- The virus that causes AIDS can hide in the bone marrow, avoiding drugs and later awakening to cause illness, according to new research that could point the way toward better treatments for the disease....
- Brazil's Silva quits smoking after 50 years BRASILIA, Brazil (AP) -- Brazil's president said Tuesday that he kicked the smoking habit he had for 50 years after a recent health scare sent his blood pressure soaring....
- WHO: over 85M African kids get polio vaccination GENEVA (AP) -- The World Health Organization says more than 85 million children under 5 in west and central Africa will be vaccinated against polio....
- Gene test claims to show what diet works best Diet not working? Blame your genes. That's the pitch behind a new test that claims to show whether people will do better on a low-fat or a low-carb weight loss plan....
- Texas lottery officials move ahead with bidding AUSTIN, Texas (AP) -- Bidding on a new lucrative Texas lottery contract should move forward because there's no evidence that state consultant Gartner Inc. and the lottery's current operator GTECH Corp. improperly shared information about the process, a lottery official said Tuesday....
- Senators: Lift ban on gays donating blood WASHINGTON (AP) -- The time has come to change a policy that imposes a lifetime ban on donating blood for any man who has had gay sex since 1977, 18 senators said Thursday....
- Cancer society casts more doubt on prostate tests ATLANTA (AP) -- Months after experts discounted the importance of routine mammograms and Pap smears for many women, the American Cancer Society is warning more explicitly than ever that regular testing for prostate cancer is of questionable value too, and can do men more harm than good....
- FDA warning for hand sanitizer in Puerto Rico SAN JUAN, Puerto Rico (AP) -- Puerto Rico's government sent inspectors across the island Thursday to stop stores from selling locally produced hand sanitizers tainted with a dangerous bacteria....
NYTimes Health News
- Flu Shots in Children Can Help Community A study of farming colonies in Canada found that giving flu vaccine to schoolchildren protected the community.
- Maker Drops Hip Device, Then Warns of Failures DePuy Orthopaedics alerted doctors to a high early failure rate of its artificial hip after announcing it would phase out the device citing slow sales.
- Recipes for Health: Clam or Mussel Stew With Greens and B... This wonderful winter seafood stew is easy to make and to serve.
- After Cancer, Removing a Healthy Breast A procedure gains popularity but doesn't improve survival odds.
- Protein Suspected in Alzheimer’s May Be Needed to Fight... Bacteria being attacked by beta amyloid, in this image enlarged 18,500 times.Beta amyloid, which was once thought to be a chief villain in Alzheimer’s, may be part of the brain’s normal defenses, researchers at Harvard suggested.
- Cases: Fake Nostalgia for a Pre-Therapy Past Navigating difficult years with the help of someone who gets it.
- 18 and Under: When a Child’s Nosebleed or Bruising Is a... Some of the ailments, like idiopathic thrombocytopenic purpura, are usually resolved on their own, but others require treatment.
- Rapid DNA Sequencing Can Help Doctors Track Cancer Treatment If altered bits of genetic material could be picked up in a patient’s bloodstream, they would serve as a direct and sensitive marker of cancer.
- Global Update: The Fight Against AIDS, Malaria and Tuberc... Using their computers, travelers will be able to donate $2 when making reservations on some Internet travel sites.
- For the Afflicted, a Little Black Box to Jog Failing Memory The Sensecam measures movement and takes digital pictures.Researchers have tested the Sensecam, which contains a digital camera and an accelerometer, as an aid to people with Alzheimer’s disease and other memory disorders.
USAToday Health News
- Hospital ship USNS Comfort sailing home from Haiti Doctors treated nearly 1,000 patients onboard, starting just days after the earthquake.
- Long-term use of anti-osteoporosis drugs linked to hip fr... A popular group of drugs prescribed to slow bone loss may be putting some patients at an increased risk of hip fractures if ...
- Panera Bread to post calories on menus at company stores Panera Bread customers around the country soon will be able to tally calories for their smokehouse turkey panini and broccoli ...
- Salmonella finding did not stop distribution, FDA says The company responsible for a ballooning recall of processed foods continued to manufacture and distribute a flavor-enhancing ...
- Too many 'preventable' deaths among new moms, experts say Pregnancy-related deaths appear to have risen nationwide over the past decade, and while they're very rare about 550 a year ...
- Should hyper kids get ECG before getting ADHD medicine? Electrocardiogram screening to check for heart problems in hyperactive children before prescribing stimulant medications may ...
- Government to warn against baby slings after deaths The U.S. government is preparing a safety warning about baby slings those popular and fashionable infant carriers that parents ...
- Q&A: How Henrietta Lacks' cells fueled medical breakthroughs The Immortal Life of Henrietta Lacks tells the story of a black woman whose tissue was taken without her consent, and some of ...
- Women who drink moderately less likely to gain weight Those who consumed a light to moderate amount of alcohol gained less weight than women who drank no alcohol at all.
- Study: People would lose 5 pounds a year if soda cost ext... If the price of sweetened drinks increased 18% people would consume an average of 56 fewer calories a day and lose about 5 pounds ...
msnbc.com:
- Men have longer sex life expectancy, study says Men are more likely than women to be interested in sex, have sex and enjoy sex, according to new scientific research, which also found people who stay active and healthy enjoy longer sex lives.
- Tainted ingredient sold after salmonella found The company responsible for a ballooning recall of processed foods continued to manufacture and distribute a flavor-enhancing ingredient for a month after tests confirmed it was made with contaminated equipment, according to a Food and Drug Administration report.
- Baby slings to get safety warning after deaths The U.S. government is preparing a safety warning about baby slings — those popular and fashionable infant carriers that parents can sling around their chests to carry their baby.
- Will economic recovery lead to poor health habits? A cyclical turn, from recession to growth, would make some Americans more inclined to unhealthy behaviors. Msnbc.com fact-checks this claim — and more.
- ‘Drugged driving’ a growing threat, official says Motorists under the influence of drugs are a growing threat on U.S. roads, while the number who drink and drive has fallen thanks to education and law enforcement, a top U.S. drug control official said on Tuesday.
- Donating a kidney doesn’t shorten donor’s life People who donate one of their kidneys are likely to live just as long as someone with two healthy kidneys, assuming they survive the initial somewhat riskier period.
- Brazil's Silva quits smoking after 50 years President Luiz Inacio Lula da Silva says a recent health scare that sent his blood pressure soaring prompted him to kick the smoking habit he had for five decades.
- Assisted suicide network members indicted A Georgia grand jury has indicted four members of an assisted suicide group on charges they helped a 58-year-old with cancer kill himself.
- Two of oldest in the world die on same day Two of the oldest people in the world have died on the same day.
- Tenn. woman pleads guilty to faking breast cancer A Tennessee woman pleaded guilty Tuesday to faking breast cancer in a scam that netted thousands of dollars worth of sick leave donated by her City Hall co-workers and money from a church and other charities.
MSN Health News
- H1N1 Flu Spreads Slower Than Seasonal Flu: Study
- Severe Injuries From ATV Accidents on the Rise
- Alcoholics' Relapses Better Understood
- Vaccination, Prevention Is Beating Back Hepatitis
- High Natural Estrogen Might Raise Women's Stroke Risk
- Clinical Trials Update: March 10, 2010
- Youth Baseball Injuries Becoming More Common
- Jump in Kids' Sports Injuries Due to Overuse
- As You Age, Better Health Means Better Sex
- Youth Baseball Injuries Becoming More Common
CBS Health News
- Assisted Suicide Group "Glad" for Trial Leader of Final Exit Network Hopes Group's Work Will Be Validated in Court Case
- Video: First Ever Live TV Anchor Colonoscopy In Full: CBS Evening News anchor Katie Couric guided The Early Show anchor Harry Smith through a colonoscopy on live TV. Couric is an advocate of colorectal cancer prevention.
- A Look Inside Harry's Colonoscopy "Early Show" Co-Anchor Says Hello to His Liver, Finds Peace of Mind From Results
- Ever-Macho Cuba Now Paying for Sex Changes Cuba Once Persecuted Homosexuals and Transsexuals But Now Funds Sex Changes under Universal Health Care System
- Breast Milk Cheese Mom: Bon Appe-teat! Woman Whose Chef Husband Turned Extra Lactation into Cheese Says It's Totally Safe
- Video: Harry Smith's Colonoscopy Results Dr. Mark Pochapin gave Harry Smith a good bill of health after his live televised colonoscopy.
- Video: Colonoscopy Fact vs. Fiction Harry Smith gets the scoop of a lifetime before his live on-camera colonoscopy from Dr. Mark Pochapin, director of the The Jay Monahan Ctr. for Gastrointestinal Health.
- Video: Harry Smith's Live Colonoscopy Harry Smith underwent a colonoscopy by Dr. Mark Pochapin live during The Early Show as Katie Couric oversaw the procedure.
- Inside Colonoscopy Screenings Dr. Mark Pochapin Explains How Doctors Perform This Important Test for Colon Cancer
- Video: Colonoscopy Prep for Harry Smith Katie Couric helps Harry Smith get ready for his colonoscopy and explains why the procedure is so important for men and women.
BBC UK Health News
- Call to halt NHS medical database Doctors leaders urge ministers to halt the development of a medical records database for patients in England.
- 'No proof' IVF aided by acupuncture There is no evidence acupuncture or Chinese herbal medicine boost the chance of IVF success, fertility experts warn.
- Street actress reveals depression Coronation Street actress Beverley Callard reveals she has been receiving treatment for depression.
- Social care deal 'dead in water' Hopes of reaching a cross-party deal on funding social care appear to be dead in the water.
- MP writes to police over hospital An MP writes to police to ask if there is a basis for a criminal inquiry into activities at Stafford Hospital.
- 'Problem kids' risk future pain Children with behavioural problems are twice as likely to suffer chronic pain as adults than others, say researchers.
- Illegal cord blood sample warning Parents, hospitals and private firms are being warned over risky and illegal collections of umbilical cord blood
- 'London bomb stress' recognised Psychologists say they have treated hundreds of survivors of the 2005 London bombings for post-traumatic stress disorder.
- Patients 'get care in cupboards' Patients are being treated in mop cupboards, storerooms and kitchens due to wards being full, a survey suggests.
- Women who drink wine in moderation stay slim, says study Women can enjoy a tipple and stay slim, according to a study showing moderate drinkers gain less weight than teetotallers.
New England Journal of Medicine
- AIDS in America -- Forgotten but Not Gone (No abstract is available for this citation)
- Can the States Nullify Health Care Reform? (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 GHESKIO Field Hospital and Clinics after the Earthqua... (No abstract is available for this citation)
- Returning Home to Haiti -- Providing Medical Care after t... (No abstract is available for this citation)
- Civil-Military Collaboration in the Initial Medical Respo... (No abstract is available for this citation)
- Be Not Afraid (No abstract is available for this citation)
- Health Care Volunteers and Disaster Response -- First, Be... (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)
NEJM This Week - Audio Summaries
- 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 This Week: Supplement to the New England Journal of ... This summary covers the issue of February 11, 2010. Featured are articles on childhood obesity, other cardiovascular risk factors, and premature death; stent graft versus balloon angioplasty for failing dialysis-access grafts; single-dose liposomal amphotericin B for visceral leishmaniasis in India; long-term results of hypofractionated radiation therapy for breast cancer; lack of cyclophilin B in osteogenesis imperfecta; and innate immunity and HIV; a review article on the enigma of spontaneous preterm birth; a case report of a man with arthralgias, oral ulcers, vision loss, and vocal-cord paralysis; and Perspective articles on performing futile CPR, on failing to thrive, and on the constitutionality of the individual mandate for health insurance.
NEJM - Image of the Week
- 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 . . .
- Radiation Pneumonitis after Radiotherapy for Breast Cancer A 58-year-old woman with a history of stage I cancer in the right breast (T1N0M0, according to the tumor–node–metastasis classification) presented with a 2-week history of shortness of breath and cough. Eight months before presentation, . . .
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...
Latest headlines from BMJ
- Treatment for lymph node tuberculosis
- Will a market deliver quality and efficiency in health ca...
- Will a market deliver quality and efficiency in health ca...
- Will a market deliver quality and efficiency in health ca...
- Will a market deliver quality and efficiency in health ca...
- Stop wasting money on commercialising the NHS
- Doctors on the dole
- Tachycardia due to atrial flutter with rapid 1:1 conducti... Flecainide can "organise" atrial fibrillation into atrial flutter with 1:1 conduction, leading to cardiovascular compromise.
- An old battle: England's libel laws versus scientific debate
- Overhaul hospital payment system to reflect care pathways...
The Lancet
- [Editorial] International Women's Day 2010 International Women's Day, first marked in Copenhagen in 1910, will celebrate its centenary on March 8, 2010. It is a day when women are recognised for their achievements irrespective of ethnic origin, culture, economics, or politics. This will be an occasion to look back on past accomplishments and, more importantly, to look ahead to the potential and opportunities that await future generations of women. This year, the UN theme is Equal rights, equal opportunities: progress for all. Gender equality and empowerment of women are fundamental to the mission of the UN to achieve equal rights and dignity for all. Partial progress has been made towards the Millennium Development Goals (MDGs)—MDG 3 aims to promote gender equality, and MDG 5 to improve maternal health.
- [Editorial] Raising awareness of antiphospholipid antibod... Speaking to the BBC last week, Graham Hughes, who first described antiphospholipid syndrome in 1983, urged for more efforts to raise awareness of this disorder, which often remains undiagnosed and untreated with catastrophic consequences, such as multiple miscarriages, or stroke at a young age.
- [Editorial] Time for a responsible internet age The internet has revolutionised publishing. Through user-generated content anyone can make words, images, or videos public. But should internet sites that allow such content to be posted be responsible for what is uploaded?
- [Comment] Apixaban to prevent venous thromboembolism afte... For potentially life-threatening venous thromboembolism, including deep venous thrombosis and pulmonary embolism after major orthopaedic surgery, conventional pharmacological prophylaxis is with unfractionated heparin, low-molecular-weight heparins, pentasaccharides, and antagonists of vitamin K. Despite remarkable progress in development of new antithrombotic treatments, these drugs are still widely used.
- [Comment] Radiotherapy for endometrial cancer: a key piec... With a rising yearly incidence of more than 20 women per 100 000, endometrial cancer is now the most common gynaecological cancer in developed countries. More than 75% of patients present with disease confined to the uterus. After hysterectomy and bilateral salpingo-oophorectomy, histopathological variables are used to assign risk of recurrence. Endometrial cancer of high-intermediate risk accounts for around 30% of women with early disease, of whom about 15% either have occult metastases or will develop metastatic disease. Adjuvant treatment to reduce the risk of recurrence has traditionally been external beam radiotherapy (EBRT), which is presently offered to about a third of women with endometrial cancer, with or without vaginal brachytherapy (VBT). However, although EBRT reduces the rate of pelvic relapse, it does not improve survival.
- [Comment] Treating HIV infection with drugs for HSV-2 inf... Jairam Lingappa and colleagues, in The Lancet today, present results from the Partners in Prevention HSV/HIV Transmission Study. This study was in HIV-1 discordant couples, and the primary objective was to directly assess the efficacy of suppressive therapy with aciclovir in reduction of onward transmission of HIV-1 from partners co-infected with herpes simplex virus type 2 (HSV-2). In the past few years, other placebo-controlled trials have studied the effects of aciclovir or valaciclovir on HIV-1 transmissibility, with genital shedding of HIV-1 RNA as a proxy of transmissibility. In these trials, suppressive therapy of HSV-2 reduced genital shedding of HIV-1 RNA. However, the Partners in Prevention Study showed that suppressive therapy with aciclovir did not reduce onward transmission of HIV-1.
- [Comment] Identifying sick children in primary care In developed countries, every child will present to a primary health-care practitioner more than once every year with symptoms of an acute infection. Primary care physicians faced with such a child know that the likelihood of serious disease is about 1%, but what has not been clear is the evidence-based approach that clinicians should take in investigating such children. In The Lancet today, Ann Van den Bruel and colleagues address this uncertainty in a systematic review of 30 studies.
- [Comment] Developments in the management of Hodgkin's lym... Since our Seminar in The Lancet, the management of Hodgkin's lymphoma has developed, including the increasing use of functional imaging with fluorodeoxyglucose positron-emission tomography (FDG-PET), or PET/CT. Compared with conventional imaging, pretreatment PET leads to a change in stage in up to 40% of patients with modification in treatment in about half of these, but no randomised trials have assessed the effect on outcome of the inclusion of PET findings when defining management.
- [Comment] Calling young researchers This year, The Lancet and the Global Forum for Health Research are teaming up with the First Global Symposium on Health Systems Research (Montreux, Switzerland, Nov 16–19, 2010) to launch an essay competition for young researchers. The theme of the competition is “health-systems research: towards universal health coverage”.
- [Comment] Peer review: what would we do without it? The time has come again to publicly acknowledge by listing their names on our website the many expert researchers, clinicians, public health specialists, policy makers, statisticians, and epidemiologists who have given up their valuable and increasingly restricted time to the important but undervalued task of peer review. A big thank you to you all! Without you we would not be able to publish the best papers, and without you the research and review material we publish would not be presented in the best possible way. Your employers and the institutions you work in have still not put enough value and recognition on this academic task that is so important to the current edifice of research evidence. We still hope that this will change one day. Until then, please accept our gratitude and our expression of pleasure to work with you as a small compensation.
Listen to The Lancet
- 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.
- Listen to The Lancet: 2 January David Molyneux introduces the Neglected Tropical Diseases Series.
- Listen to The Lancet: 19 December Professor Kathy Albain discusses chemotherapy and tamoxifen use for postmenopausal women with node-positive breast cancer.
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--The end is in sight (until later) The Senate may vote today to delay until September 30 Medicare's 21% reimbursement cut. If this happens, we'll update readers here. (Health Leaders Media)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.
- 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)
- Medical News of the Obvious You might already be aware of this week's finding if you've watched baseball in the past decade or so and noticed that Mark McGwire's arms are about the circumference of the average ballplayer's waist in the 70s. But just to be sure, researchers recently compared the BMIs of professional baseball players from 1876 to 2007 to find that, like serving sizes and master bathrooms, they've gotten bigger.Clear, right? But in taking the next step, drawing conclusions from this study, this article from HealthDay gets about as confused as a science article can be. The study authors are concerned because they correlated the ballplayers' "increased BMIs with an increased risk of death." (We're assuming that's a risk of premature death, since it seems pretty certain that the 1876 team would be dead regardless of their % body fat.)But a critic of the study argued first that ballplayers' increasing size is not a health risk, and then that the players might be dying early because they're using steroids. Um, we're not scientists, but mightn't there be a relationship (even a causal one, perhaps?) between steroid use and increased BMI?
- QD: News Every Day--Ratcheting up the pressure to pass re... The push is on to pass health care reform. The president is using his bully pulpit as opponents push back, targeting members of Congress who could for it or against. (Los Angeles Times, Washington Post, NPR, Politico)Primary care shortageGovernment support of medical school education is falling, and medical colleges are shrinking their enrollments and raising medical school tuition to make up for the huge shortfalls. (USA Today)
- QD: News Every Day--President resigned to reconciliation ACP Internist continues its daily wrap-up of current events affecting internal medicine.Health care reformCiting the Children's Health Insurance Program and COBRA unemployment health coverage as examples, President Barack Obama called on Congress to pass health care reform using reconciliation. Those two health programs used the legislative tactic to secure passage. Senate Minority Leader Mitch McConnell said health care reform was bigger legislation, and "Big legislation always requires big majorities." (Washington Post, Wall Street Journal)Haitian earthquake reliefThe overwhelming wave of trauma victims has dwindled to a trickle aboard the USNS Comfort, the military hospital ship anchored in the harbor of Port-au-Prince, Haiti. Civilian doctors want the ship to stay to handle what they describe as a second wave of treatment--resetting poorly healed fractures and remaining public health issues. The Navy has not decided what the Comfort's future mission might be, if any. Read reports of the challenges internists faced while aboard the ship. (Baltimore Sun, U.S. Navy, Annals of Internal Medicine)Lt. Yonnette Thomas, Officer in Charge of the Center for Information Dominance Learning Site in Norfolk, translates between Haitian patients and a delegation of visiting physicians from Colombia aboard the USNS Comfort.
- Chasms and comparisons covered by Carolyn Clancy As one would expect from such a diverse group, comparisons were a common topic at the co-located National Medical Home Summit, National Retail Clinic Summit, and Population Health and Disease Management Colloquium this week. During an opening session, Carolyn Clancy, head of the AHRQ, updated us on some of the comparison work her agency has been doing. Last year's stimulus bill dedicated a lot of funds ($300 mill directly, more through the Secretary of HHS) to the agency's work on comparative effectiveness.But there's still a long way to go, according to Dr. Clancy. "We're a little bit slow to translate scientific advances into clinical practice," she understated. The good news is that in recent years there have been steady declines in the "quality chasm" between guidelines and care actually provided. If the current pace continues, Dr. Clancy said, "my top statistician tells me it will take 20 years to close the gap between the highest quality care and that which gets delivered."Her agency's trying to spend that effort along by providing info for patients about evidence-based care, supporting research to gather needed evidence, and scanning the horizon to see what questions are likely to come up next. There's a particular need and effort to figure out the best practices for narrower patient groups (such as the 9% of diabetics with no comorbidities, for example), she said. And for those who worry that comparative effectiveness could lead to rationing, she reassured the audience that the agency's findings are meant to be "descriptive not prescriptive."
- QD: News Every Day--Medicare cuts delayed by 30 days Medicare reimbursement cuts have been delayed for 30 days. (Nowhere else in our country's economy would someone's paycheck be bandied about like this.) The same legislation, actually a jobs bills, also extended the time that the federal government will pick up some of the tab for COBRA health insurance. (Health Leaders Media, Los Angeles Times)As mentioned in yesterday's edition, the president plans to siphon off some Republicans by incorporating a few of their ideas. He might need them to counter Democrats who opposed health care reform legislation, but Republican leadership scoffed at the idea of breakaways. (ACP Internist, Washington Post, Politico)H1N1 influenzaH1N1 influenza took an unexpected course in its timing and severity. Novel pandemics are different than seasonal flu outbreaks, explains those who tracked its course. And seasonal flu was mild this year, too. (Wall Street Journal, Pittsburgh Tribune-Review) In case you missed it ...W.G. Watson, MD, is a 100-year-old practicing obstetrician. One baby he delivered grew up to become his practice's partner, as a matter of fact. (CNN)
AAFP News Now
- 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.
- ACCME Updates Providers, Stakeholders on System for CME A... The Accreditation Council for Continuing Medical Education, or ACCME, has completed the second phase of testing its Program Activity and Reporting System, or PARS, a new Web-based portal designed to streamline data collection from ACCME-accredited providers.
- '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.
- ACIP Makes Universal Flu Vaccination Recommendation The influenza vaccination recommendations for the 2010-2011 flu season should be a lot less complicated than those for the current season, thanks to a new recommendation from the CDC's Advisory Committee on Immunization Practices, or ACIP. During the committee's Feb. 24-25 meeting in Atlanta, ACIP members voted without objection to expand the recommendation for annual influenza vaccination to include all people ages 6 months and older in whom the vaccine is not contraindicated.
- NIH Consensus Development Conference to Address VBAC Issues A consensus development conference scheduled for March 8-10 at the NIH campus in Bethesda, Md., will draw together a diverse group of experts to address key issues related to vaginal birth after cesarean, or VBAC.
Journal of Internal Medicine
- 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.
- Job strain predicts recurrent events after a first acute ... Abstract. László KD, Ahnve S, Hallqvist J, Ahlbom A, Janszky I. (Karolinska Institute, Stockholm, Sweden; Semmelweis University, Budapest, Hungary; Uppsala University, Uppsala, Sweden; and Karolinska Institute, Stockholm, Sweden). Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. J Intern Med 2010; 00: 000[ndash]000.Objectives. Studies investigating the prognostic role of job stress in coronary heart disease are sparse and have inconclusive findings. We aimed (i) to investigate whether job strain predicts recurrent events after acute myocardial infarction (AMI) and if so (ii) to determine behavioural and biological factors that contribute to the explanation of this association.Design. Prospective study.Setting. Ten emergency hospitals in the larger Stockholm area, Sweden.Subjects. Non-fatal AMI cases from the Stockholm Heart Epidemiology Program case[ndash]control study who were employed and younger than 65 years at the time of their hospitalization (n = 676).Results. During the 8.5 year follow-up, 155 patients experienced cardiac death or non-fatal AMI; totally 96 patients died, 52 of cardiac causes. After adjustment for potential confounders, patients with high job strain had an increased risk for the combination of cardiac death and non-fatal AMI relative to those with low job strain, the hazard ratio (HR) and the 95% confidence interval (CI) being 1.73 (1.06[ndash]2.83). Results were similar for cardiac [HR (95% CI): 2.81 (1.16[ndash]6.82)] and total mortality [HR (95% CI): 1.65 (0.91[ndash]2.98)]. We found no evidence for mediation from lifestyle, sleep, lipids, glucose, inflammatory and coagulation markers on the association between job strain and the combination of cardiac death and non-fatal AMI.Conclusions. Job strain was associated with poor long-term prognosis after a first myocardial infarction. Interventions focusing on reducing stressors at the workplace or on improving coping with work stress in cardiac patients might improve their survival post-AMI.
- Impact of waist circumference versus adiponectin level on... Abstract. Holewijn S, den Heijer M, van Tits LJ, Swinkels DW, Stalenhoef AFH, de Graaf J (Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands). Impact of waist circumference versus adiponectin level on subclinical atherosclerosis. A cross-sectional analysis in a sample from the general population. J Intern Med 2010; 00: 000[ndash]000.Objective. Waist circumference is a clinical marker of obesity and an established risk factor for cardiovascular (CV) disease. Adiponectin, an adipocyte-derived hormone and new biomarker of obesity, was recently proposed as the missing link between obesity and increased cardiovascular risk. We evaluated waist and adiponectin in a middle-aged population-based cohort to compare the impact of both obesity-markers on subclinical atherosclerosis, in relation to other CV risk factors.Design, setting & subjects. Seven noninvasive measurements of atherosclerosis (NIMA), as surrogate markers of (subclinical) atherosclerosis, were determined in 1517 participants of the Nijmegen Biomedical Study, aged 50[ndash]70 years, who were drawn from the Dutch community.Results. Both men and women with a high waist (M >104 cm; F >95 cm) showed increased pulse wave velocity (PWV) (M: +9.4%; F: +8.3%) and thicker intima-media thickness (IMT) (M: +7.3%; F: +4.3%) and women also showed increased plaque thickness (+16.6%). After adjustment for other CV risk factors both men and women showed increased IMT (M: +4.8%; F: +2.8%) and men also showed increased PWV (+9.6%). Both men and women with a low adiponectin level (M <2.2 mg L[minus]1; F <3.5 mg L[minus]1) showed a decreased ankle-brachial index after exercise (M: [minus]9.5%; F: [minus]3.9%) and increased IMT (M: +3.7%; F: +3.6%) and women also showed increased PWV (+6.8%), but after adjustment for other CV risk factors low adiponectin level was no longer associated with deteriorated outcomes of NIMA.Conclusions. Waist circumference showed independent associations with noninvasive measurements of subclinical atherosclerosis, whereas the association of adiponectin level with subclinical atherosclerosis was not independent of other CV risk factors. Prospective studies are needed to elucidate, if the atherogenic effect of a low adiponectin level is mediated by other CV risk factors and not by low adiponectin level intrinsically.
- Weak associations between human leucocyte antigen genotyp... Abstract. Björkbacka H, Lavant EH, Fredrikson GN, Melander O, Berglund G, Carlson JA, Nilsson J (Lund University, Malmö University Hospital, Malmö; and Lund University, Lund University Hospital, Lund; Sweden). Weak associations between human leucocyte antigen genotype and acute myocardial infarction. J Intern Med 2010; doi: 10.1111/j.1365-2796.2009.02209.x.Objectives. Human leucocyte antigens (HLAs) are polymorphic molecules involved in antigen presentation. Associations between HLA type and autoimmune diseases, such as type 1 diabetes and rheumatoid arthritis, are well established but the potential association of genetic variation affecting antigen presentation with cardiovascular disease has not been systematically investigated in large cohorts. The importance of such studies is stressed by recent experimental findings of an involvement of autoimmunity in the atherosclerotic disease process.Results. An SSP-PCR method was used for HLA genotyping to determine associations of HLA-DRB1, -DQA1 and -DQB1 with cardiovascular disease in a population-based cohort of 1188 acute myocardial infarction (AMI) patients and 1191 matched healthy controls. The HLA-DRB1*0101 allele, as well as the HLA-DRB1*0101-DQA1*01-DQB1*05 haplotype, was found to be associated with increased risk for AMI (OR 1.24; 95% CI 1.00[ndash]1.54 for both). In contrast, the DRB1*07 and DQA*02 alleles (OR 0.78; 95% CI 0.65[ndash]0.95 for both), as well as the DRB1*07-DQA*02-DQB*02 haplotype, conferred protection (OR 0.79; 95% CI 0.63[ndash]0.98). An HLA risk score taking each individual's both haplotypes into account was higher amongst cases (2.43 ± 0.92 vs. 2.29 ± 0.95, P = 0.001). The association between HLA risk score and AMI was independent of other cardiovascular risk factors assessed.Conclusions. This study demonstrates that the associations between HLA-DRB1 and DQA1 loci and cardiovascular disease exists but that they are considerably weaker than those previously reported for other diseases with an established autoimmune aetiology such as type 1 diabetes, systemic lupus erythematosus and rheumatoid arthritis.
Journal of General Internal Medicine
- Primary Non-adherence of Medications: lifting the veil on... Primary Non-adherence of Medications: lifting the veil on prescription-filling behaviors Content Type Journal ArticleCategory EditorialDOI 10.1007/s11606-010-1286-0Authors Matthew D. Solomon, Stanford University 300 Pasteur Drive, Falk Bldg-CVC Stanford CA 94305 USASumit R. Majumdar, University of Alberta Alberta Canada Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Validation of the Group-Based Medical Mistrust Scale Amon... ABSTRACT BACKGROUND Socioculturally relevant measures of medical mistrust are needed to better address health disparities, especially among Black men, a group with lower life expectancy and higher death rates compared to other race/gender groups. OBJECTIVES The study aim was to investigate the psychometric properties of the Group-Based Medical Mistrust Scale (GBMMS) in a Black male sample. DESIGN Data were collected as part of a randomized controlled trial testing educational strategies to support Black men’s decisions about prostate cancer screening. PARTICIPANTS Participants included 201 Black men ages 40–75 years recruited in New York City during 2006–2007. MAIN MEASURES The primary measures included: race-based medical mistrust, health care participation, avoidance of health care, perceived access to health care, health care satisfaction, racial identity, residential racial segregation, attitudes towards prostate cancer screening, and past prostate cancer screening behavior. KEY RESULTS An exploratory factor analysis suggested a three-factor structure. Confirmatory factor analysis supported the three-factor model. Internal consistency was high for the total GBMMS and the three sub-scales: Suspicion, Discrimination, and Lack of Support. Construct validity was supported by: significant positive correlations between GBMMS and avoidance of health care and racial identity as well as significant negative correlations with health care access, health care satisfaction, pt?>and attitudes about prostate cancer screening. ANOVA showed that the GBMMS was associated with greater residential racial segregation. Higher total GBMMS scores were associated with not visiting a physician in the last year and not having a regular physician. CONCLUSIONS The present findings provide strong additional evidence that the GBMMS is a valid and reliable measure that may be used among urban Black men. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1288-yAuthors Rachel C. Shelton, Mount Sinai School of Medicine Department of Oncological Science/Cancer Prevention and Control 1425 Madison Avenue Box 1130 New York NY 10029 USAGary Winkel, The City University of New York The Graduate Center 365 Fifth Avenue New York NY 10016 USAStacy N. Davis, Temple University Department of Public Health, Ritter Annex 9th Floor, 004-09, 1301 Cecil B. Moore Avenue Philadelphia PA 19122-6091 USANicole Roberts, Albert Einstein College of Medicine Jack and Pearl Resnick Campus, Department of Epidemiology and Population Health 1300 Morris Park Avenue; Belfer, 13th Floor Bronx NY 10461 USAHeiddis Valdimarsdottir, Reykjavik University School of Health and Education Ofnleiti 2, 103 Reykjavik IcelandSimon J. Hall, Deane Prostate Health and Research Center Mount Sinai School of Medicine 5 East 98th Street, 6th Floor New York NY 10029 USAHayley S. Thompson, Albert Einstein College of Medicine Jack and Pearl Resnick Campus, Department of Epidemiology and Population Health 1300 Morris Park Avenue; Belfer, 13th Floor Bronx NY 10461 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Procedures Performed by Hospitalist and Non-hospitalist G... Abstract BACKGROUND In caring exclusively for inpatients, hospitalists are expected to perform hospital procedures. The type and frequency of procedures they perform are not well characterized. OBJECTIVES To determine which procedures hospitalists perform; to compare procedures performed by hospitalists and non-hospitalists; and to describe factors associated with hospitalists performing inpatient procedures. DESIGN Cross-sectional survey. PARTICIPANTS National sample of general internist members of the American College of Physicians. METHODS We characterized respondents to a national survey of general internists as hospitalists and non-hospitalists based on time-activity criteria. We compared hospitalists and non-hospitalists in relation to how many SHM core procedures they performed. Analyses explored whether hospitalists’ demographic characteristics, practice setting, and income structure influenced the performance of procedures. RESULTS Of 1,059 respondents, 175 were classified as “hospitalists”. Eleven percent of hospitalists performed all 9 core procedures compared with 3% of non-hospitalists. Hospitalists also reported higher procedural volumes in the previous year for 7 of the 9 procedures, including lumbar puncture (median of 5 by hospitalists vs. 2 for non-hospitalists), abdominal paracentesis (5 vs. 2), thoracenteses (5 vs. 2) and central line placement (5.5 vs. 3). Performing a greater variety of core procedures was associated with total time in patient care, but not time in hospital care, year of medical school graduation, practice location, or income structure. Multivariate analysis found no independent association between demographic factors and performing all 9 core procedures. CONCLUSIONS Hospitalists perform inpatient procedures more often and at higher volumes than non-hospitalists. Yet many do not perform procedures that are designated as hospitalist “core competencies.” Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1284-2Authors Rajiv Thakkar, Johns Hopkins University School of Medicine 4940 Eastern Avenue Baltimore MD 21224-2735 USAScott M. Wright, Johns Hopkins University School of Medicine 4940 Eastern Avenue Baltimore MD 21224-2735 USAPatrick Alguire, American College of Physicians 190 North Independence Mall West Philadelphia PA 19106-1572 USARobert S. Wigton, University of Nebraska Medical Center College of Medicine 985524 Nebraska Medical Center Omaha NE 68198-5524 USARomsai T. Boonyasai, Johns Hopkins University School of Medicine 4940 Eastern Avenue Baltimore MD 21224-2735 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- The Association of Provider Communication with Trust amon... Abstract Background Adults with sickle cell disease often report poor interpersonal healthcare experiences, including poor communication with providers. However, the effect of these experiences on patient trust is unknown. Objective To determine the association between patient ratings of the previous quality of provider communication and current trust in the medical profession among adults with sickle cell disease. Research design Cross-sectional survey. Participants A total of 95 adults with sickle cell disease. Measurements The four-item Provider Communication Subscale from the Consumer Assessment of Healthcare Plans and Systems Survey; The five-item Wake Forest Trust in the Medical Profession Scale. Main results Better ratings of previous provider communication were significantly associated with higher levels of trust toward the medical profession. A 10% increase in provider communication rating was associated with a 3.76% increase in trust scores (p < 0.001, 95% CI [1.76%, 5.76%]), adjusting for patient-level demographic, clinical, and attitudinal characteristics. Conclusions Poorer patient ratings of provider communication are associated with lower trust toward the medical profession among adults with sickle cell disease. Future research should examine the impact of low trust in the medical profession on clinical outcomes in this population of patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1247-7Authors Carlton Haywood, The Johns Hopkins University School of Medicine, The Johns Hopkins Berman Institute of Bioethics Division of Hematology Baltimore MD USASophie Lanzkron, The Johns Hopkins University School of Medicine Division of Hematology Baltimore MD USANeda Ratanawongsa, University of California, San Francisco, San Francisco General Hospital San Francisco CA USAShawn M. Bediako, University of Maryland, Baltimore County Department of Psychology Baltimore MD USALakshmi Lattimer, The Johns Hopkins University School of Medicine Baltimore MD USANeil R. Powe, University of California, San Francisco, San Francisco General Hospital San Francisco CA USAMary Catherine Beach, The Johns Hopkins University School of Medicine The Johns Hopkins Berman Institute of Bioethics Baltimore MD USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Electronic Prescribing Improves Medication Safety in Comm... Abstract BACKGROUND Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive. OBJECTIVE To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors. DESIGN, PARTICIPANTS Prospective, non-randomized study using pre-post design of 15 providers who adopted e-prescribing with concurrent controls of 15 paper-based providers from September 2005 through June 2007. INTERVENTION Use of a commercial, stand-alone e-prescribing system with clinical decision support including dosing recommendations and checks for drug-allergy interactions, drug-drug interactions, and duplicate therapies. MAIN MEASURES Prescribing errors were identified by a standardized prescription and chart review. KEY RESULTS We analyzed 3684 paper-based prescriptions at baseline and 3848 paper-based and electronic prescriptions at one year of follow-up. For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions (95% confidence interval (CI), 36.7–49.3) at baseline to 6.6 per 100 prescriptions (95% CI, 5.1–8.3) one year after adoption (p < 0.001). For non-adopters, error rates remained high at 37.3 per 100 prescriptions (95% CI, 27.6–50.2) at baseline and 38.4 per 100 prescriptions (95% CI, 27.4–53.9) at one year (p = 0.54). At one year, the error rate for e-prescribing adopters was significantly lower than for non-adopters (p < 0.001). Illegibility errors were very high at baseline and were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year). CONCLUSIONS Prescribing errors may occur much more frequently in community-based practices than previously reported. Our preliminary findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety. TRIAL REGISTRATION ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1238-8Authors Rainu Kaushal, Weill Medical College of Cornell University Department of Pediatrics 402 East 67th Street, Room-LA-259 New York NY 10065 USALisa M. Kern, New York-Presbyterian Hospital New York NY USAYolanda Barrón, Health Information Technology Evaluation Collaborative (HITEC) New York NY USAJill Quaresimo, Taconic IPA Fishkill NY USAErika L. Abramson, New York-Presbyterian Hospital New York NY USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Oversight of Financial Conflicts of Interest in Commercia... Abstract BACKGROUND Studies of conflicts of interest in clinical research have focused on academic centers, but most clinical research takes place in nonacademic settings. OBJECTIVE To compare oversight and management of investigators’ financial relationships in academic and nonacademic research settings. DESIGN, SETTING, AND PARTICIPANTS Survey of officials at 199 sites that contributed participants to commercially sponsored phase 3 clinical trials published in JAMA or the New England Journal of Medicine in 2006 and 2007. MEASUREMENTS AND MAIN RESULTS Response rates were 66% for academic medical centers, 37% for nonacademic medical centers (inpatient), and 27% for outpatient nonacademic sites. Almost all academic medical centers (97%) and most nonacademic medical centers (87%) followed written conflict-of-interest policies, whereas 44% of outpatient nonacademic sites had written policies (P < 0.001). Academic and nonacademic medical centers relied mainly on internal institutional review boards (69% and 71%, respectively); outpatient nonacademic sites relied primarily on independent institutional review boards (59%; P < 0.001). CONCLUSIONS Nonacademic sites have substantially different approaches to the oversight and management of financial relationships in commercially sponsored clinical research than academic medical centers. These differences warrant more attention to how financial relationships are monitored in community research settings. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1264-6Authors Kevin P. Weinfurt, Duke University School of Medicine Center for Clinical and Genetic Economics, Duke Clinical Research Institute PO Box 17969 Durham NC 27715 USAMark A. Hall, Wake Forest University Center for Bioethics, Health, and Society Winston-Salem NC USAN. Chantelle Hardy, Duke University School of Medicine Center for Clinical and Genetic Economics, Duke Clinical Research Institute PO Box 17969 Durham NC 27715 USAJoëlle Y. Friedman, Duke University School of Medicine Center for Clinical and Genetic Economics, Duke Clinical Research Institute PO Box 17969 Durham NC 27715 USAKevin A. Schulman, Duke University School of Medicine Center for Clinical and Genetic Economics, Duke Clinical Research Institute PO Box 17969 Durham NC 27715 USAJeremy Sugarman, The Johns Hopkins University Berman Institute of Bioethics and Department of Medicine Baltimore MD USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Depression in Relation to Long-term Control of Glycemia, ... Abstract Background Little information is available about the association of depression with long-term control of glycemia, blood pressure, or lipid levels in patients with diabetes. Objective To determine whether minor and major depression at study enrollment compared with no depression are associated with higher average HbA1c, systolic blood pressure (SBP) and LDL cholesterol over the long term in patients with an indication for or receiving drug treatment. Design Cohort study. Patients A total of 3,762 patients with type 2 diabetes mellitus enrolled in the Pathways Epidemiologic Study in 2001–2002 and followed for 5 years. Main Measures Depression was assessed at study enrollment using the Patient Health Questionnaire-9 (PHQ-9). SBP and information on cardiovascular co-morbidity were abstracted from medical records, and LDL cholesterol and HbA1c measured during clinical care were obtained from computerized laboratory data during a median of 4.8 years’ follow-up. Key Results Among those with an indication for or receiving drug treatment, after adjustment for demographic and clinical characteristics, average long-term HbA1c, SBP, and LDL cholesterol did not differ in patients with comorbid diabetes and minor or major depression compared with those with diabetes alone. Conclusions The adverse effect of depression on outcomes in patients with diabetes may not be mediated in large part by poorer glycemic, blood pressure, or lipid control. Further study is needed of the biologic effects of depression on patients with diabetes and their relation to adverse outcomes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1272-6Authors Susan R. Heckbert, University of Washington Department of Epidemiology Seattle WA USACarolyn M. Rutter, Group Health Research Institute Biostatistics Unit Seattle WA USAMalia Oliver, Group Health Cooperative Group Health Research Institute Seattle WA USALisa H. Williams, University of Washington Department of Medicine (Dermatology) Seattle WA USAPaul Ciechanowski, University of Washington Department of Psychiatry Seattle WA USAElizabeth H. B. Lin, Group Health Cooperative Group Health Research Institute Seattle WA USAWayne J. Katon, University of Washington Department of Psychiatry Seattle WA USAMichael Von Korff, Group Health Cooperative Group Health Research Institute Seattle WA USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- A Marriage of Convenience A Marriage of Convenience Content Type Journal ArticleCategory Healing ArtsDOI 10.1007/s11606-010-1277-1Authors Nitin Agrawal Kapur, Yale University School of Medicine Department of Internal Medicine 154 Willard Street New Haven CT 06511 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Results of the Medications At Transitions and Clinical Ha... Abstract Background This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. Methods Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients’ number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness. Results Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient’s age ≥65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09–4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14–1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19–0.63) or bottles (OR, 0.55; 95% CI, 0.27–1.10) at admission was beneficial. Conclusion Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1256-6Authors Kristine M. Gleason, Northwestern Memorial Hospital Division of Quality and Operations, Department of Clinical Quality Management Chicago IL USAMolly R. McDaniel, Northwestern Memorial Hospital Division of Quality and Operations, Department of Clinical Quality Management Chicago IL USAJoseph Feinglass, Northwestern University Feinberg School of Medicine Division of General Internal Medicine, Department of Medicine Chicago IL USADavid W. Baker, Northwestern University Feinberg School of Medicine Division of General Internal Medicine, Department of Medicine Chicago IL USALee Lindquist, Northwestern University Feinberg School of Medicine Division of General Internal Medicine, Department of Medicine Chicago IL USADavid Liss, Northwestern University Feinberg School of Medicine Division of General Internal Medicine, Department of Medicine Chicago IL USAGary A. Noskin, Northwestern University Feinberg School of Medicine Institute for Healthcare Studies Chicago IL USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Perspectives of Non-Hispanic Black and Latino Patients in... Abstract Background Racial/ethnic disparities exist in the prevalence and outcomes of diabetes and hypertension in the U.S. A better understanding of the health beliefs and experiences of non-Hispanic Blacks and Latinos with these diseases could help to improve their care outcomes. Methods We conducted eight focus groups stratified by participants’ race/ethnicity, with 34 non-Hispanic Blacks and Latinos receiving care for diabetes and/or hypertension in one of 7 community health centers in Boston. Focus groups were designed to determine participants’ levels of understanding about their chronic illness, assess their barriers to the management of their illness, and inquire about interventions they considered may help achieve better health outcomes. Results Among both groups of participants, nutrition (traditional diets), genetics and environmental stress (e.g. neighborhood crime and poor conditions) were described as primary contributors to diabetes and hypertension. Unhealthy diets were reported as being a major barrier to disease management. Participants also believed that they would benefit from attending groups on management and education for their conditions that include creative ways to adopt healthy foods that complement their ethnic diets, exercise opportunities, and advice on how to prevent disease manifestation among family members. Conclusions Interactive discussion groups focused on lifestyle modification and disease management should be created for patients to learn more about their diseases. Future research evaluating the effectiveness of interactive diabetes and hypertension groups that apply patient racial/ethnic traditions should be considered. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-010-1278-0Authors Beverley E. Russell, The Center for Community Health Education Research and Service CCHERS 716 Columbus Ave, Suite 398 Boston MA 02120 USAEdith Gurrola, The Division of General Internal Medicine of Brigham and Women’s Hospital Boston MA USAChima D. Ndumele, The Division of General Internal Medicine of Brigham and Women’s Hospital Boston MA USABruce E. Landon, Harvard Medical School The Department of Health Care Policy Boston MA USAJames A. O’Malley, Harvard Medical School The Department of Health Care Policy Boston MA USATom Keegan, The Division of General Internal Medicine of Brigham and Women’s Hospital Boston MA USAJohn Z. Ayanian, The Division of General Internal Medicine of Brigham and Women’s Hospital Boston MA USALeRoi S. Hicks, The Division of General Internal Medicine of Brigham and Women’s Hospital Boston MA USAfor the Community Health and Academic Medicine Partnership Project Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
Latest articles from Medical Marketing and Media
- PhRMA to DDMAC: Let my people tweet PhRMA revived its push to add an FDA bug linking to risk info in search engine sponsored links and called on FDA to clear the way for "microblogging of newsworthy regulatory events" on drugs and biologics.
- GSK launches surprising cervical cancer ads What began as a sparkly new ad for perfume quickly shifted gears, from trivial to terrifying, once the young female actor glimpsed the perfume bottle's script: cervical cancer.
- AMA to help docs cash in on EHR stimulus dollars Doctors that demonstrate the "meaningful use" of electronic health records (EHR) in their practices are eligible for at least $44,000 over five years, an incentive the American Medical Association is facilitating with a new partnership.
- Smart phones and apps proliferate among docs, surveys say About 80% of all US physicians will be using smart phones by 2012, and not just for drug reference or clinical information. An explosion of new healthcare professional-facing apps - over 1,500 in Apple's app store alone - will expand mobile device usage to include patient care and administrative functions, according to Manhattan Research survey.
- DTC spending stabilized in 2009 amid strong growth for ca... Pharma spending on consumer advertising was largely flat in 2009, rising 1.9% to $4.5 billion over 2008 spend, according to data from The Nielsen Company. That's good news for media companies, suggesting that spending has hit bottom following two years of steep declines.
- Xyzal campaign to give allergies a 'Clean Sweep' Sanofi-Aventis is poised to launch a new Xyzal campaign for allergy season, having recently acquired full commercialization responsibilities on the drug after UCB's exit from US primary care in February.
- Publicis launches Razorfish Health as standalone It's not exactly news that Razorfish has a health practice, but the digital agency, which was acquired by Publicis last year, is making it official with the launch of Razorfish Health, an "independent, dedicated" health and wellness agency.
- Prescriber data law in Maine headed for federal court A federal appeals court will hear oral arguments regarding Maine's prescription data law, which allows physicians to "opt-out" of commercially traded data pertaining to their prescribing habits.
- DDMAC to get upgrade in reorg DDMAC is being upgraded from a division to an office, an FDA official said yesterday.
- Aricept TV spots hype benefits, says DDMAC Eisai got an FDA untitled letter for two Aricept TV ads that the agency said overstate the efficacy of the drug.
WHO news
- 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.
- Equal rights and opportunities for women and girls essent... 8 March -- On the occasion of International Women's Day, WHO encourages joining forces to fix the failures in health systems so that girls and women may enjoy equal access to health information and services.
- 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.
- Accelerating efforts to advance the rights of adolescent ... 3 March 2010 -- WHO along with five other UN agencies, have signed a joint statement enhancing the rights of adolescent girls
- 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.
- WHO mourns passing of Professor Ihsan Dogramaci 26 February -- On 25 February, WHO was saddened by the death of Professor Ihsan Dogramaci, who will be remembered for his tireless efforts and accomplishments in public health care. He was the last living signatory of the WHO Constitution, signed in New York in July 1946.
- 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.
- Statement of the World Health Organization on allegations... 22 January 2010 -- Providing independent advice to Member States is a very important function of the World Health Organization (WHO). We take this work seriously and guard against the influence of any improper interests. The WHO influenza pandemic policies and response have not been improperly influenced by the pharmaceutical industry.
All MayoClinic.com Topics
- Dust mite allergy Dust mite allergy — Comprehensive overview covers symptoms and treatment of allergy to dust mites.
- Female fertility: Why lifestyle choices count Female fertility — Understand what you can do to protect and promote your fertility.
- Pet allergy: What to do for relief Pet allergy — Comprehensive overview covers symptoms and treatment of allergy to animals.
- Thumb arthritis: Self-care measures can ease pain Thumb arthritis — Comprehensive overview covers symptoms, treatment of osteoarthritis in your basal (carpometacarpal) joint.
- Aphasia: Communications disorder can be disabling Aphasia — Comprehensive overview covers causes, treatment, coping skills for this communication disorder.
- Arteriovenous fistula: An abnormal blood vessel connection Arteriovenous fistula — Comprehensive overview covers the causes and treatment of this blood vessel condition.
- Breast-feeding: What every mom needs to know Breast-feeding is a learned art. Here's help understanding the basics.
- Migraines: Are they triggered by weather changes? Can weather changes trigger migraines? Learn more.
- Cystitis: Antibiotics, other treatments can help Cystitis — Comprehensive overview covers symptoms, causes, treatment, prevention of bladder inflammation.
- Dystonia: Movement disorder can be crippling Dystonia — Comprehensive overview covers symptoms, causes, treatment of this painful muscle-contraction disorder.
WebMD Health
- New Diarrhea Danger for Children A severe diarrhea-causing germ once thought to only affect the elderly or seriously ill is now affecting a growing number of healthy children
- Platelet-Rich Plasma Helps Tennis Elbow Platelet-rich plasma -- injections of a patient's own blood platelets -- heals of tennis elbow better than cortisone shots, a study finds.
- CDC: Genital Herpes Rates Still High One in six Americans between the ages of 14 and 49 have genital herpes and close to 1 in 2 black women are infected, new figures from the CDC reveal.
- Good Health Boosts Sexual Life Expectancy Good health may not only help you live longer, it could help you enjoy a longer, more satisfying sex life as well, a study shows.
- Melanoma Cases on the Rise While some researchers suggest the rising rates of melanoma may simply reflect a change in how doctors diagnose melanoma and the increased availability of skin cancer screenings, a leading dermatologist says the increase is real.
- Companies Get Poor Grades for Kids' Food Ads Most companies lack meaningful policies to curb the marketing of high-fat and high-sugar junk food to children, according to a report by a consumer watchdog group.
- Vaccinate Kids to Stop Flu in Community New research confirms that giving flu shots to large numbers of school-age children can protect the community at large.
- Long-Term Health Risks Low for Kidney Donors Kidney donors fare just as well as non-donors over the long term, according to a new study.
- 'Curry' Cream May Fade Wrinkles A moisturizing cream whose active ingredient is the extract that gives Indian curry its distinctive flavor, smel,l and deep orange color may help fade fine facial lines, wrinkles, and aging spots.
- Tumor-Melting Virus vs. Prostate Cancer Reovirus is harmless to normal cells -- but it destroys many kinds of cancer cells. A new study in patients with prostate cancer takes the virus closer to being a new cancer treatment.
CNN.com - Health
- Healthier men want more sex for more years Healthier men, no matter their age, are going to have better sex more frequently and desire it more often than healthier women.
- Minorities' higher Alzheimer's risk Francisca Terrazas and other Latinas are about 1.5 times more likely than Anglos to develop Alzheimer's and other forms of dementia, a new report says. Read how her family copes.
- What can I do for chronic sinusitis? I have been diagnosed with chronic sinusitis. It would seem like every six months or so, I have an episode where I am unable to go to work for about three days because I develop a temperature, swollen lymph nodes, (recently, swollen, inflammed tonsils) headaches and skin flora on my scalp. How is skin flora associated with sinusitis? Will this ever stop?
- Women drinkers less likely to gain Some women avoid drinking calorie-filled cocktails, wine, and beer because they're worried about packing on the pounds. Now, a new study suggests that women who are moderate drinkers actually tend to gain less weight over time than teetotalers.
- 'You just don't look disabled' People come up to Aimee Mullins all the time and say, "you know, I have to tell you, you just don't look disabled."
- Supreme Court takes vaccine appeal Parents who say that a range of preventive vaccines given their young children can cause serious health problems will have their appeal heard by the U.S. Supreme Court.
- 'Speed-dating' doctors woo patients A pioneering Texas program invites prospective patients to casually meet and size up a lot of doctors in a short amount of time.
- Dems: No health bill sked promises Despite a call from the White House for health care legislation to pass this month, key Democrats are avoiding any promises about how soon the next steps may come.
- Thought urged on prostate screening Most men 50 and older should seriously consider the potential risks of treatment before deciding whether to be screened for prostate cancer, the American Cancer Society said Wednesday in revised guidelines.
- Winter sports can trigger asthma Do you cough, wheeze, or get short of breath when you exercise in cold weather? You could have asthma, but you've got plenty of company. Exercise-induced asthma is surprisingly common among people who work out in cold climates, whether they're jogging around the neighborhood or gunning for gold in Vancouver.
MedlinePlus Health News
- Obesity and Colon Cancer Source: HealthDay - Related MedlinePlus Pages: Colorectal Cancer, Obesity
- As You Age, Better Health Means Better Sex Association held true for people well into their 80s, study found Source: HealthDay Related MedlinePlus Pages: Seniors' Health, Sexual Health
- Vaccinating Children against Flu Helps Protect Wider Comm... Source: National Institute of Allergy and Infectious Diseases - Related MedlinePlus Page: Flu
- FDA Approves Botox to Treat Wrist, Finger Spasms U.S. regulators on Tuesday approved the use of Allergan Inc's wrinkle smoother Botox to treat spasms of the elbow, wrist and fingers in adults.Source: Reuters Health Related MedlinePlus Pages: Botox, Muscle Disorders
- Medication Fears Lead to Worse Side Effects It may not be surprising, but a new study offers some proof that patients who are worried about their medications are more likely to have side effects from them.Source: Reuters Health Related MedlinePlus Pages: Medicines, Rheumatoid Arthritis
- Psychotherapy Can Help People with Lupus Cope After 10 sessions, anxiety, depression and stress lessened, researchers say Source: HealthDay Related MedlinePlus Page: Lupus
- Herpes Infects One in Six in U.S. Most don't know they have the disease, CDC says, upping risks for transmitting it to others Source: HealthDay Related MedlinePlus Page: Herpes Simplex
- Kidney Donors Go on to Lead Long, Healthy Lives Study of more than 80,000 who gave one up shows procedure carries few risks Source: HealthDay Related MedlinePlus Pages: Kidney Transplantation, Organ Donation
- Kids Who Get Flu Shots Protect the Unvaccinated Inoculating children can prevent influenza from spreading, experts say Source: HealthDay Related MedlinePlus Pages: Childhood Immunization, Flu
- Most Drug Studies Don't Help Docs Pick Best Treatment The problem? Available meds ignored in favor of drugs in the pipeline, review finds Source: HealthDay Related MedlinePlus Pages: Clinical Trials, Medicines
WSJ.com: Health Blog
- Not ‘War and Peace’ But Orphan-Drug Applications Are Few "It's not 'War and Peace,' " an FDA official said of the process. "The applications are six or seven pages."
- As Health-Care Finale Gets Closer, Both Sides Boost Spending A business coalition backed by the U.S. Chamber of Commerce and other groups will allocate between $4 million and $10 million on anti-bill ads.
- InterMune’s Lung Drug Gets Backing From FDA Panel The FDA is expected to make a final decision on the treatment by early May.
- African-Americans, Hispanics Have Increased Risk of Alzhe... Barriers to access to health care could contribute to underdiagnosis of dementia in minority population.
- Obama Takes Case Against Health Insurers on the Road There could be an underlying conflict with part of the overhaul plan designed to thwart premium increases considered excessive.
- Merck, Sanofi Herd Animal-Health Businesses Into One Corral Animal-care operations are expected to benefit from demand in emerging markets and because of an aging population, which is seen as favorable to pet ownership.
- Soft-Drink Score: Lower Sales in Schools; More Talk About... NYC Mayor Bloomberg said yesterday said that such a state tax proposed in New York just makes sense.
- InterMune Stock Gets Boost as FDA Staff Questions Lung Drug The "tone was less negative than expected,'' an anlayst said about the agency's comments on the drug.
- Abortion Remains High Hurdle in Health-Care Push Democratic leaders are urging party members to avoid making abortion a deal breaker.
- Another Plus Month for Health-Care Jobs That continues the series of monthly job gains that has made health care an economic bright spot.
National Institutes of Health (NIH) News Releases
- Vaccinating Children against Flu Helps Protect Wider Comm... Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 influenza season show that immunizing children against seasonal influenza can significantly protect unvaccinated community members against influenza as well. The study was conducted to determine if immunized children could act as a barrier to limit the spread of influenza to the wider, unvaccinated community, a concept known as herd immunity.
- New Approach to Immune Cell Analysis Seen as First Step t... Investigators have developed a new mathematical approach to analyze molecular data derived from complex mixtures of immune cells. This approach, when combined with well-established techniques, readily identifies changes in small samples of human whole blood, and has the potential to distinguish between health and disease states.
- Food Allergy-Related Disorder Linked to Master Allergy Ge... Scientists have identified a region of a human chromosome that is associated with eosinophilic esophagitis (EoE), a recently recognized allergic disease. People with EoE frequently have difficulty eating or may be allergic to one or more foods. This study further suggests that a suspected so-called master allergy gene may play a role in the development of this rare but debilitating disorder.
- Scientists Find New Form of Prion Disease that Damages Br... National Institutes of Health (NIH) scientists investigating how prion diseases destroy the brain have observed a new form of the disease in mice that does not cause the sponge-like brain deterioration typically seen in prion diseases. Instead, it resembles a form of human Alzheimer's disease, cerebral amyloid angiopathy, that damages brain arteries.
- Statement from Paul A. Sieving, M.D., Ph.D., Director of ... Glaucoma is one of the world's leading causes of vision loss and blindness. Vision organizations around the globe highlight this disease as a research and public health priority during World Glaucoma Week. The National Eye Institute (NEI), part of the National Institutes of Health, takes this opportunity to reaffirm its commitment to supporting research that will identify risk factors for the condition and develop treatments to preserve the sense of sight.
- Leading Toxicologists Highlight Advances to Safeguard Pub... The government's leading toxicologists and environmental health scientists will share their latest scientific accomplishments, offer continuing education courses, discuss funding and training opportunities, receive input on future research priorities, and more, at the Society of Toxicology (SOT) annual meeting. Staff from the National Institute of Environmental Health Sciences (NIEHS), one of the National Institutes of Health, and the National Toxicology Program (NTP) will speak at more than 30 different sessions and present more than 60 posters on topics ranging from improving toxicity testing to translational research.
- Statement of Anthony S. Fauci, M.D. Director, National In... A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone. The study was designed to provide needed evidence for selecting step-up care for such children and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
- Childhood Asthma Treatment: Not One-Size-Fits-All A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone. The study was designed to provide needed evidence for selecting step-up care for such children and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
- Independent Consensus Panel to Release Vaginal Birth Afte... Vaginal birth after cesarean (VBAC) is the delivery of a baby through the vagina after a previous cesarean delivery. For most of the 20th century, clinicians believed that once a woman had undergone a cesarean, all of her future pregnancies required delivery by that procedure as well. In the 1980s, vaginal birth after cesarean (VBAC) also began to be considered a viable option for these women. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising. What accounts for these changing practice patterns?
- Funds Boost Research into Causes, Interventions for Age-R... The Research Partnership in Cognitive Aging, a public-private effort to promote the study of brain function with age, will award up to $28 million over five years to 17 research grants to examine the neural and behavioral profiles of healthy cognitive aging and explore interventions that may prevent, reduce or reverse cognitive decline in older people.
AOL News Collection:health collection
- Here's What the American People Want Seldom has the phrase "the American people want" been repeated as frequently as during the debate over health care reform.Seldom has the phrase "the American people want" been repeated as frequently as during the debate over health care reform.The Pointhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652783/1268233642167.JPEGGetty Images]]>
- Bans, Taxes Seen as Effective Against Junk Food A hefty tax on foods like pizza and soft drinks could be enough to trim five pounds off the average American, a new study suggests.A hefty tax on foods like pizza and soft drinks could be enough to trim five pounds off the average American, a new study suggests.Calorie Controlhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652808/1268243184357.JPEGGetty Images]]>
- Eating Can Be Hazardous to Your Health Four in 10 Americans say they have been sickened in the past two years by something they ate, according to a recent poll.Also: Should Junk Food Be Taxed?Four in 10 Americans say they have been sickened in the past two years by something they ate, according to a recent poll.Also: Should Junk Food Be Taxed?Food Safetyhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652800/1268240504524.JPEGGetty Images]]>
- Limbaugh Vows to Leave US for Health Care Needs If Congress is successful in passing health care reform, the conservative radio host says he will leave the country in protest.If Congress is successful in passing health care reform, the conservative radio host says he will leave the country in protest.http://o.aolcdn.com/photo-hub/news_gallery/6/5/652651/1268158451434.JPEGGetty Images]]>
- Health Reform Hinges on Votes From Abortion Foes To get enough votes for it to pass, top Democrats in the House will need the support of pro-life colleagues like Bart Stupak.Plus: 10 Wrong Reasons to Oppose ReformTo get enough votes for it to pass, top Democrats in the House will need the support of pro-life colleagues like Bart Stupak.Plus: 10 Wrong Reasons to Oppose ReformWill Overhaul Happen?http://o.aolcdn.com/photo-hub/news_gallery/6/5/652720/1268188537445.JPEGAP]]>
- Geriatric Set Getting It On Later in Life Good news for older folks: A new study finds healthy men and women are having more and better quality sex in their golden years.Good news for older folks: A new study finds healthy men and women are having more and better quality sex in their golden years.Still Got Ithttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652756/1268225283166.JPEGGetty Images]]>
- California Considers Condoms on Porn Sets A state board is expected to review a request by AIDS health care advocates that adult-film workers be required to engage in safe-sex practices.A state board is expected to review a request by AIDS health care advocates that adult-film workers be required to engage in safe-sex practices.Safe Sexhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652684/1268172512159.JPEGAFP / Getty Images]]>
- Maternal Death Rates Up, New Study Says Despite a federal goal to reduce maternal deaths, the number of woman who die after childbirth is climbing.Despite a federal goal to reduce maternal deaths, the number of woman who die after childbirth is climbing.Reasons Unclearhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652674/1268168336013.JPEGGetty Images]]>
- Alzheimer's Hits Minorities Especially Hard, Study Finds Deaths from Alzheimer's jumped 46 percent between 2000 and 2006, a new report says. Blacks are twice as likely to suffer from it.Deaths from Alzheimer's jumped 46 percent between 2000 and 2006, a new report says. Blacks are twice as likely to suffer from it.Dementia Researchhttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652638/1268154573200.JPEGAP]]>
- Two of the World's Oldest People Die on Same Day Mary Josephine Ray, 114 years old, and Daisey Bailey, 113 years old, were among the top 10 supercentenarians.Mary Josephine Ray, 114 years old, and Daisey Bailey, 113 years old, were among the top 10 supercentenarians.Long Lifehttp://o.aolcdn.com/photo-hub/news_gallery/6/5/652525/1268081910294.JPEGAP]]>
WashingtonPost Health News
- On health-care reform, Republicans target Democrats' div... As Republicans work to prevent a health-care bill from reaching President Obama, they are scrambling to exploit divisions between Democrats in the House and the Senate.
- 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.
- A few setbacks and changes in routine to lose 10 pounds Me Minus 10 got off to a rocky start two weeks ago: No sooner had I pledged to lose 10 pounds than I got, first, a GI-tract malady and then a wicked head cold (both now resolved). Neither helped me mentally or physically. Nor did learning, upon purchase of a new scale, that I have 12, not 10 poun...
- The Misfits: Swimming pool lanes etiquette Appropriately clad in a Speedo, swim cap and nose plugs, Bob Axelrod told me a story.
- Featured Advertiser
- 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.
- Salmonella prompts processed-food recall Thousands of types of processed foods -- including many varieties of soups, chips, frozen dinners, hot dogs and salad dressings -- may pose a health threat because they contain a flavor enhancer that could be contaminated with salmonella, the Food and Drug Administration said Thursday.
American Medical News
- Mass layoffs at hospitals increased in January There is concern that state budget cuts could make things worse.
- Industry support of CME under scrutiny Federal officials proposed having physicians pay their own way as one solution to eliminate bias. The ACCME said it will continue to monitor the debate.
- HIPAA privacy rules detailed in AMA online guide The resource tool will explain new security regulations and lay out deadlines for compliance.
- Insurer antitrust exemption would end under House bill But the move would not increase competition among health plans, said an insurance industry association, citing nonpartisan research.
- Medicare physician pay cut delayed as Senate clears logjam The 21% reduction will return April 1 unless Congress delays it further. The Senate is considering a bill to make Oct. 1 the new deadline.
- Health plans extend their market dominance "Highly concentrated" insurance markets are found in all but three U.S. metropolitan areas, according to an American Medical Association report.
- Liability reform gets nod in Obama proposal after health ... The president said he was open to expanding liability reform pilots and to three additional GOP ideas raised at the White House meeting.
- Medicare PECOS deadline extended again Doctors now have until the end of the year to ensure that they are current on the Medicare enrollment system and avoid claims denials.
- Hypertension seen as neglected disease More aggressive screening, improved surveillance and less-expensive medications could reduce the number of U.S. adults with the cardiovascular risk factor, an IOM report says.
- H1N1 protection added to next season's flu shots A CDC advisory panel recommends nearly everyone in the U.S. receive the new enhanced vaccine.
FOXNews.com
- N.Y. Chef Makes Cheese From Breast Milk Daniel Angerer is used to getting attention over the food that comes out of his restaurant Klee Brasserie, but the New York chef is making more headlines than ever over a new dish that instead comes out of his fiance's brassiere.
- Day Care Workers Charged With Giving Kids Sleep Supplement Two former Ohio day care workers have been charged with giving children an over-the-counter dietary supplement to make them sleep.
- Panera to Post Calories at Corporate-Owned Stores Panera Bread customers around the country soon will be able to tally calories for their smokehouse turkey panini and broccoli cheddar soup with just a glance at the menu board
- Ky. Woman Unaware of Pregnancy, Delivers Surprise Baby A 32-year-old Kentucky woman who said she didn't know that she was pregnant delivered her newborn son on the floor of her laundry room by herself and even cut the umbilical cord.
- Assisted Suicide Group Preparing for Trial The leader of an assisted suicide group charged with helping a 58-year-old Georgia man with cancer kill himself says he's looking forward to a trial that he hopes will validate the group's work.
- Men Outlive Women Sexually Men have shorter life spans than women on average, but when it comes to sexual life expectancy, the guys have the advantage.
- Stress Changes Who Men Find Attractive When men are under stress, instead of preferring women who resemble themselves as they normally do, they choose dissimilar women, researchers now find.
- Salty, Sweet: Study Says Fat is the Sixth 'Taste' People sensitive to the taste of fat tend to eat less of it and are less likely to be overweight, according to Australian research that found human tongues can detect fatty tastes.
- CDC: U.S. Herpes Rates Remain High About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said on Tuesday.
- Conjoined Twins Growing Too Big for Shared Heart The parents of 3-year-old conjoined twins face a difficult decision because their daughters are growing too big for the heart they share, Sky News reported.
CBC | Health News
- Superbug MRSA on rise in Canada There has been a dramatic increase in the number of cases of Canadians becoming infected or colonized by the superbug MRSA since 1995, both in hospitals and within the community, a study has found.
- TB is 185 times more common among Inuit A national analysis of health data suggests tuberculosis is 185 times more common among Canada's Inuit than it is among others born in Canada.
- N.L. lab head quits after drug error fiasco Dr. Nash Denic has resigned as head of laboratory services at Newfoundland and Labrador's largest health authority after a drug-testing fiasco in which lab officials are accused of reacting to the problem too slowly.
- Virus can attack prostate cancer Researchers in Alberta have successfully tested a new viral approach to treating prostate cancer in a small number of men.
- Eastern Health may discipline lab staff The head of a St. John's-based health authority plagued by a new set of laboratory mistakes says staff may be disciplined for failing to document problems and alert managers
- Flu shots for children protect adults: study Vaccinating children against seasonal flu helps protect others in their community, a new Canadian study suggests.
- B.C. to market health tourism B.C. Health Minister Kevin Falcon says he has a plan to market health-care services to rich, offshore patients similar to the way the province sells higher education to foreign students.
- Avastin fight now moves to P.E.I. A cancer patient who successfully helped lobby the New Brunswick government to fund an expensive cancer drug is now shifting his focus to P.E.I. in an effort to have Avastin funded by that province.
- N.L. health staff slow on drug errors A review of drug testing errors in Newfoundland and Labrador finds that Eastern Health Authority staff didn't react quickly enough when problems administering cyclosporine were first identified.
- Baby could have survived methadone OD: doctor A baby girl's body began to shut down hours after swallowing a lethal dose of methadone in her Calgary home, a manslaughter trial has heard.
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
- Sick ships: Cruises see rise in norovirus cases More than 400 passengers were sickened by the norovirus on a Celebrity Cruise lines ship in mid-February. That outbreak of gastrointestinal illness is one of eight to hit cruise ships in 2010 — with four in just one week, according to the CDC.
- Tainted ingredient sold after salmonella found The company responsible for a ballooning recall of processed foods continued to manufacture and distribute a flavor-enhancing ingredient for a month after tests confirmed it was made with contaminated equipment, according to a Food and Drug Administration report.
- When the real world looks like “Wonderland” Like Alice down the rabbit hole, Olivia Watts sometimes sees people who look as if they have magnified heads or distorted bodies. The 6-year-old has a neurological condition known as “Alice in Wonderland” syndrome.
- Men have longer sex life expectancy, study says Men are more likely than women to be interested in sex, have sex and enjoy sex, according to new scientific research, which also found people who stay active and healthy enjoy longer sex lives.
- NYT: Flu shots in kids provide ‘herd immunity’ Although previous studies have demonstrated what scientists call “herd immunity,” none have been so incontrovertible as a study of farming colonies in Canada.
- Baby slings to get safety warning after deaths The U.S. government is preparing a safety warning about baby slings — those popular and fashionable infant carriers that parents can sling around their chests to carry their baby.
- Minority babies set to become majority in 2010 Demographers say this year could be the "tipping point" when the number of babies born to minorities outnumbers that of babies born to whites.
- Will economic recovery lead to poor health habits? A cyclical turn, from recession to growth, would make some Americans more inclined to unhealthy behaviors. Msnbc.com fact-checks this claim — and more.
- Britain may force owners to microchip dogs British dog owners may be forced to microchip their pets and take out insurance, part of a proposed crackdown on the country's dangerous canines.
- ‘Drugged driving’ a growing threat, official says Motorists under the influence of drugs are a growing threat on U.S. roads, while the number who drink and drive has fallen thanks to education and law enforcement, a top U.S. drug control official said on Tuesday.
WSJ.com: Health
- Push to Cure Rare Diseases FDA staff members are doing something unusual. They are leaving Washington to help drug makers take a crucial step in developing drugs for rare diseases.
- 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.
- Sanofi, Merck to Revive Venture The drug companies said they plan to re-form a joint venture that would be the world's largest seller of animal medications, motivated in part by growing demand for livestock and meat in emerging markets.
- When Anger Is Illness Anger-management programs have become antidotes for road raging, office freak-outs and fury-induced vandalism. What's not clear is if they work.
- Cosmetic Surgery Fell in '09 There were 10 million surgical and nonsurgical procedures last year, down 2.4% from 2008, according to a survey.
- When Disease Can't Be Diagnosed Researchers say the lack of a diagnosis affects far more people than was previously thought. One mother's quest to find a diagnosis for her son illustrates the challenges facing many families.
- New Ovarian-Cancer Test A new test will help doctors distinguish between ovarian cancer and benign growths prior to surgery, allowing patients with cancerous masses to get more effective treatment faster.
- New Risk in Pain-Reliever Use Regular use of pain-relief medicine appears to increase men's risk of hearing loss, especially among middle-aged men, according to an American Journal of Medicine study.
- High Court Weighs Funeral Protests The Supreme Court agreed to decide whether the father of a fallen Marine can collect damages from a religious sect that picketed his son's funeral and whether vaccine makers are immune from lawsuits under state law.
- Soft-Drink Sales Drop in Schools The American Beverage Association plans to report that sales of soda and other drinks in U.S. secondary schools have dropped sharply since 2004, a sign that efforts to improve nutrition in schools are progressing.
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
- 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.
- $295,000 In Medical School Debt... Why do medical schools... Rob Centor: "Why do medical schools charge students so much money? It was not this way when I went to medical school. I paid an average of $1000 per year in the early 1970s. Using an inflation calculator, that would become around $5000 per year in current dollars. Yet that same school and most state schools charge 3 times that much."References:http://www.huffingtonpost.com/2010/02/23/295000-in-medical-school_n_473601.html http://www.medrants.com/archives/5327Image source: OpenClipArt.org, public domain. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Video: "Help Your Heart With the Mediterranean Diet" Help Your Heart With the Mediterranean Diet from ChefMD. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- The 2010 Annual Perioperative Medicine Summit Starts Today The annual Perioperative Medicine Summit 2010 starts on March 4 in Miami:http://periopmedicine.org and @PeriopSummitI maintain their website for the University of Miami and Cleveland Clinic, and help with the Twitter account, hosting of PDF handouts, videos, etc.Dr. Jaffer, Chief of Division of Hospital Medicine and Summit Director will text his own tweets at http://twitter.com/PeriopSummitExpect multiple free handouts posted on the front page of the summit website during March 4-6, 2010 and clinical pearls and discussions on Twitter: http://periopmedicine.org and @PeriopSummitProgram and Abstracts of the 5th Annual Perioperative Medicine Summit 2010Summit BrochureSummaryDr. Amir K. Jaffer and Dr. Franklin Michota, the founding Summit Directors, in collaboration with Dr. David Hepner, will direct the 5th Annual Perioperative Medicine Summit in Miami, Florida.The course is co-sponsored by the University of Miami Miller School of Medicine and the Cleveland Clinic in collaboration with the Society for Perioperative Assessment and Quality Improvement (SPAQI).The goal of the Summit is to enable clinicians who are actively engaged in perioperative medical care to incorporate the latest findings from clinical research into their practices so that they can improve the quality and safety of their medical care.Map of the Meeting LocationView Larger MapMap of Eden Roc Resort Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Green tea may be a cancer fighter - Cleveland Clinic video A new study finds the tea shows promise as a possible oral cancer fighter. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
- Cigarette smokers have lower IQs than non-smokers, and th... From Reuters:Young men who smoked a pack of cigarettes a day or more had IQ scores 7.5 points lower than non-smokers in a study of over 20,000 Israeli military recruits."Adolescents with poorer IQ scores might be targeted for programs designed to prevent smoking," concluded the researchers in the journal Addiction.The average IQ for non-smokers was 101, while it was 94 for men who had started smoking before entering the military. IQ steadily dropped as the number of cigarettes smoked increased, from 98 for people who smoked one to five cigarettes daily to 90 for those who smoked more than a pack a day. IQ scores from 84 to 116 are considered to indicate average intelligence.The study may suggest that lower IQ individuals are more likely to choose to smoke, rather than that smoking makes people less intelligent.References:http://www.reuters.com/article/idUSTRE61M3UQ20100223Comments from Google Buzz:Dr Mike Cadogan - By definition non-smokers smarter than smokers...Ben Ferguson - That's a weird conclusion to come to, in my opinion. They associated essentially pack-years with intelligence, which would seem to indicate a dosage effect, but then the suggestions were that they had lower IQs to begin with? It's a bit of a non sequitur. That there's a dosage effect would suggest that most of them had equal IQs before starting smoking; to conclude that they started smoking as a result of having lower intelligence to begin with has nothing to do with their aims and even undermines their findings.Lakshman Swamy - Smoking is an addiction, and the smoking population is marginalized as it is. Obviously smoking is terrible for you... but let us not forget that smokers need healthcare and health advice more than most. I worry that this will further a "judging" attitude on the part of physicians.Arin Basu - There is a problem in reducing entities like intelligence to single numbers like IQ scores (this is an offhand comment, I have not read /this/ particular article), but talking of programme targetting on the basis of studies that go to suggest "if you have low IQ then you smoke", in other words, implicitly accepting low IQ as /cause/ of smoking is dangerous. Well spotted though.Image source: Wikipedia, Tomasz Sienicki, Creative Commons Attribution ShareAlike 2.0 License. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook.
Medgadget
- WebMD Embracing Social Networking With "Health Exchanges" WebMD Health Corp. finally bought into the hype of social networking and has integrated its own community platform into WebMD.com. WebMD Health Exchange allows consumers to connect to others that have similar conditions and health concerns, and to discuss these matters with the help of a physician moderator that can keep the service from becoming a medical rumourville. From the announcement: WebMD Health Exchange is being integrated throughout each of the core content areas of WebMD.com, giving members the ability to safely and easily connect with others on topics that are most relevant to them. In addition to expert-led communities, members are empowered to create their own communities and to exchange information with other users. Communities can be created for public access- which are searchable on WebMD and the Internet, or members can create their own private communities to securely exchange information with friends and family by invitation. Expert Health Exchange communities will take advantage of the knowledge and credibility of leading specialists from renowned health and medical organizations and patient advocacy groups. Physicians from Duke Medicine will provide expertise for communities ranging from asthma to rheumatoid arthritis. Experts from the National Health Council, National Osteoporosis Foundation, American Gastroenterological Association, North American Menopause Society, and the American Veterinary Medical Association will lead related community discussions, as will Dr. Pamela Peeke on diet, Dr. David Colbert on skin and beauty, Dr. Robert Harrington on heart disease, Dr. Susan Evans on skin problems and treatments and bestselling author Richard M. Cohen on living with health issues. The WebMD Health Exchange will also enable third party sponsors to create branded exchanges and to host consumer discussions on specific health and wellness topics most important to them. Link: WebMD Health Exchange Press release: WebMD Announces New Health Social Networking Platform on WebMD.com ......
- Now Available: Stem Cell Therapeutics in US Without FDA A... Stem cell therapies are still a long way from receiving FDA approval in the US, but it turns out there is at least one group of doctors that's actually offering it right now. Regenerative Sciences in Broomfield, Colorado makes available the Regenexx procedure, a bone and cartilage regeneration technology, as an alternative to orthopedic surgery or a life time dependence to NSAIDs. Because Regenerative Sciences operates exclusively within Colorado, the company believes that Federal laws do not apply to it. This is probably more a study of the commerce clause of the Constitution rather than regenerative medicine, but we're at least glad to see docs taking initiative and testing out the limits of their ability to treat people. More from the Singularity Hub: Doctors Skirt FDA To Provide Human Stem Cell Therapy... Link: Regenexx......
- Third Eye Retroscope Gives Docs a Better View of The Colon The Third Eye Retroscope from Avantis Medical Systems (Sunnyvale, CA) is getting some good reviews in two studies just published in Gastrointestinal Endoscopy. The device works in conjunction with a standard colonoscope to look behind, kind of like a rear view mirror in a car. And as designed, this device is proving valuable in spotting polyps that would otherwise have gone unnoticed. From an Avantis Medical press release: The first study was led by Dr. Jerome D. Waye, Clinical Professor of Medicine at Mount Sinai School of Medicine, New York, NY. Titled “A Retrograde-Viewing Device Improves Detection of Adenomas in the Colon: A Prospective Efficacy Evaluation,” the study involved 14 investigators and 249 patients at 8 medical centers in the U.S.1 The investigators found that the Third Eye improved detection and removal of polyps by 13.2% compared to the colonoscope alone. For adenomas, the polyps that are most likely to become cancers over time, the additional detection rate with the Third Eye was 11.0% for lesions of all sizes. For medium-size adenomas (at least 6 mm in diameter), the additional detection rate with the Third Eye was 25.0%, and for large adenomas (at least 10 mm), they found 33.3% more with the Third Eye. Thus, the Third Eye not only allowed for identification of more polyps, but its greatest yield was in the detection of larger adenomas, which are further along in the progression to cancer. The second study was led by Dr. Daniel C. DeMarco, Director of Endoscopy at Baylor University Medical Center, Dallas, TX. Titled “Impact of Experience with a Retrograde-Viewing Device on Adenoma Detection Rates and Withdrawal Times during Colonoscopy: the Third Eye Retroscope Study Group,” the study involved 298 patients at 9 U.S. sites, and was conducted by 17 investigators who had not previously used the device.2 Overall, beginning with the very first time they used the device, the Third Eye allowed the investigators to find 16.0% more adenomas in addition to those they were able to find with the colonoscope alone. However, after each investigator had gained some experience with the device by performing 15 procedures, their average additional adenoma detection rate with the Third Eye compared to the colonoscope alone was 25.0%. Again considering their overall results from start to finish, the endoscopists found a higher proportion of larger pre-cancerous adenomas that were hidden from the colonoscope by folds, including 24.3% more adenomas at...
- At-Home Robot Supposedly Helps Elderly Keep Tabs on Life Next week at the Intercompany Long Term Care Insurance Conference (ILTCI) in New Orleans, Robosoft a company out of Bidart, France, will unveil a new robot that can assist the elderly and dependent in their own home. Although the video below spotlights some impressive capabilities, the robot has no hands to bring you a cup of water and is essentially a Dell laptop on wheels. From Robosoft's press release: Kompaï is intended to help dependent persons in their daily lives. It is a mobile and communicative product. Somewhat like a dog, it has its "basket", which is the recharging dock that it heads back to when its batteries are low. Equipped with speech, it is able to understand simple orders and give a certain level of response. It knows its position within the house, how to get from one point to another on demand or on its own initiative, and it remains permanently connected to the internet and all its associated services. Its primary means of communication with people is speech, with an additional touch screen that features simple icons. Future generations of Kompaï will be equipped with visual abilities, and also the possibility to understand and express emotions. And later, the addition of arms will allow it to handle objects, leading to meal preparation and tidying; more practical functions, yet still fundamental in everyday life. Press release: Robosoft introduces Kompaï......
- Continuous Left Atrial Pressure Monitoring Helps With Man... St. Jude Medical is touting results of a recently published study that analyzed the clinical benefits of frequent and regular left atrial pressure (LAP) monitoring in patients with heart failure. In the study, patients wore a special device, called HeartPOD, that monitored their LAP and routed the data wirelessly to their cardiologist. The physician, in turn, was able to adjust the prescription drug dosage taken by the patient on a daily basis. The results show that this leads to better overall outcomes for patients and a greater understanding of the condition for the physicians involved. The above picture was given to us by St. Jude Medical. And we think it has a clue as to the future of this technology. Imagine this kind of monitoring shows more and more positive outcomes in the future clinical studies, and it wins all needed regulatory approvals. One day we might be seeing these pressure monitoring sensors embedded into the electrodes of AICDs and pacemakers. Wouldn't that be neat? Results from this study demonstrated that regular monitoring of LAP in combination with a dynamically adjusted prescription plan can be used to drive appropriate adjustment of HF treatments, and as a result, improved LAP control and reduction of HF events that may result in hospitalization or death. Following implantation of an LAP sensor, all subjects in the study were free of major adverse cardiac and neurological events at six weeks, meeting the trial's primary endpoint. Over a median follow-up of 25 months, LAP control was achieved for at least six consecutive months in 76 percent of patients, with a 67 percent reduction in the frequency of elevated LAP readings (over 25 mmHg). Throughout this same period, there was a significant 84 percent average decrease in HF events including HF hospitalization and all-cause mortality once LAP-guided therapy was initiated. Over the course of treatment, patients also had significant improvements in HF symptoms and quality of life. The report outlined results of the first 40 patients enrolled in the trial; 20 patients enrolled in three Australian or New Zealand sites and 20 patients enrolled in four U.S. sites. The early results of the HOMEOSTASIS trial led to the establishment of the LAPTOP-HF (Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy) Study, a larger pivotal, randomized, controlled, prospective, multi-center clinical investigation. The LAPTOP-HF study will be conducted under a U.S. Food and Drug Administration (FDA) Investigational...
- Clinical Voice Recognition on Your iPhone Thanks to Drago... Nuance Communications (Burlington, MA), makers of the popular Dragon Naturally Speaking voice recognition software, have unveiled new smart phone apps specifically developed for clinical professionals. The Dragon Medical Mobile package provides transcription, medical voice search, and voice recording capabilities. There's also a software development kit (SDK) available to allow other firms to integrate Dragon Medical voice recognition ability into their own applications. By utilizing Nuance's advanced, cloud-based Dragon Medical speech recognition technology, clinicians can dictate and capture information via a smartphone in real-time without having to return to the desktop or rely on the keyboard or touch screen. With Dragon Medical Mobile Dictation, all of the speech recognition is performed in the cloud using advanced real-time streaming capabilities. Utilizing the same cloud-based speech recognition technology as the Dragon Medical Mobile Dictation app, the Search app will allow clinicians to simply speak a request to conduct fast and easy searches on various medical websites. A unique display carousel will show search results simultaneously from popular websites, including MedScape, MedLine, Epocrates and Google. Once recorded, the clinicians' voice file is forwarded through Nuance's background speech recognition technology and onto transcription where a high quality draft document is created and then is sent back to the clinician for review and sign-off. The Dragon Medical Recorder app is designed for healthcare organizations that leverage either of Nuance's enterprise-wide speech-enabled dictation and transcription solutions, eScription or the Dictaphone Enterprise Speech System. Press release: Nuance Extends Power and Experience of Mobile, Voice-Enabled Documentation and Search to the Healthcare Industry; Unveils Dragon Medical Mobile Apps for Smartphones ... Product page: Dragon Medical Mobile Technologies for Smartphones ......
- COR Analyzer for Automatic Identification of Coronary Ste... Rcadia Medical Imaging out of Haifa, Israel won European approval for the COR Analyzer software for identifying coronary artery stenosis from coronary CT angiography (cCTA) data. The app runs on standard PCs and will automatically process CT angiogram studies sent to it over the hospital network. The application then replies whether it identified a stenotic legion, pointing out to radiologists or cardiologists the area of concern. Here's the application workflow and features of the COR Analyzer: Isolate the heart region within a study Find major anatomical structures Locate the coronary artery tree and track the arteries Label coronary artery segments Segment the blood vessel internals and draw an accurate center line Detect severe stenotic lesions Findings can be easily verified and validated using simple visualization tools including standard 2-D projections, schematic 3-D and curved MPR views. The system automatically generates a report which includes a summary of findings and curved MPR snapshots. It can be easily edited by the physician to produce the final report. The automatically generated curved MPR images with marked detected lesions can be exported to any PACS/Workstation either manually or automatically upon completion of processing. These images will appear as secondary capture series for the corresponding study. Main features Detects of significant coronary lesions Displays 3D coronary tree & curved MPRs Generates patient findings' reports Exports to PACS and workstation Runs on any 64-slice or higher CTA scanner Product page: COR Analyzer System ... Press release: Rcadia Medical Imaging's COR Analyzer(R) System Receives CE Mark ... (hat tip: MassDevice)...
- Technique Allows Scientists to Peer Through Opaque Materials Researchers at the City of Paris Industrial Physics and Chemistry Higher Educational Institution (ESPCI) have shown that opaque substances can actually be viewed through, and can be made to perform like optical lenses, using laser light and a bit of mathematics. The technology may allow viewing of cells and other biological components through tissue that would otherwise shield them. In order to demonstrate their approach to characterize opaque substances, the researchers first passed light through a layer of zinc oxide, which is a common component of white paints. By studying the way the light beam changed as it encountered the material, they were able to produce a numerical model called a transmission matrix, which included over 65,000 numbers describing the way that the zinc oxide layer affected light. They could then use the matrix to tailor a beam of light specifically to pass through the layer and focus on the other side. Alternatively, they could measure light emerging from the opaque material, and use the matrix to assemble of an image of an object behind it. In effect, the experiment shows that an opaque material could serve as a high quality optical element comparable to a conventional lens, once a sufficiently detailed transmission matrix is constructed. Abstract in Physical Review Letters: Measuring the Transmission Matrix in Optics: An Approach to the Study and Control of Light Propagation in Disordered Media Viewpoint in APS Physics: The information age in optics: Measuring the transmission matrix More: Physicsists find a way to see through paint, paper, and other opaque materials ......
- VERATHERM Hyperthermic Perfusion System Gets FDA Green Light ThermalTherapeuticSystems of Pittsburgh, Pennsylvania received FDA regulatory approval to market the VERATHERM Portable Hyperthermic Perfusion System in the US. The portable device provides cardiac perfusionists with the ability to regulate and monitor the temperature, pressure and flow of sterile fluids, such as cardioplegia. Features from the product page: Overall Console Dimensions: 12" x 19" x 14.7" [HxWxD] Weight: 26.4 pounds Computer: Touch screen controls, stores and manages procedure data Propulsion: 250-4000mL/min flow range Temperature Source: Direct thermoelectric Temperature Set-point: Warms fluid to maximum settable 43°C regardless of liquid or base temperature Temperature Monitoring: Built-in direct temperature monitoring In-line Pressure Monitoring: Built-in direct pressure monitoring Disposable: Proprietary design with integrated temperature and pressure sensors efficiently delivers sterile fluids Features: Disposable pressure and temperature sensors are built into the device; telescoping IV pole (37.5" extended height) Use and Location: Portable and fully functional wherever 115 VAC, 50/60Hz, 15 Amp power is available Storage: Shelf, storage closet or table-top Disinfection: Fluid is contained within the disposable set, so that there is no direct console contact with any fluid. This allows for quick and easy disinfection of the console. Press release: ThermalTherapeutic Systems Announces FDA Clearance of the VERATHERM(TM) Portable Hyperthermic Perfusion System ... Product page: VERATHERM Portable Hyperthermic Perfusion System ... (hat tip: MassDevice)...
- sterEOS 2D|3D Workstation Images Spines With Significant ... Biospace Med, maker of X-ray imaging systems out of Paris, France, just received FDA approval to use the firm's sterEOS 2D|3D workstation on pediatric patients to image the spine. The company claims that the system provides imagery competitive to that of CT scanners, but with only .1% of the radiation dose. Patients remain standing while the system simultaneously takes an X-ray from the front and laterally, after which a computer reconstructs the two frames into a three dimensional representation of the spine. This allows for quick imaging of patients in a weight bearing position while significantly reducing their radiation exposure compared with CT. From the press announcement: “FDA clearance for sterEOS pediatric use in spine will have a significant impact on demand for EOS as it will allow for the first time to visualize in 3D the spine deformations in the standing, weigh bearing position and retrieve fundamental clinical parameters for surgical planning. This is all done at a drastically reduced radiation exposure, and enables to repeat exams for a better follow up from childhood to adulthood,” said Peter Newton, M.D., Rady Children’s Hospital, San Diego, Ca. “Reduction of radiation exposure is especially important for children and adolescents who have scoliosis or other types of musculoskeletal disorders that are being followed on a frequent basis and therefore need to have regular x-rays over a long period of time to watch the progression of their condition and treatment. A technology that can reduce radiation exposure up to 10 times compared to a conventional x-ray and up to 100 or more times compared to a CT scan is a major breakthrough for orthopedic imaging, especially for the pediatric population.” Press release: FDA clears Biospace med's sterEOS 2D|3D workstation for pediatric use in spine... Biospace Med homepage... (hat tip: MassDevice)...
The Health Care Blog
- Stressed Out System By ROB LAMBERTS I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this....
- Hospital Quality Group Obscures Hospital Quality Reports,... By MICHAEL MILLENSON The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem. “The organization that...
- What Happens Next in MA? By PAUL LEVY What happens next in Massachusetts with insurance reimbursement rates now that many of the facts and figures have been made public? Here's what I see. The dominant parties in the state on whose watch the disparities in...
- Policy for Equal Access Care: You Make It Possible At New York-Presbyterian Hospital, we’re building technology and influencing policy that will shape the future of health care delivery. Visionary executive leaders are driving momentum in the movement toward a connected health information technology environment—the next frontier in modern medicine....
- What Good are Health Insurers? By BILL KRAMER As the health reform effort moves into the final stages, everyone seems to be taking a whack at health insurers. Some of the insurers’ wounds are self-inflicted, such as WellPoint’s announcement of 39% premium increase for individual...
- Community Wars? WebMD launches Health Exchange By Matthew Holt Just when we thought things were calming down in the world of Health 2.0, it’s kicking off. WebMD has been watching Everyday Health take over its spot as top Health site ranking in the ComScore rankings (cue...
- The 2010 DiabetesMine Challenge By Amy Tenderich We have just opened the 2010 DiabetesMine Design Challenge. This year, we’ll be selecting THREE Grand Prize winners to EACH receive $7,000 in cash and a support package to help winners realize and commercialize their design ideas....
- Octopus and other Fishes By Matthew Holt One of the most fun times at HIMSS last week was the MEDecision party at the Georgia aquarium. I took a few videos of the Fish and the humans—so something a little different for you all The...
- Health 2.0 Europe--Webinar on Wednesday This Wednesday, March 10th at 4:30 CET / 7:30AM PST our FREE hour long webinar series will be highlighting the upcoming Health 2.0 Europe conference with our Parisian partner, Denise Silber of Basil Strategies. Joining in the discussion and presenting...
- Why Rush Vendor Certification of EHR Technologies? By David C. Kibbe and Brian Klepper A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they've fallen off Democrats' broader health reforms. David Blumenthal and his staff have...
KevinMD.com
- Help doctors to best care for their patients by Alex Lickerman, MD Part four of a series. See also parts one, two, and three. When dealing with your doctor’s biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- DVDs don’t help infants learn language Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer Infants don’t learn a great deal from language-acquisition DVDs, and may in fact be hindered from learning vocabulary, researchers have found. Tots who watched such DVDs over a six-week period didn’t have better language knowledge scores than youngsters who didn’t watch, and those who first [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Robotic surgery is driven by patient demand Robotic surgery, which mostly used for prostate surgery, is one of the newer trends that hospitals are embracing. But are the costs, which can reach into the millions of dollars, worth the expense? That’s a question discussed in a recent New York Times piece. There’s no question that robotic surgery costs more — almost $2,000 more [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Primary care needs to be valued first before it can be saved by Toni Brayer, MD I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen. One insurer even told him (the [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Aggressive behavior in children and the family dynamic by Claudia M. Gold, MD In the Tony award winning play God of Carnage two couples meet in an elegant living room for an ostensibly civilized conversation about the aggressive act of one couple’s child against the other’s. The meeting soon degenerates to reveal the underbelly of conflict in the two marriages. Husband and wife hurl [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Vaccine safety still concerns parents Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer Even though 90% of parents believe vaccines protect their children against disease, many are also concerned about potential adverse effects, a new survey found. More than half of survey respondents said they were concerned about vaccine safety profiles, particularly for newer immunizations, Gary L. Freed, [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Electronic medical records need to better focus on patients The biggest problem with today’s push for electronic medical records is an archaic user interface. Physician Alexander Friedman, writing a scathing essay in The Wall Street Journal, agrees. Today’s electronic medical records are written for the benefit of insurance companies, which scrutinize each doctor’s note carefully for billing purposes. But, as Dr. Friedman astutely points out, [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Helping organ donation with donor advocate teams by John Schumann, MD One of the joys of practicing at an academic center is that I get to do many different things in my job. The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice. Two months a year, I take my turn rotating on the [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Smartphones and the future of wireless medicine Eric Topol discusses the future of smartphones in health care and wireless medicine in this TEDMED 2009 lecture. Is a new strategy needed in the war against cancer? How did David Blaine break the world record for holding his breath? Can we grow organs instead of transplanting them? An innovative way to help ALS patients Surgery’s pre-painkiller, pre-antiseptic past and [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
- Why physicians are working fewer hours Originally published in MedPage Today by Michael Smith, MedPage Today North American Correspondent Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed. After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of [...]Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
Canadian Medicine
- 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
- IN THE NEWS: Is fee-for-service billing outdated? Is fee-for-service billing outdated?In a new "Mythbusters" entry, the Canadian Health Services Research Foundation dismisses the notion that most Canadian doctors prefer to be paid fee-for-service. The foundation's analysis points to blended models of remuneration -- incorporating salaried work, capitation and some fee-for-service payments -- as the future of physicians' income. [CHSRF]Patients get email adviceThe Canadian Medical Association typically gives advice to its members: doctors. But it's branched out a bit with a new project to give guidance to patients on how best to communicate with their doctors via email. Among the pieces of advice are: keep it short, be clear, don't send attachments without permission, and "do not discuss more than one subject per email." [CMA Email Guidelines for Patients] [CMA News] Get Canadian Medicine news by email or in an RSS reader
Latest Activity on DoctorsHangout.com
- nitinkansal joined Doctors Hangout Team's group nitinkansal joined Doctors Hangout Team's group OrthopediciansA group for Orthopedicians from all corners of the World. Share your clinical cases and knowledge here.
- APRAJITA VERMA and Capt (Dr) Bipin are now friends APRAJITA VERMA and Capt (Dr) Bipin are now friends
- nitinkansal is now friends with Aditya Shah and Jogi nitinkansal is now friends with Aditya Shah and Jogi
- Dr.Chakrapani and அடிவைர் are now friends Dr.Chakrapani and அடிவைர் are now friends
- kartik and poonam maurya are now friends kartik and poonam maurya are now friends
- Diptarko Roy Ghatak joined Basmah's group Diptarko Roy Ghatak joined Basmah's group Books Loversthis group is for meds who love to read
- KINSHUK left a comment for Vamseedhar Tiruttani KINSHUK left a comment for Vamseedhar Tiruttani
- KINSHUK left a comment for Dr.Yamini Reddy KINSHUK left a comment for Dr.Yamini Reddy
- hemalatha s. and Dr. Harsh are now friends hemalatha s. and Dr. Harsh are now friends
- KINSHUK left a comment for poonam maurya KINSHUK left a comment for poonam maurya
DoctorWorld.NET: Upcoming stories
- Health secretary piles pressure on insurers WASHINGTON (Reuters) - U.S. Health Secretary Kathleen Sebelius ratcheted up the pressure on health insurance companies on Wednesday, urging them to forgo short-term profits and stop fighting President Barack Obama's health reform plans. Read more... | Original Medical News | Votes so far: 1 / 0
- Guideline Pharmacotherapy Curbs Cardiovascular Deaths When pharmacotherapy for cardiovascular disease meets national guidelines, patients have significantly lower mortality, researchers report. Reuters Health Information Read more... | Original Medical News | Votes so far: 1 / 0
- Home Abortion Drug Use Effective, Safe for Most Medication-induced home abortions are safe for women who are 50 to 63 days pregnant, a new study from Sweden shows. Reuters Health Information Read more... | Original Medical News | Votes so far: 1 / 0
- Circumcision May Not Cut HIV Spread Among Gay Men in the ... Although studies in Africa have shown that circumcision can lower the spread of HIV among heterosexuals, it may not do much to prevent infections among gay and bisexual men in Western countries, a new study suggests. Reuters Health Information Read more... | Original Medical News | Votes so far: 1 / 0
- Health Tip: What's Behind Childhood Obesity (HealthDay) HealthDay - (HealthDay News) -- Obesity is a major problem in the United States, and children are no exception. Today's kids are spending more hours watching TV, sitting at the computer or playing video games, and less time being active. Read more... | Original Medical News | Votes so far: 1 / 0
- Jump in Kids' Sports Injuries Due to Overuse (HealthDay) HealthDay - WEDNESDAY, March 10 (HealthDay News) -- Orthopedic surgeons warn that sports injuries in children are rising dramatically, creating a "silent epidemic." Read more... | Original Medical News | Votes so far: 1 / 0
- Youth Baseball Injuries Becoming More Common (HealthDay) HealthDay - WEDNESDAY, March 10 (HealthDay News) -- In the coming weeks, millions of American children will dust off their bats and gloves and head out to the baseball field. Read more... | Original Medical News | Votes so far: 1 / 0
- Clinical Trials Update: March 10, 2010 (HealthDay) HealthDay - (HealthDay News) -- Here are the latest clinical trials, courtesy of ClinicalConnection.com: Read more... | Original Medical News | Votes so far: 1 / 0
- Few US Studies Compare One Drug to Another: Report Comparing medical treatments to find the best and the cheapest may be a pillar of U.S. healthcare reform efforts, but very little such research is being done, according to a report published on Tuesday. Reuters Health Information Read more... | Original Medical News | Votes so far: 1 / 0
- End of Life/Palliative Care Some tips for providers on how to be sensitive to the cultural and religious beliefs of their patients when counseling them on end of life care Quality Interactions®: A Patient-Based Approach to Cross-Cultural Care Read more... | Original Medical News | Votes so far: 1 / 0
GruntDoc
- Are most emergency room visits really unnecessary? – By... Much of the ongoing health care reform debate has focused on unnecessary health care expenses—specifically, medical bills that rack up without demonstrably improving peoples' health. According to Peter Orszag, the director of the federal Office of Management and Budget, about $700 billion, or 5 percent of the U.S. gross domestic product, is wasted on unnecessary [...] Related posts:Dying man robbed in ER waiting room – More health news- msnbc.com Dying man robbed in ER waiting room – More health... Sam Ko’s Emergency Medicine Blog: Ten Emergency Medicine Websites I Love and Will Marry Sam Ko’s Emergency Medicine Blog: Ten Emergency Medicine Websites I... Emergency Medicine Bloggers | Life in the Fast Lane Prompted by a series of tweets and buzzes pertaining to... Related posts brought to you by Yet Another Related Posts Plugin.
- 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.
- edwinleap.com | Cataract surgery for me! I’m having cataract surgery in the morning, so I covet your prayers for a successful procedure. I guess it’s what happens when one’s beard begins to turn the color of a hillside with light snow. via edwinleap.com | Cataract surgery for me!. Best of luck to Dr. Leap (and moreso to his surgeon). Prayers for one of the [...] Related posts:edwinleap.com | When you die, doctor… This is a sample section from a new book I’m... edwinleap.com | Grand Rounds is up! Welcome to Grand Rounds for February 9th. How are you?... Snow Removal Tips – How to Shovel Snow – Popular Mechanics Snow Removal Tips – How to Shovel Snow – Popular... Related posts brought to you by Yet Another Related Posts Plugin.
- AP News: Patients try to keep appointments with jailed doc COVINGTON, Ky. (AP) – Patients of a northern Kentucky psychiatrist jailed on a charge he stabbed a woman with a sword have tried to keep appointments with him in jail. Kenton County jail Chief Deputy Scott Colvin said deputies have had to turn away several patients of Douglas Rank, charged last month with first-degree assault [...] Related posts:Dr. Wes: An Open Letter To Patients Regarding Health Reform Dr. Wes: An Open Letter To Patients Regarding Health Reform... Weirdest prescription? From an old HS buddy (also a Navy Man) now... China’s ultimatum: smoke or be fined | Weird True Freaky | News.com.au China’s ultimatum: smoke or be fined | Weird True Freaky... Related posts brought to you by Yet Another Related Posts Plugin.
- Better Health broadcasting from HIMSS Better Health (Dr Val’s organization, of which I am a small idler wheel) is at HIMSS10, doing interviews. It’s entertaining, you can ask questions of the interviewees through the chat stream, so it’s interactive. Broadcasting here: USTREAM. Related posts:Better Health Coverage of HIMSS Starts Today HIMSS10, one of the world's premier conferences on medical information... Homoeopathy sceptics plan mass [...] Related posts:Better Health Coverage of HIMSS Starts Today HIMSS10, one of the world's premier conferences on medical information... Homoeopathy sceptics plan mass ‘overdose’ – Health News, Health & Families – The Independent First, don’t do this: In what is being billed as... Health Care Law Blog: AHLA Connections: Legal Implications of Health Care Social Media The current issue of the American Health Lawyers Association's Connections... Related posts brought to you by Yet Another Related Posts Plugin.
- Doctor Anonymous Greetings from Atlanta, Georgia which is about 800 miles from Doctor Anonymous World Headquarters in Northeastern Ohio. What am I doing here? Well, I'm attending my first HIMMS conference (which stands for the Healthcare Information and Management Systems) annual meeting. These are the 37 best posts that the medical blogosphere has to offer this week. In [...] Related posts:edwinleap.com | Grand Rounds is up! Welcome to Grand Rounds for February 9th. How are you?... Grand Rounds Vol 6, No. 19 | A Groundhog’s Perspective on Med Blogs | More iPad Grand Rounds Vol 6, No. 19 | A Groundhog’s Perspective... Dr. Nick hosts Grand Rounds The Godfather of the Medblog Grand Rounds series hosts this... Related posts brought to you by Yet Another Related Posts Plugin.
- Emergency Medicine Bloggers | Life in the Fast Lane Prompted by a series of tweets and buzzes pertaining to the knowledge base of Emergency Medicine bloggers we felt it was time to overhaul our ‘BlogRoll‘ and create a separate table for the Emergency bloggers, their twitter handles and RSS feeds. via Emergency Medicine Bloggers | Life in the Fast Lane. Nice list! If you find an [...] Related posts:Sam Ko’s Emergency Medicine Blog: Ten Emergency Medicine Websites I Love and Will Marry Sam Ko’s Emergency Medicine Blog: Ten Emergency Medicine Websites I... We’re Failing Our Residents: Training ED Docs for the Real W… : Emergency Medicine News Emergency Medicine News: February 2010 – Volume 32 – Issue... Symtym lives one of every EM Docs’ nightmares: patient in your own ED Patient It’s a Friday, early afternoon, so the bike trail... Related posts brought to you by Yet Another Related Posts Plugin.
- Dubai police chief: Mossad should be ‘ashamed’ over H... Jerusalem (CNN) — Dubai’s police chief said Sunday the secretive Israeli foreign intelligence unit Mossad “needs to be ashamed” after the January killing of a Hamas leader in a Dubai hotel. via Dubai police chief: Mossad should be ‘ashamed’ over Hamas killing – CNN.com. I concur. Really, 26 people to smother one guy? Seriously…. Related posts:Physician killed for denying [...] Related posts:Physician killed for denying drug seeker a prescription By Dori Hjalmarson, Bill Estep and Karla Ward - dhjalmarson@herald-leader.com... Best triage Chief Complaint of the night “Pt got a Hini shot today and now feels bad”.... Related posts brought to you by Yet Another Related Posts Plugin.
Youtube Medical
- Paws & Claws Pet Medical Center, Troutdale, OR Author: SuperPagesSuperVideo Keywords: Added: March 9, 2010
- Insidermedicine In Depth - March 8, 2010 - Junk Food Author: insidermedicine Keywords: Added: March 9, 2010
- Insidermedicine In 60 - March 8, 2010 Author: insidermedicine Keywords: Added: March 9, 2010
- Fat tax on pizza and soda of 18-percent Author: KLBJAM590 Keywords: Added: March 9, 2010
- Virginia Adult & Pediatric Allergy & Asthma Author: SuperPagesSuperVideo Keywords: Added: March 9, 2010
- Advanced Veterinary Complex, Inc., Reisterstown, MD Author: SuperPagesSuperVideo Keywords: Added: March 8, 2010
- CLINICAL MEDICINE PROGRAM AT IUSOM Author: IUSOM Keywords: Added: March 8, 2010
- Emergency Veterinary Clinic Yorktown, VA Author: SuperPagesSuperVideo Keywords: Added: March 8, 2010
- Dr. Thomas Jang and his prostate cancer study published i... Author: umdnj Keywords: Added: March 8, 2010
- Orchid Springs Animal Hospital, Winter Haven, FL Author: SuperPagesSuperVideo Keywords: Added: March 7, 2010
Flickr Medical
- Ecuador Mission Trip 2010 Florida Hospital Memorial Medical Center posted a photo: FHMMC team members Esteban Modad and Bill Griffis in Machala, Ecuador
- Ecuador Mission Trip 2010 Florida Hospital Memorial Medical Center posted a photo: FHMMC team members Chris Blaikie, Alex Heggblod, Stuart Reynolds, Esteban Modad, Dr. Patricia Modad, Dr. George Ehringer, Barbara Duffy, Bill Griffis, Donna Griffis in Machala, Ecuador
- Ecuador Mission Trip 2010 Florida Hospital Memorial Medical Center posted a photo:
- Ecuador Mission Trip 2010 Florida Hospital Memorial Medical Center posted a photo: Valuable supplies were collected before the mission trip
- Ecuador Mission Trip 2010 Florida Hospital Memorial Medical Center posted a photo: A group of 11 FHMMC team members left on Sunday, March 7 for Machala, Ecuador. The group includes Esteban Modad, Robert Davis, Dr. Patricia Modad, Linda Misko, Stuart Reynolds, Barbara Duffy, Dr. George Ehringer, Donna Griffis, Bill Griffis, Alex Heggblod and Chris Blaikie
- Studio4photography - Portrait - 10031 Studio4Photography posted a photo: The Chiropractor
- Lieutenant Archibald Browning Smith Drysdale University of Glasgow Library posted a photo: Lieutenant Archibald Browning Smith Drysdale Rank: Lieutenant Regiment: Royal Army Medical Corps - Special Reserve Degree: MB ChB (Photograph ID: Ch 4/4/2/2/319 Copyright University of Glasgow) Archie Drysdale was born on 14th October 1895 in Glasgow. He was the eldest son of Robert Steele Drysdale, a colliery agent, and Annie McNeill Stewart. He studied medicine at Glasgow University from 1913, taking classes in surgery, pathology, anatomy and midwifery before graduating MB ChB in June 1918. He was commissioned into the Royal Army Medical Corps the following September for a three-year period of service. Initially he was sent to the army camp at Squires Gate in Blackpool before being sent to Paris. One of his early duties was running a field hospital in Northern Italy in charge of 3 prisoners of war doctors and 300 patients. Two of the prisoner of war doctors were from Prussia and the other was a heart specialist from Budapest who he became quite close to. The two men continued to exchange Christmas cards and correspondence for a number of years after this posting. He was later stationed in Austria and Egypt. While in Egypt one of his roles was to accompany Turkish prisoners of war from Alexandria back to Constantinople. He found this job remarkably easy. The men were so glad to be returning home that they seldom bothered reporting any medical complaints. It was during his time in Egypt that he was promoted to the rank of Captain. He then moved onto his final appointment which was in a military hospital in Jerusalem. On finishing his commission on 10th September 1921 he returned home to Glasgow. While at home he met one of his old lecturers by chance and was told of a vacant position at the University. He applied and was appointed demonstrator in Anatomy on 6th October 1921. After his year at University he worked as an assistant for Dr Gray in Stanhope, Durham. It was during this time that he met his wife and got married. Archie was also active in the Second World War, running the St John's Ambulance Brigade in Cadishead, Lancashire. He continued working in the medical profession until retirement and then died in his eighties on 8th May 1980 in Lancaster. For more information please visit the online Glasgow University First World War Roll of Honour at: www.universitystory.gla.ac.uk/ww2-intro/ Or contact the Duty Archivist at Glasgow University Archive Services: www.gla.ac.uk/services/archives/contactus/
- Texas State Sen. Robert Nichols, Pat Wallace, Elmer G. Ellis ETMC posted a photo: Sen. Robert Nichols talks with ETMC Athens Administrator Pat Wallace and ETMC President/CEO Elmer G. Ellis at the ETMC Athens expansion groundbreaking ceremony. The $32.4 million project will expand care areas for several services.
- Medical visit to Kigali lays foundation for long-term med... US Army Africa posted a photo: www.usaraf.army.mil Medical visit to Kigali lays foundation for long-term medical exchanges By Rick Scavetta, U.S. Army Africa KIGALI, Rwanda – Rwandan Defense Force recently welcomed senior medical officer from U.S. Army Africa and Combined Joint Task – Horn of Africa to Rwanda’s military hospital. Col. Alfonso Alarcon, U.S. Army Africa’s senior medical officer, and Navy Cmdr. Anthony Battaglia, force surgeon at CJTF-HOA, met with RDF medical officers to discuss future partnership efforts. “This visit provided a comprehensive assessment of medical health systems to lay the foundation for long-term medical exchanges with the RDF,” Alarcon said. “Our ultimate goal is to share information that improves the RDF’s medical capability and quality of care.” Some opportunities to build the capacity may include offering first responder mentoring, casualty evacuations and hospital-based surgical and medical expertise, Alarcon said. When it comes to sharing medical experiences, Rwandan doctors can offer lessons in treating tropical diseases and trauma not often seen by U.S. doctors, Alarcon said. “The RDF medical service has accumulated many medical lessons learned,” Alarcon said. “Having the RDF share experiences from medical challenges in Darfur peacekeeping and other regional conflicts, offers an opportunity for U.S. medical troops to learn more.” U.S. Army Africa has partnered with Rwanda in a variety of fields over the past year, to include mentoring in logistics and leadership development. During Natural Fire 10, a humanitarian assistance and disaster relief exercise held in Uganda in October 2009, Rwandan medics also worked alongside military medics from the U.S., Kenya, Burundi, Uganda and Tanzania. While in Kigali, Charles Murego, M.D., director of the Rwandan military’s medical service, showed the Americans the RDF’s medical clinics and introduced them to several medical officers. “Discussions with Dr. Murego and the RDF medical teams were productive,” Alarcon said. “There was a sense of mutual respect and understanding.” To learn more about U.S. Army Africa visit our official website at www.usaraf.army.mil Official Twitter Feed: www.twitter.com/usarmyafrica Official YouTube video channel: www.youtube.com/usarmyafrica
- Medical visit to Kigali lays foundation for long-term med... US Army Africa posted a photo: www.usaraf.army.mil Medical visit to Kigali lays foundation for long-term medical exchanges By Rick Scavetta, U.S. Army Africa KIGALI, Rwanda – Rwandan Defense Force recently welcomed senior medical officer from U.S. Army Africa and Combined Joint Task – Horn of Africa to Rwanda’s military hospital. Col. Alfonso Alarcon, U.S. Army Africa’s senior medical officer, and Navy Cmdr. Anthony Battaglia, force surgeon at CJTF-HOA, met with RDF medical officers to discuss future partnership efforts. “This visit provided a comprehensive assessment of medical health systems to lay the foundation for long-term medical exchanges with the RDF,” Alarcon said. “Our ultimate goal is to share information that improves the RDF’s medical capability and quality of care.” Some opportunities to build the capacity may include offering first responder mentoring, casualty evacuations and hospital-based surgical and medical expertise, Alarcon said. When it comes to sharing medical experiences, Rwandan doctors can offer lessons in treating tropical diseases and trauma not often seen by U.S. doctors, Alarcon said. “The RDF medical service has accumulated many medical lessons learned,” Alarcon said. “Having the RDF share experiences from medical challenges in Darfur peacekeeping and other regional conflicts, offers an opportunity for U.S. medical troops to learn more.” U.S. Army Africa has partnered with Rwanda in a variety of fields over the past year, to include mentoring in logistics and leadership development. During Natural Fire 10, a humanitarian assistance and disaster relief exercise held in Uganda in October 2009, Rwandan medics also worked alongside military medics from the U.S., Kenya, Burundi, Uganda and Tanzania. While in Kigali, Charles Murego, M.D., director of the Rwandan military’s medical service, showed the Americans the RDF’s medical clinics and introduced them to several medical officers. “Discussions with Dr. Murego and the RDF medical teams were productive,” Alarcon said. “There was a sense of mutual respect and understanding.” To learn more about U.S. Army Africa visit our official website at www.usaraf.army.mil Official Twitter Feed: www.twitter.com/usarmyafrica Official YouTube video channel: www.youtube.com/usarmyafrica
Delicious Medical
- Blood Pressure Chart - Normal Blood Pressure Range
- Epidemiology - Wikipedia, the free encyclopedia Epidemiology
- Find Dentists or Doctors in New York and Book Online Inst...
- Lyme disease - Wikipedia, the free encyclopedia
- PayFlex - Login
- Musculos : Anatomia, funciones, biomecanica
- Inhalable Insulin Bacteria | Facts About Diabetes
- atlas
- Medical
- nervios del pie NERVIOS RAQUÍDEOS
WordPress Medical
- HelpGuide.org Via Kafeneio, let me draw your attention to HelpGuide.org, a very useful site to help in a variety o
- BIG omission in medical research Kevin Drum: In the LA Times today, researchers Michael Hochman and Danny McCormick explain the sorry
- Did Marine Corps hide Camp Lejeune benzene data? Barbara Barrett at McClatchy newspapers: Congressional investigators late Tuesday requested detailed
- More evidence about Gulf War illness Janet Raloff in Science News: Nearly two decades after vets began returning from the Middle East com
- Love 4 lovely longer lifestyle Have a healthy wealthy, and happy lifestyle with little flaxibility in self only.
- Ask And You Shall Receive I’m pretty sure this story is not exactly what the God was talking about. But since I had just
- Elanor makes some advances! Yesterday we had a very important doctor’s appointment. Ever since Elanor began to walk, she
- Flamboyant Hong Kong socialite buried with his toys One of Hong Kong’s most flamboyant socialites was buried on Tuesday with paper replicas of his
- Major studies decades ago revealed variability of menstru... But people are still naïve about the basic cause of the difficulty to achieve pregnancy Sex educatio
- Gay Couples Find Surrogate Mothers in India A new form of medical tourism is arising. Recently, there has been an increase in American gay coupl
Medical Cavity. Suggest a news source or drop your feedback at news@medicalcavity.com
